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The Role of Optical Coherence Tomography Angiography in Non-Arteritic Ischemic Optic Neuropathy: A Case Report Syntia Nusanti; Brigitta Marcia Budihardja; Lazuardiah Anandi; Rona Ali Badjrai
Majalah Oftalmologi Indonesia Vol 48 No 2 (2022): Ophthalmologica Indonesiana
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/journal.v48i2.100597

Introduction: Non-arteritic ischemic optic neuropathy (NAION) is the second most common optic neuropathy in adults. Since circulatory insufficiency is presumed to have a role in pathogenesis of NAION, optical coherence tomography angiography (OCTA) is suggested as a tool in assessing NAION patients, while optical coherence tomography (OCT) can detect structural changes. This case report aims to describe the congruity of visual field defect with OCT and OCTA result in a case of bilateral NAION, highlighting the role of both OCT and OCTA in NAION. Case Report: A 52-years-old male came due to painless, progressive blurry vision in both eyes, especially in lower visual field, for the past 7 months. Humphrey visual field examination revealed inferior visual field defects in both eyes. OCTA showed reduced retinal perfusion in the superior part bilaterally. OCT revealed ganglion cell loss in the superior part of his right eye and almost all parts of his left eye. Retinal nerve fiber layer (RNFL) thinning was found in the superior part bilaterally. Discussion: In this case, the congruity of visual field defect, reduced perfusion, ganglion cell-inner plexiform layer (GCIPL), and RNFL thinning portrayed the connection of hypoperfusion as the presumed underlying mechanism of NAION, neuron loss as the result of the hypoperfusion, and the visual field loss as the presenting symptom in NAION. Conclusion: This finding demonstrates the role of OCT-A and OCT in diagnosing and monitoring progression in patients with NAION.OCT-A is a useful tool to evaluate microvascular changes, while OCT can be used to evaluate RNFL and GCIPL thinning.

The Role of Optical Coherence Tomography Angiography in Non-Arteritic Ischemic Optic Neuropathy: A Case Report Syntia Nusanti; Brigitta Marcia Budihardja; Lazuardiah Anandi; Rona Ali Badjrai
Majalah Oftalmologi Indonesia Vol 48 No 2 (2022): Ophthalmologica Indonesiana
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/journal.v48i2.100597

Introduction: Non-arteritic ischemic optic neuropathy (NAION) is the second most common optic neuropathy in adults. Since circulatory insufficiency is presumed to have a role in pathogenesis of NAION, optical coherence tomography angiography (OCTA) is suggested as a tool in assessing NAION patients, while optical coherence tomography (OCT) can detect structural changes. This case report aims to describe the congruity of visual field defect with OCT and OCTA result in a case of bilateral NAION, highlighting the role of both OCT and OCTA in NAION. Case Report: A 52-years-old male came due to painless, progressive blurry vision in both eyes, especially in lower visual field, for the past 7 months. Humphrey visual field examination revealed inferior visual field defects in both eyes. OCTA showed reduced retinal perfusion in the superior part bilaterally. OCT revealed ganglion cell loss in the superior part of his right eye and almost all parts of his left eye. Retinal nerve fiber layer (RNFL) thinning was found in the superior part bilaterally. Discussion: In this case, the congruity of visual field defect, reduced perfusion, ganglion cell-inner plexiform layer (GCIPL), and RNFL thinning portrayed the connection of hypoperfusion as the presumed underlying mechanism of NAION, neuron loss as the result of the hypoperfusion, and the visual field loss as the presenting symptom in NAION. Conclusion: This finding demonstrates the role of OCT-A and OCT in diagnosing and monitoring progression in patients with NAION.OCT-A is a useful tool to evaluate microvascular changes, while OCT can be used to evaluate RNFL and GCIPL thinning.

