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Pan R, Ye C, Zhang Z, Kwapong WR, Wang R, Lu K, Liao L, Yan Y, Yang T, Cao L, Jiang S, Zhang X, Liu J, Tao W, Wu B. Distinct alterations of retinal structure between thalamic and extra-thalamic subcortical infarction patients: A cross-sectional and longitudinal study. CNS Neurosci Ther 2024; 30:e14543. [PMID: 38018655 PMCID: PMC11017429 DOI: 10.1111/cns.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS Cerebrovascular lesions in the primary visual cortex, the lateral geniculate nucleus, and the optic tract have been associated with retinal neurodegeneration via the retrograde degeneration (RD) mechanism. We aimed to use optical coherence tomography (OCT) to assess the effects of the strategic single subcortical infarction (SSI) location on retinal neurodegeneration and its longitudinal impacts. METHODS Patients with SSI were enrolled and stratified by lesion location on cerebral MRI into the thalamic infarction group and extra-thalamic infarction group. Healthy controls from the native communities were also recruited. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) were quantified using OCT. Generalized estimating equation (GEE) models were used for cross-sectional analyses and linear mixed models for longitudinal analyses. P < 0.05 was considered statistically significant. RESULTS We included a total of 283 eyes from 149 SSI patients. Of these, 115 eyes of 60 patients with follow-up were included in the longitudinal analyses. Cross-sectionally, thalamic-infarction patients had reduced retinal thickness compared with extra-thalamic infarction patients after adjustment for age, gender, disease duration, and vascular risk factors (p = 0.026 for RNFL, and p = 0.026 for GCIPL). Longitudinally, SSI patients showed greater retinal thinning compared with healthy controls over time (p = 0.040 for RNFL, and p < 0.001 for GCIPL), and thalamic infarction patients exhibited faster rates of GCIPL thinning in comparison with extra-thalamic infarction patients (p < 0.001). CONCLUSION Our study demonstrates a distinct effect of subcortical infarction lesion site on the retina both at the early stage of disease and at the 1-year follow-up time. These results present evidence of significant associations between strategic infarction locations and retinal neurodegeneration. It may provide novel insights for further research on RD in stroke patients and ultimately facilitate individualized recovery therapeutic strategy.
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Affiliation(s)
- Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Zhimeng Zhang
- West China School of MedicineSichuan UniversityChengduChina
| | | | - Ruilin Wang
- Department of OphthalmologyWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yuying Yan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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Cheng W, Liu J, Jiang T, Li M. The application of functional imaging in visual field defects: a brief review. Front Neurol 2024; 15:1333021. [PMID: 38410197 PMCID: PMC10895022 DOI: 10.3389/fneur.2024.1333021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/31/2024] [Indexed: 02/28/2024] Open
Abstract
Visual field defects (VFDs) represent a prevalent complication stemming from neurological and ophthalmic conditions. A range of factors, including tumors, brain surgery, glaucoma, and other disorders, can induce varying degrees of VFDs, significantly impacting patients' quality of life. Over recent decades, functional imaging has emerged as a pivotal field, employing imaging technology to illustrate functional changes within tissues and organs. As functional imaging continues to advance, its integration into various clinical aspects of VFDs has substantially enhanced the diagnostic, therapeutic, and management capabilities of healthcare professionals. Notably, prominent imaging techniques such as DTI, OCT, and MRI have garnered widespread adoption, yet they possess unique applications and considerations. This comprehensive review aims to meticulously examine the application and evolution of functional imaging in the context of VFDs. Our objective is to furnish neurologists and ophthalmologists with a systematic and comprehensive comprehension of this critical subject matter.
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Affiliation(s)
- Wangxinjun Cheng
- Department of Rehabilitation, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Queen Mary College, Nanchang University, Nanchang, China
| | - Jingshuang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Queen Mary College, Nanchang University, Nanchang, China
| | - Tianqi Jiang
- The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Moyi Li
- Department of Rehabilitation, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Lian Y, Cheng X, Chen Q, Huang L, Xie L, Wang W, Ni J, Chen X. Case report: Beneficial effects of visual cortex tDCS stimulation combined with visual training in patients with visual field defects. Front Neurol 2024; 15:1344348. [PMID: 38327623 PMCID: PMC10847570 DOI: 10.3389/fneur.2024.1344348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Background Visual field defect (VFD) refers to the phenomenon that the eye is unable to see a certain area within the normal range of vision, which may be caused by eye diseases, neurological diseases and other reasons. Transcranial direct current stimulation (tDCS) is expected to be an effective treatment for the recovery or partial recovery of VFD. This paper describes the potential for tDCS in combination with visual retraining strategies to have a positive impact on vision recovery, and the potential for neuroplasticity to play a key role in vision recovery. Methods This case report includes two patients. Patient 1 was diagnosed with a right occipital hemorrhage and homonymous hemianopia. Patient 2 had multiple facial fractures, a contusion of the right eye, and damage to the optic nerve of the right eye, which was diagnosed as a peripheral nerve injury (optic nerve injury). We administered a series of treatments to two patients, including transcranial direct current stimulation; visual field restoration rehabilitation: paracentric gaze training, upper and lower visual field training, VR rehabilitation, and perceptual training. One time per day, 5 days per week, total 6 weeks. Results After 6 weeks of visual rehabilitation and tDCS treatment, Patient 1 Humphrey visual field examination showed a significant improvement compared to the initial visit, with a reduction in the extent of visual field defects, increased visual acuity, and improvement in most visual functions. Patient 2 had an expanded visual field, improved visual sensitivity, and substantial improvement in visual function. Conclusion Our case reports support the feasibility and effectiveness of tDCS combined with visual rehabilitation training in the treatment of occipital stroke and optic nerve injury settings.
