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Srisombut T, Ittipanichpong P, Arjkongharn N, Tangon D, Kreesang R, Kemchoknatee P. Factors predictive of poor visual outcome in indirect traumatic optic neuropathy: A retrospective cohort study. Injury 2024; 55:111238. [PMID: 38091645 DOI: 10.1016/j.injury.2023.111238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION The gold standard treatment for indirect traumatic optic neuropathy (ITON) has not yet been conclusively established, and it is essential to gain an understanding of visual prognosis and to counsel patients regarding the predictive risk factors of poor visual outcomes. Currently, there is limited information regarding ITON in Thai populations; therefore, this study aimed to determine the risk factors of poor visual outcome in patients with this condition. METHODS A retrospective review was conducted of all ITON cases diagnosed at Rajavithi Hospital and Sawanpracharak Hospital between January 2016 and December 2022 in order to determine clinical characteristics and evaluate associated risk factors of poor visual prognosis using binary logistic regression analysis. RESULTS The mean age of this cohort of 101 patients was 36.17 years, with a male predominance of 73.3 %. Motor vehicle accidents were the most common cause of ITON, with a statistically significant 79.2 % of cases. The patients were categorized into an "improved group" of 29 patients and an "unimproved group" of 72. The unimproved group had a significantly older mean age and poorer initial visual acuity of 20/200 (p-values 0.001 and p < 0.001 respectively). There was no significant difference between Computed Tomography (CT) findings in the two groups. The improved group had significantly better visual acuity (VA) at 1-month and final follow-up visit than the unimproved group (both p < 0.001). Differences between gender, Glasgow coma score, associated underlying diseases, and duration from trauma to intravenous glucocorticoids therapy in the two groups were not statistically significant. Multivariable logistic regression analysis identified patient age of 40 years or more (Odds ratio (OR) 3.447, 95 % CI, 1.085-10.955, p = 0.036) and poor baseline VA (OR 6.628, 95 % Confidence Interval (CI), 2.308-19.036, p < 0.001) as significant risk factors for poor visual outcome in ITON patients. CONCLUSIONS No clear benefit was found of intravenous glucocorticoids in treatment of ITON. Patients aged 40 years or more and/or with poor baseline visual status should be advised that they are at increased risk of poor final visual outcomes.
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Affiliation(s)
- Thansit Srisombut
- Department of Surgery, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand
| | - Paradee Ittipanichpong
- Department of Ophthalmology, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand
| | - Niracha Arjkongharn
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, 10400, Thailand
| | - Duanghathai Tangon
- Faculty of Medicine, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Rinrada Kreesang
- Department of Surgery, Sawanpracharak Hospital, 3 Attakavee, Pak Nam Pho, Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand
| | - Parinee Kemchoknatee
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2, Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, 10400, Thailand.
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Trask WM, Mak MYK, Gohill J, Kherani A, Subramaniam S. Acute Neuroimaging Findings in Traumatic Optic Neuropathy. Can J Neurol Sci 2023; 50:937-938. [PMID: 36329656 DOI: 10.1017/cjn.2022.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- William M Trask
- Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Y K Mak
- Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Jitendra Gohill
- Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Amin Kherani
- Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Suresh Subramaniam
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Maher MD, Agarwal M, Tamhankar MA, Mohan S. Traumatic Brain Injury and Vision. Neuroimaging Clin N Am 2023; 33:325-333. [PMID: 36965949 DOI: 10.1016/j.nic.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Traumatic brain injury disrupts the complex anatomy of the afferent and efferent visual pathways. Injury to the afferent pathway can result in vision loss, visual field deficits, and photophobia. Injury to the efferent pathway primarily causes eye movement abnormalities resulting in ocular misalignment and double vision. Injury to both the afferent and efferent systems can result in significant visual disability.
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Affiliation(s)
- Mary D Maher
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mohit Agarwal
- Division of Neuroradiology, Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Madhura A Tamhankar
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Siyanaki MRH, Azab MA, Lucke-Wold B. Traumatic Optic Neuropathy: Update on Management. Encyclopedia (Basel, 2021) 2023; 3:88-101. [PMID: 36718432 PMCID: PMC9884099 DOI: 10.3390/encyclopedia3010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Traumatic optic neuropathy is one of the causes of visual loss caused by blunt or penetrating head trauma and is classified as both direct and indirect. Clinical history and examination findings usually allow for the diagnosis of traumatic optic neuropathy. There is still controversy surrounding the management of traumatic optic neuropathy; some physicians advocate observation alone, while others recommend steroid therapy, surgery, or both. In this entry, we tried to highlight traumatic optic neuropathy's main pathophysiologic mechanisms with the most available updated treatment. Recent research suggests future therapies that may be helpful in traumatic optic neuropathy cases.