Challenges in Diagnosing Functional Visual Loss and Malingering: a Case Report: Poster Presentation - Case Report - General practitioner Rona Ali Badjrai; Sarah Shabrina; Subandono Bambang Indrasto; Arlin Chyntia Dewi
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/01gvwf45

Abstract Introduction : Functional Visual Loss (FVL) is decreased visual acuity and/or altered visual fields without any associated organic pathology and is considered within the spectrum of malingering. It manifests as either simulating an ophthalmic disease or denying ophthalmic disease. Thorough history-taking and careful examination of the patient are essential in reaching the diagnosis. Case Illustration : A 17-year-old female came with complaints of a spinning headache, sudden and painless blurry vision in both eyes, double vision, and a history of syncope for the last two days. Ophthalmology examination revealed UCVA was 0.5/60 for both eyes with inconsistent answers from the patient. The confrontation test, light reflex, funduscopy, Humphrey visual test, OCT, and MRI were normal. Malingering was suspected and a psychiatric consultation was made. The patient was found to be a victim of bullying and had a history of visual hallucinations. The patient was then diagnosed with severe depression with psychotic signs. Discussion : Conclusion : FVL can be suspected when there is inconsistency in the results of some clinical basic tests. Despite the association between FVL and psychological problems like depression is complicated, this condition may occur in a bidirectional relationship in which depression leads to disability or contrarily. In conclusion, diagnosing visual problems in malingering patients can be challenging. Subjective and objective tests are needed to help practitioners confirm the malingering state of the patient. Practitioners also should be aware of the underlying risk of psychological problems among persons reporting visual function loss.

How Childhood Obesity May Be Harming Your Child’s Vision: A Systematic Review of High Myopia in Obese Children and Adolescents: Oral Presentation - Observational Study - General practitioner Ajeng Kartika; Seruni Hanna Ardhia; Marcelius Patria Prabaniswara; Sarah Shabrina; Rona Ali Badjrai
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/tnc8xh79

Abstract Introduction & Objectives : High myopia is a severe and progressive form of myopia that can result in blindness. The prevalenceof high myopia is rising globally, and obesity has been identified as a potential risk factor, particularly in children and adolescents. This review aims to evaluate complex interplay between obesity and myopia in the young population. Methods : A systematic literature review was conducted through PubMed, Embase, and Cochrane databases using relevant keywords. Abstract-only papers, case reports/series, and review studies were excluded, and only studies published in English between 2019 - 2023 were considered. The study selection process will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Results : This review analyzed four studies that involved 1.326.898 participants aged between 5 to 19 years. The majority of the studies found a significant association between obesity and high myopia (p<0.05). One of the studies reported that individuals with a normal BMI have a 40% lower risk of developing high myopia compared to those who are obese. Additionally, one study found that even a slightly higher BMI value, which is not yet categorized as obesity, was significantly linked to high myopia (OR 1.19; p=0.009). Conclusion : Most of the studies showed a significant association between high myopia and higher BMI, especially in cases of obesity. However, to establish a deeper understanding of the potential link between high myopia and obesity, further studies are necessary to consolidate data from a larger population and investigate the underlying pathological pathway.

Retinal Nerve Fiber Layer as The Preferred Objective Measure in Differentiating Pseudopapilledema with True Papilledema: A Systematic Review: Oral Presentation - Observational Study - General practitioner Lourisa Ruth Eldenia; Rona Ali Badjrai; Lazuardiah Anandi; Fierda Ovita Azhari; Erika Anggraini; Brigitta Marcia Bidihardja; Syntia Nusanti
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/pcx3g043

Abstract Introduction & Objectives : Distinguishing pseudopapilledema from true papilledema may generate confusion for some cases. Regardless of the subjective judgment on clinical examination alone, objective measurement for confirmation of diagnosis might be costly, operator-dependent, invasive, or not readily available. This study aims to evaluate whether retinal nerve fiber layer (RNFL) could be the reliable and efficient objective measure to ascertain the diagnosis. Methods : Literatures were obtained by comprehensive searching on PubMed, ProQuest, Google Scholar, and Cochrane between 2012 - 2023. Last search was March 26, 2023. Non-english study, animal study, review articles, case studies, and editorial letters were excluded. We included studies with available full-text containing both groups of papilledema and pseudopapilledema. The result was presented according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline. Results : A total of 615 participants were included from 8 different studies all comprising a group of papilledema and pseudopapilledema with or without optic disc drusen (ODD). Studies resulted in good accuracy on RNFL in differentiating pseudopapilledema with papilledema as the area under curve ranging from 0,78 to 0,91. However, specificity and sensitivity were varied between 65-100% and 33-91% respectively. Lower accuracy was found when pseudopapilledema only includes patients with ODD or papilledema was narrowed to mild papilledema. Conclusion : RNFL is a useful objective measure with favorable accuracy in differentiating pseudopapilledema with papilledema especially in acute settings or whenever operator-dependent examination is not obtainable

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