Abstract
Purpose :
To characterize the spectrum and visual acuity impact of neuro-ophthalmologic disease in a cohort of Ebola virus disease (EVD) survivors from the West African Ebola outbreak from 2014 - 2016.
Methods :
Patients who previously underwent screening for enrollment in the Ebola Virus Persistence in Ocular Tissues and Fluids Study (EVICT study), were eligible for this post-hoc review of EVD survivors with neuro-ophthalmologic findings. Medical chart review was performed, and neuro-ophthalmologic implications including afferent pupillary defect (APD), motility problems, and optic nerve disease (optic pallor or atrophy) were collected. Eyes with vision-compromised cataract were excluded from the analysis, as the majority were dense lenses precluding adequate view of the fundus. Demographic characteristics including age, sex, and visual acuity were also collected. The extent of vision impairment was stratified into the following categories: normal (20/20); mild impairment (20/25 – 20/40); moderate impairment (20/50 – 20/160); and severe impairment (20/200 or poorer). An unpaired T-Test was performed using Microsoft Excel (Microsoft Corporation, Redmond, WA); a p-value < 0.05 was considered significant.
Results :
A total of 191 eyes (121 patients) were included in the analysis. The mean age was 31.5 ± 16.1 years ranging from 4 to 70 years of age, and the mean logMAR was 0.45 ± 0.84; Snellen VA 20/56. Seventy percent (70%) were female. Of 191 eyes, twelve (6.3%) eyes of 8 patients had optic nerve disease, and 4 patients had bilateral disease. VA impairment was classified as severe (n = 7), moderate (n=1), mild (n=1), and normal (n=3). The mean logMAR in the optic nerve disease group (1.46 ± 1.21) was significantly worse than in the non-optic nerve disease group (0.39 ± 0.77), p-value = 0.014. Of 8 patients with optic nerve disease, three patients showed associated neurologic symptoms including headache, numbness, and eye pain. Of 121 patients, eleven (9.1%) patients had ocular motility issues including 9 with exotropia, 1 with esotropia, and 1 with vertical gaze palsy, and 5 patients demonstrated relative APD.
Conclusions :
In this post-hoc analysis, we identified a subset of EVD survivors with optic nerve disease and motility disorders. Patients with optic nerve pathology showed worse visual acuity with severe vision impairment and rare association with neurologic symptoms.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.