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Show Letters to the Editor Patient-Reported Outcomes for Ocular Myasthenia Gravis: Response W e applaud Dr. Wong et al for their work designing and preliminarily validating a disease-specific patientreported outcome (PRO) measure, OMGRate, for patients with ocular myasthenia gravis (OMG) (1). We look forward to reviewing the results from their larger, multicenter study to validate the OMGRate among patients across the OMG disease spectrum and their assessment of the responsiveness of the OMGRate to treatment. If successful, OMGRate would be an important step toward understanding and measuring how our patients with OMG are affected by disease and the treatments we prescribe. It would also provide a much needed, diseasespecific PRO measure for future clinical trials. Bilateral Optic Disc Edema Associated With COVID-19 in Pediatric Populations W e thank the authors for their contribution to the literature with their Clinical Correspondence regarding a case of bilateral disc edema after COVID-19 infection. This is an interesting avenue for future research, and developments made in other arenas of medicine may provide an ideal platform for quantitative analysis of the issue at hand. Spaceflight-associated neuro-ocular syndrome (SANS) is a condition found in astronauts after long-duration spaceflight (1). It is characterized by a constellation of symptoms, most notably including papilledema seen on fundoscopy. There have been many theories regarding the etiology of this syndrome, the foremost of which centers around the cephalad fluid shift of microgravity increasing intracranial pressure (ICP) in astronauts. With limited orbital capabilities, space medicine has turned to remote, noninvasive technologies to track the trajectory of SANS, and the application of these technologies to cases such as the one discussed in this Clinical Correspondence has the potential to improve pediatric neurological care. There has been a recent push to quantify the changes in intracranial pressure noninvasively in space medicine. There has been a suggestion that quantification of ocular glymphatic spaces on optical coherence tomography (OCT) might correlate with quantifiable changes in intracranial pressure, after trials in patients with idiopathic intracranial hypertension (2). In pediatric populations especially, it is critical to minimize distress while also gaining adequate information to make diagnoses. The possibility of a short, noninvasive test that could lead to a quantitative measurement of ICP would revolutionize the care of children with Letters to the Editor: J Neuro-Ophthalmol 2023; 43: e356-362 Lindsey B. De Lott, MD, MS, Joshua R. Ehrlich, MD, MPH Department of Ophthalmology and Visual Sciences (LBDL, JRE), Michigan Medicine, Ann Arbor, Michigan, Institute for Healthcare Policy and Innovation (LBDL, JRE), Michigan Medicine, Ann Arbor, Michigan, Department of Ophthalmology and Visual Sciences (LBDL, JRE), Michigan Medicine, Ann Arbor, Michigan; and Institute for Healthcare Policy and Innovation (LBDL, JRE), Michigan Medicine, Ann Arbor, Michigan L. B. De Lott (K23EY027849) and J. R. Ehrlich (K23EY027848) were supported by grants from the National Institutes of Health, Bethesda, MD. REFERENCE 1. Wong SH, Eggenberger E, Cornblath W, Xhepa A, Miranda E, Lee H, Burke A, Barnett C, Preliminary findings of a dedicated ocular myasthenia gravis rating scale: the OMGRate, Neuroophthalmology. 2020;44:148–156. multisystem inflammatory syndrome. Quantitative OCT could potentially be used in place of lumbar puncture in children to avoid distress and pain during investigative processes, as well as limiting potential complications (3,4). The Clinical Correspondence contained an OCT for the patient being discussed, showing that OCT is already performed as part of a diagnostic workup in these cases. We hope that this relatively novel technology brought about as part of the innovation driven by professional spaceflight can be applied to benefit patient care on the Earth in the future. Deekshitha Umasankar, BSc(Hons), Lauren Elizabeth Church, MSc Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom The authors report no conflicts of interest. REFERENCES 1. Mader TH, Gibson CR, Pass AF, Kramer LA, Lee AG, Fogarty J, Tarver WJ, Dervay JP, Hamilton DR, Sargsyan A, Phillips JL, Tran D, Lipsky W, Choi J, Stern C, Kuyumjian R, Polk JD. Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. Ophthalmology. 2011;118:2058–2069. 2. Denniston AK, Keane PA, Aojula A, Sinclair AJ, Mollan SP. The ocular glymphatic system and idiopathic intracranial hypertension: author response to “hypodense holes and the ocular glymphatic system.” Invest Ophthalmol Vis Sci. 2017;58:1134–1136. 3. Bonadio W. Pediatric lumbar puncture and cerebrospinal fluid analysis. J Emerg Med. 2014;46:141–150. 4. Bodilsen J, Mariager T, Vestergaard HH, Christiansen MH, Kunwald M, Lüttichau HR, Kristensen BT, Bjarkam CR, Nielsen H. Association of lumbar puncture with spinal hematoma in patients with and without coagulopathy. JAMA. 2020;324:1419–1428. e357 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
