Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss
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(2020) 20:51
NEURO-OPHTHALMOLOGY (A KAWASAKI, SECTION EDITOR)
Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss Tanyatuth Padungkiatsagul 1,2 & Loh-Shan Leung 2 & Heather E. Moss 2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses. Recent Findings Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions. Summary With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can be challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhances the provider’s ability to make early diagnosis and monitor progression of these conditions. Keywords Multimodal ophthalmic imaging . Maculopathy . AZOOR complex diseases . Retinal dystrophy . Retinal ischemia . Toxic retinopathy
Introduction Visual loss can result from any pathology along the visual pathway. A comprehensive ophthalmic examination usually identifies the cause, with common etiologies including refractive error, ocular surface dryness, cataract, macular degeneration, and glaucoma. When the examination is unrevealing, patients are often referred to neurologists or neuroophthalmologists for evaluation of potential retrobulbar (optic nerve or cerebral) causes of visual loss. When doing these This article is part of the Topical Collection on Neuro-Ophthalmology * Heather E. Moss [email protected] 1
Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2
Department of Ophthalmology, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA 94303, USA
3
Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
evaluations, it is important for neurologists to be aware of retinopathies which may be occult on physical examination so that they may be included in the differential diagnosis (Table 1). In the case of monocular vision loss, differentiating between optic neuropathy and retinopathy can be straightforward in patients with an obviously abnormal retina examination, an abnormal optic nerve head appearance, or a relative afferent pupillary defect, which is a differe
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