Purchase this article with an account.
Rebecca Moran, Nancy Blace, Nour Haddad, Tybee Eleff; Diagnostic Yield of Laboratory Testing and Imaging Studies in Patients with Optic Atrophy in an Inner City Population. Invest. Ophthalmol. Vis. Sci. 2018;59(9):616.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Additional diagnostic testing is indicated when a comprehensive patient history and exam fails to determine the etiology of optic atrophy. Currently, a review of literature reveals limited evidence describing the appropriate diagnostic algorithm and its yield in the workup of optic atrophy except for one study conducted in a primarily Caucasian population. We performed a retrospective chart review to report the etiologies of optic atrophy in an inner city, primarily a Hispanic and African American community, and to describe the utility of diagnostic testing in the evaluation of isolated optic atrophy. This is, to our knowledge, the first study conducted in a tertiary care center focusing on patients of African American and Hispanic descent.
A retrospective chart review of all patients with a diagnosis of optic atrophy seen in the neuro-ophthalmology clinic at Bronx Lebanon Hospital Center between January 2011 and November 2016. All patients were assessed for an etiologic diagnosis of optic atrophy by a comprehensive neuro-ophthalmologic eye exam, complete with dilated fundus evaluation, patient systemic and ocular history, medication, social and family history as well as laboratory testing and neuroimaging. The patients were then identified to have the following etiologies: Idiopathic, compressive, ischemic, toxic-nutritional, traumatic, infectious, demyelination, inflammatory and retinal pathology.
106 patients met inclusion criteria of the 193 reviewed charts. The results indicate that the most common etiology of optic atrophy across all races in our study population was idiopathic in 33.0% of patients (N= 35). The next following most common etiology was compressive in 14.1% (N=15). Our study found that 29.2 % (N=31) had a determination of etiology based on neuroimaging, while only 11.3 % (N=12) had a diagnosis made by laboratory studies. The high yield diagnostic laboratory test was syphilis serology (Rapid Plasma Reagin) found to be positive in 9 patients.
Neuroimaging has a higher diagnostic yield than laboratory testing for assessing the etiology of optic atrophy and should be performed on all patients with unexplained optic atrophy. We recommend directed laboratory testing only when suspicion is high based on exam or historical findings rather than a "shot gun" approach.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only