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2006 Program

  The Sally Letson Foundation
and the University of Ottawa, Faculty of Medicine
present

Neuro-Ophthalmology Update

September 14, 15, and 16, 2006
The Westin Hotel
(4th Floor Ballrooms Confederation I/Provinces)
11 Colonel By Drive, Ottawa, Ontario
Canada

2006 Symposium goals and objectives

The purpose of this symposium is to provide a comprehensive review on the clinical presentation, diagnosis, and management of neuro-ophthalmic disorders.

In the first section of the symposium, an overview of common neuro-ophthalmic entities will be addressed with special emphasis on novel ocular and neuro-imaging technologies. Days 2 and 3 will focus on afferent and efferent neuro-ophthalmic conditions which require prompt recognition and urgent intervention by the clinician. In these sessions, the cardinal clinical features, differential diagnosis, use of ancillary investigations, and management strategies for important neuro-ophthalmic diseases will be presented. World-renowned experts will share their knowledge and clinical expertise in didactic sessions which will be intermixed with clinical case presentations. The meeting will provide an interactive and open forum for discussion between guest lecturers and meeting participants. The meeting will conclude with an exciting debate showcasing current controversies in the field of neuro-ophthalmology.

These three days will be of academic and practical interest to ophthalmologists, neurologists, neurosurgeons, fellows, residents, and ophthalmic medical personnel.

This year's Bryan St.L. Liddy Lecture will be given by Dr. Andrew G. Lee on "Neuro-ophthalmology in the neuro-imaging era: now more than ever" and the A.G. Watson Lecture will be given by Dr. Peter J. Savino on "Giant cell arteritis."

At the conclusion of the symposium, audience participants will be able to:

  • Obtain a focused history designed to unveil important neuro-ophthalmic diagnoses
  • Implement a thorough neuro-ophthalmic examination of the afferent and efferent visual systems
  • Identify neuro-ophthalmic manifestations of common neurological and neurosurgical diseases
  • Interpret the results of established and novel ancillary investigations in the context of neuro-ophthalmic diseases including perimetry, optical coherence tomography, and the multifocal ERG
  • Identify the appropriate modality of neuro-imaging to investigate intracranial lesions associated with neuro-ophthalmic disorders
  • Diagnose and manage neuro-ophthalmic emergencies affecting the afferent and efferent pathways
  • Recognize countering viewpoints in current neuro-ophthalmic controversies to help implement appropriate management strategies in clinical practice

