scholarly journals Low Contrast Visual Acuity Might Help to Detect Previous Optic Neuritis

2020 ◽  
Vol 11 ◽  
Author(s):  
Soo-Hyun Park ◽  
Choul Yong Park ◽  
Young Joo Shin ◽  
Kyoung Sook Jeong ◽  
Nam-Hee Kim
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuritis ◽  
Roc Curve ◽  
Demyelinating Disease ◽  
Area Under The Curve ◽  
Youden Index ◽  
High Contrast ◽  
Roc Curve Analysis ◽  
Low Contrast

Optic neuritis (ON) has been considered to be an important factor in the diagnosis of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), making ON detection increasingly critical for early diagnosis. Furthermore, subclinical ONs presenting no distinct decrease in visual acuity can be missed. Low contrast visual acuity (LC-VA) is known to be able to capture visual loss not seen in conventional high-contrast visual acuity (HC-VA) in MS. Therefore, to increase the sensitivity of ON detection, we investigated the advantage of LC-VA over conventional HC-VA. One hundred and eight patients with demyelinating disease (35 MS, 73 NMOSD) with ON at least 3 months prior and 35 controls underwent neuro-ophthalmic evaluation, including best-corrected conventional high contrast visual acuity (HC-VA) and 2.5% and 1.25% low contrast visual acuity (LC-VA). Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) of various visual functions were used to determine the most relevant visual function test for the detection of optic nerve involvement. Additionally, the optimal cutoff point was obtained from the Youden index (J-index) as the points with the best sensitivity-specificity balance. When distinguishing ON from non-ON, the area under the ROC curve (AUC) was highest for the 2.5% LC-VA (0.835, P < 0.001; sensitivity 71.5%, specificity 88.6%), while it was 0.710 (P < 0.001) for the HC-VA and 0.770 (P < 0.001) for the 1.25% LC-VA. In discriminating between controls and ON, the AUC was also highest for the 2.5% LC-VA 0.754 (P < 0.001; sensitivity 71.5%, specificity 78.5%), while it was 0.719 (P < 0.001) for HC-VA and 0.688 (P < 0.001) for 1.25% LC-VA. In eyes with a history of ON (n = 137), the HC-VA and 2.5% LC-VA were abnormal in 64.2 and 71.5%, respectively (P < 0.001), with their combination detecting abnormalities in approximately 85.4% (P < 0.001). The 2.5% LC-VA was superior to HC-VA in detecting ON when distinguishing ON from non-ON or control. The 2.5% LC-VA might be a useful, feasible, and rapid method to detect ON. Furthermore, combining 2.5% LC-VA with conventional HC-VA would be better for detecting optic nerve involvements.

scholarly journals Minimum Detectable Change of Visual Acuity Measurements Using ETDRS Charts (Early Treatment Diabetic Retinopathy Study)

2021 ◽  
Vol 18 (15) ◽  
pp. 7876
Author(s):  
María Carmen Sánchez-González ◽  
Raquel García-Oliver ◽  
José-María Sánchez-González ◽  
María-José Bautista-Llamas ◽  
José-Jesús Jiménez-Rejano ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Early Treatment ◽  
High Reliability ◽  
Minimal Detectable Change ◽  
High Contrast ◽  
Detectable Change ◽  
Low Contrast ◽  
Minimum Detectable Change ◽  
The Mean

In our work, we determined the value of visual acuity (VA) with ETDRS charts (Early Treatment Diabetic Retinopathy Study). The purpose of the study was to determine the measurement reliabilities, calculating the correlation coefficient interclass (ICC), the value of the error associated with the measure (SEM), and the minimal detectable change (MDC). Forty healthy subjects took part. The mean age was 23.5 ± 3.1 (19 to 26) years. Visual acuities were measured with ETDRS charts (96% ETDRS chart nº 2140) and (10% SLOAN Contrast Eye Test chart nº 2153). The measurements were made (at 4 m) under four conditions: Firstly, photopic conditions with high contrast (HC) and low contrast (LC) and after 15 min of visual rest, mesopic conditions with high and low contrast. Under photopic conditions and high contrast, the ICC = 0.866 and decreased to 0.580 when the luminosity and contrast decreased. The % MDC in the four conditions was always less than 10%. It was minor under photopic conditions and HC (5.83) and maximum in mesopic conditions and LC (9.70). Our results conclude a high reliability of the ETDRS test, which is higher in photopic and high contrast conditions and lower when the luminosity and contrast decreases.

