The primary goal of the first edition of this book was to provide the reader with an easy-to-follow, heavily referenced guide to the management of common neuro-ophthalmologic conditions. In this edition, we have specifically chosen to focus on recent references, and we emphasize the best available clinical evidence. To this end, we include letters or case reports if they add significant new information. We include pre-1990 references only if they are of historical significance. We have tried to be inclusive, however, in the construction of our tables and charts, and provide the references as needed. The secondary goal of this book is to discuss and classify the available clinical evidence concerning the evaluation and treatment of various neuro-ophthalmologic processes and grade the strength of any recommendations that are made. Readers will have to judge for themselves which is the best approach for the individual patient; the authors emphasize that these guidelines are not meant to define any particular standard of care for these conditions.
In this edition, we classify the clinical evidence into the following four categories and, where appropriate, summarize the class of evidence for each section.
Class I: Well-designed, randomized, power-controlled clinical trials including meta-analyses of such trials.
Class II: Well-designed controlled studies without randomization including meta-analyses of such studies.
Class III: Retrospective observational studies, cohort, or case–control studies, or multiple time series with or without intervention.
Class IV: Expert opinion, case series, case reports.
We grade the strength of the recommendations from each section as follows:
Level A: A principle for patient management reflecting a high degree of clinical certainty (usually requires class I evidence that directly addresses the clinical question).
Level B: A recommendation reflecting moderate clinical certainty based on either class II evidence or strong consensus of class III evidence with significant and consistent results.
Level C: An acceptable practice option with low clinical certainty based on class III or class IV evidence.
Level U: Inconclusive or conflicting evidence, or opinion that is insufficient to support an evidence-based recommendation.
1. The Diagnosis of Optic Neuropathies
2. Optic Neuritis
3. Optic Disc Edema with a Macular Star and Neuroretinitis
4. Nonarteritic Ischemic Optic Neuropathy
5. Arteritic Anterior Ischemic Optic Neuropathy and Giant Cell Arteritis
6. Traumatic Optic Neuropathy
8. Transient Vision Loss
9. Visual Field Defects
11. Third Nerve Palsies
12. Fourth Nerve Palsies
13. Sixth Nerve Palsies
14. Supranuclear Disorders of Gaze
15. Ocular Myasthenia Gravis
16. Thyroid Eye Disease: Graves Ophthalmopathy
17. Nystagmus and Other Ocular Oscillations
19. Lid Retraction and Lid Lag
20. Anisocoria and Pupillary Abnormalities
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