Neuro-Ophthalmic Literature Review

Neuro-Ophthalmic Literature Review David A. Bellows, Noel C. Y. Chan, John J. Chen, Hui-Chen Cheng, Panitha Jindahra, Peter W. MacIntosh, Collin McClelland, Michael S. Vaphiades, and Xiaojun Zhang The Medical Eye Center, Manchester, New Hampshire, USA; Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong; Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota, USA; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Mahidol University, Bangkok, Thailand; Department of Ophthalmology, Illinois Ear and Eye Infirmary, Chicago, Illinois, USA; Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA; Departments of Ophthalmology, Neurology, and Neurosurgery, UAB Callahan Eye Hospital, Birmingham, Alexandria, USA; Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, USA; Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, Hebei, China Peripapillary Hyperreflective Ovoid Mass-Like Structures: Multimodal Imaging – A Review Jeffery RCH, Chen FK. Peripapillary hyperreflective ovoid mass-like structures: Multimodal imaging-A review. Clin Exp Ophthalmol. 2023;51:67–80. Prior to the establishment of the Optic Disk Drusen Consortium the ovoid peripapillary structures detected on optical coherence tomography (OCT) were felt to be buried optic disk drusen. These structures have since been redefined as peripapillary hyperreflective ovoid mass-like structures (PHOMS) and identified as a manifestation of axoplasmic stasis. The authors discuss the characteristic findings of PHOMS on multimodal OCT and review the literature pertaining to the co-existence of PHOMS with diseases other than optic disk drusen. These include papilloedema, anterior ischaemic optic neuropathy, tilted disk syndrome, inflammatory demyelinating disorders as well as retinal and orbital diseases. David Bellows Anti-Hypertensive Medications – Before Bed or Not? Labowsky MT, Rizzo III JF. The controversy of chronotherapy: Emerging evidence regarding bedtime dosing of antihypertensive medications in non-arteritic anterior ischaemic optic neuropathy. Semin Ophthalmol. 2023;38:99–104. This is a review article highlighting the marked conflict between therapeutic recommendations published in the ophthalmology and cardiology literature, with the former arguing against taking anti-hypertensive medications at bedtime to reduce risk of sequential non-arteritic anterior ischaemic optic neuropathy (NAION) while the latter arguing in favour of bedtime dosing to reduce the risk of cardiovascular disease (CVD). The observation of “blinding upon awakening” in patients with NAION has prompted the postulations of nocturnal hypotension contributing to NAION development. Since then, studies have been conducted to identify such association with conflicting results. This review summarises the results in the literature evaluating nocturnal hypotension, blood pressure fluctuations and NAION throughout the years. One of the studies argued the blunted “morning surge” instead of nocturnal dip being the potential contributing factor in NAION. Nevertheless, the purported association between nocturnal hypotension and NAION has become widely accepted in ophthalmology. This aetiological belief has led to the recommendation to patients who have experienced NAION to refrain from bedtime dosing of anti-hypertensive medications to reduce the risk of sequential NAION. This review also brings readers’ attention to the recent literature on benefit of bedtime anti-hypertensive dosing in the cardiology world. “Chronotherapy” is a term used for specific timing CONTACT John J. Chen Chen.john@mayo.edu Mayo Clinic, Department of Ophthalmology, 200 First Street, SW, Rochester, MN 55905 NEURO-OPHTHALMOLOGY 2023, VOL. 47, NO. 3, 171–176 https://doi.org/10.1080/01658107.2023.2201136 © 2023 Taylor & Francis Group, LLC of medication dosing for therapeutic effect. In a meta-analysis of 153 human trials (1976–2020), beneficial effects of bedtime dosing were found in the majority of studies in terms of sleep time systolic blood pressure (BP), biomarkers of hypertension associated end-organ damage and adverse medication events. The benefit of bedtime antihypertensive dosing was further substantiated by two large scale prospective clinical trials looking at ingestion time and cardiovascular endpoints. Contrary to recommendations in the ophthalmic literature, mean elevation of asleep BP was a strong predictor of CVD. However, it is important to note that the ophthalmic complications reported in this trial only involved retinal artery thrombotic occlusion and not NAION. It is therefore important for neuro-ophthalmologists to take note of this active and vibrant controversy while counselling patients who have lost vision due to NAION. Noel Chan International Diagnostic Criteria for MOGAD Banwell B, Bennett JL, Marignier R, Kim HJ, Brilot F, Flanagan EP, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol. 2023;22:268–282. The international diagnostic criteria for myelin oligodendrocyte glycoprotein (MOG) antibodyassociated disease (MOGAD) was recently published in Lancet Neurology. The MOGAD diagnosis criteria are: (a) Core clinical demyelinating event: optic neuritis; myelitis; acute disseminated encephalomyelitis; cerebral monofocal or polyfocal deficits; brainstem or cerebellar deficits; or cerebral cortical encephalitis, often with seizures (b) Positive MOG-IgG test on a cell-based assay (c) Exclusion of better diagnoses including multiple sclerosis Unlike the international diagnostic criteria for neuromyelitis optica spectrum disorder (NMOSD), published in 2015 that allows for a diagnosis of seronegative NMOSD, the diagnosis of MOGAD hinges on a positive MOG-IgG assay and does not propose a separate category of seronegative MOGAD. Therefore, the sensitivity of the MOGIgG assay remains unclear. However, the specificity of the MOG-IgG assay has been well studied and is about 98%, with lower specificity and positive predictive values at the low titres of 1:20 and 1:40. Therefore, there are some nuances with the MOGAD diagnostic criteria, which largely hinges on the knowledge that the MOG-IgG assay is not 100% specific. If a patient has a high MOG-IgG titre, the presence of one of the core clinical demyelinating events will be enough to meet the criteria for a diagnosis of MOGAD. However, if a patient has a low MOG-IgG titre or have a positive MOGIgG test in the cerebrospinal fluid but not in the serum, there must be clinical or radiological supportive findings suggestive of MOGAD. For example, findings that would help support a diagnosis of MOGAD optic neuritis include bilateral optic neuritis, longitudinal optic nerve enhancement, perineural optic sheath enhancement, and/or optic disc oedema. Clinical and radiological features supportive of MOGAD myelitis and brain attacks are also provided. In summary, the international MOGAD criteria provide a large step towards having a uniform diagnosis of MOGAD. Additional clinical features of MOGAD may become recognised in the future to expand the phenotype of MOGAD, but it will be important to validate the more rare atypical presentations because false positive MOG-IgG results can occur, especially in low pre-test probability situations with low MOG-IgG titres. John Chen Increased Risk for Dementia or Alzheimer’s Disease Among Patients with Age-Related Macular Degeneration Tsai HR, Lo RY, Liang KH, Chen TL, Huang HK, Wang JH, Lee YC. Risk of subsequent dementia or Alzheimer disease among patients with age-related macular degeneration: A systematic review and meta-analysis. Am J Ophthalmol. 2023;247:161–169. The authors conducted a systemic review and meta-analysis to elucidate the association of agerelated macular degeneration (AMD) with 172 D. A. BELLOWS ET AL.