scholarly journals Shear wave elastography in optic neuritis: diagnostic accuracy of the optic nerve and adjacent fat tissue values

2021 ◽  
Vol 21 (86) ◽  
pp. e194-e199
Author(s):  
Mustafa Devran Aybar ◽  
◽  
Onder Turna ◽  
Keyword(s):  
Optic Nerve ◽  
Diagnostic Accuracy ◽  
Optic Neuritis ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Curve Analysis ◽  
Fat Tissue ◽  
Roc Curve Analysis ◽  
Optic Nerves ◽  
The Mean

Introduction: In this study, we attempt to determine the diagnostic performance of shear wave elastography of the optic nerve and adjacent fat tissue in patients with optic neuritis. Methods: The study included a patient group consisting of 72 eyes of 36 patients who were diagnosed with unilateral optic neuritis, and an age-matched control group of 36 eyes of 18 healthy subjects. The patient group consisted of 25 multiple sclerosis patients and 11 recurrent isolated optic neuritis patients. The mean shear wave elastography values of the optic nerves and intraorbital fat tissue adjacent optic nerves were recorded using m/s and kPa as units. ROC curve analysis was performed, and the diagnostic accuracy of shear wave elastography values was determined. Results: The mean shear wave elastography values of the optic nerves with neuritis (2.49 ± 0.41 m/s and 17.56 ± 4.42 kPa) were significantly higher than the values of the contralateral normal optic nerves (1.71 ± 0.32 m/s and 9.02 ± 2.34 kPa) (p = 0.006 and p = 0.004, respectively) in the optic neuritis group. The mean shear wave elastography values of intraorbital fat tissue adjacent optic nerves with neuritis (1.87 ± 0.32 m/s and 9.65 ± 1.12 kPa) were significantly higher than the values of the contralateral normal side (1.47 ± 0.27 m/s and 6.78 ± 1.14 kPa) (p = 0.025 and p = 0.022, respectively) in the optic neuritis group. ROC curve analysis showed a high diagnostic accuracy for determining optic neuritis with shear wave elastography values of the optic nerves (AUC 0.955 [95% CI, 0.933–0.978] in m/s and AUC 0.967 [95% CI, 0.940–0.985] in kPa). Conclusions: Shear wave elastography may be an important alternative diagnostic tool in the diagnosis of optic neuritis.

scholarly journals Validation of PELOD-2 score as a predictor of life-threatening organ dysfunction in pediatric sepsis

2020 ◽  
Vol 60 (5) ◽  
pp. 227-32
Author(s):  
Yuyun Romaria Simanjuntak ◽  
Indra Saputra ◽  
Silvia Triratna ◽  
Achirul Bakri ◽  
Yulia Iriani
Keyword(s):  
Organ Dysfunction ◽  
Roc Curve ◽  
Area Under The Curve ◽  
Youden Index ◽  
International Consensus ◽  
Failure Assessment ◽  
Life Threatening ◽  
Sepsis Definition ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock

Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction due to immune dysregulation against infection. It recommends the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score to evaluate life-threatening organ dysfunction. But the SOFA tool has not been adjusted for pediatric patients.  The Indonesian Pediatrics Society (IPS) uses the same sepsis definition and recommends using the PELOD-2 score as an indicator of life-threatening organ dysfunction in children.     Objective To evaluate the validity of the PELOD-2 score for predicting life-threatening organ dysfunction in pediatric sepsis. Methods A prospective cohort study was conducted in children with sepsis who were admitted to the PICU.  Subjects were taken consecutively with inclusion criteria of 1 month-18 years of age, with organ dysfunction, having two or more symptoms of systemic inflammatory response syndrome (SIRS), and suspected or proven infection.  PELOD-2 score, with and without lactate result, of each subject were plotted to receiver operating characteristic (ROC) curve, then we determined the most optimal cut off point to predict the life-threathneing organ dysfunction in pediatric sepsis based on the sensitivity and specificity of each score. Results Sixty-six patients were analyzed, with 40 males and 26 females aged 2 to 183 months (median 11 months).  Twenty patients died while in the PICU. A PELOD-2 score (with lactate) cut-off ≥ 7 was determined by ROC curve, with sensitivity of 80% and specificity of 78%. The area under the curve (AUC) of PELOD-2 score (with lactate) was 84.8% (95%CI 74.7 to 95.9%).  A PELOD-2 score (without lactate) ≥ 7  was the most optimum cut off based on its Youden index, it haD 70% of sensitivity and 80% of specificity. Conclusion PELOD-2 score ≥ 7 , with or without lactate component is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis. 

