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Biomedical subjects

E Gramer

Publications and source records attributed to E Gramer.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Effect of systolic blood pressure on the location of visual field defects in upper and lower visual half-fields in patients with chronic simple glaucoma].

In earlier studies we found that visual field defects occur more frequently in the lower half of the visual field and that low systolic blood pressure occurs more frequently in low-tension glaucoma (stage II) compared to primary open-angle glaucoma (POAG) (stage II). We wanted to find out whether visual field defects in the lower half of the visual field point to insufficient perfusion of the optic nerve head due to low blood pressure. We therefore examined the visual fields of 153 eyes of 153 patients with POAG and regulated IOP with program 31 or 33 of the Octopus perimeter 201. With program Delta the loss per test point in the upper and lower hemifield was calculated. The mean systolic blood pressure was calculated for each patient from the blood pressure recordings during the observation time and over a long-term follow-up period (3-19 visual field examinations during a period of 1-8 years). With the Delta program we decided case by case whether the visual field showed a tendency to deteriorate or not. An asymmetry in the mean loss per test point between the two visual hemifields in a relation of 2:1 or more was found in 71 eyes out of 153. In the upper hemifield 50 out of 71 patients had two times greater loss per test point than in the lower hemifield. These patients showed a mean systolic blood pressure of 158 +/- 37 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Sensitivity of noise field campimetry as a screening method for glaucoma].

The glaucoma patient can perceive his or her visual field loss subjectively with snow field campimetry with the Tübingen electronic campimeter (TEC). The sensitivity of this new method of examination for glaucoma has not previously been evaluated. We were interested in finding whether absolute and relative scotomas could be detected with such high probability that snow field campimetry could be used as a screening method for the early detection of glaucoma. Analysis of the severity of scotoma is not possible, so that snow field perimetry can indeed by regarded as a screening procedure. A total of 76 eyes of 76 patients with glaucoma and stage I-IV visual field loss and 20 eyes of 20 patients with ocular hypertension were examined with threshold determining static perimetry (Octopus or Humphrey perimeter) and with the snow field of the TEC in controlled conditions. A qualitative comparison was drawn to evaluate how often a pathologic or normal finding was confirmed by snow field campimetry: of the 76 eyes affected by scotoma, 65 eyes (85.5%) showed pathologic findings consistent with the result of snow field campimetry, and 11 eyes showed normal findings. The visual field loss was 63.6% for glaucomatous visual field loss stage I: 90.9% for glaucomatous visual field loss stage II, and 95% for visual field loss stages III and IV. For 16 of the 20 eyes with ocular hypertensions normal findings were reported with snow field campimetry. Snow field campimetry is suitable for use as a quick screening procedure, but only for absolute glaucomatous scotomas.

Adult↗
PubMed1990

[Significance of raised intraocular pressure in glaucomatous visual field defects. A clinical study].

1. 300 eyes of 300 patients with primary open angle glaucoma (POAG) were examined with program 31 of the Octopus perimeter 201 and the amount of visual field loss (total loss) was quantified with program Delta. The total loss was correlated to the height of the maximum intraocular pressure (IOP max). There was no correlation in the interindividual comparison between IOP max and total loss. This shows the influence of IOP independent risk factors in POAG. 2. In an intraindividual comparison 108 eyes of 54 patients with POAG were examined under the question: Have eyes with the four times higher amount of visual field loss in one eye compared to the other, a significant higher IOP max in the eye with the more severe damage. The intraindividual comparison excludes cardiovascular risk factors, because they affect both eyes. So the difference in IOP can show better the damaging influence of IOP: Eyes with the higher amount of visual field loss showed a significant higher IOP max. This shows the impact of the elevated IOP is a risk factor in POAG. 3. 300 eyes of 300 patients with POAG were further examined under the question, whether the relation between the mean loss per test point in the upper half of the visual field in comparison to the mean loss per test point in the lower half of the visual field is different at different IOP max levels. 162 eyes with an IOP max of less than 30 mmHg and 75 eyes with an IOP max of 30 up to 36 mmHg and 63 eyes with IOP max of 37 and more mmHg were evaluated and the 3 groups were compared. With an increasing height of IOP max an increasing equal distribution of the visual field loss in upper and lower visual field half was found. High IOP results in a diffuse nerve fibre damage and more IOP-unindependent risk factors result in localized visual field damage. So there are at least two pathomechanisms in POAG.

Glaucoma, Open-Angle↗
PubMed1989

Optic nerve head measurements: the optic nerve head analyzer--its advantages and its limitations.

