Podcasts about optic

For a limited time, new Cash App customers that watch this show may be eligible for a $10 sign up bonus. All you have to do is download the app, use our code OPTIC10 when creating your account, send $5 to a friend within 14 days, and you'll get $10 - it's that easy. Terms apply. That's Money. That's Cash App.OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG

Get BP Pro: https://www.breakingpoint.gg/?subscribe=trueThieves go back-to-back! The boys had 30 minutes to run a show. Thank you everyone for showing love to Rab, Trei, Don, and Ace this season for another fantastic fkn season of Dope Check

FaZe ZooMaa, Ben, and Parasite break down the Call of Duty League matches from 5/24/2025!

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League matches from 5/18/2025!

OPTIC ARE BACK, CHAMPS SECURED?

On the 176th episode of the Ego Chall Podcast, Justin Binkowski and Preston Byers discuss the final week of online play in the 2025 Call of Duty League (CDL) season, including 0-2 performances from the Toronto Ultra and Carolina Royal Ravens, OpTic Texas's up-and-down showing, the Miami Heretics finishing off a perfect qualifier run, and much more.

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League matches from 5/16/2025!

OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQGWe Went Back To The Scuf House | The Flycast Ep. 148 00:00 Intro 01:00 Going family friendly 08:00 going out with friends 17:00 Having kids, meeting new people 27:00 Sneaking into 100t office 31:00 Back at the Scuf House 51:00 Best Games of All Time

Go to http://shopify.com/optic to sign up for your $1-per-month trial and start selling today. Go to http://drinktrade.com/OPTIC to get 50% off your one month trial. For a limited time, new Cash App customers that watch this show may be eligible for a $10 sign up bonus. All you have to do is download the app, use our code OPTIC10 when creating your account, send $5 to a friend within 14 days, and you'll get $10 - it's that easy. Terms apply. That's Money. That's Cash App. OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG 00:00 Intro 02:00 Scump & Boze on Mercules 06:30 Hecz Streaming career 09:00 AI content, MJ coming to the NBA 18:00 Who's next to have a baby? 26:00 The Office follow up show 29:50 Ads 34:50 Kai Cenat Streamer University 41:00 Tory Lanez 47:00 Dreamhack Dallas

Dope Check is sponsored by PrizePicks - sign up at https://prizepicks.onelink.me/ivHR/BreakingPoint for $50 when you make your first $5 pickDownload the NEW Breaking Point app on iOS and Android - https://onelink.to/bypudqJoin the Generational Haters Club: https://www.youtube.com/channel/UCi-nd4Y4U8DbxbO9SJTYG2A/join00:02:30 Are we in the Plumber era?00:28:00 Return to twitch?00:35:30 Sunday's Matches Abysmal00:40:00 ROKKR and Gentlemates rosters01:02:00 OpTic Mercules01:21:00 Who is the SND GOAT?01:33:00 Rokkr not making Champs01:47:00 Can Merc be ROTY?01:50:30 Falcons plan for EWC02:18:30 Champs Race Update & StandingsSign up for The Full Wrap, 1 email a week from BP covering all your CDL and CoD news - https://breaking-point-full-wrap.beehiiv.com/subscribeMercules SAVES OpTic, Pre-Champs ROSTERMANIA?! Dope Check Ep. 60Listen on Spotify:Visit our website: https://www.breakingpoint.gg/Find us on Twitter: https://twitter.com/GGBreakingPointPlay CDL Fantasy: http://breakingpoint.gg/fantasyMERCULES SAVES OPTIC, PRE-CHAMPS ROSTERMANIA?! Dope Check Ep. 60__________________________________________________________________#CallOfDuty #CDL #BO6 #OpTic

On the 174th episode of the Ego Chall Podcast, Justin Binkowski and Preston Byers discuss Mercules' OpTic Texas debut, Cloud9 New York's new roster defeating Atlanta FaZe, the Miami Heretics continuing their undefeated streak, and more.

OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQGWe Went To Get Ice Cream ft. OpTic Mercules | The Flycast Ep. 147

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Black Ops 6 Call of Duty League matches from 5/9/2025!Like, comment, subscribe!

Check out Mercules here: https://www.twitch.tv/tbemerc https://x.com/Tbemercules This episode is sponsored by BetterHelp — go to http://betterhelp.com/optic to get 10% off your first month. Go to http://factormeals.com/optic50off and use code optic50off to get 50% off and free shipping on your first box. OpTic and the Call of Duty Endowment are teaming up for Military Appreciation Night on May 14th in Arlington! ⚾ Join us as we honor our veterans and celebrate their service, all while enjoying a night of baseball and gaming. It's a special moment for both the military and gaming communities. OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG MEET OpTic MERCULES | The OpTic Podcast Ep. 214 00:00 Welcome Mercules to OpTic 09:30 Mercules on Challengers 15:00 What controller does Mercules use 25:00 Scump 1v1 vs Tenz 28:00 Mercules telling his parents 31:00 Coming in to the CDL

On the 173rd episode of the Ego Chall Podcast, Justin Binkowski and Preston Byers discuss OpTic Texas replacing Skyz with Mercules, Cloud9 New York benching Mack and Attach, and much more.

Welcome to another episode of the NEW Scrap Time Podcast! In this episode we discuss OpTic BENCHING Skyz for the Major 3 standout player Mercules. You can expect to see new podcast episodes once a week on both YouTube and your favorite audio platform!Follow The Hosts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ben Nissim⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠JKap⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Octane⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Chelly

Dope Check is sponsored by PrizePicks - sign up at https://prizepicks.onelink.me/ivHR/BreakingPoint for $50 when you make your first $5 pickDownload the NEW Breaking Point app on iOS and Android - https://onelink.to/bypudqJoin the Generational Haters Club: https://www.youtube.com/channel/UCi-nd4Y4U8DbxbO9SJTYG2A/joinSign up for The Full Wrap, 1 email a week from BP covering all your CDL and CoD news - https://breaking-point-full-wrap.beehiiv.com/subscribeOPTIC ARE BACK, LA THIEVES FRAUDS? Visit our website: https://www.breakingpoint.gg/Find us on Twitter: https://twitter.com/GGBreakingPointPlay CDL Fantasy: http://breakingpoint.gg/fantasy

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League on 5/3/2025!