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Affiliation(s)
| | - Mohammed A. Azab
- Department of Neurosurgery, University of Cairo University, Cairo 12613, Egypt
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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Sujanthan S, Shmuel A, Mendola JD. Visually driven functional MRI techniques for characterization of optic neuropathy. Front Hum Neurosci 2022; 16:943603. [PMID: 36158617 PMCID: PMC9500431 DOI: 10.3389/fnhum.2022.943603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Optic neuropathies are conditions that cause disease to the optic nerve, and can result in loss of visual acuity and/or visual field defects. An improved understanding of how these conditions affect the entire visual system is warranted, to better predict and/or restore the visual loss. In this article, we review visually-driven functional magnetic resonance imaging (fMRI) studies of optic neuropathies, including glaucoma and optic neuritis (ON); we also discuss traumatic optic neuropathy (TON). Optic neuropathy-related vision loss results in fMRI deficit within the visual cortex, and is often strongly correlated with clinical severity measures. Using predominantly flickering checkerboard stimuli, glaucoma studies indicated retinotopic-specific cortical alteration with more prominent deficits in advanced than in early glaucoma. Some glaucoma studies indicate a reorganized visual cortex. ON studies have indicated that the impacted cortical areas are briefly hyperactive. For ON, brain deficits are greater in the acute stages of the disease, followed by (near) normalization of responses of the LGN, visual cortex, and the dorsal visual stream, but not the ventral extrastriate cortex. Visually-driven fMRI is sensitive, at least in ON, in discriminating patients from controls, as well as the affected eye from the fellow eye within patients. The use of a greater variety of stimuli beyond checkerboards (e.g., visual motion and object recognition) in recent ON studies is encouraging, and needs to continue to disentangle the results in terms of change over time. Finally, visually-driven fMRI has not yet been applied in TON, although preliminary efforts suggest it may be feasible. Future fMRI studies of optic neuropathies should consider using more complex visual stimuli, and inter-regional analysis methods including functional connectivity. We suggest that a more systematic longitudinal comparison of optic neuropathies with advanced fMRI would provide improved diagnostic and prognostic information.
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Affiliation(s)
- Sujeevini Sujanthan
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada
- *Correspondence: Sujeevini Sujanthan
| | - Amir Shmuel
- Departments of Neurology, Neurosurgery, Physiology and Biomedical Engineering, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Janine Dale Mendola
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada
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Ma H, Gao Y, Li JM, Bao YK, Nie C, Yin P, Lyu X, Ding XY, Lu R. Analysis of retinal vasculature changes in indirect traumatic optic neuropathy using optic coherence tomography angiography. Int J Ophthalmol 2022; 15:1344-1351. [PMID: 36017033 DOI: 10.18240/ijo.2022.08.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the retinal vasculature alterations in indirect traumatic optic neuropathy (ITON) patients following craniofacial trauma by optic coherence tomography angiography (OCTA). METHODS Patients diagnosed of monocular ITON were recruited from August 2016 to May 2020. OCTA was performed using the AngioVue OCT-A system for two cube scans centered at the optic nerve head and fovea. OCTA data included thicknesses of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), as well as proportion of capillary perfusion and data were analyzed for correlation with post-injury timepoints: within 7, 8-30, 31-90, and 91-365d. RESULTS A total of 73 ITON patients were studied. Significant thinning of RNFL and GCC layers and attenuation of microvascular perfusion were observed in ITON eyes as compared to contralateral unaffected eyes (for most of the analyzed sectors and quadrants, P<0.05). Without respect to surgical intervention and vision recovery, the decrease in retinal layer thicknesses and microvascular perfusion was time-dependent, and most significant within three months (P<0.001). CONCLUSION ITON presents with time-dependent thinning of retinal layers and attenuation of microvasculature, indicating possible degeneration of retinal ganglion cells due to reduced retinal blood supply.