Neuro-Ophthalmology Update: Program

THURSDAY, SEPTEMBER 14, 2006
Day 1Neuro-ophthalmology: an overview
Purpose: To review the clinical approach to neuro-ophthalmic diseases with emphasis on investigative techniques. Clinical cases will be used to create an interactive format and to facilitate discussion. The intended audience includes ophthalmic medical personnel, fellows, residents, neurologists, and ophthalmologists.
7:30 a.m.Registration and Continental Breakfast
8:00 a.m.Opening Remarks
W. Bruce Jackson, MD, FRCSC
SESSION I — NEURO-OPHTHALMOLOGY
8:10 a.m.Neuro-anatomy of the visual pathways: where is the lesion?
Julie Falardeau, MD, FRCSC
8:30 a.m.Taking the history - what to ask and what to listen for
Fiona Costello, MD, FRCPC
8:50 a.m.The patient with vision loss: where to look and what to look for
Martin W. ten Hove, MD, FRCSC
9:10 a.m.Ocular motility: what every doctor needs to know
Fiona Costello, MD, FRCPC
9:30 a.m.Questions & Answers
9:55 a.m.Break
SESSION II — NEURO-OPHTHALMOLOGY
10:20 a.m. The pupil: not just a black hole
Julie Falardeau, MD, FRCSC
10:50 a.m. How to interpret the visual field: the good, the bad and the ugly
Anthony C. Arnold, MD
11:10 a.m. Visual loss with a normal eye exam
Fiona Costello, MD, FRCPC
11:30 a.m.Questions & Answers
Moderator - Fiona Costello, MD, FRCPC
12:00 p.m.LUNCH
SESSION III — NEURO-OPHTHALMOLOGY: MAKING THE DIAGNOSIS
1:00 p.m.Introduction
Fiona Costello, MD, FRCPC
1:10 p.m. Neuro-ophthalmic signs of stroke
Fiona Costello, MD, FRCPC
1:30 p.m. The montage of multiple sclerosis
Elliot M. Frohman, MD, PhD
1:50 p.m. Suprasellar space invaders
Amin B. Kassam, MD
2:10 p.m. The aura of migraine
Andrew G. Lee, MD
2:30 p.m. Questions & Answers
2:50 p.m. Break
SESSION IV — IMAGING TECHNIQUES
3:15 p.m. Optical coherence tomography: quantifying axon loss in the optic nerve
Fiona Costello, MD, FRCPC
3:35 p.m. The role of the multifocal ERG
Stuart G. Coupland, PhD
3:50 p.m. Neuro-imaging: which test is best?
Eric R. Eggenberger, DO
4:10 p.m. Questions & Answers
4:25 p.m. Introduction of 2006 Bryan St. L. Liddy Lecturer
Brian H. Lorimer, COMT
4:30 p.m. 2006 Bryan St.L. Liddy Lecture
Neuro-ophthalmology in the neuro-imaging era: now more than ever
Andrew G. Lee, MD
5:00 p.m. Questions & Discussion
Moderator - Julie Falardeau, MD, FRCSC
5:10 p.m. Closing Remarks
Fiona Costello, MD, FRCPC
5:15 p.m. Adjourn
FRIDAY, SEPTEMBER 15, 2006
Day 2Neuro-ophthalmic diagnoses you don't want to miss
Purpose: Main symposium - presentation of important neuro-ophthalmic diseases, approach to diagnosis and management.
7:15 a.m. Registration and Continental Breakfast
7:55 a.m. Opening Remarks
Dean of Medicine, University of Ottawa
Peter Walker, MD, FRCPC
SESSION V — WHAT'S UP DOC? I CAN'T SEE
8:00 a.m. Acute unilateral optic disc edema
Anthony C. Arnold, MD
8:20 a.m. Acute bilateral optic disc edema
Peter J. Savino, MD
8:40 a.m. Acute retrobulbar optic neuropathy
Alfredo A. Sadun, MD, PhD
9:00 a.m. Optic atrophy is NOT a diagnosis
Andrew G. Lee, MD
9:20 a.m. Questions & Answers
9:40 a.m. Break
SESSION VI — NEURO-OPHTHALMIC EMERGENCIES I: ASK THE EXPERTS
Program: An interactive session during which time cases of neuro-ophthalmic afferent dysfunction presented in Session V will be further discussed and questions regarding clinical investigations and management options will be directed to the panel. This session will implement clinical cases around which a discussion will be coordinated by the moderator with audience participation and interaction from the panel of experts.

Moderator - Anthony C. Arnold, MD
Panel

  • Eric R. Eggenberger, DO
  • Amin B. Kassam, MD
  • Andrew G. Lee, MD
  • Alfredo A. Sadun, MD, PhD

    • Case Topics/Video Presentations: A case (5-10 minutes) will be presented for each topic, and then an interactive discussion with the panel and audience will be moderated (10-15 minutes per case)

    10:10 a.m. Papilledema (coping with the pressure)
    Andrew G. Lee, MD
    10:30 a.m. Compressive optic neuropathies (scoping out the suprasellar space)
    Amin B. Kassam, MD
    11:05 a.m. Ischemic causes of vision loss (alarming amaurosis)
    Eric R. Eggenberger, DO
    11:25 a.m.Atypical optic neuropathies
    Alfredo A. Sadun, MD, PhD
    11:45 a.m. Questions & Answers
    Moderator - Anthony C. Arnold, MD
    12:00 p.m. LUNCH
    SESSION VII — DOUBLE TROUBLE
    Moderator - Martin ten Hove, MD, FRCSC
    1:00 p.m. Dire diplopia
    Fiona Costello, MD, FRCPC
    Julie Falardeau, MD, FRCSC
    1:30 p.m. Unnerving nystagmus
    Elliot M. Frohman, MD, PhD
    1:50 p.m. Saccadomania
    Agnes Wong, MD, PhD, FRCSC, Associate Professor of Ophthalmology & Vision Science, Neurology, and Otolaryngology - Head & Neck Surgery University of Toronto
    2:10 p.m. Neuromuscular junction dysfunction
    Julie Falardeau, MD, FRCSC
    2:30 p.m. Questions & Answers
    2:50 p.m. Break
    3:10 p.m. Introduction of 2006 A. G. Watson Lecturer
    Brian C. Leonard, MD, FRCSC
    3:15 p.m. 2006 A. G. Watson Lecture
    Giant cell arteritis
    Peter J. Savino, MD
    3:50 p.m. Questions & Answers
    Moderator - Andrew G. Lee, MD
    SESSION VIII — MANAGEMENT OF NEURO-OPHTHALMIC EMERGENCIES II: ASK THE EXPERTS
    Program:An interactive session with audience participation during which time cases of neuro-ophthalmic efferent dysfunction will be presented and questions regarding clinical investigations and management options will be directed to the panel.