Pre-Show Friday Major IV Qualifiers

Get Dreamhack Dallas tickets here: https://OpTic.link/DreamhackOpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQGHILARIOUS WAY APG HYPES UP FORMAL ON MAINSTAGE

Go to http://shopify.com/optic to sign up for your $1-per-month trial and start selling today. Get Dreamhack Dallas tickets here: https://OpTic.link/Dreamhack OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG 00:00 Miami Event 11:00 CDL Major Thoughts 14:00 Dreamhack Dallas 20:00 Best meals in Miami 31:00 Ads32:30 CDL this weekend 35:00 Hecz Minecraft 40:00 NBA 47:00 100 Men vs 1 Gorilla 56:00 Goat Argument 100 Scumps vs 1 Gorilla | The OpTic Podcast Ep. 223

In today's episode, Wade reviews the Athlon Helios BTR Gen 2. Please send all questions to support@alymunitions.com #texaspredatorhunting #allymunitions #podcast #outdoors Follow us:Instagram: https://www.instagram.com/allymunitions/ https://www.instagram.com/allyoutdoors/ https://www.instagram.com/wade.thejudge/ https://www.instagram.com/texaspredatorhunting/Facebook: https://www.facebook.com/wade.chandler.56808

Welcome to another episode of the NEW Scrap Time Podcast! In this episode we discuss rostermania following Major 3, including OpTic deciding to stick according to Shotzzy on stream. You can expect to see new podcast episodes once a week on both YouTube and your favorite audio platform!Follow The Hosts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ben Nissim⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠JKap⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Octane⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Chelly

On the 172nd episode of the Ego Chall Podcast, Justin Binkowski and Preston Byers continue to discuss Call of Duty League (CDL) Major 3, Shotzzy's statement on a potential OpTic Texas roster change, Atlanta FaZe's disappointing Major performance, and more.

Welcome to episode #219 of The COD Casuals, where we discuss all things Call of Duty, casual and professional!In this episode, we are looking ahead to major 3 in Miami, and cover all the big talking points leading up to this event. This is a very important major for a lot of the mid-pack teams, and their hopes for qualifying for champs. Lots of teams have made changes, and some have shown improvement while others have continued to slide downhill. We make our predictions for who is going to show out for this major, and what some teams need to do in order to keep their championship hopes alive. Which team do you feel needs to make a change the most? Is there any team that needs to stick together after this major, or is no team safe? Please let us know as we discuss this and much more! Hope you all enjoy the episode and we'll see you next week.Follow us:Twitter: ⁠⁠@TheCODCasuals⁠⁠Instagram: ⁠⁠@TheCODCasuals⁠⁠TikTok: ⁠⁠@TheCODCasuals⁠⁠Contact us:Business Inquiries: TheCODCasuals@gmail.com

OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQGWe Went to Top Golf | The Flycast Ep. 14500:00 Intro 01:00 Pamaj Streaming Schedule 02:00 Infinite OpTic stories 10:00 Scuf House 18:00 Making content in a house 21:45 Best games out right now 25:50 What next for Pamaj 28:30 MaNiaC Watch Party 42:00 Dreamhack Event is IMPORTANT 48:00 Best TV Shows51:20 What's your wind down routine? 56:00 FaZe house funny moments 58:30 Doing more

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League matches from 4/25/2025!

Pre-Show Saturday Major III Miami

Pre-show Friday Major III Miami

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League matches from 4/24/2025Like, comment, subscribe!

I don't cry often. Not because I'm especially tough—more because medicine does a pretty good job training that out of you. But sometimes? It happens. In this episode, I walk through four times I cried as a doctor (yes, one of them involves Rugrats), what led up to those moments, and what came after. There's also a side quest into diagnosing The Sandlot's Mr. Myrtle, a few shoutouts to comment-section philosophers, and some thoughts on whether it's even worth debating people who think vaccines contain nanobots. So yeah, a little bit of everything. Takeaways: Some Stories Stay with You. Some Break You Open. A patient. A family. A sound you can't unhear. It was week two of med school rotations, and I still think about it 15 years later. Residency Will Humble You—Sometimes Publicly. One attending. Two missed steps. Twenty minutes of educational humiliation in front of the entire department. I held it together… until I didn't. What's Worse Than Getting Diagnosed with Cancer Again? Getting that news and then getting paged for a bilateral open globe trauma five minutes later. Yep, that happened. The Rugrats Made Me Cry. Between Patients. In Clinic. If you don't tear up when Chucky says, “She's in the flowers,” you might already be in the flowers. I'm just saying. I Diagnosed the Blind Guy in The Sandlot. Of Course I Did. Was it glaucoma? Optic nerve trauma? A bizarre case of Hollywood medicine? Yes. Also: yes, my children left the room. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit http://www.EyelidCheck.com for more information.  Today's episode is brought to you by DAX Copilot from Microsoft. DAX Copilot is your AI assistant for automating clinical documentation and workflows helping you be more efficient and reduce the administrative burdens that cause us to feel overwhelmed and burnt out. To learn more about how DAX Copilot can help improve healthcare experiences for both you and your patients visit aka.ms/knockknockhi. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

Go to http://hims.com/optic to start your free online visit today. OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG 00:00 Live From Miami
03:00 Bracket Predictions 11:00 Halo championship 14:00 First meal in Miami 21:45 Ads 23:10 Dreamhack 25:30 roster changes in CDL (Beans Visa Issues) 30:00 New Nintendo Switch 33:00 Who wins Miami CDL 37:45 What's the best Post Season Sport? 42:00 Iguana encounter

