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1 Giant cell arteritisGross anatomy and histology of the normal superficial temporal artery.; Histopathology of the superficial temporal artery involved by active and healed GCA; Summary of the main histopathologic findings in GCASamuel Bidot, MD, Emory Eye Center Atlanta, Georgia; Amit M. Saindane, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
2 Clinical Features of NeuroretinitisA 13-year-old girl was seen for assessment of blurred vision and optic disc edema in her right eye. Her examination showed: best-corrected visual acuity of hand motion OD and 20/25 OS; pupils: no relative afferent pupil defect; color vision: 0/14 plates OD and 14/14 plates OS; humphrey visual fields...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Jason H. Peragallo, MD, Associate Professor of Ophthalmology, Departments of Ophthalmology and Neurology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner...
3 Bilateral Optic Disc Edema from Hypertensive RetinopathyA 29 year-old woman was assessed for 2 weeks of headaches and 4 days of blurred vision in both eyes. Her blood pressure was 225/135. Her examination showed: best-corrected visual acuity: 20/25 OD, 20/30 OS; pupils equal and reactive without relative afferent pupillary defect; intraocular pressures 1...Benjamin I. Meyer, MD, Medical Student, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medicine
4 Retrograde trans-synaptic degeneration from a longstanding occipital lobe tumorThis is an illustrated guide that (1) discusses the localization of paracentral homonymous hemianopic scotomatous visual field defects and (2) discusses the concept of trans-synaptic retrograde degeneration.; ; A 43-year-old woman was assessed for longstanding blurred vision in both eyes. Her examin...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of M...
5 Optic disc pseudoedema due to Leber hereditary optic neuropathyA 23-year-old woman developed sequential painless central vision loss in both eyes (right eye 5 months ago and left eye 2 months ago). Her examination showed bilateral optic neuropathies: visual acuity: 20/300 eccentrically OU (no improvement with pinhole); pupils: equal and reactive with no relativ...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of M...
6 "Checkboard" visual field loss due to bilateral homonymous hemianopsiasA 70-year-old man with vascular risk factors was seen for assessment of sudden visual field loss in both eyes. His examination showed: visual acuity: 20/20 OD and 20/25 OS; pupils: equal with no relative afferent pupillary defect; color vision: 14/14 plates correct OU; anterior segment exam: normal ...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of M...
7 Compressive optic neuropathy from cavernous hemangiomaA 42-year-old man was seen for assessment of progressive blurring of vision in his left eye (OS) over several weeks. His examination showed a left optic neuropathy: visual acuity: 20/20 OD and 20/20-2 OS; pupils: 1+ left relative afferent pupillary defect; color vision: 14/14 plates correct OU. Ther...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Aaron M. Yeung, MD, Ocular pathology fellow, Department of Ophthalmology, Emory University School of Medicine;Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Prof...
8 Myelin oligodendrocyte glycoprotein (MOG) - antibody optic neuritisThis is an illustrated guide to the clinical diagnosis of myelin oligodendrocyte glycoprotein (MOG)-antibody optic neuritis.; ; Myelin oligodendrocyte glycoprotein (MOG) is a glycoprotein on the surface of myelin and is found exclusively in the central nervous system (CNS). MOG likely mediates a com...Bryce Buchowicz, MD, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medici...
9 NeurosarcoidosisThis is an illustrated guide to the clinical diagnosis of neurosarcoidosis. Sarcoidosis is a chronic systemic inflammatory disorder characterized by non-caseating granulomas. It can affect multiple organ systems including the lungs, skin, orbit, and brain. When there is central nervous system (CNS) ...Bryce Buchowicz, MD, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medici...
10 Optic disc melanocytomaA 26-year-old woman was seen for assessment of an asymptomatic optic nerve abnormality in her left eye. Her examination showed normal afferent visual function: visual acuity: 20/30 OD and 20/25 OS; PH 20/20 OU; pupils: no relative afferent pupil defect; color vision: 14/14 plates correct OU. Humphre...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of M...
11 Funduscopic Findings of Acute Central Retinal Artery OcclusionA 59-year-old man was referred for assessment acute vision loss in the right eye. His examination showed: best-corrected visual acuity: light perception OD, 20/20 OS; pupils: Relative afferent pupillary defect OD; color vision: unable to visualize control plate OD, 14/14 OS correct Ishihara plates. ...David B. Enfield, MD, Ophthalmology Resident, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medicine
12 Toxoplasmic chorioretinitis with unilateral disc edemaA 53-year-old man had a history of high myopia and a seronegative spondyloarthropathy treated with immunosuppressive agents. He presented with mild, painless vision loss in his right eye. His examination showed findings of a right anterior optic neuropathy: visual acuity: 20/20 OD (right eye), 20/20...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Nancy J. Newman, LeoDelle Jolley Chair in Ophthalmology, Professor of Ophthalmology and Neurology, Instructor of Neurosurgery, Departments of Ophthalmology, Neurology and Neurosurg...