scholarly journals Bilateral retinal pathology following a first-ever clinical episode of autoimmune optic neuritis

2020 ◽  
Vol 7 (2) ◽  
pp. e671 ◽  
Author(s):  
Carla A. Wicki ◽  
Praveena Manogaran ◽  
Tanja Simic ◽  
James V.M. Hanson ◽  
Sven Schippling
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Structural Damage ◽  
Inner Plexiform Layer ◽  
Fiber Layer ◽  
Low Contrast ◽  
Time Points ◽  
Acute Optic Neuritis ◽  
Retinal Pathology ◽  
Clinical Episode

ObjectiveThis longitudinal study aimed to assess changes in retinal structure and visual function following a first-ever episode of acute optic neuritis (ON).MethodsClinical and optical coherence tomography (OCT) data obtained over a period of 12 months were retrospectively analyzed in 41 patients with a first-ever clinical episode of acute ON. OCT scans, high-contrast visual acuity (HCVA), and low-contrast visual acuity (LCVA) were acquired at baseline and at 1, 3, 6, and 12 months thereafter. Macular ganglion cell and inner plexiform layer (GCIP), peripapillary retinal nerve fiber layer (pRNFL), and macular inner nuclear layer (INL) thicknesses were assessed by OCT. Linear mixed-effects models were used to analyze OCT variables of ipsilateral ON and contralateral non-ON (NON) eyes over time.ResultsThe mean change of GCIP thickness in ON eyes was significant at all follow-up time points, with nearly 75% of the total reduction having occurred by month 1. In ON eyes, thinner GCIP thickness at month 1 correlated with lower LCVA at month 3. Mean pRNFL thickness in ON eyes differed significantly from NON eyes at all postbaseline time points. INL thickness was significantly increased in ON eyes (month 1) but also in contralateral NON eyes (month 12).ConclusionsRetinal structural damage develops rapidly following acute ON and is associated with subsequent functional visual deficits. Our results also suggest bilateral retinal pathology following unilateral ON, possibly caused by subclinical involvement of the contralateral NON eyes. Moreover, our data may assist in clinical trial planning in studies targeting tissue damage in acute ON.

Interleukin-8 is associated with acute and persistent dysfunction after optic neuritis

2014 ◽  
Vol 20 (14) ◽  
pp. 1841-1850 ◽  
Author(s):  
S Rossi ◽  
C Motta ◽  
V Studer ◽  
C Rocchi ◽  
G Macchiarulo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Proinflammatory Cytokines ◽  
Inflammatory Cytokine ◽  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Neuronal Damage ◽  
Low Contrast ◽  
Acute Optic Neuritis ◽  
Csf Levels

Background: Acute optic neuritis is often in association with multiple sclerosis (MS). Proinflammatory cytokines trigger neuronal damage in neuroinflammatory disorders but their role in optic neuritis is poorly investigated. Objective: The objective of this work is to investigate the associations of intrathecal contents of proinflammatory cytokines with transient and persistent dysfunctions after optic neuritis. Methods: In 50 MS patients followed for up to six months, cerebrospinal fluid (CSF) levels of IL-1β, TNF and IL-8 were determined, along with clinical, neurophysiological and morphological measures of optic neuritis severity. Results: Visual impairment, measured by high- and low-contrast visual acuity, and delayed visual-evoked potential (VEP) latencies were significantly correlated to IL-8 levels during optic neuritis. IL-8 at the time of optic neuritis was also associated with persistent demyelination and final axonal loss, inferred by VEP and optical coherence tomography measures, respectively. Contents of IL-8 were correlated to functional visual outcomes, being higher among patients with incomplete recovery. Multivariate analysis confirmed that IL-8 significantly predicted final visual acuity, at equal values of demographics and baseline visual scores. Conclusion: Our study points to IL-8 as the main inflammatory cytokine associated with demyelination and secondary neurodegeneration in the optic nerve after optic neuritis.

