What are the research gaps in neuro-ophthalmology that warrant systematic analysis?

From the Guidelines

I strongly recommend focusing on the following research gaps in neuro-ophthalmology for systematic analysis: "What is the efficacy of novel glaucoma interventions, such as MIGS, in reducing intraocular pressure and preventing disease progression compared to traditional treatments?". This question addresses the need for high-quality evidence on the effectiveness of new glaucoma interventions, as highlighted by the lack of strong evidence in recent systematic reviews 1. Other promising narrow research questions include:

• "What is the correlation between retinal nerve fiber layer thickness and cognitive decline in early Parkinson's disease?"
• "How effective is low-dose atropine in preventing myopia progression in children with neurofibromatosis type 1?"
• "What is the predictive value of pupillary light reflex parameters for outcomes in traumatic brain injury patients?"
• "Do specific OCT biomarkers predict conversion from radiologically isolated syndrome to clinically definite multiple sclerosis?" These questions target specific clinical applications, patient populations, and measurable outcomes that would benefit from systematic analysis, addressing current knowledge gaps where evidence-based guidance is needed for clinical decision-making, as emphasized by the need for reliable systematic reviews in the field of refractive error 1. The development of core outcome sets, as mentioned in the context of glaucoma research 1, could also be explored in other areas of neuro-ophthalmology to improve the quality and comparability of systematic reviews. Additionally, the management of idiopathic intracranial hypertension (IIH) is an area where consensus guidelines have been developed 1, but further research is needed to address uncertainties and improve patient outcomes.

From the Research

Potential Research Gaps in Neurophthalmology

Some potential research gaps in the field of neurophthalmology that could be explored through systematic analysis include:

• What is the optimal timing for plasma exchange treatment in patients with severe optic neuritis, and how does it impact visual recovery outcomes 2?
• Can a novel magnetic resonance imaging scoring system be developed to differentiate between optic neuritis in neuromyelitis optica spectrum disease and multiple sclerosis 3?
• What are the most effective treatment strategies for atypical forms of optic neuritis, and how do they differ from typical optic neuritis treatment approaches 4?
• How can optical coherence tomography be used to distinguish between neuromyelitis optica and multiple sclerosis, and what are the implications for disease diagnosis and management 5?
• What are the differences in macular and peripapillary neurovascular alterations between multiple sclerosis and neuromyelitis optica spectrum disorder, and how can these be used to facilitate differentiation between the two conditions 6?
• What is the role of immune prophylaxis in preventing the development of multiple sclerosis in patients with optic neuritis, and what are the potential benefits and risks of this approach 4?
• How do the clinical presentation and disease course of optic neuritis differ between patients with neuromyelitis optica spectrum disorder and those with multiple sclerosis, and what are the implications for treatment and management 3, 5, 6?
• What are the potential applications of optical coherence tomography angiography in diagnosing and monitoring optic neuritis, and how does it compare to other imaging modalities 6?