Neuro-Ophthalmic Literature Review

Neuro-Ophthalmic Literature Review David A. Bellows, Noel C.Y. Chan, John J. Chen , Hui-Chen Cheng, Peter W. MacIntosh, Jenny A. Nij Bijvank, Michael S. Vaphiades, Sui H. Wong, and Xiaojun Zhang I had always been taught that they don’t progress! Pan Z, Wei CC, Peng X, Zhang Q, Xu L, Yang H, Wei WB, Wang YX, Jonas JB. Myelinated retinal nerve fibre progression in a 10-year follow-up. The Beijing Eye Study 2011/2011. Am J Ophthalmol. 2021;230:68–74. doi: 10.1016/j.ajo.2021.04.018. The Beijing Eye Study is a population-based longitudinal study that included 4439 participants in 2001 and 2695 participants at follow-up in 2011. Myelinated retinal nerve fibres (MRNFs) were identified in 29 individuals (35 eyes) at the beginning of the study and 20 participants (23 eyes), who remained participants in the study, were reexamined in 2011. Good quality fundus photographs were available for 17 of these individuals (19 eyes). The data showed that all MRNFs present in 2011 were also present in 2001 and that no new MRNFs were detected. The most common location was juxtapapillary, which occurred in 79% of eyes. The mean area of MRNFs increased from 4233 μm to 5243 μm (or 1010 μm) during the study period. The larger increases in MRNF area were associated with the following characteristics: male sex; higher pulse rate; higher serum concentration of low density lipoprotein; longer axial length; small optic disk area; peripheral location; and smaller MRNF areas. David A. Bellows NMOSD – late versus very late Nakahara K, Nakane S, Nagaishi A, Narita T, Matsuo H, Ando Y. Very late onset neuromyelitis optic spectrum disorders. Eur J Neurol. 2021;28(8):2574–2581. doi: 10.1111/ene.14901. In this retrospective review of Japanese patients with neuromyelitis optica spectrum disorders (NMOSD), 76 patients were classified according to the age of onset: ≤49 years (early onset – NMOSD); 50–69 years (late onset – NMOSD); and ≥70 years (very late onset – NMOSD). Clinical, laboratory, and neuroimaging findings were then compared among the three groups. Among 12 males and 64 females included, 46 (61%), 22 (29%) and 8 (11%) were identified as EO-NMOSD, LO-NMOSD, and VLONMOSD, respectively. Unexpectedly, oral prednisolone remained the main stay of long-term treatment in the majority of the subjects especially in the EONMOSD and LO-NMOSD groups. Out of the 76 patients, azathioprine was only used in two patients, while four patients were being put on Tacrolimus or Eculizumab. None of the eight VLO-NMOSD patients was treated with steroid sparing immunosuppressants or biological agents. In this study, optic nerve lesions were observed significantly less frequently in patients with VLONMOSD (p = 0.028). They also found that VLONMOSD had significantly longer length of spinal cord lesions during a myelitis episode (p = 0.032) as compared with the other two groups. This echoed with recent studies reporting the higher tendency of patients with EO-NMOSD manifesting with optic neuritis as the first symptom, while LO-NMOSD tend to develop myelitis first. Interestingly, it has been reported that optic neuritis is also less frequently seen in patients with late onset multiple sclerosis than those with early onset (<50 years old). Furthermore, a recent international multi-centre database also revealed that EO-NMOSD (≤35 years) was associated with more frequent optic neuritis relapses, and LONMOSD (>48 years) had a higher risk of ambulatory disability. In the current study, VL-NMOSD was also CONTACT John J. Chen.john@mayo.edu Chen Department of Ophthalmology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA NEURO-OPHTHALMOLOGY 2021, VOL. 45, NO. 6, 417–424 https://doi.org/10.1080/01658107.2021.1981038 © 2021 Taylor & Francis Group, LLC noted to have higher nadir expanded disability status scale and Nurick scale scores, which coincided with a previous study by Sepulveda et al., which reported patients with LO-NMOSD (≥50 years) with aquaporin 4 antibodies to have worse outcomes over a short follow-up period as compared to seropositive EO-NMOSD patients. The authors hypothesised the above findings to be related to the increased levels of circulating cytokines and proinflammatory markers as well as impairment of the immune system during ageing. Interleukin 6 amplifiers may also play a critical role in chronic inflammation as well as initiation and progression of the cytokine storm. Although this study is retrospective in nature with a variable disease duration at 70 (16.3–143) months, this is one of the few case series focusing on clinical manifestations of VLO-NMOSD. However, the findings await confirmation by a larger prospective study and it will be important for future investigators to have a more uniform age cut-off during the classification for comparisons of results. Noel C.Y. Chan Is post-spaceflight optic disc oedema associated with changes of the intracranial compartment? Marshall-Goebel K, Macias BR, Kramer LA, Hasan KM, Ferguson C, Patel N, Ploutz-Snyder RJ, Lee SMC, Ebert D, Sargsyan A, Dulchavsky S, Hargens AR, Stenger MB, Laurie S. Association of structural changes in the brain and retina after long-duration Spaceflight. JAMA Ophthalmol 2021;139:781–4 Long-duration spaceflight has been found to cause structural changes in the brain and eye. The authors conducted a cohort study to investigate the association between intracranial compartment volumes and peripapillary total retinal thickness after spaceflight. They enrolled 19 healthy International Space Station crew members (mean age, 45.2 years), with average spaceflight duration of 191 days. Optical coherence tomography –derived peripapillary total retinal thickness and magnetic resonance imaging –derived measures of lateral ventricle volume, white matter volume, and whole brain plus cerebrospinal fluid volume were collected before and immediately after spaceflight. After adjustments for mission duration, the result showed a positive, although not attaining statistically significant, association between total retinal thickness and lateral ventricle volume (5.1 μm increase in postflight total retinal thickness per 1-mL postflight increase in lateral ventricle volume, p = 0.07). No associations were noted between spaceflight-induced changes in total retinal thickness and white matter volume or brain tissue plus cerebrospinal fluid volume. The authors concluded that while weightlessness-induced fluid redistribution during spaceflight may be a common stressor to the brain and retina, the development of optic disc oedema appears to be uncoupled with changes occurring in the intracranial compartment. Hui-Chen Cheng Progressive ocular changes in International Space Station crew members with missions exceeding 6-month duration Macias BR, Ferguson CR, Patel N, Gibson C, Samuels BC, Laurie SS, Lee SMC, Ploutz-Snyder R, Kramer L, Mader TH, Brunstetter T, Alferova IV, Hargens AR, Ebert DJ, Dulchavsky SA, Stenger MB. Changes in the optic nerve head and choroid over 1 year of spaceflight. JAMA Ophthalmol