The Optic Nerve Head Analyzer (ONHA) calculates by means of computer-assisted analysis of stereo images different parameters of the optic disc: disc diameter, disc size, cup/disc ratio (CDR), neuroretinal rim area, and excavation volume for the disc quadrants and for the total disc. To obtain first indications of the clinical value of ONHA measurements for diagnosis and follow-up in glaucoma we examined the reproducibility of measurement results for different diseases. Furthermore, we studied the mean values of the different disc parameters in healthy eyes. It was investigated: 1) whether the reproducibility is different in the different disc parameters; 2) whether the reproducibility in different eye diseases is different as compared to healthy eyes; 3) by which criteria the reproducibility is influenced; 4) whether there is a correlation between disc size and size of rim area. The reproducibility was studied in 178 eyes of 178 patients, who were all examined twice with the ONHA. The mean difference between the results of first and second measurement was calculated for the different disc parameters. Differences were found in the reproducibility of the parameters: e.g., the mean difference between first and second measurement was 1.8 percent for the disc size, and 5.6 percent for the neuroretinal rim area. For the disc quadrants, the reproducibility of values was worse than for the total disc. No marked differences of reproducibility of disc parameters were found for different diseases. Reproducibility depends, for instance, upon correct determination of the disc margin. In healthy eyes, a significant correlation was found between rim area and disc size: larger discs have a larger neuroretinal rim area than smaller discs. Thus, the rim areas of different eyes are only comparable for equally sized discs. Relative values, as for instance, cup/disc ratio, or the quotient of rim area and disc size, are therefore better suited for comparison of different eyes than absolute values. The recent developments in automatic disc analysis equipment and the clinical relevance of the results for diagnosis and follow-up in glaucoma are discussed.

Diagnosis, Computer-Assisted↗
PubMed1989

Long-term studies of visual field changes by means of computerized perimetry (Octopus 201) in eyes with glaucomatous field defects after normalization of the intra-ocular pressure.

UNLABELLED: 126 eyes with open-angle glaucoma and defects of the visual field were studied over five years (+/-1.3) by repeated perimetries with Octopus Perimeter, Program 31, after the IOP had been normalized from 26.49 mm Hg to 19 mm Hg. All patients had suffered visual field defects in the period with increased pressure preceding our study and had many perimetric examinations before. The aim of the study was to check the behaviour of the visual field defects after pressure normalization. For evaluation of the visual fields, the upper most line of the test-points and the 6 test-points surrounding the blind spot were disregarded. The evaluation of each field and the comparison with preceding fields (no change, better, or worse) were done by the symmetry test of Bowker instead of the Delta Program, taking into account each of the 61 test-points with a significance level of 5%. In each patient the eye with the heavier field loss was evaluated. RESULTS: 67% of all eyes had no change during the observation time, 12% became better, and 21% worse. Improvement of the visual fields occurred even in old age: 10% became better in the age-group over 70 years. The total loss decreased in the 15 eyes which improved by 269 dB. In eyes which deteriorated, the total loss increased by 282 dB. The good news of this study is that normalization of IOP can stop the further decay of the visual-field in 67% and an improvement of the field loss is possible even in old age of with heavy field loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1989

[Pallor of the optic papilla--an early sign of glaucoma. A clinical controlled study of optic disk pallor and papillar cupping in glaucoma simplex, ocular hypertension and normal eyes with the optic nerve head analyzer].

Double examinations of 99 eyes (34 healthy, 12 with ocular hypertension, 53 with primary open-angle glaucoma) were performed with the Optic Nerve Head Analyzer to evaluate whether an increase in disk pallor or in the cup-disk ratio (CDR) is the earlier sign of glaucoma. In eyes with primary open-angle glaucoma the CDR and the mean optic disk pallor value are significantly higher than in healthy eyes. There is no significant difference in the CDR of patients with ocular hypertension as compared to normals. However, the mean pallor value is significantly higher in eyes with ocular hypertension than in healthy eyes. Therefore, an increase in pallor may precede a significant increase in the CDR or detectable visual field defects.

Glaucoma, Open-Angle↗
PubMed1988

[Optic papilla parameters in healthy subjects--quantified with the optic nerve head analyzer].