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Affiliation(s)
- Huan Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yang Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Jin-Miao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yue-Kun Bao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Cong Nie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Pan Yin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xi Lyu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Yan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Rong Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Hong EH, Yang JJ, Yeon Y, Cho HS, Lee JY, Lee WJ, Kim YJ, Moon Y, Lim HW. Quantitative evaluation of intraorbital optic nerve in optic atrophy using diffusion tensor imaging. Sci Rep 2022; 12:12103. [PMID: 35840614 DOI: 10.1038/s41598-022-16267-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to quantitatively investigate the microstructural properties of the optic nerve (ON) in vivo using diffusion tensor imaging (DTI) in patients with unilateral optic atrophy (OA) and to determine their association with retinal nerve fiber layer (RNFL) thickness of the optic nerve head (ONH). Six patients with unilateral OA and 11 control subjects underwent DTI. ONs from ONH to the orbital apex were tracked. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were computed in both ONs and their correlation with RNFL thickness measured using optical coherence tomography was also analyzed. FA of atrophic ON was lower than that of non-affected and control ONs (atrophic [A], 0.136 ± 0.059; non-affected [N], 0.384 ± 0.048; control [C], 0.389 ± 0.053). MD and RD of atrophic ONs were higher than those of non-affected and control ONs (MD, A, 0.988 ± 0.247; N, 0.658 ± 0.058; C, 0.687 ± 0.079; RD, A, 0.920 ± 0.247; N, 0.510 ± 0.054; C, 0.532 ± 0.078). All DTI measures of atrophic ON except for AD showed a significant correlation with RNFL thickness of ONH; FA showed the strongest correlation, followed by RD and MD (FA, R2 = 0.936, P < 0.001; RD, R2 = 0.795, P < 0.001; MD, R2 = 0.655, P = 0.001). This study reports quantitative analysis of the ON using DTI and differences in DTI measures between atrophic and normal ONs. The significant correlation between DTI measures and RNFL thickness suggests the applicability of DTI as a clinical tool to evaluate the ON.
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Sims JR, Chen AM, Sun Z, Deng W, Colwell NA, Colbert MK, Zhu J, Sainulabdeen A, Faiq MA, Bang JW, Chan KC. Role of Structural, Metabolic, and Functional MRI in Monitoring Visual System Impairment and Recovery. J Magn Reson Imaging 2021; 54:1706-1729. [PMID: 33009710 PMCID: PMC8099039 DOI: 10.1002/jmri.27367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022] Open
Abstract
The visual system, consisting of the eyes and the visual pathways of the brain, receives and interprets light from the environment so that we can perceive the world around us. A wide variety of disorders can affect human vision, ranging from ocular to neurologic to systemic in nature. While other noninvasive imaging techniques such as optical coherence tomography and ultrasound can image particular sections of the visual system, magnetic resonance imaging (MRI) offers high resolution without depth limitations. MRI also gives superior soft-tissue contrast throughout the entire pathway compared to computed tomography. By leveraging different imaging sequences, MRI is uniquely capable of unveiling the intricate processes of ocular anatomy, tissue physiology, and neurological function in the human visual system from the microscopic to macroscopic levels. In this review we discuss how structural, metabolic, and functional MRI can be used in the clinical assessment of normal and pathologic states in the anatomic structures of the visual system, including the eyes, optic nerves, optic chiasm, optic tracts, visual brain nuclei, optic radiations, and visual cortical areas. We detail a selection of recent clinical applications of MRI at each position along the visual pathways, including the evaluation of pathology, plasticity, and the potential for restoration, as well as its limitations and key areas of ongoing exploration. Our discussion of the current and future developments in MR ocular and neuroimaging highlights its potential impact on our ability to understand visual function in new detail and to improve our protection and treatment of anatomic structures that are integral to this fundamental sensory system. LEVEL OF EVIDENCE 3: TECHNICAL EFFICACY STAGE 3: .
