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. 2016 Feb;6(1):9–10. doi: 10.1212/01.CPJ.0000481033.17694.e2

The application of optical coherence tomography in neurologic diseases

Khichar Shubhakaran 1
PMCID: PMC5765890  PMID: 29443230

I read with interest the review on optical coherence tomography (OCT) in various neurologic diseases by Maldonado et al.1 OCT is used extensively for clinical decision-making and monitoring of many posterior segment diseases based on macular, optic nerve, and retinal nerve fiber layer (RNFL) imaging.2 It is a noninvasive imaging technique and provides high-resolution, cross-sectional images of the retina, the RNFL, and the optic nerve head.2 I would like to draw particular attention to another important role OCT can play.3 OCT can aid with diagnosis, exclusion of diagnosis, and precipitation of angle closure glaucoma with topiramate use.4 Topiramate is used frequently in various neuropsychiatric conditions and is proving to be a promising drug (relatively inexpensive and with a low side effect profile). With better definition of optic nerve pathology, OCT will prove a useful tool to monitor and avoid topiramate side effects.4

Disclosures:

The author reports no disclosures.

Correspondence to: drkhicharsk@gmail.com

Footnotes

Correspondence to: drkhicharsk@gmail.com

References

  • 1.Maldonado RS, Mettu P, El-Dairi M, Bhatti MT. The application of optical coherence tomography in neurologic diseases. Neurol Clin Pract 2015;5:460–469. [DOI] [PMC free article] [PubMed]
  • 2.Adhi M. Optical coherence tomography: current and future applications. Curr Opin Ophthalmol 2013;24:213–221. [DOI] [PMC free article] [PubMed]
  • 3.Mitra A, Ramakrishnan R, Kader MA. Anterior segment optical coherence tomography documentation of a case of topiramate induced acute angle closure. Indian J Ophthalmol 2014;62:619–622. [DOI] [PMC free article] [PubMed]
  • 4.Shubhakaran KP. Anterior segment optical coherence tomography in angle closure glaucoma with topiramate use. Indian J Ophthalmol 2014;62:1174–1175. [DOI] [PMC free article] [PubMed]
  • 5.Karalezli A, Koktekir BE, Celik G. Topiramate-induced changes in anterior chamber angle and choroidal thickness. Eye Contact Lens Epub 2015 May 23. [DOI] [PubMed]
  • 6.Palomares P, Amselem L, Diaz-Llopis M. Optical coherence tomography for diagnosis and monitoring of angle-closure glaucoma induced by topiramate. Can J Ophthalmol 2007;42:633–634. [PubMed]
Neurol Clin Pract. 2016 Feb;6(1):9–10.

Authors Respond:

M. Tariq Bhatti, MD, Ramiro S. Maldonado, MD, Pradeep Mettu, MD, Mays El-Dairi, MD: We would like to thank Dr. Shubhakaran for his insightful comments regarding our review article on the application of OCT in neurologic diseases.1 Topiramate is often used for a variety of neurologic diseases including migraines, bipolar disorder, epileptic seizures, and infantile spasms. From a pathomechanistic perspective, topiramate-induced glaucoma is due to ciliochoroidal effusion resulting in forward displacement of the iris-lens diaphragm causing shallowing of the anterior chamber and subsequent elevated intraocular pressure. As mentioned by Dr. Shubhakaran, OCT of the anterior segment demonstrates shallowing of the anterior chamber and conventional retinal OCT can show choroidal thickening as early as 1 week after starting topiramate therapy.5 These anatomical changes can occur without producing any ocular symptoms but certainly increase the risk of developing unilateral or even bilateral acute angle closure glaucoma in patients with asymptomatic narrow angles.6 It would be prudent to consult with an ophthalmologist to evaluate for narrow angles before initiating therapy and utilizing OCT to monitor subclinical ocular changes at 1 week after the start of therapy. However, we would like to emphasize that topiramate-induced glaucoma is a clinical diagnosis and requires measuring intraocular pressure.

Duke University, Durham, NC.

Disclosures: R.S. Maldonado and P. Mettu report no disclosures. M. El-Dairi serves as a consultant for Prana Biotechnology and receives research support from The Knights Templar. M. Bhatti has received funding for travel from and serves on a scientific advisory board, as a consultant, and on the speakers' bureaus for Novartis and serves on the editorial board of Journal of Neuro-Ophthalmology.

Correspondence to: tariq.bhatti@duke.edu

Articles from Neurology: Clinical Practice are provided here courtesy of American Academy of Neurology

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