13.3 Medical Retina – Age-Related Macular Degeneration (AMD)
13.4 Medical Retina - Diabetes
13.5 Medical Retina – Retinal Vein Occlusion (RVO)
13.6 Vitreoretinal Surgery
13.11 Ocular Oncology
18-46 years old
Acute unilateral ON
Visual symptoms ≤ 8/7
RAPD and VF defect
No previous ON
No previous steroid treatment
No systemic disease (other than MS) that could account for this presentation
IVMP – accelerates visual recovery, but no long-term VA benefits
po prednisone – may increase number of new attacks
MS risk – Caucasian, young adult, recurrent ON, female, prior history neurological symptoms, brain MRI lesions, spine MRI lesions, CSF oligoclonal bands
1991. The Clinical Profile of Optic Neuritis: Experience of the Optic Neuritis Treatment Trial. Archives of Ophthalmology 109(12) 1673-1678.
Beck, R.W.M.D., Cleary, P.A.M.S., Anderson, M.M.J.P.A.C. et al. 1992. A Randomized, Controlled Trial of Corticosteroids in the Treatment of Acute Optic Neuritis. The New England Journal of Medicine 326(9) 581-588.
If 1st episode ON & ≥ 2 MRI lesions, give the ONTT regimen, then IM IFNβ-1a weekly to reduce risk of MS from 50% to 33% at 3 years. If low risk give ONTT regimen
10 year results: 40% reduction in CDMS if treated immediately with Avonex i.e. Early treatment of MS reduces long term morbidity
Galetta, S. 2002. The controlled high risk Avonex multiple sclerosis trial (CHAMPS Study). Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 21 292-295.
Kinkel, R.P., Dontchev, M., Kollman, C. et al. 2012. Association Between Immediate Initiation of Intramuscular Interferon Beta-1a at the Time of a Clinically Isolated Syndrome and Long-term Outcomes: A 10-Year Follow-up of the Controlled High-Risk Avonex Multiple Sclerosis Prevention Study in Ongoing Neurological Surveillance. Archives of Neurology 69(2) 183-190.
Beta interferon weekly 2 years decrease risk progression to CDMS if given for
(beta interferon alternate days also decreased conversion to CDMS)
IV steroids or surgical decompression does not improve outcome in traumatic optic neuropathy
Spinal cord injury patients with high dose IV methylprednisolone (30mg/kg bolus then infusion) within 8 hours of injury had better motor/sensory outcomes
Committee, T.N.I.I.H.S.G.W. 2014. Effect of Acetazolamide on Visual Function in Patients With Idiopathic Intracranial Hypertension and Mild Visual Loss: The Idiopathic Intracranial Hypertension Treatment Trial. JAMA 311(16) 1641-1651.
Klopstock, T., Yu-Wai-Man, P., Dimitriadis, K. et al. 2011. A randomized placebo-controlled trial of idebenone in Leber's hereditary optic neuropathy. Brain : a journal of neurology 134(Pt 9) 2677-2686.
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Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.