    Moderator - Eric R. Eggenberger, DO
    Panel

  • Eric R. Eggenberger, DO
  • Alfredo A. Sadun, MD, PhD
  • Peter J. Savino, MD
  • Martin ten Hove, MD, FRCSC

    • Case Topics/Video Presentations: A case (5-10 minutes) will be presented for each topic and then an interactive discussion with the panel and audience will be moderated (10-15 minutes per case)

    4:00 p.m. Spasmus nutans
    Fiona Costell, MD, FRCPC
    4:15 p.m. Management approach to isolated ocular motor nerve palsies
    Alfredo A. Sadun, MD, PhD
    4:30 p.m. Superior oblique myokymia
    Martin ten Hove, MD, FRCSC
    4:45 p.m. Questions & Answers
    Moderator - Eric R. Eggenberger, DO
    5:05 p.m. Closing Remarks
    Fiona Costello, MD, FRCPC
    5:10 p.m. Adjourn
    6:30 p.m. Reception (Confederation II and III)
    SATURDAY, SEPTEMBER 16, 2006
    Day 3Controversies in neuro-ophthalmology
    7:15 a.m. Registration and Continental Breakfast
    7:55 a.m. Opening Remarks
    Fiona Costello, MD, FRCPC
    SESSION IX — CONTROVERSIES
    Program:An interactive discussion during which time "pro" versus "con" arguments will be presented by 2 speakers regarding controversial topics including diagnostic and management approaches for neuro-ophthalmic disorders.
    Format: A "pro" position will be discussed by one speaker for 5 minutes, followed by a "con" position by a countering speaker for 5 minutes. A 10-minute discussion will then be moderated with audience participation and questions may be directed towards the panel of experts for each topic.
    8:00 a.m. Introduction: Rules of engagement
    Andrew G. Lee, MD
    8:10 a.m. Is pharmacological testing for Horner's Syndrome necessary?
    Julie Falardeau, MD, FRCSC "pro" vs Anthony C. Arnold, MD "con"
    8:30 a.m. Is early initiation of disease modifying therapy for optic neuritis warranted?
    Elliot M. Frohman, MD, PhD "pro" vs Fiona Costello, MD, FRCPC "con"
    8:50 a.m. Should you image an isolated but presumed vasculopathic ocular motor cranial neuropathy?
    Peter J. Savino, MD "pro" vs Eric R. Eggenberger, DO "con"
    9:10 a.m. Viagra and vision loss: does sex make you blind?
    Alfredo A. Sadun, MD, PhD "pro" vs Andrew G. Lee, MD "con"
    9:30 a.m. Questions & Answers
    9:50 a.m. Break
    10:15 a.m. Are IV steroids and antiplatelet agents indicated in every case of GCA?
    Alfredo A. Sadun, MD, PhD "pro" vs Anthony C. Arnold, MD "con"
    10:35 a.m. The sordid saga of the third nerve palsy: do you still need an angiogram in 2006?
    Andrew G. Lee, MD "pro" vs Anthony C. Arnold, MD "con"
    10:55 a.m. Managing myasthenia gravis: is there a role for corticosteroids in every patient?
    Eric R. Eggenberger, DO "pro" vs Brian R. Younge, MD "con"
    11:15 a.m. Questions & Answers
    Moderator - Alfredo A. Sadun, MD, PhD
    11:50 a.m. Closing Remarks
    W. Bruce Jackson, MD, FRCSC
    12:00 p.m. Adjourn