The inflammatory and infectious optic neuropathies are a broad, heterogeneous, and common group of diseases producing visual loss. Although many now-distinct syndromes have been previously combined as “typical or atypical optic neuritis,” recent developments highlight the importance of precision terminology as well as an individualized evaluation and treatment approach. In this episode, Gordon Smith, MD, FAAN speaks with Eric Eggenberger, DO, MS, FAAN, author of the article “Optic Neuritis” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Eggenberger is a professor of ophthalmology, neurology, and neurosurgery at the Mayo Clinic in Jacksonville, Florida. Additional Resources Read the article: Optic Neuritis Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: This is Dr Gordon Smith. Today I'm interviewing someone who really needs no introduction, Dr Eric Eggenberger, about his article on optic neuritis, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Eric, welcome to the podcast, and maybe you can introduce yourself to our audience. Dr Eggenberger: Thank you. Thanks for having me. So, my name is Eric Eggenberger. I work at Mayo Clinic Florida, and I am involved exclusively in neuro-ophthalmology. Dr Smith: I just had the pleasure, Eric, of talking yesterday with Lindsey De Lott about non-optic neuritis causes of optic neuropathy. And so, I'm going to kind of reference a little bit what I learned yesterday. She was great. I wonder if you might begin by talking a little bit about nomenclature. You talk about the need for use of precise terminology in your article. And yesterday she taught me a lot about the risk of misdiagnosis and other causes of optic neuropathy, and the two seem related. So, I wonder if you can maybe lay the foundation for our conversation by talking about terminology? Dr Eggenberger: I think that's a great point. So, we are in an era now where, instead of lumping all these different diagnoses together, we have learned to split apart some of these clinical entities. And so, I think it's really important that we focus on precise terminology and recognize that all optic neuritis is not the same. And we have very different, distinct clinical pathways for these imaging pathways, treatment pathways, for these different types of optic neuritis, whether that's MS related, whether it's MOG related or aquaporin-4 related. Dr Smith: So, I wonder maybe we can begin by just, you know, giving our listeners wisdom, pearls, and pitfalls about, how do you recognize when someone with a suspected optic neuropathy has optic neuritis versus a noninflammatory optic neuropathy? Dr Eggenberger: So, that's a really important issue because there's a lot of clinical overlap in terms of exam findings. So, for instance, in any optic neuropathy, let's say it's unilateral, you typically are going to see decreases in acuity and field and color, and you're going to see a relative afferent pupillary defect. And then it's really the context that that occurs in that helps us distinguish different disease entities. So, with optic neuritis, typically you're going to have pain. And that's oftentimes going to be in the younger populations compared to some of the other common optic neuropathies we see, like ischemic optic neuropathy, for instance. Dr Smith: Right. So maybe we can talk a little bit about, kind of, your overall diagnostic approach, right? A lot of this is, of course, based on age and context, but young people get ischemic lesions and older people can have inflammatory lesions. So, what's your overall approach to the patient you just described? Let's say it's a forty-eight-year-old woman who comes to the emergency department with subacute unilateral vision loss and there's dyschromatopsia, APD, reduced acuity. And, you know, let's just say a fairly, you know, benign-looking fundoscopic exam. What do you do to evaluate that patient? Dr Eggenberger: In that particular context, I think we're looking at other contextual clues. Is there other vascular risk factors or other things to point you in one direction or the other? One of the important parts you mentioned was the fundus exam. So, we know with ischemic optic neuropathy, 100% of the time with AIOM, you're going to see disc edema. And so, in the context of that story, we want to confirm on our exam an optic neuropathy, and then we can kind of focus on the retrobulbar courses or different types of optic neuropathies. From an exam perspective, in that particular patient we'd be looking to measure the acuity, quantify that. And in the ER, you're not going to be able to do a perfect field, but you'll get some sense of the field and how much field loss there is. And then as you mentioned, the afferent pupillary defect is critical. And we're going to get a little bit of the historical features in terms of pain. With typical retrobulbar optic neuritis, most of those patients are going to experience some pain, and usually it's pain on eye movements. And those would be the clinical things to focus on. Other exposures the patient may or may not have had, any other concomitant conditions, would all help point you in different directions, perhaps, and then we're probably on towards imaging. Dr Smith: Yeah, maybe you can talk a little bit about that? What's the appropriate use of imaging? I mean, presumably the patients, like the one I just threw out there, are pretty much all going to get neuroimaging. What's your approach to that? How do you protocol the study? What should we be looking for? Dr Eggenberger: In our clinic, we would typically be ordering an MRI orbit and brain, and each of those has a specific purpose. The orbit is going to show us the extent of the optic neuropathy. So, we're particularly looking for a longitudinally extensive optic nerve lesion or more than half of the optic nerve involved. And most patients acutely, if it isn't an “itis" situation, we'll see enhancement. And then the MR brain is going to be useful for looking for other evidence of demyelination within the central nervous system. We may at some point get down to doing an MR cord, but I think acutely it's going to be brain and orbit that most of our patients are getting. Dr Smith: Let's say that we did the scan and, sure enough, there's sort of a shorter segment, so less than half the length of the nerve region of enhancement. What's the rest of your diagnostic evaluation look like for that patient? Dr Eggenberger: So, in that particular case, we would look at the remainder of the brain. So, we're looking for other evidence of demyelination and any other contextual clues, systemically that would point you one direction or another. But with a shorter segment involved, one of the more common things we might encounter would be multiple sclerosis-related optic neuritis. Dr Smith: Would you look for aquaporin-4 and MOG in a patient with what appears to be an isolated, uncomplicated short segment optic neuritis? Dr Eggenberger: So, I think it really depends a bit on the context. I would never fault anybody for looking at MOG or an aquaporin-4 in that context because those are really treatment-altering diagnoses, but the yield in this particular case with a short segment involved and depending on the acuity and other features is probably going to be pretty low. Dr Smith: I really liked as an aside- I wasn't going to go there next, but you kind of got me thinking about it, you have a really nice section in your article. Which, all of it's great, but talking about how to manage low titer MOG antibodies. I wonder if you could talk about that because I think that's a lesson, maybe, that is transferable to a lot of other testing that we do. in terms of pre-prior probability and titer and so forth. Dr Eggenberger: Yeah, that's really an important point. So, we've seen this come up a number of times where the MOG antibody is a very good test, but in low titer it has a relatively low positive predictive value, perhaps 50%. In those cases, particularly without a classic clinical context, you have to be extremely alert for some other diagnosis that could mimic what you think is inflammatory demyelinating optic neuritis, but in fact is infectious or some other cause. Dr Smith: Yeah, super, super important and helpful. In terms of aquaporin-4, how does that compare in terms of predictive values, lower titer positive results? Dr Eggenberger: So aquaporin-4, the test has a very high specificity. So, it's quite useful if positive. You have to keep in mind there can be some false negatives, but the test otherwise is quite specific. And that is a diagnosis, you know, we never want to miss. It's a vicious disease. It tends to be a blinding disease, particularly without treatment. Bad things happen when we miss that, and we want to get on that diagnosis early and do pretty aggressive early and prophylactic treatment. Dr Smith: Your article covers not only the common causes of optic neuritis and, you know, MS, isolated optic neuritis, MOGAD NMO, you talk about a bunch of other things. I wonder, in this patient that we've been discussing, in the absence of any other historical information that seems relevant---or maybe you can define what would seem relevant---would you do other evaluation in that individual, other serologic evaluation and so forth, just in terms of diagnosis? Dr Eggenberger: In that particular case, without other red flags, I don't think I would initially. And follow-up is going to give you a lot of this context. So, you'd be on the lookout for other systemic conditions. So, if the patient had some arthropathy, if the patient had any pulmonary disease