The cup-disk ratio (CDR), the size of the neuroretinal rim area as well as the other disk parameters investigated with the Optic Nerve Head Analyzer (ONHA) were measured in double examinations of 32 healthy eyes in 32 patients. Thus, "normal" values were determined for the various disk parameters. A new method is presented for calculating one average pallor value for the disk. The mean value for disk pallor in healthy eyes is determined. Examination of the CDR in the quadrants of the disk reveals significant differences. According to the results of a multi-regressional analysis of the various disk parameters, the size of the neuroretinal rim area in healthy eyes is influenced by the size of the disk, the disk volume and the elevation volume. The correlation between the size of the neuroretinal rim area and the size of the disk reveals a significant interdependence: a larger disk also has a greater neuroretinal rim area as compared to a smaller disk. This means that sizes of neuroretinal rim areas of different disk should only be compared when the disks are the same size. Relative values, such as the CDR or the ratio between the size of the neuroretinal rim area and disk size (rim area/disk area), are therefore better suited for comparison.

Humans↗
PubMed1987

Alterations of carboxypeptidases N activities in patients with thyroid dysfunction.

Serum carboxypeptidases N (EC. 3.4.17.3) were determined spectrophotometrically in 87 patients with disturbances of thyroid function and in 131 euthyroid individuals, including 33 women taking estrogens for contraception. Carboxypeptidases N (CN) can be subdivided into CN1 and CN2, according to variable substrate affinity. In addition, measurements of blood pressure and in vitro tests of thyroid function were performed. In euthyroid controls, CN1 was negatively correlated with age. No significant differences between CN1 and CN2 have been observed with regard to sex. In patients with hyperthyroidism, the mean values of both enzymes were elevated, but this tendency proved to be significant only for CN2. In hypothyroid patients CN1 and CN2 levels were normal. Elevations of CN1 and CN2 in the hyperthyroid state seem not to be related to underlying immunological processes but to the thyroid hormone excess itself. In euthyroid women taking estrogens for contraception CN2 was also elevated.

Arginine↗
PubMed1987

[Quantification and progression of the visual field defect in glaucoma without hypertension, glaucoma simplex and pigmentary glaucoma. A clinical study with the Delta Program of the 201 Octopus perimeter].

Visual field defects of stages I-IV, in 451 eyes of 451 glaucoma patients, were examined with the Octopus 201 perimeter: 83 patients with low-tension glaucoma (LTG), 316 patients with primary open-angle glaucoma (POAG), and 52 patients with pigmentary glaucoma (PG). Program 31 or 33 was used, with an eccentricity range of up to 30 degrees, 73 test points, and a 6 degrees grid. The mean total field loss (TL) as well as the mean loss per test point (TL/TP) in the 30 degrees field, in the field quadrants, and in the eccentricity ranges from 0-10 degrees, 10-20 degrees, and 20-30 degrees were calculated for each patient with Program Delta. In addition, for each visual field the quotient of total loss and of the number of disturbed test points was calculated, providing a measurement of the mean depth of the field defects. For definition and comparison of visual fields in the different glaucomas at identical stages of the disease according to the amount of TL, the 3 patient groups were subdivided into 4 stages of sensitivity loss: Stage 1: TL less than or equal to 100 dB; Stage 2: TL 101-400 dB; Stage 3: TL 401-800 dB; Stage 4: 801-1600 dB. The results of a comparison of eyes with LTG, POAG, and PG at the same stage of disease were as follows: I. Location of scotomas: 1. Defects more frequent in the lower field in LTG as compared to POAG in stage 2. 2. Defects more frequent in the upper than in the lower field in POAG. 3. Almost equal number of defects in the upper and lower halves in PG. 4. In all 3 glaucoma types the defects are more frequently found in the nasal than in the temporal half of the visual field. 5. In LTG and POAG of all stages the defects are most frequently found in the upper nasal and most seldom in the lower temporal quadrant. 6. In all glaucoma types the defects occur on average most frequently between 10 degrees and 20 degrees of eccentricity. 7. With increasing IOP in POAG the scotomas tend to be equally distributed in the upper and lower quadrants. II. Depth of scotomas: 1. Scotomas are deepest in LTG; they are less deep in POAG, and least deep in PG. 2. In PG the mean scotoma depth depends significantly on maximum IOP.(ABSTRACT TRUNCATED AT 400 WORDS)

Computers↗
PubMed1986

[Site and depth of glaucomatous visual field defects in relation to the size of the neuroretinal edge zone of the optic disk in glaucoma without hypertension, simple glaucoma, pigmentary glaucoma. A clinical study with the Octopus perimeter 201 and the optic nerve head analyzer].

