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PubMedDate not supplied

Ocular hypertension and corneal thickness: a long-term prospective study. Results after two years.

PURPOSE: To study the importance of the central corneal thickness (CCT) in patients with ocular hypertension in a 2-year follow-up. METHODS: A total of 110 subjects with ocular hypertension (intraocular pressure [IOP] >21 mmHg and normal automated visual field test) were admitted to the study. All patients periodically underwent the following tests: 1) circadian IOP curve; 2) standard automated perimetry (SAP, Humphrey 30-2 SITA test); 3) short wavelength automated perimetry (SWAP); 4) frequency doubling technology perimetry (FDT, N-30 threshold test); 5) nerve fiber layer analysis with GDx; 6) ibopamine test; 7) ultrasonic pachymetry. Patients were divided into three groups, based on corneal thickness. The frequency of abnormal tests within these groups was evaluated with the Pearson's chi2 test. Baseline IOP was corrected using the Doughty and Zaman formula. CCT was also considered as a continuous variable. A control group of 48 normal subjects was also considered. RESULTS: The mean CCT was 562.8 microm +/- 37.7. The difference with respect to normal subjects was statistically significant (p < 0.01). Using the correction formula, 43 eyes (39.1%) had an IOP <21 mmHg. Abnormal test results were more frequently found with FDT. The percentage of abnormal results was found to be inversely proportional to CCT. The other tests gave inconsistent or conflicting results. Using the values of CCT as a continuous variable, no significant association was found with the GDx number and the visual field indices. CONCLUSIONS: The results of our 2-year study confirm the importance of CCT measurement in the evaluation of the risk of developing glaucomatous damage.

Adult↗

PubMedDate not supplied

The multifocal pattern electroretinogram in chloroquine retinopathy.

PURPOSE: Optimal screening for ocular toxicity caused by chloroquine and hydroxychloroquine is still controversial. With the multifocal pattern electroretinogram (mfPERG), a new electrophysiological technique has recently become available to detect early changes of ganglion cells. In this study this new technique is applied to a series of 10 patients seen consecutively receiving long-term chloroquine medication. METHODS: In 10 patients receiving chloroquine medication, clinical examination, Amsler visual field testing and computerized color vision testing were performed. If toxicity was suspected, automated perimetry was carried out. In addition, in all patients conventional pattern electroretinogram (PERG) and mfPERG testing were performed. RESULTS: On clinical examination 8 patients showed no chloroquine-associated maculopathy, while 2 patients did. Of these 2, only 1 reported abnormalities when viewing the Amsler chart, while automated perimetry showed typical, ring-like paracentral scotomas in both affected patients and color vision was significantly abnormal. In the normal patients, 4 of 8 had a mild color vision disturbance, which correlated to age-related macular changes. The amplitudes of the PERG and the central (approximately 10 degrees ) responses of the mfPERG were markedly reduced in chloroquine maculopathy, while the latencies were unchanged. The peripheral rings of mfPERG (ranging to 48 degrees ) were not affected by chloroquine toxicity. Both PERG and mfPERG were less affected by age-related macular changes. CONCLUSIONS: The reduction of PERG and central mfPERG responses in chloroquine maculopathy may help with the early detection of toxicity.

Adult↗

PubMed1991

Adding automated perimetry to glaucoma evaluation and treatment.

Tangent-screen visual fields were compared with the fields determined by a newly acquired automated perimeter in 100 eyes of consecutive patients with glaucoma or suspected glaucoma. The tangent screen found defects in 12 eyes, and the automated perimeter found defects in 34 eyes. Because the automated perimeter found new defects or defects much worse than were found by the tangent-screen examinations, three patients received timolol, and a laser iridotomy, two laser trabeculoplasties, and three filtering operations were done on other patients. The major benefit in switching from tangent screen to automated perimetry was increased confidence in the visual fields tested as an indicator for treating patients with glaucoma. A minor problem in using the automated perimeter was that the testing was slightly longer and more tiring. This problem was reduced by using a translucent occluder, rather than the universally used opaque one.

Glaucoma↗

PubMed1990

Effects of pupillary dilation on automated perimetry in normal patients.

The effects of pupillary dilation (tropicamide 1%) on automated static threshold perimetry were studied in 18 normal subjects using the Humphrey field analyzer 30-2 and STATPAC programs. The mean defect worsened by 0.83 decibels (standard deviation, 0.92 decibels) in dilated fields as compared with baseline visual fields (P = 0.001). These findings indicate that pupillary dilation in healthy subjects who are not receiving ocular medications produces statistically significant declines in threshold sensitivities. Valid comparison of results from serial visual field testing, therefore, depends on control of or adjustment for the effect of pupillary dilation.

Adult↗

PubMed2006

Test-retest variability in structural and functional parameters of glaucoma damage in the glaucoma imaging longitudinal study.

