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Radhika Pooja Patel, Kaleena Bulan Michael; Retinal nerve fibre layer analysis in toxic and nutritional optic neuropathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5507.
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Toxic and nutritional optic neuropathy is a well-recognised condition characterised by chronic and excessive use of tobacco and alcohol, often combined with the nocuous effect of poor nutrition. The arrival of newer technologies such as optical coherence tomography (OCT) in routine clinical use has allowed clinicians to examine the structural changes of the optic disc more closely, although published reports on its role in this condition has been scarce. Previously described changes include retinal nerve fibre layer (RNFL) thickening in the acute phase, followed by thinning later in time. RNFL damage has also been described to favour certain quadrants in the optic nerve head. Here we described common findings of retinal nerve fibre layer analysis in patients with toxic and nutritional optic neuropathy.
This is a single centre, retrospective cross-sectional study of retinal nerve fibre layer analysis of 27 patients with suspected toxic nutritional optic neuropathy over 5 years (May 2012 – May 2017), referred for electrophysiology testing. Diagnosis was provided by clinicians based on history, examination, visual fields and bloods tests. All patients had reports electrophysiological tests which supports the diagnosis, and had the retinal nerve fibre layer analysis performed by the Heidelberg Spectralis OCT.
27 patients met the inclusion criteria and were included in the study. Of these, 17 were male and 10 female, with a mean age of 53 (range 38 – 71).85% were found to have bilateral RNFL thinning. 63% had either unilateral or bilateral RNFL thickening. 56% showed coexistence of both RNFL thickening and thinning. Of the 12 patients who underwent PMB analysis 75% had bilateral thinning.RNFL thinning was found to be most common in the temporal quadrants, while RNFL thickening occur at similar frequencies in all other quadrants.
This is the largest case series to date to describe OCT RNFL findings in patients with toxic nutritional optic neuropathy. Interestingly, coexistence of RNFL thinning and thickening was found in more than half of our patients. As our OCT RNFL findings are not as clear cut or well defined as previously anticipated this could suggest insult to the optic nerve head to occur in more than one occasion in toxic and nutritional optic neuropathy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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