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    Surveying old, new diagnostic tests for pediatric neuro-ophthalmic cases

    Top advances over past 25 years see growth in diagnostics, increased use of genetic testing



    Optic nerve sheath diameter

    If the optic nerve sheath diameter is enlarged, but decreases by 15% or 20% when the eye is abducted 30°, this indicates that subarachnoid fluid is being pushed posteriorly, as in optic neuritis or papilledema. If the optic nerve sheath diameter is enlarged but does not decrease on abduction, this indicates a tumor or some sort of infiltration, according to Dr. Siatkowski.

    Neuroimaging also has reached advances in the past 25 years, he said.

    Due to radiation concerns in children, he believes that computed tomography should be avoided unless absolutely urgent, as magnetic resonance imaging is still good for bone, orbit, and soft tissue.

    It is important to use gadolinium unless there is allergy or renal disease. The use of gadolinium provides a greater chance of spotting masses, where the infused study clearly demonstrates a mass lesion that was missed on the non-contrast study.

    Genetic testing is increasingly performed today. Commercially available testing is sometimes the quickest and cheapest option, such as for dominant optic neuropathy, he noted.

    Dr. Siatkowski recommended that ophthalmologists stay familiar with functional visual loss testing and teach others in the profession how to use it, because it is commonly seen in children.

    Some testing devices that have been around a long time and remain useful include the ophthalmoscope, retinoscopy, neutral density filters, and Frenzel goggles.

    Finally, Dr. Siatkowski stressed the importance of doing a thorough history and exam. “It’s still the gold standard and well worth your time,” he said. 



    R. Michael Siatkowski, MD

    e: [email protected]

    This article was adapted from Dr. Siatkowski’s presentation at the 2016 meeting of the American Academy of Ophthalmology. Dr. Siatkowski has no related disclosures.

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