hints, if there was anything else that could lead you on a broader expedition. But I think in the context of this case, acutely in the ER, I probably wouldn't do a big lab plug for this. I probably would kind of go down the most likely road and start our treatments, and then follow that patient up. Dr Smith: Yeah, I know your article does a really great job, I think, of outlining when do you need to think about some of these less common causes. Well, can we talk about treatment, Eric? Because I want to move on to some other things. But- so, we've got a patient with isolated optic neuritis, nothing else, you know, in terms of the other antibodies we've talked about. What state-of-the-care- or, state-of-the-art treatment for that patient? Dr Eggenberger: So, the acute treatment for these inflammatory, optic neuritis-type cases is very similar Initially. High dose steroids remains kind of the standard. And then, in MS-related optic neuritis, we may or may not see a taper. So many times it's just an acute treatment of three to five days high dose. Whether that's oral or PO, we could institute either depending on the particular case. And then the taper would depend on the potential cause. So, for instance, with these antibody-driven diseases---so with MOG- or particularly with aquaporin-4---if it's a longitudinally extensive region of optic nerve involved, we tend to use a longitudinally extensive taper. And so, we use prednisone in those cases for several months while we're getting everything else set and deciding what the overall course is going to bring. Dr Smith: What about IV versus oral? There must be something about my practice. I was telling this to Lindsey. Every time on our hospital service, we seem to have at least two patients with optic neuropathies, which I always enjoy, but I find it's a little weird to admit someone who's doing just fine otherwise to the hospital with three days of IV SOLU-MEDROL. So, I'm always trying to figure out, like, how can I get this patient home? And your article had the best term I've heard in a long time, which is “SOLU smoothies.” I mean, are there other strategies that you sometimes use, other than just high-dose IV methylprednisolone? Dr Eggenberger: So, I agree with you. It's sometimes hard to admit somebody for just an IV therapy. And we'll do this as an outpatient, high-dose IV, but we'll also use high-dose orals. And in times in the past when there's been methylprednisolone shortage, we've used high-dose oral or IV dexamethasone as well. I think the IV form, although it's the gold standard, the high-dose oral forms have pretty equivalent bioavailability and are pretty tolerable in my experience. And certainly more convenient. Dr Smith: I wonder if we should switch and maybe talk a little bit about aquaporin-4, I mean, you emphasized that this is a vicious disease---I love the way you describe that---and often blinding. What updates do you have in terms of our therapeutic approach to NMO? That's been rapidly evolving of late. Dr Eggenberger: Right, so these are cases we're always going to share with neuroimmunology. And it requires kind of a multidisciplinary approach, in my opinion, for ideal or for best outcomes. And so, all of these patients are going to get put on prophylactic medications. So, this is a disease you just can't leave untreated. Bad stuff will happen for sure. And we now, fortunately, have some approved, FDA-approved medications that can positively impact the course of this disease. So, that's been a welcome addition. Dr Smith: What are the FDA-approved medications at this point for NMO? Dr Eggenberger: So, there are several at this point, and this is an area that's in growth, fortunately. And again, these are cases we're going to be sharing with our neuroimmunology colleagues. So, these are IV medications typically aimed at complement or CD19. And they all are relatively effective at quieting the course of the disease. Dr Smith: Maybe we can talk a little bit about MOG? I think that most of our listeners are probably pretty familiar with aquaporin-4 and NMO, what- maybe you could describe MOG a little bit and the therapeutic approach for patients with MOG-associated disease? Dr Eggenberger: So, MOG has been a real interesting kind of condition to learn more about. We certainly see a lot of MOG, and I'm sure we saw MOG before it was formally described, but I think we just thought it was kind of a benign, maybe monophasic MS type of presentation. But MOG tends to come in with a loss of acuity that kind of rivals aquaporin-4. So, the acuity tends to be pretty, pretty depressed, but it's very steroid-responsive. So, a lot of times these are the patients, you'll see that their vision will start to improve even when they're on the initial few days of the high-dose steroids. And many times we can get their vision back to 20/20 or very close to that. Dr Smith: And do these patients need chronic management? Dr Eggenberger: So, that's an area of controversy to some degree. About 50% of the optic neuritis MOG-related cases are going to have a relapsing course. And because the disease is steroid-responsive, many times we'll follow these patients after a first attack to see if this is the condition that's going to declare itself to be relapsing or if this is just going to be a monophasic kind of presentation of optic neuritis. We don't have great biomarkers to separate patients who are going to be in that 50% monophasic course versus the other half. It'll be relapsing. And so, it depends on the patient. If there's somebody that's, as many of these patients are, been very steroid responsive, they get back to 20/20, we can teach them about the disease so that if they do have a relapse, we can get them high-dose steroids in a relatively rapid fashion and they're otherwise healthy, we're probably going to watch that patient. And if it's somebody that doesn't recover 100%, there's other issues with treating them with high-dose steroids potentially in the future, then we may learn more towards an earlier prophylactic approach in that patient. Dr Smith: And what would that approach look like? Is it different from NMO or using more IVIG or B cell depletion as opposed to complement inhibition, for instance? Dr Eggenberger: In MOG, we know that the B cell depletion strategies don't work as well. And so most times we're turning to IVIG, and we found that pretty effective. That's kind of our go-to at this point. Dr Smith: Eric, it's a joy talking to you and I'd love to keep going about content, but I'll refer our listeners to your outstanding article. I mean, you're such a highly regarded neuro-ophthalmologist and educator. I wonder if you could talk to us about why you've done neuro-ophthalmology, and maybe this is an opportunity for you to convince all of our great residents that are listening or students what's great about being a neuro-ophthalmologist. Dr Eggenberger: I think neuro-ophthalmology is by far the most interesting part of neurology. So, it's an area that I think a lot of general neurologists, in my view, don't get enough of in their residency. But it's kind of the essence of neurology, where in neurology you're localizing down to the millimeter and in neuro-ophthalmology,  we're localizing down to the micron level. We have several new emerging diseases like these varieties of optic neuritis we're focused on. We're learning lots about those. You get to be involved in lots of different areas of neurology. So, we'll see not just demyelinating conditions, we'll see trauma as it relates to the visual system. And we'll see tumor, and we see all different flavors, stroke, and in any piece of neurology, commonly we'll have some vision aspect that we that we get involved in. So, we see a wide variety of conditions. So, I think it's been a really exciting place to be within neurology. And it's rapidly changing at this point. We're getting new therapeutics. So, it's, I think it's a great time to be a neuro-ophthalmologist. Dr Smith: Yeah, listening to you talk and just reflecting on it, it's really true. Neuro-ophthalmology does cover the entire span of neurology, right? I'm a neuromuscular guy and we see a lot of ocular myasthenia, which is another super exciting area. But we've been talking about optic neuritis, and your article talks about infectious causes and the paraneoplastic and a whole host of things. So, you're a great advocate and salesperson for your field. You convinced me. Dr Eggenberger: Efferent neuro-ophthalmology we love, we could talk about ocular myasthenia and other aspects for another hour. And we get involved in all kinds of cases: third nerve palsies, ocular myasthenia, trauma that involves the efferent system, all different aspects. It's really a great subspecialty, and you get to see a bit of all of neurology. Dr Smith: I'm trying to remember who it was, Eric. It was an attending of mine at medical school. I went to medical school at the Mayo Clinic in Rochester, and I want to say it was Manny Gomez, who was a very famous tuberous sclerosis person, who told me that neuro-ophthalmology was the most elegant specialty within neurology. That stuck with me. Thank you so much for joining me today. I really appreciate it. Dr Eggenberger: Thank you. I appreciate it as well. Dr Smith: So again, today I've been interviewing Dr Eric Eggenberger about his really wonderful article on optic neuritis, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum audio episodes from the neuro-ophthalmology and other issues. And listeners, thank you very much for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

