SARDs/IMR — Awareness Central

This page contains videos referred to by the Sudden Acquired Retinal Degeneration Sydrome (SARDs) and Immune Mediated Retinitis (IMR) — approach to diagnostic and therapeutic modalities presentation created by Dr. Grozdanic, available on our Documentation page.

If you have a broadband connection, we recommend that you download the complete presentation file directly from Iowa State University.  The complete file contains the presentation file as well as all of the videos that you see below on this page.

To download the complete file, which is approximately 250 MB,  click on the icon below.

 

Page 5 — SARDs pupil 

• No red light response
• Good blue response
• White light usually elicits pupil responses in SARDs patients.

 

Page 6 — SARDs pupil

• White light is an unreliable source for evaluation of PLR responses in dogs with SARDs and IMR.
• Deficient / incomplete or absent PLRs after white light stimulus can frequently be seen in dogs with SARDs.

 

Page 7 — IMR pupil response

• Red response is always present, albeit very slow, incomplete, and with prominent escape
• Blue response is always normal

 

Page 16 — IMR & SARDs — evaluate carefully for other neurological symptoms

• 5 year old castrated male
• History of ataxia, hypermetria, nystagmus, change in mentation, no visual problems

 

Page 17 – IMR & SARDs — evaluate carefully for other neurological symptoms

• SARDs patient
• History of sudden onset of blindness
• Neurology examination: ataxia, stiff gait, head tilt, circling behavior, proprioceptive deficits.

•  IMR patient
• History of sudden onset of blindness
• Smell loss, hearing loss, and change in behavior (would sporadically look like he “stares at an object” for 1-2 hours)

 

 Page 32 — SARDs — response to steroid + doxy therapy

• SARDs patient
• Symptoms of ataxia, hearing, and vision loss.
• Dog is currently on .5 mg/kg BW of prednisone twice/week.
• Discontinuation of theraphy results in immediate onset of neurological symptoms and full blindness.
• Current length of treatment is 16 months post diagnosis.

Page 34 — Treatment Criteria — menace and ERC vs. visual maze testing

• Absence of menace and ERC activity is not evidence of blindness
• Visual maze test should be checked in dim and bright light conditions
• Both patients in movies were referred to as with absent ERG and diagnosed as blind
• Patients with residual vision are best candidates fo treatment

 

Page 46 — SARDs pupil response — post IVIg

• Healthy dog pupil response

• SARDs before IVIg
• SARDs post IVIg

 

Page 47 — SARDs — lack of visual response after IVIg therapy

• Owner described loss of vision and sense of hearing over 4 weeks
• Patient had significant loss of retinal structure
• However, owner decided to pursue IVIg treatment
• No visual recovery detected, although, owner reports better hearing.

 

Page 48 — SARDs visual response after IVIg therapy

• Menace recovered 2 weeks after treatment
• Patient remains visual 12 months after treatment

 

• First SARDs patient ever treated with IVIg.
• Patient remains visual 22 months after treatment.

 

Page 49 — SARDs post IVIg therapy

• Movies show patient before and 24 hours after systemic IVIg therapy
• Rocovery of visual navigation is evident
• No recovery in menace and ERG response could be detected

 

Page 50 — SARDs post IVIg therapy

• Movies show patient before and 24 hours after systemic IVIg therapy
• Rocovery of visual navigation is evident
• No recovery in menace and ERG response could be detected
• Patient also had symptoms of polyuria and polydipsia, which resolved 10 days after treatment

 

Page 51 — SARDs response to IVIg treatment

• Most frequent response to IVIg treatment is recovery of visual navigation in bright light conditions
• SARDs patients are frequently completely night blind and do not recover menace response
• Visual maze testing in dim and bright light conditions is essential when making determination of whether patient is blind or not

 

Page 52 — SARDs and IVIg treatment

• It is not unusual to observe visual recovery which is limited to objects with a good contrast to the background
• This patient was treated with intra-ocular IVIg

 

Page 53 — IMR — lack of visual response after theraphy

• Even with the best effort and investment of time and resources, this can be the outcome of therapeutical effort.
• Owners should have realistic expectations about the outcome of therapy.

