Eyeworld

EW FEATURE 34 Neuro-ophthalmology for the anterior segment surgeon • June 2018 intravenous antiviral medications, he added. Dr. Golnik said there is no real scientific data on using a combina- tion of medications. He noted that particularly for patients presenting with double vision, there is a high likelihood for recovery of single binocular vision with oral antivirals, and he added that it's hard to show that intravenous antivirals can guar- antee better outcomes. "Since these patients are virtually always treated with antivirals, we don't know what happens if they are not," he said. It is possible spontaneous improve- ment in double vision would occur as well. How patients with neuro- ophthalmic outcomes of VZV generally do Dr. Golnik said that in terms of out- comes for patients with neuro-oph- thalmic manifestations of VZV, you have to separate the patients into those with optic nerve vision loss and those with double vision. From a double vision stand- point, he said that the vast majority of patients have good recovery of function and resolution of double vision. He found that more than 90% of patients had recovery of single binocular vision. Meanwhile, for those with optic nerve vision loss, Dr. Golnik said that there are fewer cases, and re- sults tend to be extremely variable. "I tell patients their vision could improve back to normal or not at all," he said. Some patients are left legally blind in one eye and some patients recover to better than 20/30 vision. "In my experience, these people do very well as long as they do not have a significant neurological com- plication," Dr. Kedar said. Antiviral treatment improves vision in about half of patients; however the degree of improvement is variable, he said. Patients with isolated double vision from cranial nerve or orbital in- volvement do very well with about 90% reporting single vision by 6–12 months. Long-term antiviral prophylaxis Dr. Golnik said that he doesn't know of any evidence to support the use of long-term antiviral pro- phylaxis in these patients. Dr. Kedar said that the only literature for long-term antiviral prophylaxis is for patients with acute retinal necrosis where they do 6 months of prophylactic treatment or in patients who are immunocom- promised. He said that usually for a patient with zoster and neuro-oph- thalmic complications, he will keep them on antiviral treatment for 3–6 months, although there is no evidence to support it. "Prevention is better than cure," Dr. Kedar said. Since herpes zoster is a disease of the elderly and immu- nosuppressed, he highly recom- mends that anyone above the age of 50 receives the shingles vaccine. EW Editors' note: Drs. Golnik and Kedar have no financial interests related to their comments. Contact information Golnik: karl.golnik@uc.edu Kedar: sachin.kedar@unmc.edu Preferred medications Oral antiviral medications are usu- ally sufficient in most patients with isolated neuro-ophthalmological problems, Dr. Kedar said. However, patients who have neurological signs or symptoms, abnormal MRI brain or abnormal CSF studies suggesting central nervous system varicella zos- ter infection should be treated with JULY 20, 2018 VANCOUVER, BC, CANADA CELEBRATING 10 YEARS OF INNOVATION UNITING OVER 300 LEADERS In the development of ground-breaking ophthalmic technologies WWW.OIS.NET /OIS.NET @OISTWEETS /OPHTALMOLOGYSUMMIT FOUR SEASONS VANCOUVER Neuro-ophthalmic continued from page 32

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