This episode we discuss the 2025 NFL Draft, give a brief history of Optic downtowns and our feelings on uptowns, PSA re-holder guidelines, PSA not grading Certified mirror gold cards. SCL HC S6E29

Welcome to another episode of the NEW Scrap Time Podcast! In this episode we discuss the upcoming Major 3 event as well as give our predictions for the bracket. You can expect to see new podcast episodes once a week on both YouTube and your favorite audio platform!Follow The Hosts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ben Nissim⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠JKap⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Octane⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Chelly

FaZe ZooMaa, Ben, Temp, Parasite, and Octane break down the Call of Duty League matches from 4/20/2025!

This episode is sponsored by BetterHelp — go to http://betterhelp.com/optic to get 10% off your first month. Go to http://shopify.com/optic to sign up for your $1-per-month trial and start selling today. OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG Scump Is Going Pro AGAIN | The OpTic Podcast Ep. 221 00:00 Intro 01:00 Pickleball 10:00 Done w/ the 90's 22:00 HCS this weekend 31:00 Ads 34:45 Wagers 38:00 Castro wedding 42:00 Miami 49:00 New CoD leaks

In today's episode, host Dr. Amanda Redfern invites Dr. Nancy Newman to share updates in the treatment of Leber hereditary optic neuropathy (LHON), covering several clinical trials underway that involve idebenone and gene therapy.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Optic neuropathies encompass all congenital or acquired conditions affecting the optic nerve and are often a harbinger of systemic and central nervous system disorders. A systematic approach to identifying the clinical manifestations of specific optic neuropathies is imperative for directing diagnostic assessments, formulating tailored treatment regimens, and identifying broader central nervous system and systemic disorders. In this episode, Gordon Smith, MD, FAAN speaks with Lindsey De Lott, MD, MS, author of the article “Optic Neuropathies” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. De Lott is an assistant professor of neurology and ophthalmology at the University of Michigan in Ann Arbor, Michigan. Additional Resources Read the article: Optic Neuropathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @lindseydelott Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: Hello, this is Dr Gordon Smith. Today I'm interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Lindsey, welcome to the podcast, and perhaps you can introduce yourself to our audience. Dr De Lott: Thank you, Dr Smith. My name is Lindsey De Lott and I am a neurologist and a neuro-ophthalmologist at the University of Michigan. I also serve as the section lead for the Division of Neuro-Ophthalmology, which is actually part of the ophthalmology department rather than the neurology department. And I spend a good portion of my time as a researcher in health services research, and that's now about 60% of my practice or so. Dr Smith: I'm super excited to spend some time talking with you. One, I'm a Michigan person. As we were chatting before this, I trained with Wayne Cornblath and John Trobe, and it's great to have you. I wonder if we maybe can begin- and by the way, your article is outstanding. It is such a huge topic and it was actually really fun to read, so I encourage our listeners to check it out. But you begin by talking about misdiagnosis as being a common problem in this patient population. I wonder if you can talk through why that is and if you have any pearls or pitfalls in avoiding it? Dr De Lott: Yeah, I think there's been a lot of great research looking at misdiagnosis in specific types of optic neuropathies; in particular, compressive optic neuropathies and optic neuritis. A lot of that work has come out of the group at Emory and the group at Washington University. But a lot of neuro-ophthalmologists across the country really contributed to those data. And one of the statistics that always strikes me is that, you know, for example, in patients with optic nerve sheath meningiomas, something like 70% of them are actually misdiagnosed. And a lot of those errors in diagnosis, whether it's for compressive optic neuropathy or some other type of optic neuropathy, really comes down to the way that physicians are really incorporating elements of the history in the physical. For example, in optic neuritis, we know that physicians tend to anchor pretty heavily on pain in general. And that often tends to lead them astray when optic neuritis was never the diagnosis to begin with. So, it's really overindexing on certain things and not paying attention to other features of the physical exam; for example, say presence of an afferent pupillary defect. So, I think it just really highlights the need to have a really relatively structured approach to patients that you think have an optic neuropathy when you're trying to sort of plan your diagnostic testing and your treatment. Dr Smith: I do maybe five or six weeks on our hospital service each year, and I don't know if it's just a Richmond thing, but there's always at least two people in my week who come in with an optic neuropathy or acute vision loss. How common is this in medical practice? Or neurologic practice, I should say? Dr De Lott: Optic neuropathies themselves… if you look across, unfortunately we don't have any great data that puts together all optic neuropathies and gives us an actual sort of prevalence estimate or an incidence estimate from year to year. We do have some of those data for specific types of optic neuropathies like optic neuritis and NAION, and you're probably looking around five-ish per one hundred thousand. So, these aren't that common, but at the same time they do get funneled to- often to emergency rooms and to neurologists from our ophthalmology colleagues and optometry colleagues in particular. Dr Smith: So, one other question I had before kind of diving into the topic at hand is how facile neurologists need to be in recognizing other causes of acute visual loss. I mean, we see acute visual loss as neurologists, we think optic neuropathy, right? Optic neuritis is sort of the go-to in a younger patient, and NAION in someone older. But what do neurologists need to know about other ophthalmologic causes? So, glaucoma or acute retinal disorders, for instance? Dr De Lott: Yeah, I think it's really important that neurologists are able to distinguish optic neuropathies from other causes of vision loss. And so, I would really encourage the listeners to take a look at the excellent article by Nancy Newman about vision loss in this issue where she really kind of breaks it down into vision loss that is acute and chronic and how you really think through distinguishing optic neuropathies from other causes of vision loss. But it is really important. For example, a patient with a central retinal artery occlusion may potentially be eligible for treatments. And that's very different from a patient with optic neuritis and acute vision loss. So, we want to be able to distinguish these things.  