Retinal nerve fiber thickness in inflammatory demyelinating diseases of childhood onset

2009 ◽  
Vol 15 (7) ◽  
pp. 802-810 ◽  
Author(s):  
EA Yeh ◽  
B Weinstock-Guttman ◽  
N Lincoff ◽  
J Reynolds ◽  
A Weinstock ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Nerve Fiber ◽  
Demyelinating Disease ◽  
Transverse Myelitis ◽  
Demyelinating Diseases ◽  
Healthy Controls ◽  
Fiber Layer ◽  
Cross Sectional ◽  
Low Contrast ◽  
Retinal Nerve Fiber

Purpose To evaluate retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography (OCT) in children with acquired demyelinating diseases. Methods This is a cross-sectional study of patients seen between 2006–2008 at the Pediatric MS Center of the Jacobs Neurological Institute. Consensus definitions for pediatric demyelinating disease were followed. All children received OCT testing and assessment of visual acuity (VA) using Snellen and low contrast letter acuity (LCLA) charts. Results Thirty-eight children diagnosed with acquired demyelinating disease, 15 healthy controls, and five children with other neurological disorders (OND) were included. Average RNFLT in healthy controls was 107 ± 12 μm( n = 30) versus 108 ± 5 μm ( n = 10) in OND controls. In children with multiple sclerosis, average RNFLT ± SD was 99 ± 14 μm in unaffected ( n = 24) versus 83 ± 12 μmin eyes affected by optic neuritis (“affected eyes”) ( n = 10). Average RNFLT in children with acute disseminated encephalomyelitis and transverse myelitis was 102 ± 15 μm in unaffected ( n = 18) versus 67 ± 17 μm in affected eyes ( n = 6). In children with optic neuritis (ON), average RNFLT ± SD was 97 ± 13 μm in unaffected ( n = 5) versus 89 ± 12 μm in affected eyes ( n = 9). Differences between children with demyelinating disease and controls and between ON and nonON eyes were statistically significant ( P < 0.001). Bivariate correlations of RNFLT with LCLA ( P = 0.002) and VA ( P < 0.001) were significant. Conclusions OCT may be a valuable tool for the assessment and monitoring of anterior optic pathway dysfunction in children with demyelinating diseases.

scholarly journals An overview of idiopathic optic neuritis in eastern Nepal

1970 ◽  
Vol 2 (1) ◽  
pp. 10-15
Author(s):  
H Das ◽  
Maria Gautam ◽  
P Lavaju
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuritis ◽  
Clinical Features ◽  
Steroid Therapy ◽  
Pulse Methylprednisolone ◽  
Pulse Steroid Therapy ◽  
Initial Visual Acuity ◽  
Pulse Methylprednisolone Therapy ◽  
Pulse Steroid

Background: Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology. Objective: To report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in eastern Nepal. Materials and methods: The hospital data of patients with idiopathic optic neuritis admitted to the department of ophthalmology in a tertiary level center in eastern Nepal between Jan 2000 to Dec 2006 were retrospectively analyzed. The parameters studied were demographic pattern, clinical features, visual acuity and field defects. Results: Thirty-six patients (52 eyes) were found to have optic neuritis (papillits in 36 and retrobulbar optic neuritis in16 eyes). The male to female ratio was1.25:1. The mean age of the patients was 33.56±17.88 years (95 % CI=24.66 - 42.45). The most common modes of presentation were loss of visual acuity and color vision defect. One patient had features suggestive of multiple sclerosis. Vision improved in 42 eyes at discharge from the hospital. Response to pulse methylprednisolone therapy was good in most (42 eyes) of the cases except for the patients having initial visual acuity of no light perception. Conclusion: Response to pulse methylprednisolone therapy is good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world. Some similarity was observed between studies reported from the oriental countries. Keywords: optic neuritis; demographic pattern; pulse steroid therapy. DOI: 10.3126/nepjoph.v2i1.3698 Nep J Oph 2010;2(1):10-15

scholarly journals A new “ASAP Scoring System and Risk Table” in patients with Atypical Small Acinar Proliferation (ASAP) to predict the second prostate biopsy outcomes

2021 ◽  
Author(s):  
Caner Ediz ◽  
Serkan Akan ◽  
Neslihan Kaya Terzi ◽  
Aysenur Ihvan
Keyword(s):  
Prostate Biopsy ◽  
Roc Curve ◽  
Scoring System ◽  
Risk Group ◽  
Area Under The Curve ◽  
Threshold Value ◽  
Roc Curve Analysis ◽  
Atypical Small Acinar Proliferation ◽  
The Mean ◽  
Density Assessment

