Visual Pathways - NC State Veterinary Medicine · 2019-09-27 · Visual Pathways Michael Davidson...
Transcript of Visual Pathways - NC State Veterinary Medicine · 2019-09-27 · Visual Pathways Michael Davidson...
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Visual Pathways
Michael DavidsonProfessor, Ophthalmology
Diplomate, American College of Veterinary Ophthalmologists
Department of Clinical SciencesCollege of Veterinary MedicineNorth Carolina State UniversityRaleigh, North Carolina, USA
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Miller PE, Murphy CJ. Vision in Dogs. JAVMA. 1995; 207: 1623.
Miller PE, Murphy CJ. Equine Vision. In Equine Ophthalmology ed. Gilger BC. 2nd ed. 2011: pp 398-433.
Ofri R. Optics and Physiology of Vision. In Veterinary Ophthalmology. ed. Gelatt KN 5th ed. 2013: 208-270,
Vision in Animals
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www.studyblue.com
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Visual Cortex
Lateral Geniculate Body
Optic Radiation
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www.studyblue.com
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Visual Fiber (Retinotopic) Segregation
each cerebral hemisphere receives information from contralateral visual field
nasal retinal fibers decussate, temporal retinal fibers do not…right nasal hemiretinal fibers cross over project to left cerebrum, right temporal fibers remain uncrossed and project to right cerebrum
target in right half of visual field (right visual hemifield) ⇒ right nasal retina and left temporal retina ⇒ left optic tract ⇒ left dLGN ⇒ left cerebral hemisphere
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Visual Fiber (Retinotopic) Segregation
each cerebral hemisphere receives information from contralateral visual field
nasal retinal fibers decussate, temporal retinal fibers remain ipsilateral…right nasal retinal fibers cross over project to left cerebrum, right temporal fibers remain uncrossed and project to right cerebrum
target in right half of visual field (right visual hemifield) ⇒ right nasal retina and left temporal retina ⇒ left optic tract ⇒ left dLGN ⇒ left cerebral hemisphere
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Nasal Retina =Temporal hemifield
TemporalRetina =
Nasalhemifield
Fibers Decussate
Fibers Remain Ipsilateral
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OD Visual FieldOD OS
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Visual Fiber (Retinotopic) Segregation
each cerebral hemisphere receives information from contralateral visual field
nasal retinal fibers decussate, temporal retinal fibers remain ipsilateral…right nasal retinal fibers cross over project to left cerebrum, right temporal fibers remain uncrossed and project to right cerebrum
target in right half of visual field (right visual hemifield) ⇒ right nasal retina and left temporal retina ⇒ left optic tract ⇒ left dLGN ⇒ left cerebral hemisphere
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target in right half of visual field (right visual hemifield) ⇒right nasal retina and left temporal retina ⇒ left optic tract ⇒ left dLGN ⇒ left cerebral hemisphere
www.dreamstime.com
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target in left half of visual field (left visual hemifield) ⇒ left nasal retina and right temporal retina ⇒ right optic tract ⇒right dLGN ⇒ right cerebral hemisphere
www.dreamstime.com
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Visual Fiber Segregation
Object in right visual hemifield projects to:- right nasal hemiretina- left temporal
hemiretina- left cerebrum
Object in left visual hemifield projects to: - left nasal hemiretina- right temporal
hemiretina- right cerebrum
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Assessing Visual Pathways
pupillary light reflex incl. chromatic testing (optic) dazzle reflex
optokinetic reflex
electroretinogram visual-evoked response
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Cortical....PLR/Dazzle normal; Vision Abnormal
Afferent Arm Before LGB ...PLR/Dazzle and Vision Abnormal
Brainstem Reflexes and Visual Pathways
**ipRGCs
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(Optic) Dazzle Reflex Test
partial eyelid blink in response to bright light- subcortical reflex- eyelids may open then close- contralateral closure < or sometimes absent
afferent=optic nerve/tract to rostral colliculi efferent= CN VII
present 1-2 days postnatally in dogs/cats
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LGB
Rostral ColliculiPretectal Nuclei
CN VII
CN VII nuclei
Obicularis oculi mm.