Dr Smith: So maybe we can pivot to that a little bit. Just for our listeners, our focus today is going to be on- not so much on optic neuritis, although obviously we need to talk a little bit about how we differentiate optic neuritis from non-neuritis optic neuropathies. It seems like the two most common situations we encounter are ischemic optic neuropathies and optic neuritis. Maybe you can talk a little bit about how you distinguish these two? I mean, some of it's age, some of it's risk factors, some of it's exam. What's the framework, of let's say, a fifty-year-old person comes into the emergency room with acute vision loss and you're worried about an optic neuropathy? Dr De Lott: The first step whenever you are considering an optic neuropathy is just making sure that the features are present. I think, really going back to your earlier question, making sure that the patient has the features of an optic neuropathy that we expect. So, it's not only vision loss, but it's also the presence of an apparent pupillary defect in a patient with a unilateral optic neuropathy. In a person who has a bilateral optic neuropathy, that apparent pupillary defect may not be present because it is relative. So, you really would have to have asymmetric vision loss between the two eyes. They should also have impairment of their color vision, and they're probably going to have some kind of visual field defect, whether that's central scotoma or an arcuate scotoma or an altitudinal defect that really respects the horizontal meridian. So, you want to make sure that, first and foremost, you've got a patient that really meets most of those- most of those features. And then from there, we're looking at the other features on their history. How acute is the onset of the vision loss? What is the progression over time? Is there pain associated or not associated with the vision loss? What other medical issues does the patient have? And you know, one of the things you already brought up, for example, is, what's the age of the patient? So, I'm going to be much more hesitant to make a diagnosis of optic neuritis in a much older patient or a diagnosis on the other side, of ischemic optic neuropathy, in a much younger patient, unless they have really clear features that push me in that direction. Dr Smith: I wonder if maybe you could talk a little bit about features that would push you away from optic neuritis, because, I mean, people who are over fifty do get optic neuritis- Dr De Lott: They do. Dr Smith: -and people who get ischemic optic neuropathies who are younger. So, what features would push you away from optic neuritis and towards… let's be broad, just a different type of optic neuropathy? Dr De Lott: Sure. We know that most patients with optic neuritis do have pain, but that pain is accompanied---within a few days, typically---with vision loss. So, pain alone going on for a number of days without any visual symptoms or any of those other things I listed, like the afferent papillary defect, the visual field defect, would push me away from optic neuritis. But in general, yes, most optic neuritis is indeed painful. So, the presence of optic disc edema is unfortunately one of those things that an optic neuritis may be present, may not be present, but in somebody with ischemia that is anterior---and that's the most common type of ischemic optic neuropathy, would be anterior ischemic optic neuropathy---they have to have optic disc edema for us to be able to make that diagnosis, and that is a diagnosis of NAION, or nonarteritic ischemic optic neuropathy. An APD in this case, again, that's just a feature of an optic neuropathy. It doesn't really help you to distinguish, individual field defects are going to be relatively similar between them. So then in patients, I'm also looking, like I said, at their history. So, in a patient where I'm entertaining a diagnosis of ischemic optic neuropathy, I want to make sure that they have vascular risk factors or that I'm actually doing things like measuring their blood pressure in the office if they haven't seen a physician recently or checking a lipid panel, hemoglobin A1c, those kinds of things, to look for vascular risk factors. One of the other features on exam that might push me more- again, in a patient with ischemic optic neuropathy, where it might suggest ischemia over optic neuritis, would be some other features on exam like a crowded optic disc that we sometimes will see in patients with ischemic optic neuropathy. I feel like that was a bit of a convoluted answer. Dr Smith: I thought that was a great answer. And when you say crowded optic disc, that's the- is that the “disc at risk”? Dr De Lott: That is the “disk at risk,” yes. So, crowded optic disk is really a disk that is smaller than what we see in the average population, and the average cup to disk ratio is 0.3. So, I think that's where 30% of the disk should be. So, this extra wiggle room, as I sometimes will explain to my patients. Dr Smith: And then, I wonder if you could talk a little bit about more- just more about exam, right? You raised the importance of recognizing optic disc edema. Are there aspects of that disc edema that really steer you away from optic neuritis and towards ischemia-like hemorrhages or whatnot? And then a similar question about the importance of careful visual field testing? Dr De Lott: So, on the whole, optic disc edema is optic disc edema. And you can have very severe optic neuritis with hemorrhages, cotton wool spots, which is essentially just an infarction of the retinal nerve fiber layer either overlying the disc or other parts of the retina. And ischemia, you can have some of the same features. In patients who have giant cell arteritis, which is just one form of anterior ischemic optic neuropathy, patients can have a pallid optic disc edema where the optic disc is swollen and white-looking. But on the whole, swelling is swelling. So, I would caution anyone against using the features of the optic nerve swelling to make any type of, sort of, definitive kind of diagnosis. It's worth keeping in mind, but I just- I would caution against using specific features, optic nerve swelling. And then for visual field testing, there are certain patterns that sometimes can be helpful. I think as I mentioned earlier, in patients with ischemic optic neuropathy, we'll often see an altitudinal defect where either the top half or, more commonly, the bottom half of the vision is lost. And that vision loss in the field corresponds to the area of swelling on the disk, which is really rewarding when you're actually able to see sectoral swelling of the disk. So, say the top half of the disk is swollen and you see a really dense inferior defect. And other types of optic neuropathy such as hereditary optic neuropathies, toxic and nutritional optic neuropathies, they often cause more central field loss. And in patients who have optic neuropathies from elevated intracranial pressure, so papilladema, those folks often have more subtle visual field loss in an arcuate pattern. And it's only once the optic nerves have sustained a pretty significant injury that you start to see other patterns of field loss and actual decline in visual acuity in those patients. I do think a detailed visual field assessment can often be pretty helpful as an adjunct to the rest of the exam. Dr Smith: So, we haven't talked a lot about neuroimaging, and obviously, neuroimaging is really important in patients who have optic neuritis. But how about an older patient in whom you suspect ischemic optic neuropathy? Do those patients all need a MRI scan? And if so, is it orbits and brain? How do you- how do you protocol it? Dr De Lott: You're asking such a good question, totally controversial in in some ways. And so, in patients with ischemic optic neuropathy, if you are confident in your diagnosis: the patient is over the age of fifty, they have all the vascular, you know, they have vascular risk factors. And those vascular risk factors are things like diabetes, hypertension, high blood pressure, hyperlipidemia, obstructive sleep apnea. They have a “disc at risk” in the fellow eye. They don't have pain, they don't have a cancer history. Then doing an MRI of the orbits is probably not necessary to rule out another cause. But if you aren't confident that you have all of those features, then you should absolutely do an MRI of the orbit. The MRI of the brain probably doesn't provide you with much additional information. However, if you are trying to distinguish between an ischemic optic neuropathy and, say, maybe an optic neuritis, in those patients we do recommend MRI orbits and brain imaging because the brain does provide additional information about other CNS demyelinating disorders that might be actually the cause of a patient's optic neuritis. Dr Smith: I wonder if you could talk a little bit about posterior ischemic optic neuropathy. That's much less common, and you mentioned earlier that those patients don't have optic disk edema. So, if there's a patient who has vision loss that- in a similar sort of clinical scenario that you talked about, how do you approach that and under what circumstances do we see patients who have posterior ischemic optic neuropathy? Dr De