north american neuro-ophthalmology society 34th annual meeting
TRANSCRIPT
Meeting Report
10.1586/17469899.3.3.261 © 2008 Expert Reviews Ltd ISSN 1746-9899 261www.expert-reviews.com
North American Neuro-Ophthalmology Society 34th Annual MeetingExpert Rev. Ophthalmol. 3(3), 261–263 (2008)
Susan P Mollan† and Tim D Matthews†Author for correspondenceRoyal Berkshire Hospital, London Road, Reading, Berkshire, RG1 5AN, UKTel.: +44 118 322 5111Fax: +44 184 427 [email protected]
North American Neuro-Ophthalmology Society 34th Annual Meeting
8–13 March 2008, Renaissance Orlando Resort at Sea World, FL, USA
Focusing on the broad range of conditions that impact the human visual pathway and ocularmotor systems, The North American Neuro-Ophthalmology Society Annual Meeting is a well-established event. Physicians and clinical scientists with an interest in neuroscience cometogether to share experiences.
Frank B Walsh SessionThe Frank B Walsh Session was a day long for-mal clinicopathic conference where clinical caseswere presented by neuro-ophthalmologists. Theemphasis was on the radiological and pathologi-cal evidence in each case. This year’s panelincluded neuro-pathologist Dr Hinton andneuro-radiologist Dr Paul Kim (both from theUniversity of Southern California, CA, USA).With 20 high quality and interesting cases, itwas difficult for the scientific committee todecide on a clear winner: in the end the prizewas awarded to both Beau Bruce and ThomasHwang (San Francisco, CA, USA).
‘What?!’ was the title for Dr Bruce’s (Atlanta,GA, USA) case. This described a patientreferred with an anterior ischemic optic neu-ropathy, who, on subsequent examination, hadvery asymmetric papilledema with choroidalfolds from raised intracranial hypertension.Investigation demonstrated cerebral venoussinus thrombosis on CT venography, secondaryto myeloid sarcoma of the mastoid bone (sub-sequently confirmed by myeloperoxidaseimmunohistochemical staining).
Dr Hwang presented ‘My orbits are melting’,with a case that was referred for progressive bilat-eral enophthalmos. Past medical history includeda ruptured left basilar artery aneurysm that wassurgically clipped and a ventriculoperitonealshunt that was inserted for hydrocephalus. Theclinical images were dramatic, the lids showed
very poor apposition to the globes and neuroim-aging revealed straightening of the optic nerves.The mechanism of this rare late complicationfrom acquired hydrocephalus remains unknown.
Stroke symposiumThe full morning stroke symposium reviewedacute stroke treatment, secondary preventionof stroke and vascular disorders of specialinterest to neuro-ophthalmologists, such asperioperative visual loss and giant cell arteritis.
One of the main panel discussions waswhether acute retinal infarction should be evalu-ated and managed similarly to acute cerebral inf-arctions. The current guidelines for acute cere-bral infarctions are derived from the NationalInstitute of Neurological Disorders and Stroketissue-plasminogen activator (t-PA) Stroke Trial(1995) [1]. This randomized, control trial was thefirst to show the benefit of t-PA in patients withless than 3 h of stroke symptoms. As no treat-ment currently offered to patients presentingwith a central retinal artery occlusion have beenproven to be effective in restoring vision by clini-cal trial, the question proposed was whetherthrombolysis would be. Both the audience andthe panel reported success in selected cases theyhad treated; however, all groups emphasized thelogistical problem of intra-arterial thrombolysis.This hypothesis is currently being evaluated inthe EAGLE trial (Feltgen et al., Germany), whichis due to report their results soon.
262 Expert Rev. Ophthalmol. 3(3), (2008)
Meeting Report Mollan & Matthews
Dr Nancy J Newman (Emory University School of Medi-cine, Atlanta, GA, USA) presented ‘Perioperative visual loss’.It is still a rare event, but, in the USA it is becoming anincreasing medico–legal issue. The American Society ofAnesthesiologists appointed a task force to review the litera-ture and obtain an expert consensus to develop a practiceadvisory document. Owing to the rarity of the complication,the task force focused on spinal surgery in the prone positionunder general anesthetic. It is known that high-risk patientsare those who have prolonged surgery and substantial bloodloss. Dr Roth (University of Chicago, IL, USA) then pre-sented his rodent model of perioperative ischemic optic neu-ropathy where head down tilt, mild hemodilution and hypo-tension, all induced injury to the retinal ganglion cells.Further work is required to fully understand the mechanismsof optic nerve injury in the perioperative settling.
