Primary Visual Pathway Changes in Individuals With Chronic Mild Traumatic Brain Injury.

Importance: Individuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients.

Objective: To determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI.

Variability Within Optic Nerve Optical Coherence Tomography Measurements Distinguishes Papilledema From Pseudopapilledema.

Background: To report a linear risk score obtained using clock-hour optical coherence tomography (OCT) data from papilledema and pseudopapilledema nerves that differentiates between the 2 diagnoses with high sensitivity and specificity.

Methods: Patients presenting to a single neuro-ophthalmologist with papilledema or pseudopapilledema were included for a retrospective review. The absolute consecutive difference in OCT retinal nerve fiber layer (RNFL) thickness between adjacent clock hours and the mean magnitude of thickness for clock hours 1-12 were compared between the 2 groups using mixed-effect models adjusting for age and clock hour with a random intercept for subjects and eyes (nested within subject).

Part II. high-dose methotrexate with leucovorin rescue for severe COVID-19: An immune stabilization strategy for SARS-CoV-2 induced 'PANIC' attack.

Here, in Part II of a duology on the characterization and potential treatment for COVID-19, we characterize the application of an innovative treatment regimen for the prevention of the transition from mild to severe COVID-19, as well as detail an intensive immunotherapy intervention hypothesis. We propose as a putative randomized controlled trial that high-dose methotrexate with leucovorin (HDMTX-LR) rescue can abolish 'PANIC', thereby 'left-shifting' severe COVID-19 patients to the group majority of those infected with SARS-CoV-2, who are designated as having mild, even asymptomatic, disease. HDMTX-LR is endowed with broadly pleiotropic properties and is a repurposed, generic, inexpensive, and widely available agent which can be administered early in the course of severe COVID-19 thus rescuing the critical and irreplaceable gas-exchange alveoli.

Part I. SARS-CoV-2 triggered 'PANIC' attack in severe COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has produced a world-wide collapse of social and economic infrastructure, as well as constrained our freedom of movement. This respiratory tract infection is nefarious in how it targets the most distal and highly vulnerable aspect of the human bronchopulmonary tree, specifically, the delicate yet irreplaceable alveoli that are responsible for the loading of oxygen upon red cell hemoglobin for use by all of the body's tissues. In most symptomatic individuals, the disease is a mild immune-mediated syndrome, with limited damage to the lung tissues.

Risk factors for poor visual outcome in patients with idiopathic intracranial hypertension.

Objectives: Determine potential risk factors for progressive visual field loss in the Idiopathic Intracranial Hypertension Treatment Trial, a randomized placebo-controlled trial of acetazolamide in patients with idiopathic intracranial hypertension and mild visual loss concurrently receiving a low sodium, weight reduction diet.

Methods: Logistic regression and classification tree analyses were used to evaluate potential risk factors for protocol-defined treatment failure (>2 dB perimetric mean deviation [PMD] change in patients with baseline PMD -2 to -3.5 dB or >3 dB PMD change with baseline PMD -3.

Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension.

Purpose: To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome.

Methods: A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation.

Syringohydromyelia in association with syringobulbia and syringocephaly: case report.

The authors present the case of a 14-year-old boy with holocord syringohydromyelia extending into the brainstem, cerebral peduncle, internal capsule, and cerebral cortex. At the posterior fossa exploration, an opaque thickened arachnoid with occlusion of the foramen of Magendie was encountered. Careful documentation of postoperative regression of the syringocephaly, syringobulbia, and syringohydromyelia was made.

Description and validation of a structured simulation curriculum for strabismus surgery.

Purpose: To describe and validate a Web-based structured simulation curriculum of strabismus surgery for residents in training using noncadaveric eye models.

Methods: A pre- and posttest of cognitive skills, objective wet laboratory structured assessment of technique, and summative global evaluation form were implemented as part of a systematic ophthalmology wet lab (OWL) curriculum. Strabismus techniques were taught using a structured simulation method on noncadaveric models of eyes.

Pediatric optic neuritis: does a prolonged course of steroids reduce relapses? A preliminary study.