13 Previous Branch Retinal Artery OcclusionThis is a typical case of an old branch retinal artery occlusion in a 64 year old woman presenting with persistent monocular vision loss. She had sudden onset of painless vision loss in the inferior field of her left eye approximately one year prior. Her past medical history was significant for atri...Benson S. Chen, MBChB FRACP,Neuro-ophthalmology fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of...
14 Homonymous Hemianopia Secondary to an Intracranial Bleed from an Arteriovenous MalformationThis case demonstrates a homonymous hemianopia resulting from hemorrhage secondary to a ruptured intracranial arteriovenous malformation (AVM), providing grounds for illustration and discussion of the correlations between localization of this lesion on cerebral imaging and resultant visual field and...Lauren Hudson, MD, PhD, Ophthalmology resident, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medicin...
15 Optic nerve hypoplasiaThis is an illustrated guide to the clinical diagnosis of optic nerve hypoplasia. Optic nerve hypoplasia (ONH) is the most common congenital optic nerve anomaly, with an estimated incidence of 1 in 2287 live births. It may present unilaterally or bilaterally. It is seen in isolation or in associati...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Jason H. Peragallo, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmol...
16 Superior segmental optic nerve hypoplasiaThis is a case of superior segmental optic nerve hypoplasia in a woman with a history of maternal diabetes. A 25 year-old woman noticed a visual field defect in her right eye. Her examination showed: visual acuity: 20/20 OD, 20/20 OS; pupils: trace relative afferent pupillary defect OD; color visi...Naa Naamuah M. Tagoe MBChB, FWACS, FGCS, Consultant Ophthalmologist, Training and Research Coordinator, Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana; Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Va...
17 Cotton wool spots in giant cell arteritisThis is a case of cotton wool spots in a patient with temporal artery-biopsy proven temporal arteritis.; ; A 66-year-old woman presents with isolated painless vision loss related to a left optic neuropathy in her left eye. She denies systemic symptoms to suggest giant cell arteritis.; Her examinatio...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of M...
18 Malignant Hypertension With Bilateral Optic Nerve EdemaThis is a case of malignant hypertension and severe hypertensive retinopathy. A 30-year-old woman with headache and vision loss in the left eye was found to have a markedly elevated blood pressure of 205/100. CT head without contrast showed acute hemorrhage in the right temporal-occipital junction a...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Michael Dattilo, MD, PhD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of...
19 Fundus AutofluorescenceThe retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments. The metabolism of the photoreceptor outer segments leads to the formation of lipofuscin. Disease states and potentially increased oxidative damage can lead to the buildup of ...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Departments of Ophthalmology and Neurology, Emory University School of Medicine
20 Vitreopapillary tractionA 64-year-old woman was referred for bilateral optic disc edema. Examination of her optic nerves showed indistinct margins at the nasal aspect of both eyes (Figure 1). Humphrey 24-2 SITA-Fast visual fields showed non-specific depressed points in both eyes (Figure 2). Optical coherence tomography (...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
21 Optical coherence tomography of the retinal nerve fiber layerA normal optical coherence tomography (OCT) of the macula is shown highlighting the position of a single retinal ganglion cell and its axon in the retinal nerve fiber layer (Figure 1). The topographical relationship of retinal ganglion cells in the retina to the visual field and position in the ante...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
22 Direct carotid-cavernous sinus fistulaA 40-year-old man presented with decreased vision and redness in his left eye. He had a significant trauma to the left side of his face about one year ago, but did not seek medical attention. External examination showed significant proptosis of the left eye (Figure 1) and conjunctival injection and ...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine, Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
23 Typical idiopathic intracranial hypertension: optic nerve appearance and brain MRI findingsA 24-year old African American woman was referred for bilateral optic disc edema that was incidentally noted on a routine eye examination. She had excellent visual function and dilated examination showed bilateral optic disc edema with peripapillary wrinkles in the right eye and pseudodrusen in the ...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
24 Incipient non-arteritic anterior ischemic optic neuropathy (NAION) evolving to symptomatic NAIONA 54-year old woman with hypertension was seen in neuro-ophthalmology consultation for asymptomatic left optic disc edema. She had a small, crowded optic disc in the right eye known as a "disc-at-risk" (Figure 1). Her visual function including 24-2 SITA-Fast Humphrey visual fields were normal in bot...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
25 Incipient non-arteritic anterior ischemic optic neuropathy (NAION)A 61-year old white man with hypertension, diabetes, and dyslipidema was seen in neuro-ophthalmology consultation for asymptomatic right optic disc edema. He had a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). He had normal visual function including normal 24-2 SITA...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
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