Lott: So, you're going to most often see patients with posterior ischemic optic neuropathy who, for example, have undergone a recent surgery. These are often associated with things like spinal surgeries, cardiac surgeries. And there are a number of risk factors that are associated with it. Things like blood pressure, drain surgery, the amount of blood loss, positioning of patient. And this is something that the surgeons and anesthesiologists are very sensitive to at this point in time, and many patients are often- this can be part of the normal informed consent process at this point in time since this is something that is well-recognized for specific surgeries. In those patients, though… again, unless you're really certain, for example, maybe the inpatient neurology attending and you've been asked to consult on a patient and it's very clear that they went into surgery normal, they came out of surgery with vision loss, and all the rest of the features really seem to be present. I would recommend that in those cases you think about orbital imaging, making sure you're not missing anything else. Again, unless all of the features really are present- and I think that's one of the themes, definitely, throughout this article, is really the importance of neuroimaging in helping us to distinguish between different types of optic neuropathy. Dr Smith: Yeah, I think one of the things that Eric Eggenberger talks about in his article is the need to use precise nomenclature too, which I plan on talking to him about. But I think having this very structured approach- and your article does it very well, I'll tell our listeners who haven't seen it there's a series of really great tables in the article that outline a lot of these. I wonder, Lindsey, if we can switch to talk about arteritic optic neuropathy. Is that okay? Dr De Lott: Sure. Yeah, absolutely. Dr Smith: How do you sort that out in an older patient who comes in with an ischemic optic neuropathy? Dr De Lott: Yeah. In patients who are over the age of fifty with an ischemic optic neuropathy, we always need to be thinking about giant cell arteritis. It is really a diagnosis we cannot afford to miss. If we do miss it, unfortunately, patients are likely to lose vision in their fellow eye about 1/3 to 1/2 the time. So, it is really one of those emergencies in neuro-ophthalmology and neurology. And so you want to do a thorough review systems for giant cell arteritis symptoms, things like headache, jaw claudication, myalgias, unintentional weight loss, fevers, things of that nature. You also want to check their inflammatory markers to look for evidence of an elevated ESR, elevated C-reactive protein. And then on exam, what you're going to find is that it can cause an anterior ischemic optic neuropathy, as I mentioned earlier. It can cause palette optic disc swelling. But giant cell arteritis can also cause posterior ischemic optic neuropathy. And so, it can be present without any swelling of the optic disc. And in fact, you know, you mentioned one of my mentors, John Trobe, who used to say that in a patient where you're entertaining the idea of posterior ischemic optic neuropathy, who is over the age of fifty with no optic disc swelling, you should be thinking about number one, giant cell arteritis; number two, giant cell arteritis; number three, giant cell arteritis. And so, I think that is a real take-home point is making sure that you're thinking of this diagnosis often in our patients who are over the age of fifty, have to rule it out. Dr Smith: I'll ask maybe a simple question. And presumably just about everyone who you see with a presumed ischemic optic neuropathy, even if they don't have clinical features, you at least check a sed rate. Is that true? Dr De Lott: I do. So, I do routinely check sedimentation rate and C-reactive protein. So, you need to check both. And the reason is that there are some patients who have a positive C-reactive protein but a normal sedimentation rate, so. And vice versa, although that is less common. And so both need to be checked. One other lab that sometimes can be helpful is looking at their CBC. You'll often find these patients with giant cell arteritis have elevated platelet counts. And if you can trend them over time, if you happen to have a patient that's had multiple, you'll see it sort of increasing over time. Dr Smith: I'm just thinking about how you sort things out in the middle, right? I mean, so that not all patients with GCF, sky-high sed rate and CRP…. And I'm just thinking of Dr Trobe's wisdom. So, when you're in an uncertain situation, presumably you go ahead and treat with steroids and move to biopsy. Maybe you can talk a bit about that pathway? Dr De Lott: Yeah, sure. Dr Smith: What's the definitive diagnostic process? Do you- for instance, the sed rate is sky-high, do you still get a biopsy? Dr De Lott: Yes. So, biopsy is still our gold-standard diagnosis here in the United States. I will say that is not the case in all parts of the world. In fact, many parts of Europe are moving toward using other ancillary tests in combination with labs and exam, the history, to make a definitive diagnosis of giant cell arteritis. And those tests are things like temporal artery ultrasound. We also, even though we call it temporal artery ultrasound, we actually need to image not only the temporal arteries but also the axillary arteries. The sensitivity and specificity is actually greater in those cases. And then there's high-resolution imaging of the vessels and the- both the intracranial and extracranial distributions. And both of those have shown some promise in their predictive values of patients actually having giant cell arteritis. One caution I would give to our listeners, though, is that, you know, currently in the US, temporal artery biopsy is still the gold standard. And reading the ultrasounds and the MRIs takes a really experienced radiologist. So, unless you really know the diagnostic accuracy at your institution, again, temporal artery biopsy remains the gold standard here. So, when you are considering giant cell arteritis, start the patient on steroids and- that's high dose, high dose steroids. In patients with vision loss, we use high dose intravenous methylprednisolone and then go ahead and get the biopsy. Dr Smith: Super helpful. And are there other treatments, other than steroids? Maybe how long do you keep people on steroids? And let's say you've got a patient who's, you know, diabetic or has other factors that make you want to avoid the course of steroids. Are there other options available? Dr De Lott: So, in the acute phase steroids are the only option. There is no other option. However, long term, yes, we do pretty quickly put patients on tocilizumab, which is really our first-line treatment. And I do that in conjunction with our rheumatology colleagues, who are incredibly helpful in managing and monitoring the tocilizumab for our patients. But when you're seeing the patients, you know, whether it's in the emergency room or in the hospital, those patients need steroids immediately. There are other steroid-sparing agents that have been tried, but the efficacy is not as good as tocilizumab. So, the American College of Rheumatology is really recommending tocilizumab as our first line steroid-sparing agent at this point. Dr Smith: Outstanding. So again, I will refer our listeners to your article. It's just chock-full of great stuff. This has been a great conversation. Thank you so much for joining me today. Dr De Lott: Thank you, Dr Smith. I really appreciate it.  Dr Smith: The pleasure has been all mine, and I know our listeners will be enjoying this as well. Again, today I've been interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. I already mentioned Dr Eggenberger and I will be talking about optic neuritis, which will be a great companion to this discussion. Listeners, thank you for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In the final episode of this four-part series, Dr. Justin Abbatemarco and Dr. Nancy Newman discuss the abstract she presented at the AAN Annual Meeting and details on the upcoming gene therapy trial.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000208987 

