No light perception vision in neuro-ophthalmology practice
inability to detect light, known as no light perception (NLP), is the most
severe form of vision loss and typically signals an aggressive or end-stage
disease process as all afferent input from the eye is lost. The goal of this
study was to determine the differential diagnosis and visual outcomes of
patients with NLP vision related to neuro-ophthalmic conditions.
Study Design: This was a retrospective case series of consecutive patients seen at tertiary neuro-ophthalmology practices at the University of Toronto, Canada.
Methods: Patients were included if they had NLP vision at any point during their clinical course. Main outcome measures were final diagnosis, treatment and visual outcome. As is routine in our practices, NLP was determined by presenting a bright light approximately 10cm from the patient’s eye with the fellow eye completely occluded. The patient was then asked if they were able to perceive any light in the eye. Patients with general ophthalmology conditions such as end stage glaucoma, retinal detachment, or traumatic open globe injuries were excluded.
Results: Seventy-two eyes of 65 patients were included. Average age was 57.6 years (range 18-93) and 58% were women. Most common diagnosis (21 patients) was compressive optic neuropathy (CON) with meningioma being most common culprit (12). Other diagnoses included optic neuritis (ON) (11 patients), infiltrative optic neuropathies due to malignancies (8), posterior ischemic optic neuropathy (PION) (7), non-arteritic anterior ischemic optic neuropathy (4), arteritic anterior ischemic optic neuropathy (AION) (3), ophthalmic artery occlusion (3), non-organic vision loss (3), radiation-induced optic neuropathy (2), cortical vision loss (1), retinitis pigmentosa with optic disc drusen (1), and infectious optic neuropathy (1). Ten patients recovered vision: 7 ON, 2 infiltrative optic neuropathy, and 1 CON. Corticosteroids resulted in 7/11 ON patients recovering vision to mean 20/60 (0.48 logMAR) over 9.0±8.6 follow-up months. Eleven patients deteriorated to NLP after presenting with at least light perception; their diagnoses included CON (3), ophthalmic artery occlusion (2), infiltration (2), ON (1), PION (1), AAION (1), and radiation-induced optic neuropathy (1).
Conclusions: NLP vision may occur due to various diagnoses. Vision recovery was mainly seen in patients with ON. Serious systemic conditions may present or relapse with NLP vision which should alert clinicians in patients with known malignancies.