The size of the neuroretinal rim area of the disk was measured with the Optic Nerve Head Analyzer in 57 eyes of 57 patients with low-tension glaucoma (LTG), glaucoma simplex (POAG), and pigmentary glaucoma. The visual fields were examined with Program 33 or 31 (30 degrees eccentricity, 6 degrees grid) of the Octopus 201 Perimeter. The mean sensitivity loss per test point in the central field, in the field quadrants, and in the ranges from 0 degrees-10 degrees, 10 degrees-20 degrees, and 20 degrees-30 degrees were calculated with the Delta program. In addition, the mean loss per disturbed point, which gives the mean depth of scotomata, was calculated. In LTG a larger vertical cup/disk ratio (CDR) was found than in POAG for the same amount of total loss. The comparison of eyes with neuroretinal rim areas of equal size revealed that in contrast to POAG and pigmentary glaucoma, eyes with LTG had a smaller mean sensitivity loss; deeper, more localized scotomata; more visual field defects in the lower field in the initial stages; more scotomata in the area up to 20 degrees. The differences between glaucoma with and without high intraocular pressure were found to be most pronounced in the initial stages of the disease. These differences appear to be caused by the varying amounts of vascular pathogenesis involved. Therefore, at least two pathomechanisms have to be considered in glaucoma.

Glaucoma, Open-Angle↗
PubMed1985

[Specificity of suprathreshold test methods in automated perimetry].

The specificity of suprathreshold automated perimetry of the central visual field was investigated comparatively with the Fieldmaster Model 225 computer perimeter, utilizing five different test strategies. The clinical study comprised 30 eyes of 30 healthy subjects. The test strategies were: (1) threshold-related supraluminosity of 5 dB with constant supraluminosity between 0 degrees and 30 degrees eccentricity; (2) threshold-related supraluminosity of 5 dB, increasing the luminosity according to the sensitivity gradient of the retina at 15 degrees eccentricity; (3) threshold-related supraluminosity of 5 dB and stepwise increase of luminosity every 5 degrees of eccentricity; (4) threshold-related supraluminosity of 3 dB and stepwise increase of luminosity every 5 degrees of eccentricity; (5) central stimuli luminosity of 200 asb and stepwise increase of luminosity every 5 degrees of eccentricity. The highest specificity of the visual field examination was obtained with test strategy 3, followed by 5, 4 and 2. The lowest specificity was obtained with test strategy 1.

Computers↗
PubMed1985

[Glaucoma without ocular hypertension. A clinical study].

One hundred eighty-four glaucomatous eyes (125 patients) with visual field defects of Stage I and II in the central visual field were examined with the Octopus perimeter 201, Program 31 or 33, and were divided into 3 groups according to maximum intraocular pressures: (1) low-tension glaucoma (21 mm Hg), (2) glaucoma simplex (22-29 mm Hg), (3) glaucoma simplex (30-39 mm Hg). In these three groups of glaucomatous eyes the cupping of the optic disk, vision and blood pressure were examined and a further check for cardiovascular risk factors was carried out by the internist. All three groups proved to have an equally high incidence of cardiac insufficiency, abnormal EKG changes and diabetes. However, a low systolic blood pressure was found to be the risk factor more often in patients with low-tension glaucoma than with glaucoma simplex. Furthermore, intraocular pressures in the low-tension glaucoma group were higher than those in the normal population. The occurrence of cupping of the optic disk, which is not present with purely vascular optic nerve diseases, and the location of visual field defects in low-tension glaucoma, which is similar to that in glaucoma simplex but different from vascular diseases, as well as the increased diurnal tension variations of diurnal tension curves compared to the normal population are all factors which indicate that low-tension glaucoma is not a purely vascular optic nerve disease, and that pressure-lowering therapy is necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

[Computerized perimetry in infants treated with ethambutol (author's transl)].

Computerized perimetry of the central visual field (Competer) was utilized in 12 eyes of children treated with Ethambutol because of tuberculosis to verify potential visual hazards of the drug. Visual acuity, visual field and the mean retinal threshold of the central field revealed no significant changes with increasing cumulative Ethambutol dose up to 166.5 g. The visual field was re-checked five times with a consecutive time lapse of 7 weeks. It can be concluded that the critical total dose of 150 g that is considered to be potential dangerous in adults does not affect the optic nerve of the infant either. Since this total dose can be exceeded in the continued treatment of the disease parents should be aware of the necessity of repeated visual field examinations or color vision testing. This concern is especially valid in infants suffering from renal tuberculosis because of higher plasma levels of the drug when excretion is prolonged.

Adolescent↗
PubMed1982

[Sensitivity of the computer perimeter Competer in early glaucomatous loss of visual field. A controlled study].

