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Hanna Maria Öhnell, MD, PhD

Hanna Maria Öhnell

Specialist physician

Hanna Maria Öhnell, MD, PhD

Case report : Bilateral damage to the immature optic radiation and secondary massive loss of retinal ganglion cells causing tunnel vision

Author

  • Maria Nilsson
  • Finn Lennartsson
  • Hanna Maria Öhnell
  • Lotta Gränse
  • Lena Jacobson

Summary, in English

We describe the case of a 30-year-old woman, who needed a formal report on her visual impairment to seek support from society. She was born preterm, and during her neonatal period, she suffered from bilateral intraventricular hemorrhage (IVH) grade 3, a condition that can cause cerebral visual impairment (CVI) due to damage to the retro-geniculate visual pathways. Individuals with such brain damage of this severity are often restricted by cerebral palsy (CP) and intellectual disability, and thus have a limited ability to cooperate in the assessment of visual function. However, our patient was capable of providing reliable test results, and she manifested only a small island of central vision in each eye, with additional reduced visual acuities. She cooperated well in examinations involving MRI of the brain, optical coherence tomography (OCT) of retinal ganglion cells, and multi-focal visual evoked potentials, with each test providing information about potential limitations in the structural prerequisites for visual function. What distinguishes our case is the severity of the damage to the optic radiations and the massive secondary loss of most of her retinal ganglion cells (GCs). However, there is some measurable visual function, which may be due to developmental neuroplasticity during early development, when surviving GCs prioritize the central visual field. Despite her visual difficulties, she is a keen portrait painter. Our patient may be representative of, and a spokesperson for, other individuals with extensive brain damage of the same etiology, who are unable to perform perimetric tests and therefore run the risk of not being recognized as severely visually impaired, and consequently, not being given the best conditions for habilitation. OCT may serve as a helpful diagnostic tool. Aim: This study aims to describe visual behavior and practical applications of visual function in relation to structural prerequisites for visual function.

Department/s

  • Diagnostic Radiology, (Lund)
  • Ophthalmology (Malmö)
  • Ophthalmology, Lund
  • Retinopathy of Prematurity
  • Clinical research in families with inherited retinal degeneration

Publishing year

2023

Language

English

Publication/Series

Frontiers in Neuroscience

Volume

17

Document type

Journal article

Publisher

Frontiers Media S. A.

Topic

  • Ophthalmology

Keywords

  • cerebral visual impairment
  • optical coherence tomography
  • retrograde trans-synaptic degeneration
  • tunnel vision
  • white matter damage of immaturity

Status

Published

Research group

  • Ophthalmology (Malmö)
  • Retinopathy of Prematurity
  • Clinical research in families with inherited retinal degeneration

ISBN/ISSN/Other

  • ISSN: 1662-4548