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Leutic Optic Neuropathy Masquerading as Glaucoma
Poster Presentations Conclusion: CSCR is characterized by a fluid detachment of the macular layers allowing leakage into the subretinal and sub-RPE spaces. Higher levels of cortisol increase the risk of the development of CSCR. In this case, the symptoms fit the diagnosis of CSCR but the clinical appearance could have mimicked other pathologies. OCT played a significant role in the confirmation of the initial diagnosis minimizing the need for repeat FAs during the course of management.
Poster 63 Left Homonymous Hemianopsia Secondary to Brain Metastasis From Non–Small Cell Lung Cancer Regina L. Portocarrero, O.D., Malcom Randall VAMC, Gainesville, Florida Background: Non–small cell lung cancer (NSCLC) is by far the most common type of lung cancer. Metastasis to the brain may occur and have visual consequences that could help make the initial diagnosis of this deadly condition. Case Summary: A 73-year-old white man presented to our clinic with complaints of decreased peripheral vision on his left side. He noticed the vision loss 3 weeks prior while driving after he inadvertently pulled out in front of a police car. His past medical history was remarkable for hypertension, hyperlipidemia, COPD, tobacco use disorder, and chronic sinusitis with frontal headache. He reported some weight loss over the past few months, and he complained of poor balance, which he attributed to his poor vision. He had no history of a stroke and did not have any related CVA symptoms. His BCVAs were 20/301 OD and 20/251 OS. His pupils and motilities were without defects. On confrontation visual fields he had a nasal defect OD and a temporal defect OS. The anterior segment and posterior segment examinations were unremarkable other than for grade 2 nuclear sclerotic cataracts. The Humphrey visual field test revealed a left homonymous hemianopsia. The patient was referred to our emergency room for further evaluation to rule out a stroke or mass. A CT scan was performed the same day, which showed a 2.5-cm lesion in the mesial portion of the right occipital lobe with moderate peritumoral edema and local mass effect. Recent chest x-ray showed a right upper lobe lung mass, which made the diagnosis of metastatic carcinoma likely. Further MRI of the brain with and without contrast was ordered as well as consults with neurosurgery and neurology. The lung biopsy showed a poorly differentiated non–small cell lung cancer consistent with the primary tumor. A PET/CT scan did not reveal any other metastasis. The patient underwent stereotactic radio surgery, but unfortunately died within 3 months of the diagnosis. Copies of visual fields and neuro-imaging are included. Conclusion: It is important to recognize the causes of neurological field defects and the proper and timely testing and referral to elucidate the etiology.
297 Poster 64 Leutic Optic Neuropathy Masquerading as Glaucoma Krishna Morar, O.D., Rebecca Rojas, O.D., and Brian Hall, O.D., SUNY State College of Optometry, New York, New York Background: Normal-tension glaucoma is a relatively common variant of primary open angle glaucoma in which intraocular pressure (IOP) is not elevated above the normal range. This represents a demanding clinical picture, as the clinician must determine whether the IOP is indeed within the normal range and whether the optic neuropathy is in fact glaucomatous in nature. Toxic, compressive, and infectious optic neuropathies can all mimic normal-tension glaucoma and should all be excluded, as they may require treatment to avoid further morbidity. Case Report: A 67-year-old black woman presented to our clinic with a history of being followed up with as a glaucoma suspect by other practitioners. The patient reported no family history of glaucoma and had no visual complaints. Initial examination findings included IOP in the low teens and optic nerves suspicious for glaucomatous damage. Visual field testing was consistently of poor reliability and as such, correlation with stereo photography of the optic nerve was questionable, as was the certainty of progression. At this point, it was decided to rule out compressive and infectious optic neuropathies, as nothing in the patient’s history suggested a toxic etiology. The patient’s MRI scan showed no evidence of a space-occupying lesion. Blood work was positive for syphilis, and once educated regarding this, the patient admitted to prior treatment for the disease. The patient was referred to an infectious disease specialist to evaluate the need for further systemic treatment. She is currently not taking medication and is seen in our clinic every 6 months. Conclusion: This case highlights the necessity of excluding other forms of optic neuropathy in patients suspected of normal-tension glaucoma. Demographic information, patient history, and correlation of subjective and objective findings should all be considered when determining the management course for these challenging patients.
