Eric Shrier

Inner Retinal Layer Thinning in Parkinson Disease

OBJECTIVE To quantify retinal thickness in patients with Parkinson disease (PD). METHODS Forty-five eyes of 24 PD patients and 31 eyes of 17 control subjects underwent a comprehensive ophthalmologic examination. We used optical coherence tomography to examine retinal thickness, separately quantifying the inner and outer retinal layers. Intraocular pressure was measured by Goldmann applanation tonometry. RESULTS The mean (SD) ages of the patients with PD and healthy subjects were 64.0 (6.5) years vs 63.5 (10.7) years (P = .77). The mean (SD) intraocular pressure was 13.6 (+/-2.7) mm Hg in the PD patients. No difference was found in either the superior or inferior outer retinal layer thickness of PD vs control eyes. The mean (SD) superior inner retinal layer thickness of PD vs control eyes was 88.79 (11.3) microm vs 103.5 (24.3) microm (P = .01), and the mean inferior inner retinal layer thickness was 89.83 (11.1) microm vs 104.0 (23.5) microm (P = .01). CONCLUSIONS The inner retinal layer is significantly thinner in PD patients than in healthy subjects. Idiopathic PD, distinct from glaucoma, needs to be considered in the differential diagnosis of retinal nerve fiber layer thinning.

Correlation of inner retinal thickness evaluated by spectral-domain optical coherence tomography and contrast sensitivity in Parkinson disease.

Background: To compare inner retinal layer (IRL) thickness measured by spectral-domain optical coherence tomography (SD-OCT) and contrast sensitivity (CS) in patients with Parkinson disease (PD) and in healthy control (HC) subjects. Methods: Consecutive patients with and without PD were prospectively analyzed using SD-OCT and Pelli-Robson CS testing. SD-OCT IRL (ganglion-cell complex) thickness, consisting of the nerve fiber layer, ganglion cell layer, and inner plexiform layer, was segmented using an RTVue Model-RT100 with an EMM5 scan parameter covering a 5.0 × 5.0 mm cube centered on the fovea. Thickness voxel measurements at 0.25-mm intervals at sequential radial distances from the foveola were acquired horizontally and vertically. SD-OCT thickness raw data files were imported and analyzed within MATLAB (version 7.10.0). A database of CS scores and IRL thickness values by foveal location was constructed and statistically evaluated using JMP 10 (SAS Institute, Inc, Cary, NC). Results: The results were compared between 28 eyes of 14 patients with PD and 28 eyes of 14 HC subjects. Controlling for age, mean CS scores of monocular right and randomized eyes were statistically lower in PD eyes (P < 0.05). IRL was significantly thinner in PD eyes than in HC eyes at several distances from the foveola (P < 0.05). The most numerous and significant thickness differences by diagnosis were located in the superior quadrant at a distance of 1.00–1.75 mm from the foveal center (17 &mgr;m; P < 0.01, maximum significant thickness difference and P value). Correlation was demonstrated between monocular CS and IRL thickness by diagnosis at multiple foveal locations for HC eyes as follows: nasal quadrant, 0.75–1.00 mm (P < 0.02); temporal quadrant, 0.50–1.00 mm (P < 0.05); superior quadrant, 1.00 mm (P < 0.05); and inferior quadrant, 1.00 mm (P < 0.03). No significant correlation was found between monocular CS and IRL thickness within PD subjects (P > 0.05 for each foveal location measured). Conclusion: CS and foveal IRL thickness are decreased in patients with PD. CS and IRL thickness correlated in HC subjects; however, no such correlation was demonstrated in PD. The functional deficit of dopaminergic interneurons, including amacrine cells, may outstrip the anatomic structural changes in the inner retina of PD patients. Inner retinal atrophic changes may underlie the pathogenesis of CS deficit and IRL thinning in PD.

Interocular Asymmetry of Foveal Thickness in Parkinson Disease

Purpose. To quantify interocular asymmetry (IA) of foveal thickness in Parkinson disease (PD) versus that of controls. Design. Prospective case-control series. Methods. In vivo assessment of foveal thickness of 46 eyes of 23 PD patients and 36 eyes of 18 control subjects was studied using spectral domain optical coherence tomography (SD-OCT). Inner versus outer layer retinal segmentation and macular volumes were quantified using the manufacturers software, while foveal thickness was measured using the raw data from each eye in a grid covering a 6 by 6 mm area centered on the foveola in 0.25 mm steps. Thickness data were entered into MATLAB software. Results. Macular volumes differed significantly at the largest (Zone 3) diameter centered on the foveola (ETDRS protocol). By segmenting inner from outer layers, we found that the IA in PD is mostly due to changes on the slope of the foveal pit at the radial distances of 0.5 and 0.75 mm (1.5 mm and 1 mm diameter). Conclusions. About half of the PD patients had IA of the slope of the foveal pit. IA is a potentially useful marker of PD and is expected to be comparable across different SD-OCT equipment. Data of larger groups may be developed in future multicenter studies.

The avascular zone and neuronal remodeling of the fovea in Parkinson disease

Inner foveal thinning and intracellular alpha‐synuclein were demonstrated in the retina in Parkinson disease. While pathognomonic alpha‐synuclein is associated with embryonic dopaminergic (DA) neurons, postmortem studies in the nervous system and retina show prominent effect also in non‐DA neurons. We evaluated foveal capillaries and foveal thickness in 23 Parkinson disease subjects and 13 healthy controls using retinal fluorescein angiography and optical coherence tomography. The size of the foveal avascular zone inversely correlates with foveal thinning. Foveal thinning highly correlates with motor impairment and also disease duration. Quantifying capillary and neuronal remodeling could serve as biological markers.