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Affiliation(s)
- Yanhua Lian
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation, Fuzhou Second Hospital, Fuzhou, China
| | - Xiaoping Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qunlin Chen
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Libin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lili Xie
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenzong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xinyuan Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Ye C, Kwapong WR, Tang B, Liu J, Tao W, Lu K, Pan R, Wang A, Liao L, Yang T, Cao L, Wang Y, Jiang S, Zhang X, Liu M, Wu B. Association between functional network connectivity, retina structure and microvasculature, and visual performance in patients after thalamic stroke: An exploratory multi-modality study. Brain Behav 2024; 14:e3385. [PMID: 38376035 PMCID: PMC10794127 DOI: 10.1002/brb3.3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Neuro-ophthalmologic symptoms and retinal changes have been increasingly observed following thalamic stroke, and there is mounting evidence indicating distinct alterations occurring in the vision-related functional network. However, the intrinsic correlations between these changes are not yet fully understood. Our objective was to explore the altered patterns of functional network connectivity and retina parameters, and their correlations with visual performance in patients with thalamic stroke. METHODS We utilized resting-state functional MRI to obtain multi-modular functional connectivity (FC), and optical coherence tomography-angiography to measure various retina parameters, such as the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), superficial vascular complex (SVC), and deep vascular complex. Visual acuity (VA) was used as a metric for visual performance. RESULTS We included 46 patients with first-ever unilateral thalamic stroke (mean age 59.74 ± 10.02 years, 33 males). Significant associations were found between FC of attention-to-default mode and SVC, RNFL, and GCIPL, as well as between FC of attention-to-visual and RNFL (p < .05). Both RNFL and GCIPL exhibited significant associations with FC of visual-to-visual (p < .05). Only GCIPL showed an association with VA (p = .038). Stratified analysis based on a disease duration of 6 months revealed distinct and significant linking patterns in multi-modular FC and specific retina parameters, with varying correlations with VA in each subgroup. CONCLUSION These findings provide valuable insight into the neural basis of the associations between brain network dysfunction and impaired visual performance in patients with thalamic stroke. Our novel findings have the potential to inform future targeted and individualized therapies. However, further comprehensive studies are necessary to validate our results.
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Affiliation(s)
- Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - William Robert Kwapong
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Biqiu Tang
- Department of Radiology, Huaxi MR Research Center (HMRRC)West China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Anmo Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Youjie Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ming Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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Ciociola EC, Patel K, Blahnik T, Ghosh A, Klifto MR, Fleischman D. A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease. J Curr Glaucoma Pract 2023; 17:126-133. [PMID: 37920375 PMCID: PMC10618602 DOI: 10.5005/jp-journals-10078-1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/02/2023] [Indexed: 11/04/2023] Open
Abstract
Aim To investigate the limitations of diagnosing glaucoma in patients with coexistent neurodegenerative disease (NDD) by collecting information on demographics, examination findings, optical coherence tomography (OCT), and visual field (VF) tests. Materials and methods Retrospective cohort study of patients with primary open-angle glaucoma and coexistent dementia, multiple sclerosis (MS), Parkinson's disease (PD), or cerebrovascular accident (CVA) from 2014 to 2020. We included patients with a minimum of 3 years of follow-up. Demographics, ophthalmic exam, OCT, and VF findings were reported and compared across NDD groups using the Chi-squared and analysis of variance tests. Results We included 199 patients with glaucoma and coexistent NDD, including dementia (51.3%), CVA (11.2%), PD (18.1%), and MS (19.6%). Cupping, neuroretinal rim thinning, pallor, and peripapillary atrophy of the optic nerve were most frequently observed. There was a high number of missing values from OCT to VF tests, and zero patients had a complete OCT or VF test. Additionally, 67.8 and 77.4% of patients received <1 OCT and VF/year, respectively. Retinal nerve fiber layer (RNFL) thinning was observed most frequently in the superior (33.2% OD and 30.7% OS) and inferior (25.6% OD and 30.2% OS) quadrants, with the most significant thinning seen in CVA patients compared to other NDDs (p < 0.05). Glaucoma hemifield tests (GHTs) were abnormal in 23.1% OD and 22.6% OS, and the average mean deviation was -7.43 [standard deviation (SD) 8.23] OD and -8.79 (SD 7.99) OS. Conclusion The OCT and VF tests are frequently unavailable and may be confounded in patients with coexistent glaucoma and NDDs, complicating glaucoma diagnosis and management. Clinical significance Diagnosing and managing glaucoma in patients with coexistent NDD is difficult, given the lack of available and reliable OCT and VF testing data. Providers may be forced to rely on intraocular pressure (IOP) and other imperfect measures. How to cite this article Ciociola EC, Patel K, Blahnik T, et al. A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease. J Curr Glaucoma Pract 2023;17(3):126-133.
