How to Best Measure Afferent Visual Pathway Damage in Neuro-Ophthalmic Disorders - The Optic Nerve, Reintal Nerve Fiber Layer, and Beyond!

Neuro-ophthalmologists have traditionally relied upon the history and physical examination to localize visual problems in their patients. While these clinical tools represent the cornerstones of our discipline, there are many ancillary testing techniques which can enhance the diagnostic process. In the following presentation, the merits of both well-established and relatively novel diagnostic tests will be discussed in the context of a typical case of optic neuritis. The relative contributions of various disease mechanisms: demyelination, axonal loss, neuronal damage, and cortical compensation will be reviewed. So too, the utility of different tests in capturing specific pathogenic processes in optic neuritis will be highlighted. Several techniques will be described with reference to the case example provided, optic neuritis; yet, the principles of how these tests may be used apply to a variety of optic nerve disorders.