DAZZLE REFLEX
CN II
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Other Rostral Colliculus-Mediated Reflexes
Coordination of eye movements in response to visual stimulus (rostral colliculi to CN III, IV, VI)
Turning of head and neck in response to visual stimulation (motor fibers in spinotectal tract)
Reticular activation system (activates cortex)
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Assessing Vision and Visual Pathways menace response obstacle or maze course
- Gearhart PM, Gearhart CC, Petersen-Jones SM. A Novel Method for Objective Vision Testing in Canine Models of Inherited Retinal Disease Invest Ophthalmol Vis Science 2008; 49: 3568-3576.
visual placing reaction- hold dog in air, advance to table edge...both forelegs will
extend visual cliff
- clear plexiglas extended over edge of table…visual animal stops at table edge
- large animals = present birth- dogs/cats = 4 week
patching or occluding for unilateral vision loss
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Menace Response cortically mediated eyelid closure +/- head
withdrawal and globe retraction- complex “response” not reflex
requires intact retina, optic nerve/tract/radiation, visual cortex, inter-cerebral cortices pathways, descending pathways to brainstem and CN VII
undefined connection with cerebellum:- may result from pathway passing through cerebellum OR
from loss of cerebellar facilitation/modulation of motor cortex
- cerebellar lesion results in ipsilateral (unilateral) or bilateral menace response loss with normal vision
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LGB
Visual CortexMotor Cortex
CN VII
Cerebellum
CN VII Nuclei
Visual inputObicularis oculi mm
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Automated Visual Field Testing
www.meadowsretina.com
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Hemianopia (vision loss/deficit in ½ of visual field in one or both eyes)
homonymous hemianopia:- loss of one hemivisual
field (e.g. loss of right visual field from loss of nasal retinal fibers in right eye and temporal fibers in left eye)
- any unilateral lesion caudal to chiasm
heteronymous hemianopia:- loss of two hemivisual
fields (e.g. loss of both temporal visual fields from loss of both nasal retinal fibers):
- chiasmal lesions if affect only crossed fibers (bitemporal hemianopia)
- Siamese cats (binasal hemianopia)
quadrantic hemianopia:- partial unilateral lesion
caudal to chiasm
www.ttuhcs.edu
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Hemianopia (vision loss/deficit in ½ of visual field in one or both eyes)
homonymous hemianopia:- loss of one hemivisual
field (e.g. loss of right visual field from loss of nasal retinal fibers in right eye and temporal fibers in left eye)
- any unilateral lesion caudal to chiasm
heteronymous hemianopia:- loss of two hemivisual
fields (e.g. loss of both temporal visual fields from loss of both nasal retinal fibers):
- chiasmal lesions if affect only crossed fibers (bitemporal hemianopia)
- Siamese cats (binasal hemianopia)
quadrantic hemianopia:- partial unilateral lesion
caudal to chiasm
www.ttuhcs.edu
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Characteristics of Visual Pathway Lesions
Retina Pre-chiasmal optic nerve Optic chiasm Optic tract Lateral geniculate body Optic radiation Occipital (visual) cortex Parietal and frontal (motor) lobe Cerebellum
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Unilateral Retinal Chain, Intraocular Retinal Ganglion Lesions
lack of direct and consensual (to fellow eye) PLRs
positive swinging flashlight test/cover uncover (Marcus-Gunn pupil)
PLRs may persist with advanced retinal disease and visual deficits (ipRGCs, high intensity blue light stimuli)
ipsilateral visual deficits (menace response)
ipsilateral optic dazzle deficits
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Unilateral Prechiasmal Optic Nerve Lesions
signs identical to retinal disorders
Left Right
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www.ttuhcs.edu
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Optic Chiasmal Lesions
total lesions cause bilateral PLR and visual deficits
PLR deficits may be recognized before visual deficits
abnormalities in behavior, appetite, temperature regulation, endocrine function dysfunction and visceral motor activities
Left Right Left Right
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Central Chiasmal Lesions
Common in humans with pituitary macroadenomas
may cause heteronymous hemianopia e.g. only crossing fibers affected:- bitemporal hemianopia
…crossing fibers from nasal hemiretina involved, loss of both temporal visual fields
Left Right
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www.ttuhcs.edu
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Pituitary Gland/Optic Chiasm
Humans = pituitary stalk directed rostroventrally, main mass of gland directly below chiasm (10mm), macroadenomas often involve central chiasm and are a common cause of vision loss
Dogs = pituitary stalk directed caudoventrally, main mass of gland is caudal (posterior) to chiasm, macroadenomas or other tumors uncommon cause of vision loss
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Unilateral Optic Tract Lesions similar to unilateral retinal or