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Affiliation(s)
- Jeffrey R. Sims
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Anna M. Chen
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Zhe Sun
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Wenyu Deng
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Nicole A. Colwell
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Max K. Colbert
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Jingyuan Zhu
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Anoop Sainulabdeen
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Thrissur, India
| | - Muneeb A. Faiq
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Ji Won Bang
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Kevin C. Chan
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Center for Neural Science, College of Arts and Science, New York University, New York, New York, USA
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Karimi S, Arabi A, Ansari I, Shahraki T, Safi S. A Systematic Literature Review on Traumatic Optic Neuropathy. J Ophthalmol 2021; 2021:5553885. [PMID: 33728056 DOI: 10.1155/2021/5553885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
Traumatic optic neuropathy (TON) is an uncommon vision-threatening disorder that can be caused by ocular or head trauma and is categorized into direct and indirect TON. The overall incidence of TON is 0.7–2.5%, and indirect TON has a higher prevalence than direct TON. Detection of an afferent pupillary defect in the presence of an intact globe in a patient with ocular or head trauma with decreased visual acuity strongly suggests TON. However, afferent pupillary defects may be difficult to detect in patients who have received narcotics that cause pupillary constriction and in those with bilateral TON. Mechanical shearing of the optic nerve axons and contusion necrosis due to immediate ischemia from damage to the optic nerve microcirculation and apoptosis of neurons is a probable mechanism. The proper management of TON is controversial. High-dose corticosteroid therapy and decompression of the optic nerve provide no additional benefit over observation alone. Intravenous erythropoietin may be a safe and efficient treatment for patients with TON.
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Li Y, Singman E, McCulley T, Wu C, Daphalapurkar N. The Biomechanics of Indirect Traumatic Optic Neuropathy Using a Computational Head Model With a Biofidelic Orbit. Front Neurol 2020; 11:346. [PMID: 32411088 PMCID: PMC7198902 DOI: 10.3389/fneur.2020.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Indirect traumatic optic neuropathy (ITON) is an injury to the optic nerve due to head trauma and usually results in partial or complete loss of vision. In order to advance a mechanistic understanding of the injury to the optic nerve, we developed a head model with a biofidelic orbit. Head impacts were simulated under controlled conditions of impactor velocity. The locations of impact were varied to include frontal, lateral, and posterior parts of the head. Impact studies were conducted using two types of impactors that differed in their rigidity relative to the skull. The simulated results from both the impactors suggest that forehead impacts are those to which the optic nerve is most vulnerable. The mode and location of optic nerve injury is significantly different between the impacting conditions. Simulated results using a relatively rigid impactor (metal cylinder) suggest optic nerve injury initiates at the location of the intracranial end of the optic canal and spreads to the regions of the optic nerve in the vicinity of the optic canal. In this case, the deformation of the skull at the optic canal, resulting in deformation of the optic nerve, was the primary mode of injury. On the other hand, simulated results using a relatively compliant impactor (soccer ball) suggest that primary mode of injury comes from the brain tugging upon the optic nerve (from where it is affixed to the intracranial end of the optic canal) during coup countercoup motion of the brain. This study represents the first published effort to employ a biofidelic simulation of the full length of the optic nerve in which the orbit is integrated within the whole head.
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Affiliation(s)
- Yang Li
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China.,Hopkins Extreme Materials Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Eric Singman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Timothy McCulley
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Chengwei Wu
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Nitin Daphalapurkar
- Hopkins Extreme Materials Institute, Johns Hopkins University, Baltimore, MD, United States.,Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
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Tow SL, Subramanian PS. Traumatic Optic Neuropathy. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lee H, Lee YH, Suh SI, Jeong EK, Baek S, Seo HS. Characterizing Intraorbital Optic Nerve Changes on Diffusion Tensor Imaging in Thyroid Eye Disease Before Dysthyroid Optic Neuropathy. J Comput Assist Tomogr 2018; 42:293-8. [PMID: 28937496 DOI: 10.1097/RCT.0000000000000680] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the optic nerve is affected by thyroid eye disease (TED) before the development of dysthyroid optic neuropathy with diffusion-tensor imaging (DTI). METHODS Twenty TED patients and 20 controls were included. The mean, axial, and radial diffusivities and fractional anisotropy (FA) value were measured at the optic nerves in DTI. Extraocular muscle diameters were measured on computed tomography. The diffusivities and FA of the optic nerves were compared between TED and controls and between active and inactive stages of TED. The correlations between these DTI parameters and the clinical features were determined. RESULTS The mean, axial, and radial diffusivities were lower in TED compared with the controls (P < 0.05). In contrast, FA was higher in TED (P = 0.001). Radial diffusivity was lower in the active stage of TED than the inactive stage (P = 0.035). The FA was higher in the TED group than in the control group (P = 0.021) and was positively correlated with clinical activity score (r = 0.364, P = 0.021), modified NOSPECS score (r = 0.469, P = 0.002), and extraocular muscle thickness (r = 0.325, P = 0.041) in the TED group. Radial diffusivity was negatively correlated with modified NOSPECS score (r = -0.384, P = 0.014), and axial diffusivity was positively correlated with exophthalmos degree (r = 0.363, P = 0.025). CONCLUSIONS The diffusivities and FA reflected changes in the optic nerve before dysthyroid optic neuropathy in TED. The FA, in particular, reflected TED activity and severity.