Scientific presentations
There were 25 platform presentations and 92 posters, with tenposters being selected for an energetic ‘Tour of Posters’ rapid-firesession. One of the most notable presentations was ‘Changes invertical misalignment in skew deviation and trochlear nervepalsy: dependence on head orientation’ presented by Dr AgnesWong (University of Toronto, Canada) as it generated stronginterest from the audience. The team demonstrated that verticalmisalignment due to skew deviation decreased substantially, ordisappeared, in the supine position. While in trochlear nervepalsy there was little or no change with different body positions.This has implications for examining patients at the bedside (“sitthem up, or you’ll miss the skew!”) and adjusting sutures afterstrabismus surgery. They postulate this could form the basis of atest to clinically differentiate between the two conditions.
Several platform presentations reported on the 15-year fol-low-up of the Optic Neuritis Treatment Trial. Neurologicaloutcomes again showed no long-term benefit of treatment withsteroids during the episode of optic neuritis. The risk of con-verting to clinically definite multiple sclerosis (MS) after 15years was significantly lower in those with a normal MRI atpresentation. Overall, only 50% of the cohort had converted toclinically definite MS by 15 years.
Optical coherence tomography (OCT) is now being usedroutinely in clinical practice, a number of platform and posterpresentations reported the OCT parameters recorded in variousneuro-ophthalmic conditions, such as MS, optic neuritis,papilledema, pseudopapilledema, pseudotumor cerebri andpituitary adenoma. Further published studies will help clarifywhether OCT is actually a useful neurodiagnostic tool.
Update on neurodegenerative disorders
The start of the symposium reviewed the recent advances in cor-tical degenerations and spinocerebellar ataxias. Later in themorning, ‘progressive supranuclear palsy’ was presented by Dr
Eggenberger (Michigan State University, MI, USA). One of thekey points was that postural instability and unexplained fallswere much more common in progressive supranuclear palsycases, typically in the first year of the disease, compared withother neurological disease such as Parkinson’s disease. Dr WHills (University of Utah, UT, USA) presented his group’s workon differentiating between progressive supranuclear palsy andParkinson’s disease. Presence of two or more of the following wasable to correctly discriminate between progressive supranuclearpalsy and PD.
• More than five square wave jerks
• Abnormal vertical optokinetic nystagmus
• Lid retraction stare
These neuro-ophthalmic findings, in addition to establishedcriteria, may assist early and accurate diagnosis.
Jacobson lecture
The first Daniel M Jacobson Memorial Lecture, was given byDr James J Corbett (University of Mississippi Medical Center,MS, USA). He reviewed ‘Familial idiopathic intracranialhypertension’ (IIH) and presented the ‘Mississippi Experi-ence’. He concluded that familial idiopathic intracranialhypertension is probably underreported and that taking adetailed family history is essential in all idiopathic intracranialhypertension cases.
Diagnostic neuroimaging symposium
Dr Nicholas Volpe (University of Pennsylvania, PA, USA)opened this symposium with a socioeconomic review ofneuroimaging in neuro-ophthalmology. Further lecturesexplored the role of neuroimaging in headaches, MS, cavern-ous sinus and skull base pathology, and optic nerve disease.There was also a look to the future with new techniques inMRI and neuroimaging limitations. We were reminded ofthe potential complication of nephrogenic systemic fibrosisfrom gadolinium use and then the importance of document-ing renal function. Despite all the advances in MRI technol-ogy and the advantages of the exquisite images, good com-munication with the radiology team remains the cornerstonein diagnosing neuro-ophthalmic conditions.
The North American Neuro-Ophthalmology Society is afriendly and relaxed international meeting that mixes medicaleducation with light-hearted socializing. Symposia not only focuson clinical education, but also on management, recent advancesin information technology and finance related to neuro-ophthal-mic practice. Medical students, residents and fellows are all madevery welcome, as are international colleagues.
The 35th Annual North American Neuro-OphthalmologySociety Meeting will be held in Nevada (NV, USA) on Febru-ary 21–26, 2009 at the Hyatt Regency Lake Tahoe Resort. Formore information see [2].
North American Neuro-Ophthalmology Society 34th Annual Meeting Meeting Report
www.expert-reviews.com 263
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement withany organization or entity with a financial interest in or financial conflictwith the subject matter or materials discussed in the manuscript. Thisincludes employment, consultancies, honoraria, stock ownership or options,expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
References
1 National Institute of Neurological Disorders and Stroke. rt-PA stroke study group. Tissue Plasminogen Activator for acute ischemic stroke. N. Eng. J. Med. 333, 1581–1587 (1995).
2 North American Neuro-Ophthalmology Societywww.nanosweb.org
Affiliations
• Susan P Mollan, MRCOphthSpecialist Registrar in Ophthalmology, Royal Berkshire Hospital, London Road, Reading, Berkshire RG1 5AN, UKTel.: +44 118 322 5111Fax: +44 184 427 [email protected]
• Tim D Matthews, FRCOphthConsultant Neuro-Ophthalmologist, The Birmingham Neuro-Ophthalmology Unit, University Hospital Birmingham, Raddlebarn Road Selly Oak, Birmingham B29 6JD, UKTel.: +44 121 627 [email protected]