Ocular Adverse Effects of Intravitreal Bevacizumab Are Potentiated by Intermittent Hypoxia in a Rat Model of Oxygen-Induced Retinopathy

Intravitreal bevacizumab (Avastin) use in preterm infants with retinopathy of prematurity is associated with severe neurological disabilities, suggesting vascular leakage. We examined the hypothesis that intermittent hypoxia (IH) potentiates intravitreal Avastin leakage. Neonatal rats at birth were exposed to IH from birth (P0)–P14. At P14, the time of eye opening in rats, a single dose of Avastin (0.125 mg) was injected intravitreally into the left eye. Animals were placed in room air (RA) until P23 or P45 for recovery (IHR). Hyperoxia-exposed and RA littermates served as oxygen controls, and equivalent volume saline served as the placebo controls. At P23 and P45 ocular angiogenesis, retinal pathology and ocular and systemic biomarkers of angiogenesis were examined. Retinal flatmounts showed poor peripheral vascularization in Avastin-treated and fellow eyes at P23, with numerous punctate hemorrhages and dilated, tortuous vessels with anastomoses at P45 in the rats exposed to IH. These adverse effects were associated with robust increases in systemic VEGF and in both treated and untreated fellow eyes. Histological analysis showed severe damage in the inner plexiform and inner nuclear layers. Exposure of IH/IHR-induced injured retinal microvasculature to anti-VEGF substances can result in vascular leakage and adverse effects in the developing neonate.

Pediatric Bilateral Blue Laser Pointer-Induced Maculopathy

Background: We report the first case of pediatric bilateral blue laser pointer maculopathy with complete resolution of visual symptoms. Case: A 12-year-old boy presented with bilateral decreased visual acuity and central scotomata after blue laser pointer exposure. He was treated with a Medrol Dosepak and topical nonsteroidal anti-inflammatory drug (NSAID), with gradual visual acuity improved from 20/40 OU to 20/20 OU over 22 weeks, but with persistent evidence of outer retinal layer disruption from the external limiting membrane to the interdigitation zone. Conclusion: Oral steroids and topical NSAIDs may be effective in improving visual outcomes in laser pointer maculopathy in the pediatric population.

Ein Blick über den Tellerrand - Forschung, Weiterbildung und Kommunikation

die dritte Ausgabe des «OphthalmoCampus» im KARGER KOMPASS OPHTHALMOLOGIE beschäftigt sich mit ganz unterschiedlichen Themen, die jedoch alle im Bezug zur Tätigkeit junger Augenärzte und -ärztinnen stehen. Zum einen stellen wir Ihnen Prof. Dr. Schmitz-Valckenberg von der Universitäts-Augenklinik in Bonn vor, der auf dem EURETINA-Kongress in Kopenhagen im Herbst letzten Jahres mit der «Ophthalmologica Lecture 2016» ausgezeichnet wurde. Sein Forschungsschwerpunkt ist die geographische Atrophie, die nicht-exsudative Spätform der altersabhängigen Makuladegeneration. Ein Interview mit Teilnehmern des Modellprojektes der Ärztekammer Westfalen-Lippe sowie dem Geschäftsführer dieser Ärztekammer, Dr. Wenning, befasst sich mit der Anerkennung von Forschung in der Weiterbildung. Außerdem wird Ihnen Prof. Molcho die Bedeutung von Körpersprache in der Arzt-Patienten-Beziehung näherbringen. Bei der Kommunikation ist es wichtig, sich nicht in seinen Rollen als Arzt und Patient gegenüberzutreten, sondern von Mensch zu Mensch zu kommunizieren. Im dritten Teil der Reihe «Wissenschaftliches Publizierens» gibt Dr. Riestenpatt, Projektmanager und Lektor des Karger Verlags, Tipps zur Begutachtung von Artikeln. Diese werden die Erstellung Ihres nächsten, oder vielleicht auch Ihres ersten, Reviews sicher erleichtern.

Bilaterale Makulopathie durch blauen Laserpointer: Ein pädiatrischer Fallbericht

Hintergrund: Wir berichten erstmals über einen pädiatrischen Fall von bilateraler durch blauen Laserpointer induzierter Retinopathie mit vollständiger Abheilung der visuellen Symptome. Fall: Ein 12-jähriger Junge stellte sich mit bilateraler Beeinträchtigung der Sehschärfe und zentralen Skotomen nach Exposition gegenüber blauem Laserpointerlicht vor. Er wurde mit einem Medrol Dosepak und einem topischen nichtsteroidalen Entzündungshemmer (NSAID) behandelt, und die Sehschärfe verbesserte sich im Laufe von 22 Wochen allmählich von 20/40 OU auf 20/20 OU, wobei allerdings eine Disruption der äußeren Retinaschicht von der äußeren Grenzmembran bis zur Interdigitationszone weiterhin bestand. Schlussfolgerung: Orale Steroide und topische NSAID können das visuelle Outcome der Laserpointer-Makulopathie in der Pädiatrie wirksam verbessern. Übersetzung aus Case Rep Ophthalmol 2017;8:152-156 (DOI:10.1159/000460289)

Hypertension, Diabetes, and the Eye

Hypertension or high blood pressure remains a serious problem not only here in the USA but worldwide as well. In the USA, almost one in three adults are afflicted with high blood pressure (National Center for Health Statistics. Health, United States, 2008) while in Europe, it is the leading cause of long-term medical care (Special Eurobarometer, Health in the European Union, September 2007). There are varied incidences of hypertension in country with some areas having up to 50 % of the chronically treated population being treated for this condition. The sequelae of hypertension include stroke, cardiac disease, renal disease, and loss of vision to name but a few. Hypertension affecting the eye is known as hypertensive retinopathy and can cause vision loss in a number of ways. The various ways hypertension can affect the eye will be described herein.