prechiasmal optic nerve but more dilated pupil contralateral to lesion
subtle anisicoria more miotic pupil persists in the
same eye regardless of which eye is stimulated
visual field contralateral to affected tract is diminished or lost- contralateral homonymous
hemianopia- vision loss most obvious in eye
contralateral to lesion visual field testing performed by
directing menace response stimuli from lateral and medial to midline (patching or occlusion)
Left Left
75% fibers OS 25% fibers OD
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www.ttuhcs.edu
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Lesions in Optic Tract
proximity to internal capsule (all ascending and descending fibers to and from motor cortex)
contralateral postural reaction deficits with normal gait (proprioceptive pathways)
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Bilateral Retina, Optic Chiasm Optic Nerve or Tract Lesions
lesions in both retinas more common than (>) chiasm > both optic nerves > caudal commissure > optic tracts
bilateral mydriasis, PLR deficits, visual deficits commensurate with lesion
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Lesions of Optic Radiation
Contralateral homonymous hemianopia
Left Left
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www.ttuhcs.edu
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Lesions of Optic Radiation
proximity to caudal limb of internal capsule (ascending and descending fibers from motor cortex):- complete contralateral
homonymoushemianopia
- contralateral hemiplegia and hemianesthesia
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Unilateral Visual Cortex Lesions
Complete, contralateral homonymous hemianopia
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www.ttuhcs.edu
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Visual Cortex Projections
To opposite visual cortex via corpus callosum
To motor cortex of both cerebral hemispheres
To cerebellum by way of pons
To rostral midbrain (rostral colliculi and to CN III, IV, VI nuclei, directly or indirectly through rostral colliculi)
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Visual Cortex rostral and medial regions:
- steropsis and processing- analysis- form, pattern, texture
caudal and lateral regions:- menace blink response
rostral region:- visual placing
caudal and medial regions:- conjugate eye movements (orientation and
attention of eyes to visual target)- corticotectal pathways directly to brainstem
(rostral colliculi, CN III, IV, VI nuclei directly or indirectly through rostral colliculi)
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Rostral Visual Cortex:visual placing
Motor Cortex
forelimbs
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Visual Cortex rostral and medial regions:
- steropsis and processing- analysis- form, pattern, texture
rostral region:- visual placing- to motor cortex
caudal and lateral regions:- menace blink response- to motor cortex
caudal and medial regions:- conjugate eye movements (orientation and attention of eyes
to visual target)- corticotectal pathways directly to brainstem (rostral colliculi,
CN III, IV, VI nuclei directly or indirectly through rostral colliculi)
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Caudomedial Visual Cortex: Conjugate gaze, orientation to visual targets
Extraocular mm.
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Visual Cortex Connections(de Lahunta)
Visual cortex and rostral midbrain (rostral colliculi, CN III, IV, VI nuclei, gaze centers) have extensive interaction in mediating visually guided behavior:- Total bilateral rostral colliculectomy caused inattention to all
visual stimuli and loss of visual placing and menace - Mesencephalic tegmentum (CN III, IV, VI, and gaze
centers) lesions cause loss of visual perception of movement and spatial orientation
- Unilateral lesion of the tegmentum cause contralateral deficit and postural dystonia (severe torsion of head) from vision loss
- Bilateral removal of visual cortex, cats can still detect objects in lateral visual field via direct rostral collicular projections from eye
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Complete, Unilateral Visual Cortex Lesions
Complete, contralateral homonymous hemianopia
Loss of menace blink response in contralateral visual field
Loss of conjugate eye movements to target in contralateral visual field
Loss of contralateral visual placing
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Bilateral Visual Cortex Lesions complications of
anesthesia (hypoxia) polioencephalomalacia
(thiamine deficiency) lead intoxication in
ruminants metabolic storage
diseases in dogs and cats
cranial trauma with contrecoup effect (human)
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Parietal Lobe and Frontal Lobe Lesions
loss of menace response and visual placing in contralateral visual field
no loss of vision no loss of conjugate
gaze (orientation and attention to target stimuli)….mediated by visual cortex with corticotectal projections directly to brainstem gaze centers
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Cerebellar Lesions
Contralateral or bilateral mydriasis with normal PLR
Ipsilateral or bilateral absence of menace blink response with normal vision
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QUESTIONS?