DIAGNOSTICS FOR NEURO-OPHTHALMOLOGIC LESIONS:
THE EYES ARE THE DOOR TO YOUR BRAIN –
AN INTERACTIVE WEB-DELIVERED TRAINING GUIDE







APPROVED BY SUPERVISORY COMMITTEE









Lewis E. Calver, M.S., Chair, Associate Professor

Biomedical Communications Graduate Program



Kim Hoggatt Krumwiede, M.A.,
Associate Professor
Biomedical Communications Graduate Program



Dario Beltran, M.D.
Department of Neurology

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ACKNOWLEDGEMENTS

I would like to thank my professors, Lew Calver and Kim Krumwiede for all of their help
and support. Thanks to Dr. Dario Beltran for all the Saturdays he spent providing me with
expertise. Special thanks to Dr. Elliot Frohman and Dr. Douglas Woo for their help with
revisions and text, and to Bruce Blausen for donation of 3D models. Thank you also to the
Vesalius Trust for financial support.

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DIAGNOSTICS FOR NEURO-OPHTHALMOLOGIC LESIONS:
THE EYES ARE THE DOOR TO YOUR BRAIN –
AN INTERACTIVE WEB-DELIVERED TRAINING GUIDE




by


RICHARD P. HOWDY, JR.






THESIS


Presented to the Faculty of the Graduate School of Biomedical Sciences

The University of Texas Southwestern Medical Center at Dallas

In Partial Fulfillment of the Requirements

For the Degree of



MASTER OF ARTS

The University of Texas Southwestern Medical Center at Dallas

Dallas, Texas

December, 2005

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Copyright

by

Richard P. Howdy, Jr.

2005

All Rights Reserved

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DIAGNOSTICS FOR NEURO-OPHTHALMOLOGIC LESIONS:
THE EYES ARE THE DOOR TO YOUR BRAIN –
AN INTERACTIVE WEB-DELIVERED TRAINING GUIDE


Publication No.



Richard P. Howdy, Jr., M.A.

The University of Texas Southwestern Medical Center at Dallas, 2005


Supervising Professor: Lewis E. Calver, M.S.






Historically, neuro-ophthalmology residents have had trouble making the transition
from reading about the diagnostics of neuro-ophthalmologic lesions to making diagnoses in
clinic. An interactive program would act as an intermediary between the text book learning
phase and the clinical examination phase by providing an interactive program. The goal of
this thesis was to create a web-delivered training guide that correlates clinical eye exams with
lesion localization for neurologists. The guide used illustrations, animations, and MRI’s to
enhance the teaching of the diagnosis of neuro-ophthalmologic lesions found primarily in
multiple sclerosis (MS) patients.
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TABLE OF CONTENTS
LIST OF FIGURES

CHAPTER 1: INTRODUCTION ......................................................................................... 1
Goal
Background
Significance
Limitations
Production
Methods
Terminology

CHAPTER 2: REVIEW OF EXISTING LITERATURE..................................................... 5

Overview
Neuro-Ophthalmology
Diagnosis and Management

Neuroanatomy Through Clinical Cases
Neuroexam.com

The Multiple Sclerosis Comprehensive Treatment Training Course

The Neuro-Ophthalmology Virtual Education Library

CHAPTER 3: METHODOLOGY....................................................................................... 13

Concept and Research Collection
Planning
Product
Components
Information
Design
Organization


3D Studio Max® by Discreet®
Adobe®
Premiere®
Macromedia®
Flash®
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Graphic Design and Macromedia® Dreamweaver® (and Macromedia®
Fireworks®)
Editing
Distribution

CHAPTER 4: EVALUATION............................................................................................ 32

CHAPTER 5: CONCLUSION............................................................................................ 37
Project
Summary
Discussion

Conclusion

Suggested Area of Further Research

APPENDIX: QUESTIONNAIRE AND RESPONSES ................................................... 39

REFERENCES

vii

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LIST OF FIGURES


Figure 2-1. Cover testing for ocular misalignment. (Reprinted from Neuro-Ophthalmology
Diagnosis and Management, Liu, Volpe, Galetta, Copyright 2001, with permission from
Elsevier.)