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Zhong YF, Tang ZH, Qiang JW, Wu LJ, Wang R, Wang J, Jin LX, Xiao ZB. Changes in DTI parameters in the optic tracts of macaque monkeys with monocular blindness. Neurosci Lett 2016; 636:248-253. [PMID: 27864005 DOI: 10.1016/j.neulet.2016.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/19/2016] [Accepted: 11/14/2016] [Indexed: 12/27/2022]
Abstract
For humans and non-human primates, the alteration of the visual pathway's white matter fibers after visual deprivation has been partially explored. However, the changes in the optic tracts after the transection of the optic nerve have not been well characterized. In the current study, we attempted to investigate the differences in optic tracts between normal and unilateral optic nerve transected macaque monkeys using diffusion tensor imaging (DTI). Four healthy neonatal macaque monkeys were randomly divided into 2 groups, with 2 in each group. Group A served as a control group, and Group B underwent unilateral (right eye) optic nerve transection to produce monocular blindness. Sixteen months (Group B16M) and thirty-two months (Group B32M) after optic nerve transection, diffusion tensor imaging was performed on all monkeys. Then, we compared fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) in bilateral optic tracts between Group A and Group B and between Group B16M and Group B32M. In both Group B16M and Group B32M, when compared with normal monkeys in Group A, FA was decreased and MD, AD and RD were increased in the bilateral optic tracts of monkeys with monocular blindness. Furthermore, compared with Group B16M, FA was reduced and MD, AD, RD were more obviously increased in the bilateral optic tracts of Group B32M, and noticeable differences in MD, AD and RD were found between the left and right optic tracts in group B32M. We believe that the results of this study would be helpful in investigation of the histological abnormalities of the integrity damage, axonal degeneration and demyelination of optic tracts in macaque monkeys with monocular blindness by DTI parameters in noninvasively and quantitatively.
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Affiliation(s)
- Yu-Feng Zhong
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Eye and ENT Hospital of Shanghai Medical College, Fudan University, Shanghai, China
| | - Zuo-Hua Tang
- Department of Radiology, Eye and ENT Hospital of Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Ling-Jie Wu
- Department of Otolaryngology, Eye and ENT Hospital of Shanghai Medical College, Fudan University, Shanghai, China
| | - Rong Wang
- Department of Radiology, Eye and ENT Hospital of Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Wang
- Department of Radiotherapy, Eye and ENT Hospital of Shanghai Medical College, Fudan University, Shanghai, China
| | - Li-Xin Jin
- Siemens Ltd. Healthcare Sector, Shanghai, China
| | - Ze-Bin Xiao
- Department of Radiology, Eye and ENT Hospital of Shanghai Medical College, Fudan University, Shanghai, China
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14
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Ellis MJ, Ritchie L, Cordingley D, Essig M, Mansouri B. Traumatic Optic Neuropathy: A Potentially Unrecognized Diagnosis after Sports-Related Concussion. Curr Sports Med Rep 2016; 15:27-32. [PMID: 26745167 DOI: 10.1249/jsr.0000000000000223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Traumatic optic neuropathy is a rare cause of visual disturbance after head injury that can be difficult to distinguish from coexisting vestibulo-ocular dysfunction because of the overlap in presenting symptoms in patients with these conditions. We present a case report of a 13-year-old girl who sustained a head injury during a ringette game leading to blurred vision and diplopia persisting 5 months after injury. Clinical history and physical examination findings were consistent with a traumatic optic neuropathy, convergence insufficiency, and postconcussion syndrome. Neuroimaging was normal. The patient was managed using a multidisciplinary approach. At 6 months of follow-up, neuro-ophthalmological examination demonstrated evidence of permanent partial optic nerve injury, and formal neuropsychological testing fell primarily within normal limits. The patient was advised to retire from collision sports. The authors discuss the value of a comprehensive multidisciplinary approach to the evaluation and management of concussion patients presenting with persistent visual symptoms.