Background: To discuss the necessity of the second prostate biopsy in the patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table as a new re-biopsy criteria. Methods: 2845 patients who were performed transrectal ultrasonography-guided prostate biopsy between January 2008 and May 2019 were evaluated. 128 patients, whose data were reached, were enrolled into the study. Before the first and the second biopsy, tPSA, fPSA, f/tPSA rate and PSA-Density assessment and changes in these parameters between the two biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy. Results: The mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of the patients with PCa were statistically significantly higher than the patients with non-PCa (p: 0.001). In the ROC curve analysis of ASS-RT, area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT score in diagnosis of malignancy was ≥ 7. The sensitivity of this value was found to be 60.8% and its specificity as 80.5%. Conclusions: The threshold value for the ASS-RT score may be used as 7 and the second biopsy may be performed immediately to patients over this value. We think that there may be no need for a second biopsy if the ASS-RT score under the 7 (especially low-risk group) before the second biopsy.

scholarly journals SAT-086 Pituitary Volume as a Diagnostic Measure for Determining the Etiology of Short Stature in Children: Receiver Operating Characteristic Curve Analysis and Cutoff Values

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Liam McGuirk ◽  
Tara P Patale ◽  
Nicholas Andrew Krasnow ◽  
Alice Alexandrov ◽  
James Haigney ◽  
...  
Keyword(s):  
Short Stature ◽  
Standard Error ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Youden Index ◽  
Pediatric Endocrinology ◽  
Roc Curve Analysis ◽  
Gh Secretion ◽  
Cutoff Values

Abstract Background: It is speculated that pituitary volume (PV) is a marker of chronic growth hormone (GH) secretion. In previous studies, we determined that children with GH deficiency (GHD) and idiopathic short stature (ISS) had significantly smaller PVs than normal controls (NCs). Cutoff values for small PVs are needed to improve the clinical utility of PV in determining children who qualify for GH therapy. Objective: To define the cutoff between pathologic and nonpathologic PV in prepubertal and pubertal children with short stature (SS). Patients and Methods: The SS group was selected from the database of a pediatric endocrinology center, which was queried for siblings (SBs) aged 6–18 yrs who underwent a GH stimulation test and MRI between 2013–2019. All 77 SBs had SS, defined as 2 SDs below mean height for age, subnormal growth velocity for at least 6 months, or predicted height at least 2 inches discrepant from midparental height. The NC group was selected from the database of a neuroradiology center; these NCs consisted of 170 randomly selected subjects aged 6–18 yrs. Patients with MRI abnormalities were excluded. PVs were calculated using the ellipsoid formula (LxWxH/2). ROC curve analysis was utilized to generate cutoff values. The diagnosis of short stature was the dependent variable and PV was the independent variable. The PV with the highest Youden index was selected as the definitive cutoff for a small PV. Results: The mean (MN) and median (MD) age of SBs was 11.6 ±2.2 and 11.9 yrs, respectively, and the MN and MD age of the NCs was 12.6 ±3.4 and 13.2 yrs, respectively. The MN and MD age of prepubertal SBs (n=29) and NCs (n=58) were 9.3 ±1.2 and 9.7, and 8.6 ±1.4 and 8.6 yrs, respectively. The MN and MD age of pubertal SBs (n=48) and NCs (n=112) were 13.0 ±1.4 and 12.7, and 14.7 ±1.9 and 14.6 yrs, respectively. The difference in MN age between SBs and NCs was significant (p&lt;0.05). For prepubertal subjects, sensitivity was 86.21% and specificity was 68.97%. The distance to corner was 0.3396, and the highest Youden index was 0.5517, corresponding to a PV of 215.02 mm3. The Area Under the Curve (AUC) was 0.8395 with a standard error of 0.0426 (p&lt;0.001). For pubertal subjects, sensitivity was 81.25% and specificity was 79.46%. The distance to corner was 0.2781, and the highest Youden index was 0.6071, corresponding to a PV of 315.0 mm3. The AUC was 0.8460 with a standard error of 0.0337 (p&lt;0.001). Conclusion: To our knowledge, we present the first study on the sensitivity and specificity of PV in determining the etiology of SS. Our data suggest that prepubertal patients with a PV&lt;215.02 mm3 and pubertal patients with a PV&lt;315.00 mm3 have small pituitary glands. Statistically calculated cutoffs are necessary to accurately diagnose pituitary hypoplasia and should be utilized to determine the etiology of SS. Future studies should include children with Tanner staging and height SDs to generate more accurate PV cutoffs.

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