Poster 65 De Morsier’s Syndrome Dina Iskander, O.D., SUNY State College of Optometry, New York, New York Background: De Morsier’s syndrome, also known as septooptic dysplasia, is a rare developmental anomaly of the brain characterized by optic nerve hypoplasia, absence of the septum pellucidum, and/or agenesis of the corpus callosum. Pituitary gland hypoplasia is highly associated with De Morsier’s syndrome and hence, De Morsier’s is a common etiology of congenital growth hormone deficiency. Associated hypopituitarism with midline brain abnormalities is the most significant cause of morbidity in these patients. De Morsier’s is of
Poster 63 Left Homonymous Hemianopsia Secondary to Brain Metastasis From Non–Small Cell Lung Cancer Regina L. Portocarrero, O.D., Malcom Randall VAMC, Gainesville, Florida Background: Non–small cell lung cancer (NSCLC) is by far the most common type of lung cancer. Metastasis to the brain may occur and have visual consequences that could help make the initial diagnosis of this deadly condition. Case Summary: A 73-year-old white man presented to our clinic with complaints of decreased peripheral vision on his left side. He noticed the vision loss 3 weeks prior while driving after he inadvertently pulled out in front of a police car. His past medical history was remarkable for hypertension, hyperlipidemia, COPD, tobacco use disorder, and chronic sinusitis with frontal headache. He reported some weight loss over the past few months, and he complained of poor balance, which he attributed to his poor vision. He had no history of a stroke and did not have any related CVA symptoms. His BCVAs were 20/301 OD and 20/251 OS. His pupils and motilities were without defects. On confrontation visual fields he had a nasal defect OD and a temporal defect OS. The anterior segment and posterior segment examinations were unremarkable other than for grade 2 nuclear sclerotic cataracts. The Humphrey visual field test revealed a left homonymous hemianopsia. The patient was referred to our emergency room for further evaluation to rule out a stroke or mass. A CT scan was performed the same day, which showed a 2.5-cm lesion in the mesial portion of the right occipital lobe with moderate peritumoral edema and local mass effect. Recent chest x-ray showed a right upper lobe lung mass, which made the diagnosis of metastatic carcinoma likely. Further MRI of the brain with and without contrast was ordered as well as consults with neurosurgery and neurology. The lung biopsy showed a poorly differentiated non–small cell lung cancer consistent with the primary tumor. A PET/CT scan did not reveal any other metastasis. The patient underwent stereotactic radio surgery, but unfortunately died within 3 months of the diagnosis. Copies of visual fields and neuro-imaging are included. Conclusion: It is important to recognize the causes of neurological field defects and the proper and timely testing and referral to elucidate the etiology.
297 Poster 64 Leutic Optic Neuropathy Masquerading as Glaucoma Krishna Morar, O.D., Rebecca Rojas, O.D., and Brian Hall, O.D., SUNY State College of Optometry, New York, New York Background: Normal-tension glaucoma is a relatively common variant of primary open angle glaucoma in which intraocular pressure (IOP) is not elevated above the normal range. This represents a demanding clinical picture, as the clinician must determine whether the IOP is indeed within the normal range and whether the optic neuropathy is in fact glaucomatous in nature. Toxic, compressive, and infectious optic neuropathies can all mimic normal-tension glaucoma and should all be excluded, as they may require treatment to avoid further morbidity. Case Report: A 67-year-old black woman presented to our clinic with a history of being followed up with as a glaucoma suspect by other practitioners. The patient reported no family history of glaucoma and had no visual complaints. Initial examination findings included IOP in the low teens and optic nerves suspicious for glaucomatous damage. Visual field testing was consistently of poor reliability and as such, correlation with stereo photography of the optic nerve was questionable, as was the certainty of progression. At this point, it was decided to rule out compressive and infectious optic neuropathies, as nothing in the patient’s history suggested a toxic etiology. The patient’s MRI scan showed no evidence of a space-occupying lesion. Blood work was positive for syphilis, and once educated regarding this, the patient admitted to prior treatment for the disease. The patient was referred to an infectious disease specialist to evaluate the need for further systemic treatment. She is currently not taking medication and is seen in our clinic every 6 months. Conclusion: This case highlights the necessity of excluding other forms of optic neuropathy in patients suspected of normal-tension glaucoma. Demographic information, patient history, and correlation of subjective and objective findings should all be considered when determining the management course for these challenging patients.
Poster 65 De Morsier’s Syndrome Dina Iskander, O.D., SUNY State College of Optometry, New York, New York Background: De Morsier’s syndrome, also known as septooptic dysplasia, is a rare developmental anomaly of the brain characterized by optic nerve hypoplasia, absence of the septum pellucidum, and/or agenesis of the corpus callosum. Pituitary gland hypoplasia is highly associated with De Morsier’s syndrome and hence, De Morsier’s is a common etiology of congenital growth hormone deficiency. Associated hypopituitarism with midline brain abnormalities is the most significant cause of morbidity in these patients. De Morsier’s is of