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Workup for Optic Atrophy

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Neuro-Ophthalmology

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Abstract

Optic nerve atrophy is a common neuro-ophthalmic problem. It represents the end result of either ascending degeneration after destruction of ganglion cells in the retina, or descending atrophy following destruction of nerve fibers in the optic nerve, chiasm, optic tract and sometimes the retrogeniculate visual pathways. It usually presents with optic nerve pallor that is typically (but not invariably) associated with decreased visual function. The key task in the evaluation is to determine whether there is an on-going process causing destruction of ganglion cells, as determining the cause may allow halting progression of vision loss, and sometimes even visual recovery. This chapter discusses how a careful neuro-ophthalmic history and exam can often establish an etiology or at least substantially narrow the differential diagnosis and guide further workup. OCT analysis can often clarify the clinical picture, and in addition may allow quantitative analysis over time. Of all diagnostic studies, neuroimaging (typically MRI with contrast) has by far the highest yield. Further testing should be performed in a directed fashion.

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Authors and Affiliations

  1. Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA

    Bart Chwalisz & Dean M. Cestari

  2. Center for Thyroid Eye Disease and Orbital Surgery, Massachusetts Eye and Ear, Boston, MA, USA

    Dean M. Cestari

  3. Unité de Neuro-ophtalmologie, Hôpital Ophtalmique Jules-Gonin, Université de Lausanne, Lausanne, Switzerland

    François-Xavier Borruat

Authors
  1. Bart Chwalisz
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  2. Dean M. Cestari
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  3. François-Xavier Borruat
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Correspondence to Dean M. Cestari .

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Editors and Affiliations

  1. Weill Cornell Medicine, Blanton Eye Institute Houston Methodist Hospital, Houston, TX, USA

    Andrew G. Lee

  2. Metabolic Neurology, Institute of Metabolism and Systems Research College of Medical & Dental Sciences University of Birmingham, Birmingham, UK

    Alexandra J. Sinclair

  3. Houston Methodist Hospital, Blanton Eye Institute, Houston, TX, USA

    Ama Sadaka

  4. Houston Methodist Hospital, Blanton Eye Institute, Houston, TX, USA

    Shauna Berry

  5. Birmingham Neuro-Ophthalmology, University Hospital Birmingham, Birmingham, UK

    Susan P. Mollan

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Chwalisz, B., Cestari, D.M., Borruat, FX. (2019). Workup for Optic Atrophy. In: Lee, A., Sinclair, A., Sadaka, A., Berry, S., Mollan, S. (eds) Neuro-Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-98455-1_13

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  • DOI: https://doi.org/10.1007/978-3-319-98455-1_13

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