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Affiliation(s)
- Michael J Ellis
- 1Department of Surgery, University of Manitoba, Winnipeg, Manitoba, CANADA; 2Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, CANADA; 3Department of Diagnostic Imaging, University of Manitoba, Winnipeg, Manitoba, CANADA; 4Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, CANADA; 5Pan Am Concussion Program, Pan Am Clinic, Winnipeg Manitoba, CANADA; 6Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, CANADA; 7Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, CANADA; and 8Department of Neurology and Neuro-ophthalmology, University of Manitoba, Winnipeg, Manitoba, CANADA
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15
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Yamada H, Yamamoto A, Okada T, Kanagaki M, Fushimi Y, Porter DA, Tanji M, Hojo M, Miyamoto S, Togashi K. Diffusion tensor imaging of the optic chiasm in patients with intra- or parasellar tumor using readout-segmented echo-planar. Magn Reson Imaging 2016; 34:654-61. [PMID: 26806681 DOI: 10.1016/j.mri.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the impact of surgery on the optic pathway of patients with intra- or parasellar mass lesions, as evidenced by readout-segmented DTI. MATERIALS AND METHODS Twenty-four patients with intra- or parasellar mass lesions were included in the study. Readout-segmented DTI and T2WI were obtained before and after surgery. The ROIs were set on the optic chiasm as well as the anterior and posterior optic tracts. For each ROI, axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA), and ADC values were calculated. DTI parameters in preoperative studies of all patients were compared and related to the presence of tumor compression. In patients who underwent surgery, pre- and postoperative DTI parameters were compared. The correlation between DTI parameters and visual function was determined. RESULTS In the preoperative studies, the optic chiasm of patients with tumor compression showed significant lower AD and RD values. The optic chiasm of patients with visual field disorder showed significantly lower AD and RD values compared to patients without the disorder. There was a negative correlation with a trend toward significance between FA values and visual field disorder scores. The comparative analysis of patients in pre- and postoperative studies showed that the optic chiasm of patients with tumor compression presented a significant lower FA (0.41 versus 0.30, p=0.0068) and higher RD values after surgery. CONCLUSIONS DTI is a useful tool to assess the impact of surgery on the optic chiasm and nerve.
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Affiliation(s)
- Hirofumi Yamada
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akira Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mitsunori Kanagaki
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - David A Porter
- Fraunhofer MEVIS, Universitätsallee 29, 28359, Bremen, Germany
| | - Masahiro Tanji
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masato Hojo
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
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16
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Abstract
Indirect traumatic optic neuropathy (ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports- or motor vehicle-related concussion, rather than military-related ballistic or blast damage. Research in this field will likely require the development of robust databases to identify patients with ITON and follow related outcomes, in addition to both in-vivo animal and virtual human models to study the mechanisms of damage and potential therapies.
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Affiliation(s)
- Eric L Singman
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland USA
| | | | - Helen White
- Director of Informatics and Information Management, Vision Center of Excellence [VCE], Office of the Assistant Secretary of Defense for Health Affairs [ASD-HA], United States Department of Defense [DOD], Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Thao D Nguyen
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Lijo Panghat
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Jessica Chang
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland USA
| | - Timothy McCulley
- Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland USA
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17
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Ozkan B, Anik Y, Katre B, Altintaş Ö, Gençtürk M, Yüksel N. Reply re. Ophthalmic Plast Reconstr Surg 2015; 31:486-487. [DOI: 10.1097/iop.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Özkan B, Anik Y, Katre B, Altintaş Ö, Gençtürk M, Yüksel N. Quantitative Assessment of Optic Nerve With Diffusion Tensor Imaging in Patients With Thyroid Orbitopathy. Ophthalmic Plast Reconstr Surg 2015; 31:391-5. [DOI: 10.1097/iop.0000000000000359] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Chen Z, Lou X, Liu M, Huang D, Wei S, Yu S, Ma L. Assessment of Optic Nerve Impairment in Patients with Neuromyelitis Optica by MR Diffusion Tensor Imaging. PLoS One 2015; 10:e0126574. [PMID: 25962183 DOI: 10.1371/journal.pone.0126574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) has been used for the evaluation of the white matter integrity. In this study, we evaluated optic nerve impairment in patients with neuromyelitis optica (NMO) using DTI. METHODOLOGY/PRINCIPAL FINDINGS Optic nerve DTI were performed on 28 NMO patients and 38 normal controls. Fractional anisotropy (FA) values were measured in the anterior, middle, and posterior parts of the intraorbital optic nerve segment. For the posterior intraorbital optic nerve, FA values of BI (0.20±0.07), MI (0.24±0.16), and NA (0.25±0.14) decreased significantly compared with that of NC (0.43±0.07) (P<0.05), and ROC analysis demonstrated that the area under the curve (AUC) measurements for BI vs. NC, MI vs. NC, NA vs. NC, and NMO (including BI, MI, and NA) vs. NC were 0.99, 0.93, 0.88, and 0.96, respectively. The corresponding diagnostic sensitivities of ROC analysis were 100%, 80%, 80%, and 91%; and the specificities were 93%, 97%, 91%, and 93%. CONCLUSIONS/SIGNIFICANCE Decreased FA value in the intraorbital optic nerve, especially in the posterior part of the nerve, was demonstrated as a characteristic MR feature for NMO-related optic nerve impairment.
