Analysis of diplopia referrals in a tertiary neuro-ophthalmology center

Theme: Neuro-ophthalmology
What: Neuro-ophthalmology
Part of: Neuro-ophthalmology I / Neuro-ophtalmolgie I
When: 6/1/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 714 B

Abstract

Purpose: Little is known about the prevalence of morbidity and mortality in patients with diplopia who receive neuro-ophthalmology consultations. The purpose of our study was to describe the referral patterns, morbidity and mortality associated with diplopia for patients referred for a neuro-ophthalmology consultation.

Study Design: Retrospective chart review.

Methods: A retrospective chart review of all patients seen by two neuro-ophthalmologists in a tertiary practice between December 2, 2021 and May 21, 2022 was performed. All patients who were referred for diplopia were included. Our primary outcome was loss of vision, while progression of symptoms or systemic morbidity or mortality without neuro-ophthalmic consult were secondary endpoints. 

Results: Overall, 196 patients were referred for diplopia. The mean age at presentation was 61.3 ± 17.0 years and 48.5% were women. The most common final diagnoses reached following neuro-ophthalmology consultation were cranial nerve palsies (38.3%), convergence insufficiency and decompensated phoria (22.4%), non-neuro-ophthalmic causes (19.9%), thyroid eye disease (4.5%), myasthenia gravis (3.5%), and multiple sclerosis (3.1%). In total, 15.3% of patients referred to neuro-ophthalmology for diplopia had potential of morbidity or mortality. Specifically, 1.0% had potential of vision loss due to severe papilledema in context of untreated idiopathic intracranial hypertension, and 3.0% had potential for systemic morbidity or mortality due to brain aneurysms (1.0%), pituitary apoplexy (0.5%), anaplastic glioma (0.5%) and other malignancy (1.0%). In addition, 11.2% had potential for progression of symptoms due to thyroid eye disease (4.6%), myasthenia gravis (3.5%), and multiple sclerosis (3.1%). Of the patients who had a pre-referral neuroimaging study, 30.1% required additional neuroimaging after neuro-ophthalmology consultation.

Conclusions: Overall, 15.3% of patients with diplopia had potential for morbidity without neuro-ophthalmology consult. This study emphasizes the importance of urgent neuro-ophthalmologic referral for patients with diplopia to allow for appropriate evaluation and investigation to reduce morbidity and mortality.

Presenter(s)

Presenting Author: Milena Cioana

Additional Author(s):

Mariam Issa, Department of Ophthalmology and Vision Sciences, University of Toronto

Marko Popovic, Department of Ophthalmology and Vision Sciences, University of Toronto

Laura Donaldson, Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada

Jonathan Micieli, Department of Ophthalmology and Vision Sciences, University of Toronto

Edward Margolin, Department of Ophthalmology and Vision Sciences, University of Toronto

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