Background: Optic neuritis is an important pediatric disorder causing visual impairment. Because of the absence of pediatric-specific studies, data extrapolated from the adult-based optic neuritis treatment trial are used to guide management of pediatric patients. Recent literature promotes a prolonged course of oral steroids to prevent relapses.

Diagnostic features of retinal nerve fiber layer rotation in skew deviation using optical coherence tomography.

A 41-year-old woman with skew deviation had cyclotorsion of both eyes. This resulted in a falsely low probability plot of retinal nerve fiber layer thickness in adjacent clock hours on optical coherence tomography (OCT) due to displacement of the retinal nerve fiber layer peaks. Ocular cyclotorsion may cause misinterpretation of OCT probability plots.

Third nerve palsy as the initial manifestation of giant cell arteritis.

Objective: Giant cell arteritis (GCA) is rarely reported as a cause of third nerve palsy. We describe the presentation and course of patients with third nerve palsy as the sole initial ocular manifestation of GCA.

Methods: Retrospective chart review of patients with third nerve palsy as the presenting sign of GCA.

Retinal arterial but not venous tortuosity correlates with facioscapulohumeral muscular dystrophy severity.

Background: Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal-dominant disease beginning with facial and shoulder girdle weakness with variable progression. Exudative retinal detachment, retinal vessel irregularities on fluorescein angiography, and retinal vessel tortuosity have been found in association with FSHD.

Methods: In this retrospective study, muscle affectedness severity was rated as mild, moderate, or severe by a neurologist masked to the retinal images.

Current pharmacologic testing for Horner syndrome.

First described in 1727, Horner syndrome occurs from injury to one of the three neurons in the oculosympathetic pathway. Its presence can be confirmed with pharmacologic testing, traditionally including cocaine testing with hydroxyamphetamine localization. More recently, apraclonidine testing has become a viable alternative in some practices.

Intracranial hypertension in systemic lupus erythematosus.

Purpose: Intracranial hypertension (IH) mimicking pseudotumor cerebri (i.e., idiopathic IH) has been reported in individuals with systemic lupus erythematosus (SLE) since the 1960s.

Contact lens strategies for the patient with dry eye.

Dry eye is the most common reason for contact lens (CL) discontinuation, and the patient with pre-existing dry eye presents particular challenges to the CL fitter. Poor tear film quality/stability, oxygen deprivation, lens deposits, and adverse reactions to CL solutions all contribute to dry eye, and lid disease, allergies, environmental factors, and medications can further hamper successful CL wear by the patient with dry eye. Health and comfort of the ocular surface is affected by the water content, ionicity, oxygen permeability, and modulus of elasticity of the lens, as well as by surface characteristics, such as protein, lipid, and mucin deposition; protein adsorption; and wettability.

Cotton wool spots associated with interferon beta-1 alpha therapy.

Purpose: To describe a case of cotton wool spots associated with interferon beta-1a treatment.

Methods: Observational case report.

Results: A 40-year-old man with a history of multiple sclerosis was on interferon beta-1a.

Rapid regression of retinochoroidal venous collaterals following optic nerve sheath fenestration in idiopathic intracranial hypertension.

A woman with idiopathic intracranial hypertension (IIH) experienced rapid regression of retinochoroidal venous collaterals ("optociliary shunt vessels") following optic nerve sheath fenestration. The presence of these vessels is a nonspecific sign of chronic retinal venous compression in patients with optic disc edema including IIH.

Optic disc edema with adjacent cilioretinal artery occlusion in a male with ulcerative colitis.

Objective: To report a case of optic disc edema with adjacent retinal ischemia in ulcerative colitis.

Design: Photo essay.

Case Report: A 36-year-old white man presented with visual loss OD.

Visual loss due to Wernicke syndrome following gastric bypass.

Purpose: To report a case of Wernicke encephalopathy after gastric bypass surgery resulting in vision loss, ophthalmoplegia, and ataxia, all of which reversed with a single dose of IV thiamine.

Methods: Observational case report.

Results: A 34-year-old woman presented with decreased vision and intermittent diplopia after gastric bypass surgery.