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Affiliation(s)
- Elizabeth C Ciociola
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Kush Patel
- Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Tyler Blahnik
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Arko Ghosh
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Meredith R Klifto
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - David Fleischman
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
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Badian RA. Schematic sectioning approaches for corneal and retinal surfaces used in ophthalmology and vision-related clinical practice and research. Exp Eye Res 2023; 230:109442. [PMID: 36940902 DOI: 10.1016/j.exer.2023.109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023]
Abstract
Schematically, the corneal surface area and other similar surfaces such as the retinal surface and the visual field area have been represented by a circle. While there are different types of schematic sectioning patterns in use, not all patterns are recognized or referred to with their respective appropriate terminology. In scientific communications, as well as in clinical practice, when dealing with corneal or retinal surfaces, it is imperative to have the ability to refer to specific areas with an as high degree of accuracy as possible. The necessity arises in many situations, either when performing tests such as corneal surface staining, corneal sensitivity test, scanning the corneal surface, reporting of the findings related to any specific corneal surface area, or using a sectioning pattern for parts of the retinal surface when locating retinal lesions, or when referring to loci with changes in the visual field. Applying the appropriate geometric terms when any pattern is used for sectioning of surfaces such as cornea or retina, for precise localization and description of the findings or changes with a high degree of accuracy using the correct terminology is a sine qua non. Hence, the idea for this work is to gain an overview of the sectioning methods that are available and in use as methodological guidance in different sectioning patterns related to the corneal, retinal, and visual field.
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Affiliation(s)
- Reza A Badian
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
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Rashid AS, Rashid D, Yang G, Link H, Gauffin H, Huang-Link Y. Homonymous visual field defect and retinal thinning after occipital stroke. Brain Behav 2021; 11:e2345. [PMID: 34487632 PMCID: PMC8553301 DOI: 10.1002/brb3.2345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/11/2021] [Accepted: 08/18/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Stroke is the most common cause of homonymous visual field defects (VFD). About half of the stroke patients recover from VFD. However, relationship between VFD and retinal changes remains elusive. PURPOSE To investigate the association between occurrence of VFD, changes of macular ganglion cell and inner plexiform layer (GCIPL) and its axon retinal nerve fiber layer (RNFL) detected with optical coherence tomography (OCT). PATIENTS AND METHODS The study consists of retrospective review of medical records and follow-up examinations. Patients with acute occipital stroke were registered. VFD was identified with confrontation and/or perimetry tests at the onset. At follow-up, the patients were examined with visual field tests and OCT measurements. RESULTS Thirty-six patients met the inclusion criteria. At onset, 26 patients (72%) had VFD. At follow-up >1 year after stroke, 13 patients (36%) had remaining VFD: 5 had homonymous hemianopia, 5 had homonymous quadrantanopia, and 3 had homonymous scotomas. Average thickness of GCIPL and RNFL were significantly reduced in each eye in patients with VFD compared to non-VFD (NVFD) (p < .01 for all comparisons). Thickness of superior and inferior RNFL quadrants was significantly reduced in VFD compared to NVFD (p < .01 for both). Among these 13 patients, 4 had characteristic homonymous quadrant-GCIPL thinning, 2 had characteristic homonymous hemi-GCIPL thinning, and 7 had diffuse GCIPL thinning. CONCLUSION GCIPL and RNFL thinning were observed in the patients with VFD. GCIPL thinning appears in two forms: atypical diffuse thinning, or homonymous hemi-GCIPL thinning. Examining GCIPL and RNFL provides easy and reliable objective measures and is therefore proposed to be of predictive value on visual function.
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Affiliation(s)
- Avan Sabir Rashid
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
| | - Darian Rashid
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
| | - Ge Yang
- Institute of Ophthalmology, University College London, London, UK
| | - Hans Link
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Helena Gauffin
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
| | - Yumin Huang-Link
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
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