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20
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Abstract
The aim of this article is to evaluate current literature on investigation and management of traumatic optic neuropathy (TON), propose recommendations for diagnosis and management, and explore novel future treatments. TON, though uncommon, causes substantial visual loss. Without clear guidelines, there is much ambiguity regarding its diagnosis and management. Investigation and treatment (conservative, medical, surgical, and combined) vary widely between centers. Electronic databases PubMed, MEDLINE, PROSPERO, CENTRAL, and EMBASE were searched for content that matched "Traumatic optic neuropathy." Articles with abstracts and full text available, published in the past 10 years, written English and limited to human adults, were selected. All study designs were acceptable except case reports and case series with fewer 10 patients. All abstracts were then evaluated for relevance. References of these studies were evaluated and if also relevant, included. A total of 2,686 articles were retrieved and 43 examined for relevance. Of these, 23 articles were included. TON is a clinical diagnosis. Visual-evoked potential is useful in diagnosis and prognosis. Computed tomography demonstrates canal fractures and concomitant injuries. Magnetic resonance images should be reserved for select and stable patients. Conservative treatment is appropriate in mild TON. Steroids are of questionable benefit and may be harmful. Surgery should be reserved for patients with radiological evidence of compression and individualized.
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Affiliation(s)
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, National University Health System, Singapore
| | - Lim Thiam Chye
- Division of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital, National University Health System, Singapore
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21
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Yan Y, Li L, Preuss TM, Hu X, Herndon JG, Zhang X. In vivo evaluation of optic nerve aging in adult rhesus monkey by diffusion tensor imaging. Quant Imaging Med Surg 2014; 4:43-9. [PMID: 24649434 DOI: 10.3978/j.issn.2223-4292.2014.02.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/17/2014] [Indexed: 01/14/2023]
Abstract
Aging of the optic nerve can result in reduced visual sensitivity or vision loss. Normal optic nerve aging has been investigated previously in tissue specimens but poorly explored in vivo. In the present study, the normal aging of optic nerve was evaluated by diffusion tensor imaging (DTI) in non-human primates. Adult female rhesus monkeys at the ages of 9 to 13 years old (young group, n=8) and 21 to 27 years old (old group, n=7) were studied using parallel-imaging-based DTI on a clinical 3T scanner. Compared to young adults, the old monkeys showed 26% lower fractional anisotropy (P<0.01), and 44% greater radial diffusivity, although the latter difference was of marginal statistical significance (P=0.058). These MRI findings are largely consistent with published results of light and electron microscopic studies of optic nerve aging in macaque monkeys, which indicate a loss of fibers and degenerative changes in myelin sheaths.
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Affiliation(s)
- Yumei Yan
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 2 Marcus Autism Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA ; 3 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 4 The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, USA
| | - Longchuan Li
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 2 Marcus Autism Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA ; 3 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 4 The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, USA
| | - Todd M Preuss
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 2 Marcus Autism Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA ; 3 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 4 The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, USA
| | - Xiaoping Hu
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 2 Marcus Autism Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA ; 3 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 4 The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, USA
| | - James G Herndon
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 2 Marcus Autism Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA ; 3 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 4 The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, USA
| | - Xiaodong Zhang
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 2 Marcus Autism Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA ; 3 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia 30329, USA ; 4 The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, USA
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