NANOSNET

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Repeated mfERG is still abnormal.

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,

Repeated mfERG is still abnormal.

Thank you both for your replies!

The main symptom of this patient is obvious photophobia when looking at LED white lights or fluorescent lights, especially in the subway station, but there is no photophobia under sunlight. 

The macular line scan is normal, and more coronal MRI images are as shown. Syphilis and TB (T-SPOT) were negative. 

This patient consulted in the online clinic. When I heard his chief complaint, I suspected a retinal disease. Moreover, his visual field is inconsistent with the MRI findings. I will see him in person this Thursday. 

What confuses me most is his mfERG. However, I just called him and he told me that they performed ffERG on him and directly carried out the mfERG without letting him rest. Even at the beginning, he couldn't see the red cross of the fixation point, and the technician had to repeat the exam.

So I suggested that he make an appointment to repeat the mfERG tomorrow. At the same time, recheck FFA and do an ICGA.

I suggested he go to the rheumatologist to further investigate the positive result of Sjögren's syndrome antibody (anti-Ro) and ANA.

I agree this could be optic perineuritis but Is there any possibility that this is an autoimmune retinopathy (normal ffERG, OCT, and AF)? 

Hi Dear All, 

Any suggestions would be greatly appreciated!

A 44-year-old male with no previous medical history. He had sudden peripheral visual field defects in both eyes accompanied by blurred vision for half a month, along with photophobia, especially with LED white light. This is more obvious in the subway station and improves slightly outdoors. There is no pain with eye movement and no headache. There is no transient vision loss or tinnitus. He denies any change in color vision.

He has been treated with methylprednisolone 500mg for 3 days and 250mg for 3 days in the local hospital. 

The visual field is slightly better after getting up in the morning but returns to the previous state in the afternoon.

The corrected visual acuity of both eyes is 20/20, and the color vision is 8/8. The anterior chamber is deep and quiet, RAPD is negative, the optic discs are slightly edematous, the cup-disc ratio is 0.3, and no lesions are seen in the retina.

The brain and orbital MRI w/wo is normal. 

The visual fields of both eyes show symmetrical concentric constriction. Fluorescein angiography (FFA) shows leakage of the optic discs in both eyes. The autofluorescence is normal.

AQP4, MOG and GFAP are negative, ANA is 1:320, and SSA is positive. The mfERG shows a severe decrease wave in the macula, while the ffERG is normal.

Any thoughts?

Thanks!

Best,