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    OCT takes on evolving role in neuro-ophthalmology

    Adding to surgical armamentarium boosts ability to pinpoint diagnosis, location of damage

    Iowa City, IA—Optical coherence tomography (OCT) plays a growing role in neuro-ophthalmology, said Randy Kardon, MD, PhD.

    “We’re using it much more to fine-tune and localize where damage is, nail down the diagnosis, give a prognosis of visual recovery, and to assess treatment,” said Dr. Kardon, professor and director of neuro-ophthalmology; director of the Iowa City VA Center for Prevention and Treatment of Visual Loss; and Pomerantz Family Chair in Ophthalmology, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City.

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    For these reasons, OCT has become more common in the offices of neuro-ophthalmologists.

    Cerebral angiogram revealed posterior cerebral artery aneurysm. Left: Pre-treatment. Right: Posttreatment coiling (Images courtesy of Randy Kardon, MD, PhD)Case in point

    Dr. Kardon shared the important role that OCT played with a recent patient he saw, a 55-year-old man who had lost his right eye in a car accident in 1977.

    The man was asymptomatic in his left eye, and the ophthalmologist who had seen him thought the patient had some cupping of the optic nerve, raising the suspicion of glaucoma. IOP was below 15 mm Hg, and visual acuity was normal. The patient’s visual field exam showed a very minor decrease in light sensitivity at a few locations, but an OCT of the optic nerve showed thinning of the neuroretinal rim.

    Related: OCT + OCTA capable of imaging both structure and function

    A ganglion cell layer analysis showed normal thickness on the temporal retina, but significant thinning on the nasal retina that seemed to respect the vertical meridian.

    “You start to worry about something in an intracranial location,” Dr. Kardon said.

    The patient had an MRI of the brain, which showed a normal pituitary gland and a small little nodule next to the chiasm that enhanced with contrast.

    The patient was then sent for an angiogram, and he was found to have an aneurysm in the posterior cerebral artery. He was treated with coiling as an outpatient and went home the same day.

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