Figure 2-2. Eye Movement Recordings. (Reprinted from Neuro-Ophthalmology Diagnosis
and Management, Liu, Volpe, Galetta, Copyright 2001, with permission from Elsevier.)


Figure 2-3. Effects of Lesions in Brainstem Pathways for Horizontal Eye Movements. (A)
Locations of lesions. (B) Eye movements during leftward and rightward gaze with lesions
shown in (A). (Reprinted from Neuroanatomy Through Clinical Cases, Blumenfeld,
Copyright 2002, with permission from Sinauer Associates.)


Figure 2-4. Trochlear Nerve (CN IV) Palsy (A) Appearance of Eyes in the presence of a
right trochlear nerve palsy. Hypertropia can be compensated for by tucking the chin and
looking up slightly. Extorsion can be compensated for by tilting the head away from the
affected eye. (B) Results of red glass testing with right trochlear nerve palsy. Red glass was
placed over the right eye. (C) Appearance of a horizontal white line to the patient with a red
glass over the right eye. (Reprinted from Neuroanatomy Through Clinical Cases,
Blumenfeld, Copyright 2002, with permission from Sinauer Associates.)


Figure 3-1. Checklist. The column on the left shows the three main categories of the guide
along with the subcategories for each section. The top row shows a list of possible materials
that may be needed for each individual page.


Figure 3-2. Title page and the three secondary pages


Figure 3-3. 3D Studio Max® models


Figure 3-4. Targa maps. (a) the initial green color map and the final blue color map, (b)
bump map, and (c) specular highlight map



viii

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Figure 3-5. Opacity map


Figure 3-6. Brainstem model


Figure 3-7. Edited model with blue iris and eyelashes


Figure 3-8. Screen grab of Adobe® Premiere® workspace


Figure 3-9. Screen grab of Macromedia® Flash® workspace


Figure 3-10. (a) Parasympathetic pathway for pupillary constriction and (b) sympathetic
system for pupillary dilation


Figure 3-11. Sample layout designs for guide interface


Figure 3-12. Screen grab from Macromedia® Fireworks® work space


Figure 4-1. Questionnaire results

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CHAPTER ONE
Introduction



Historically, neuro-ophthalmology residents have had trouble making the transition
from reading about the diagnostics of neuro-ophthalmologic lesions to making diagnoses in
clinic. An interactive program would act as an intermediary between the text book learning
phase and the clinical examination phase.

Goal

The goal of this thesis was to create a web-delivered training guide that correlates
clinical eye exams with lesion localization for neurologists. The guide will use illustrations,
animations, and MRI’s to enhance the teaching of the diagnosis of neuro-ophthalmologic
lesions found primarily in multiple sclerosis (MS) patients.

A major objective of this project was to clearly present the normal and abnormal
conditions associated with the pupils, eye movements, and diplopia. The guide allows the
viewer to see an idealized version of what is often unclear when observed in clinic. The eyes
in this guide are always clear and informative. Another objective was to effectively
coordinate Discreet® 3D Studio Max® animations with Macromedia® Flash®.

The guide will serve as a template for any projects similar in nature or for future
expansions of this project. The thesis document contains information about the methods and
processes of creating the 3D animations, integrating them into a 2D Flash platform, and
combining them into a final web-based guide.

Background
In the U.S., 250,000-350,000 people have MS with 200 new cases diagnosed each
week. The initial symptom of MS is often blurred or double vision, red-green color
distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the
later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as
1

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Document Outline

• Diagnostics For Neuro-Ophthalmologic Lesions
• Acknowledgements
• Table of Contents
• List of Figures
• Chapter One: Introduction
• Chapter Two: Review of Existing Literature
• Chapter Three: Methodology
• Chapter Four: Evaluation
• Chapter Five: Conclusion
• Appendix: Questionnaires
• References
• Vitae

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