We would like to thank Dr. Shubhakaran for his insightful comment regarding
our review article on the application of OCT in neurologic diseases.1
Topiramate is often used for a variety of neurologic diseases including migraines, bipolar disorder, epileptic seizures, and infantile spasms.
From a pathomechanistic perspective, topiramate-induced glaucoma is due to ciliochoroidal effusion resulting in forward displacement of the iris-lens diaphragm causing shallowing of the anterior chamber and
subsequent elevated intraocular pressure. As mentioned by Dr. Shubhakaran, OCT of the anterior segment demonstrates shallowing of the anterior chamber and conventional retinal OCT can show choroidal thickening as early as one week after starting topiramate therapy.2 These anatomical changes can occur without producing any ocular symptoms but certainly increase the risk of developing unilateral or even bilateral acute-angle-closure glaucoma in patients with asymptomatic narrow angles.3 It would be prudent to consult with an ophthalmologist to evaluate for narrow angles before initiating therapy and utilizing OCT to monitor sub-clinical ocular changes at one week after the start of therapy. However, we would
like to emphasize that topiramate-induced glaucoma is a clinical diagnosis and requires measuring intraocular pressure.
Disclosures: R.S. Maldonado and P. Mettu report no disclosures. M. El-Dairi serves as a consultant for Prana Biotechnology and receives research support from The Knights Templar. M. Bhatti has received funding for travel from and serves on a scientific advisory board, as a consultant, and on the speakers' bureaus for Novartis and serves on the editorial board of Journal of Neuro-Ophthalmology.
References:
1. Maldonado RS, Mettu P, El-Dairi M, Bhatti MT.The application of optical coherence tomography in neurologic diseases. Neurol Clin Pract October 2015;5:460-469.
2. Karalezli A, Koktekir BE, Celik G. Topiramate-induced changes in anterior chamber angle and choroidal thickness. Eye Contact Lens 2015 May 23. [Epub ahead of print].
3. Palomares P, Amselem L, Diaz-Llopis M. Optical coherence tomography for diagnosis and monitoring of angle-closure glaucoma induced by topiramate. Can J Ophthalmol 2007;42:633-634.
We would like to thank Dr. Shubhakaran for his insightful comment regarding our review article on the application of OCT in neurologic diseases.1 Topiramate is often used for a variety of neurologic diseases including migraines, bipolar disorder, epileptic seizures, and infantile spasms.
From a pathomechanistic perspective, topiramate-induced glaucoma is due to ciliochoroidal effusion resulting in forward displacement of the iris-lens diaphragm causing shallowing of the anterior chamber and subsequent elevated intraocular pressure. As mentioned by Dr. Shubhakaran, OCT of the anterior segment demonstrates shallowing of the anterior chamber and conventional retinal OCT can show choroidal thickening as early as one week after starting topiramate therapy.2 These anatomical changes can occur without producing any ocular symptoms but certainly increase the risk of developing unilateral or even bilateral acute-angle-closure glaucoma in patients with asymptomatic narrow angles.3 It would be prudent to consult with an ophthalmologist to evaluate for narrow angles before initiating therapy and utilizing OCT to monitor sub-clinical ocular changes at one week after the start of therapy. However, we would like to emphasize that topiramate-induced glaucoma is a clinical diagnosis and requires measuring intraocular pressure.
Disclosures: R.S. Maldonado and P. Mettu report no disclosures. M. El-Dairi serves as a consultant for Prana Biotechnology and receives research support from The Knights Templar. M. Bhatti has received funding for travel from and serves on a scientific advisory board, as a consultant, and on the speakers' bureaus for Novartis and serves on the editorial board of Journal of Neuro-Ophthalmology.
References:
1. Maldonado RS, Mettu P, El-Dairi M, Bhatti MT.The application of optical coherence tomography in neurologic diseases. Neurol Clin Pract October 2015;5:460-469.
2. Karalezli A, Koktekir BE, Celik G. Topiramate-induced changes in anterior chamber angle and choroidal thickness. Eye Contact Lens 2015 May 23. [Epub ahead of print].
3. Palomares P, Amselem L, Diaz-Llopis M. Optical coherence tomography for diagnosis and monitoring of angle-closure glaucoma induced by topiramate. Can J Ophthalmol 2007;42:633-634.