Papilledema: The Vexing Issues

In this podcast, Dr Alfredo Sadun expands upon themes he raised during his 2012 Hoyt Lecture. His paper entitled “Are We There Yet? Is Neuro-Ophthalmology at the Cusp of a Paradigm Shift? Lessons From Leber Hereditary Optic Neuropathy” represents an encapsulation of his lecture.

Jeffrey Goldberg, author of the paper “Four Steps to Optic Nerve Regeneration” discusses the outcomes of this important new review article. The paper is published in the December 2010 issue of the Journal of Neuro-ophthalmology.

Papilledema has long been recognized as a valuable sign of increased intracranial pressure (ICP). But because papilledema is based on interruption of the energy-dependent process of axoplasmic flow, it appears late after a rise in ICP. Papilledema is usually present in chronically high ICP but sometimes asymmetrically in the 2 eyes and rarely in 1 eye only. Distinguishing it from other optic neuropathies that produce elevated optic discs is challenging, especially in the chronic phase, when visual function may be impaired.

In this podcast, Dr Neil Miller,one of the authors of the editorial entitled “A Nonarteritic Anterior Ischemic Optic Neuropathy Clinical Trial: An Industry and NORDIC Collaboration” talks about what is the leading cause of sudden optic nerve–related vision loss in individuals over 50 years old (caused by inadequate blood supply to the optic nerve head). Dr Miller discusses QRK207. QRK207 will be the first trial to use a potential neuroprotective therapy delivered early to reduce permanent injury and lessen the vision loss from acute NAION.

Interview with Dr Mark Kupersmith regarding his Hoyt Lecture on Optical Imaging of the Optic Nerve: Beyond Demonstration of Retinal Nerve Fiber Layer Loss

In this podcast, Drs. Michael S. Lee and Michael Vaphiades engage in a point-counterpoint debate over whether erectile dysfunction (ED) medications are causally related to NAION?

The field of retinal prosthetic research, now more than 20 years old, has produced many high-quality technical options that have the potential to restore vision to patients with acquired disease of the outer retina. Having developed a wireless device implanted in the subretinal space, the Boston Retinal Implant Project has focused its efforts on developing scalable technologies to create a hermetic device that can deliver individually controlled pulses of electrical stimulation to each of hundreds of electrodes.

This podcast features an interview with Caroline Tilikete, author of a recent JNO State of the Art Review on Ocular Motor Manifestations of Multiple Sclerosis. The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Appropriate treatment, which both the paper and podcast explore, may improve visual outcome in some of these ocular motor disorders.

In this podcast, Dr Jeffrey Bennett discusses his review article “The Treatment of Neuromyelitis Optica”.

Management of the pregnant woman with a neuro-ophthalmic disorder may be challenging. Physiologic changes in pregnancy make vascular conditions more frequent, including retinal artery occlusion, spontaneous orbital hemorrhage, and pituitary apoplexy. Treatment of the neuro-ophthalmic complications of pregnancy requires an understanding of the risks of medications. Taking optimal care of the mother will usually result in the best care for her baby.