 

Page 54 — IMR response to steroid + doxycycline therapy

• Patient remains visual 14 months after onset of therapy.
• Currently receiving 0.5 mg/kg of prednisone twice per week.
• Complete withdrawal of steroids results in the complete blindness within 24 – 48 hours.

• Patient was initially treated with prednisone 1mg/kg BW BID.
• Gradually over time, vision was stabilized only with a dosage of 2 mg/kg BW BID.

 

Page 55 — IMR — cancer associated retinopathy response to intra-ocular IVIg therapy.

• This IMR patient progressed to blindness despite being on mega dose of system steroids over the course of 6 months (2mg/kg prednisone BID PO)
• Intra-ocular IVIg injected was pursued in an attempt to restore vision.
• Patient was diagnosed with a brain tumor and cancer associated retinopathy.
• Intra-ocular IVIg was injected in the right eye only.

 

Page 56 — IMR — cancer associated retinopathy response to intra-ocular IVIg therapy

• Thirteen (13) days post intra-ocular IVIg injection patient is capable of nagivating mase test and retrieving objects.

 

Page 57 — IMR — cancer associated retinopathy response to intra-ocular IVIg therapy

• Menace testing before IVIg treatment showed negative response bi-laterally.
• Menace (13 days post IVIg injection) showed intermittent response in the right (injected) eye, and good response in the lef t (non-injected) eye

 

Page 59 — IMR response to intra-ocular IVIg

• Patient has chronic history of seasonal skin allergies
• At this time, patient is visual (6 months post injection) and maintained on a prednisone dose of 0.5 mg/kg BW twice weekly.
• Flare-up of the skin diseases results in immediate vision loss.

 

 

Page 60 — IMR response to intra-ocular IVIg

• Patient was treated with a high dose of steroids and doxycycline over the course of 6 weeks, however, with poor response to therapy.
• Intra-ocular IVIg injected restored almost completely normal day vision, while night vision was significantly compromised.
• Patient remained visual in both eyes 5 months after single IVIg injection in left eye only.

 

Page 63 — Early detection of IMR and SARDs.

• Five year-old castrated Brittany Spaniel male — history of chronic epiphora.
• Opthalmic examination bilaterl micropunctae were identifed as possible cause of epiphora.
• Routine Red-Blue PLR screen shows slow pupil response to red light (with moderate pupil escape)
• Testing of vision did not reveal visual deficits in dim and bright light
• Scotopic flash andn flicker ERG showed normal amplitudes
• Fundus evaluation revealed pale optic nerve head and arterioral attenuation
• Owner reports history of polyphagia in the last 5 months and an increase in weight.
• Patient is hunting dog and owner believes that vision is excellent

 

Page 64 — Early detection of IMR and SARDs

• Five year-old castrated Brittany Spaniel male — 6 weeks after initial presentation, owner reports reluctance to jump on the bed in dim light conditions.
• Visual maze testing revealed some reluctance to navigate in very dim light conditions with sporadic bumping into objects
• Diagnosis of IMR was established.
• CBC, chemistry, UA, throacic and abdominal radiographs were within normal limits.
• CT scan of the brain and OCT scan of the retina were unremarkable.
• Serum testing for retinal audo-antibodies was negative.
• Detailed ERG analysis revealed only deficits in RGC function (decreased pERG amplitudes) suggestive oif the “RGC conduction block” (normal optic nerve structure — OCT, normal intrinsic activity — positive blue light PLR, abnormal conduction of signal from rod/cone system to RGCs — poor red light PLR, poor pERG amplitudes)

 

Page 68 — IMR may be the early feature of localized or system neoplastic disease

• 11 year old Miniature Pinscher, spayed female
• Chronic inflammatory bowel disease
• Chronic protein loosing enteropathy
• Chronic dermatitis
• Diffuse lymphadenopathy for 4 weeks
• Swollen right nictitatns for 2 weeks
• Presented to ophthalmology service as a consult for swollen nictitans.
• Opthmalmic examination revealed inconsistent menace in dim light in the left eye and abnormal pupil response to the red light.
• ERG (scotopic flash and flicker) were within normal limits.

If you have any questions, feel free to email us at info@sardsawareness.org.

If you have not already done so, please participate in our poll to the right.