FaZe ZooMaa, Ben, Aches, Octane, and Nameless break down the Call of Duty League matches from 4/12/2025

OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQGWe Got Kicked Out of the Heczquarters | The Flycast Ep. 144 00:00 Intro 01:00 Why are we walking around 20:00 Falcons Roster 23:10 European Pro Gamers 25:00 Getting a new dog 48:00 MaNiaC moving to Austin

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League matches from 4/11/2025!

Go to http://rocketmoney.com/optic to cancel your unwanted subscriptions with Rocket Money. Go to http://shopify.com/optic to sign up for your $1-per-month trial period. Go to http://factormeals.com/optic50off and use code optic50off to get 50% off plus free shipping on your first box. OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG Shotzzy's Thoughts on OpTic Texas After Week 1 | The OpTic Podcast Ep. 220 00:00 Intro 01:00 Scump Pickleball 06:05 Current Status of OpTic Texas 15:00 Hecz in a creative rut 22:20 CS2 Makes $80M on cases 32:00 Ads 37:45 Minecraft Movie 40:30 Mars & Aliens 51:00 Direwolves Revived 54:00 Pick 2 to defend, the rest attack

In part two of this four-part series, Dr. Justin Abbatemarco and Dr. Nancy Newman discuss current treatment options for Leber hereditary optic neuropathy (LHON). Show reference:   https://index.mirasmart.com/AAN2025/PDFfiles/AAN2025-002206.html   

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty League matches from 4/5/2025!

OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQGThe Hardest Part of OpTic Paige's Job | The Flycast Ep. 14300:00 Intro 01:00 MaNiac hosting the Halo podcast 10:00 Paige splitting time 21:00 When hitch retired from gaming 23:00 OpTic Activities 32:00 MaNiac Streaming 39:00 3 people you would have dinner with 50:00 Last time you cried

FaZe ZooMaa, Ben, Aches, Parasite, and Octane break down the Call of Duty Matches from 4/4/2025!

Go to http://hims.com/optic to start your free online visit today. This episode is sponsored by BetterHelp — go to http://betterhelp.com/optic to get 10% off your first month. Go to http://shopify.com/optic to sign up for your $1-per-month trial period. OpTic Gaming Merch: https://shop.opticgaming.com/ Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTic Check out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047 https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG 00:00 Intro 03:40 NBA Fight 10:00 OpTic Texas New Team & Scrims 14:30 HCS Kaysan LAN 19:20 Scump having kids 25:00 Streaming Scrims 30:20 Ads 36:00 CDL Schedule 40:00 Rostermania 48:00 Verdansk 52:00 New CoD room 56:20 OpTic Halo Major 58:00 MLG Anaheim 2025?

OpTic Gaming Merch: https://shop.opticgaming.com/Check out the OpTic SCUF collection and use code “OpTic” for a discount: https://scuf.co/OpTicCheck out the OpTic Podcast here: https://podcasts.apple.com/us/podcast/optic-podcast/id1542810047https://open.spotify.com/show/25iPKftrl0akOZKqS0wHQG00:00 Maniac is GM 04:00 ATB 13:30 Halo LAN this weekend 33:00 Duos in esports 44:45 Faze and OpTic Dynasty 49:00 OpTic CDL Major 1:03:00 OpTic Texas