Comparative examinations were carried out under controlled conditions in 101 eyes of 66 open-angle glaucoma patients with field defects (Stages I-III according to Aulhorn) with the Octopus and Competer computerized perimeters. The results of the Octopus perimetry were selected as a reference system to evaluate the sensitivity of the Competer in identifying early glaucomatous field defects. The interpretation of qualitative and quantitative discrepancies between the two instruments took into account the different sizes of the test fields. Of the glaucomatous field defects identified with the Octopus perimeter, 84.1% could be recognized with the Competer as well; 4% were questionably pathologic and 11.9% appeared to be false-negative in the Competers. The 11.9% false-negative results of the Competer were all due to the fact that they were scotomas beyond the test eccentricity of this perimeter. In 16.9% of the positive Competer findings the scotomas were outside the Competer test field by more than 50% of their total extent, whereas 83.1% were within the Competer test field by more than 50% of their total extent. In the light of these results it may be concluded that the Competer provides good sensitivity to detect early glaucomatous field defects once these are within 20 degrees eccentricity, while more peripherally situated scotomas will be missed. It would be advisable to enlarge the test field of the Competer to 30 degrees eccentricity. The relation of early glaucomatous field changes to disk morphology revealed that in 42.5% of the eyes definite glaucomatous disk changes were not recognized.

Adult↗
PubMed1982

[Topography of early glaucomatous visual field defects in computerized perimetry].

A total of 301 visual fields of 215 glaucoma patients exhibiting early glaucomatous field loss up to Stage II according to Aulhorn were investigated to determine the frequency distribution of absolute and relative defects at the 73 test points of Program 31 of the Octopus computer perimeter. The following results were obtained: (1) The frequency of absolute and relative defects was higher in the upper half of the visual field; (2) The frequency of both absolute and relative defects increased from 6 to 30 degrees eccentricity in the upper visual field, predominantly in the upper nasal quadrant, whereas in the temporal lower quadrant there were less absolute defects but equally frequent relative defects; (3) Defects in the nasal quadrant and above the horizontal meridian are most frequent (between 18 and 30 degrees absolute, between 12 and 30 degrees relative), while temporally of the blind spot and below the horizontal meridian they are quite rare; (4) In the upper half of the field, defects are closer to the fixation point and blind spot; the area between blind spot and macula largely free of defects. --In 71 eyes of 69 patients a similar frequency distribution was found with the Competer computer perimeter (test field 15-20 degrees eccentricity) giving good correlation with the Octopus results. --In 301 eyes of 215 patients with early glaucomatous defects the four test points in the region of the blind spot were evaluated and compared with the results of 121 eyes of 71 patients with ocular hypertension and no field changes. It appears highly probable that an increase in the size of the blind spot is associated with the incidence of field defects. --The distribution of early glaucomatous field defects in 214 eyes revealed a combination of paracentral scotomata with peripheral defects in 75.2%, exclusively peripheral scotomata in 19.6% and exclusively paracentral scotomata in 5.1%. The significance of the results with regard to the pathophysiology of glaucomatous visual field loss is discussed.

Computers↗
PubMed1982

[The physician's obligation to educate patients - legal aspects - patients' expectations].

There is some uncertainty among doctors and lawyers about the form and content of presurgical medical enlightenment of the patient. Presurgical enlightenment is of increasing significance with respect to malpractice suits. Current jurisdiction has developed principles of enlightenment that are often difficult for the doctor to handle. For routine procedures in major hospitals a standardized, pragmatically designed consent form is therefore necessary. At Würzburg University Eye Hospital the results of glaucoma and cataract surgery have been documented for years by using computer-readable forms. On the basis of these large-scale results from many thousands of procedures a written consent form was developed and tested for its suitability. Two hundred and twenty-two patients were questioned on their expectations as to proper enlightenment. The results of these broadly scattered interviews are summed up and presented. Especially with glaucoma patients, the best method of enlightenment, satisfying both medical and legal requirements, is an information booklet designed for lay people together with verbal information furnished by the doctor. Nearly all of the patients interviewed found the preoperative enlightenment complete and sufficiently clear. The majority ot them could repeat the contents of the enlightenment form four to six days after the operation. This speaks well for the adequacy of the enlightenment. As a rule, the written consent form was supplemented by verbal enlightenment from the operating physician immediately before hospitalization of the patient. A psychological investigation of preoperative anxiety with enlightened and non-enlightened patients revealed that the enlightenment form did not increase preoperative anxiety. Surgical ophthalmology lends itself to a written consent form more readily then other surgical disciplines, because diseases with poor prognoses for life are fortunately rare.

Aged↗