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Biomedical subjects

D I Kaufman

Publications and source records attributed to D I Kaufman.

9 recordsLinked to original sources
PubMed1992

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.

BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

Acute Disease↗
PubMed1992

Visual impairment in hysteria.

We have reviewed the charts of 45 neuro-ophthamological patients diagnosed with 79 monocular visual field or visual acuity losses secondary to non-organic etiology. Our aim was to determine the percentage of patients that have improvement in vision. As part of the protocol, all patients had magnetic resonance images, pattern visual evoked potentials, and flash electroretinography in addition to complete neuro-ophthalmological examinations. A single physician performed both the initial and follow-up examinations of all patients. Thirty-three percent of these patients had visual field defects only, 62% had both visual field defects and visual acuity defects, and 5% had only visual acuity defects. After organic disease was ruled out, all were given a timetable for recovery and clear reassurance regarding their prognoses for visual recovery. Seventy-eight percent of these patients showed improvement or were normal, while 22% showed no improvement. Younger patients without obvious psychiatric disorder had better prognoses than older patients.

Adolescent↗
PubMed1991

Breast cancer metastatic to the eye is a common entity.

Breast cancer metastatic to the eye is a common entity occurring in up to 30% of women with metastatic disease. The prevalence of this lesion is not appreciated because of the dominant clinical picture of metastases occurring in other organs. The diagnosis should be suspected in any women with a history of breast cancer and any visual symptoms, particularly metamorphopsia and scotomata. A thorough ophthalmologic evaluation, aided by ultrasonography, computed tomography, or magnetic resonance scanning, usually confirms the diagnosis. Early treatment with radiation therapy can alleviate symptoms and control local disease. The recognition and treatment of this disorder is important in maximizing the quality of life in patients with metastatic breast cancer, especially because newer treatment regimens prolong survival and thereby increase the chances for ocular metastasis.

Breast Neoplasms↗
PubMed1991

Effect of decreased retinal illumination on simultaneously recorded pattern electroretinograms and visual-evoked potentials.

Sixteen normal subjects and three patients with optic neuritis were studied to determine the effect of decreased retinal illumination on simultaneously recorded pattern electroretinograms (PERG) and visual-evoked potentials (VEP). Using neutral-density filters (NDF), it was found that linear modeling is an excellent fit for VEP/PERG amplitudes and latencies as log functions of retinal illumination, both for individual eyes and averages of pooled data. Within narrow statistical limits, regression slopes show that mean PERG B-wave and VEP P100 latencies are affected almost identically by decreased illumination, leaving the mean retinocortical time (RCT) virtually unchanged. However, mean B-wave amplitude was greatly reduced at retinal illuminations at which P100 amplitude was unaffected. Of clinical significance was that these latency and amplitude effects were found in each eye tested, whether normal or pathologic. In particular, the RCT in normal subjects was never found to be statistically abnormal due to decreased retinal illumination, and it faithfully represented the optic nerve lesion in the patients with optic neuritis. This result was applied to a population of eight patients with uncomplicated cataracts. The significance of these results is discussed.

Adolescent↗
PubMed1990

Optic neuritis: a prospective study.

We studied 20 patients with acute optic neuritis prospectively for 12 months. Visual fields, color vision, and VEPs to 15' checks were initially abnormal in all patients. Visual acuity was abnormal in 90% and contrast sensitivity in 95% of patients. We devised a graded visual impairment scale (GVIS) to include all visual functions tested. Complete recovery of visual function occurred in 65% of cases. Recovery in the majority of patients was rapid and complete within the first 2 months. In some patients, improvement continued over 6 months. The initial classification on the GVIS was significantly correlated with the final outcome. Patients initially classified as having moderate visual impairment recovered completely or improved to near normal vision. Sixty percent of patients initially classified as total or severe blindness had permanent visual impairment. VEP latency remained prolonged in 19 patients, even when their vision had returned to normal, and is a reliable indicator of resolved optic neuritis.

Adult↗
PubMed1988

The pattern electroretinogram: a long-term study in acute optic neuropathy.

We report a 2-year prospective study of the electroretinographic response to reversal of checkerboard patterns (P-ERG) obtained in 63 eyes with acute optic nerve lesions. The aim of the study was to document the value of P-ERG regarding diagnosis and prognosis of four types of optic neuropathy: optic neuritis, compressive or hereditary optic atrophy, and traumatic optic neuropathy. We documented visual loss by neuro-ophthalmologic examination and recorded pattern-reversal visual evoked potentials (P-VEP). The initial P-ERG was normal to large- and medium-sized checks in 89% and the P-VEP abnormal in 94% of eyes with acute optic nerve lesions. Forty-six eyes were followed for up to 2 years. Two groups emerged. Group A (n = 17) gradually and permanently had significant reduction of the P-ERG to three separate check sizes. All 17 had no improvement in acuity better than 20/100, retained centrocecal scotomas, and developed optic atrophy. In group B (n = 29) the P-ERG remained within normal limits to one or more check sizes. Twenty-two of these eyes recovered acuity to 20/25 or better and had resolution of the field defect. The data showed that P-VEP was superior to P-ERG in diagnosis of acute and chronic optic nerve lesions. However, significant reduction of the b-wave of the P-ERG to three separate check sizes correlated closely with failure of visual recovery and the eventual development of severe optic atrophy, suggesting a prognostic value for P-ERG in optic neuropathy.

Adolescent↗
PubMed1988

Electrophysiology versus psychophysics in the detection of visual loss in pseudotumor cerebri.

This study compared visual evoked potentials (VEP) and contrast sensitivity (CS) as methods of detecting visual loss in 15 women with acute onset of pseudotumor cerebri (PTC). A total of 24 out of 30 eyes (14 of 15 patients) had a visual disturbance. Neuro-ophthalmologic examination demonstrated abnormal Goldmann visual fields in 13 of 30 eyes. CS was abnormal in 18 eyes; VEP was abnormal in five eyes. Nine eyes had visual loss detected by CS only, five by perimetry only, and one had the VEP as the sole abnormality. CS was a valuable adjunct to perimetry in PTC whereas VEP was rarely helpful.

Adolescent↗
PubMedDate not supplied

Improving the reliability of pattern electroretinogram recording.

The pattern electroretinogram (PERG) is a small electrical response of the retina to a reversing checkerboard pattern, usually less than 6 microV in amplitude. Unfortunately, the PERG can be obscured by artifacts such as blinks, eye movements, poor fixation, and amplifier saturation. Amplitude criterion artifact rejection systems found on commercial signal averagers eliminate large amplitude artifacts but are insensitive to small amplitude artifacts associated with amplifier saturation. Such saturation often occurs for several recording sweeps after large amplitude signals such as eye blinks are rejected. The presence of post-saturation artifacts complicates clinical PERG analysis. In this paper we describe procedures to remove these small amplitude artifacts from the PERG. These include computer selection of inputs for averaging and use of tracings with small input numbers to approximate PERG amplitudes. These procedures greatly reduce the variability of PERG amplitudes in the normal population, making PERG amplitude a more reliable clinical measure.

Adolescent↗