PURPOSE: To determine the test-retest variability in perimetric, optic disc, and macular thickness parameters in a cohort of treated patients with established glaucoma. PATIENTS AND METHODS: In this cohort study, the authors analyzed the imaging studies and visual field tests at the baseline and 6-month visits of 162 eyes of 162 participant in the Glaucoma Imaging Longitudinal Study (GILS). They assessed the difference, expressed as the standard error of measurement, of Humphrey field analyzer II (HFA) Swedish Interactive Threshold Algorithm fast, Heidelberg retinal tomograph (HRT) II, and retinal thickness analyzer (RTA) parameters between the two visits and assumed that this difference was due to measurement variability, not pathologic change. A statistically significant change was defined as twice the standard error of measurement. RESULTS: In this cohort of treated glaucoma patients, it was found that statistically significant changes were 3.2 dB for mean deviation (MD), 2.2 for pattern standard deviation (PSD), 0.12 for cup shape measure, 0.26 mm for rim area, and 32.8 microm and 31.8 microm for superior and inferior macular thickness, respectively. On the basis of these values, it was estimated that the number of potential progression events detectable in this cohort by the parameters of MD, PSD, cup shape measure, rim area, superior macular thickness, and inferior macular thickness was 7.5, 6.0, 2.3, 5.7, 3.1, and 3.4, respectively. CONCLUSIONS: The variability of the measurements of MD, PSD, and rim area, relative to the range of possible values, is less than the variability of cup shape measure or macular thickness measurements. Therefore, the former measurements may be more useful global measurements for assessing progressive glaucoma damage.

Adult↗

PubMed2006

Intereye concordance in locations of visual field defects in primary open-angle glaucoma: diagnostic innovations in glaucoma study.

PURPOSE: To determine the overlap in defective visual field locations between the right and left eyes of primary open-angle glaucoma patients. DESIGN: Cross-sectional retrospective analysis of data from a prospectively designed longitudinal study. PARTICIPANTS: Patients with glaucomatous optic neuropathy in at least 1 eye and 2 consecutive reliable standard automated perimetry fields within 15 months were included, yielding 468 eyes of 234 patients. METHODS: Concordance in defective visual field locations between right and left eyes were calculated as the number of overlapping locations divided by the total number of defective locations (intereye concordance ratio). Concordance ratios also were calculated within an eye over time (intraeye concordance ratio) and between unmatched pairs of fields (unmatched concordance ratio). RESULTS: Intereye concordance (0.24+/-0.02) was significantly smaller than intraeye concordance (0.37+/-0.02) and significantly larger than unmatched concordance (0.14+/-0.01). There was a significant interaction between concordance type and defect size, such that there was no difference in concordance ratios for defects of fewer than 8 locations, and the difference between intereye concordance versus intraeye concordance and unmatched concordance ratios increased with larger defect sizes. CONCLUSIONS: A spatial relationship exists between defective locations of an individual's eyes. Future studies will show whether information about the spatial relationship is useful to guide the modification of visual field test locations to improve detection of loss and perhaps also progression.

Adult↗

PubMed2006

Modeling the sensitivity to variability relationship in perimetry.

PURPOSE: Studies in glaucoma patients show that standard automated perimetry results increase in variability as sensitivity decreases. However, the reasons for this change are unclear. This study presents the principle of Divergent Dysfunction as a possible explanation for this change in variability, and incorporates it into a model that can be used to simulate perimetry. METHODS: A computer program was written to simulate visual field test results based on the model, using a Full Threshold testing strategy. The validity of the simulation was tested by comparing it with normal sensitivity values, and with test-retest data from 63 participants evaluated five times each over the course of 1 month. The effect on the simulated data of varying parameters of the model was investigated, such as changing the magnitude of variability and the percentages of false positive and negative responses. RESULTS: The correlation between subject and simulated test-retest data was 0.987. Several factors were found to affect the sensitivity-variability relationship for the simulated data, most notably the rate of sensitivity decline, the percentage of false positives, and the starting luminance of the test procedure. CONCLUSIONS: The principle of Divergent Dysfunction presented here provides a plausible explanation for the sensitivity-variability relationship for standard automated perimetry in glaucomatous eyes. The model and resultant simulation program aim to provide an intuitive demonstration of the principle, which can also be used to examine the effectiveness of different testing strategies. These findings have great implications for future clinical research.

Computer Simulation↗

PubMed2005

Feasibility and outcome of automated static perimetry in children using continuous light increment perimetry (CLIP) and fast threshold strategy.

PURPOSE: Visual field testing in children is always a challenge as testing is hampered by fatigue effects, easy distraction and lack of comprehension. For that reason new testing strategies for automated perimetry have mainly been evaluated on adults. We tested the feasibility and outcome of automated static perimetry in children in a standard clinical setting. METHODS: Twenty-eight children aged 5-14 years were examined at the Twinfield perimeter, including healthy children, children with unilateral pathologies (normal eye tested) and children with strabismus. Fast threshold strategy (FT) and continuous light increment perimetry (CLIP) strategy were used in a randomized order. One eye per subject was examined and each test was performed twice. RESULTS: Reliable results were obtained in many children starting from the age of 8 years. In children aged 13 years and over, adult testing strategies were possible in most cases with good reproducibility. No significant difference was found between the children with strabismus and the other children. Mean sensitivity (MS) increased and fixation losses decreased as a function of age. Continuous light increment perimetry showed a lower number of abnormal fields and fewer false-positive errors compared to FT. CONCLUSION: Automated static perimetry is possible in many children in a clinical setting using a commercially available Twinfield perimeter in a session of clinically practical duration. Test performance was not only dependent on age, but also on the child's maturity and ability to concentrate. Especially in children up to the age of 8 years, testing with the ramp stimulus (CLIP) was easier than with a staircase strategy (FT).

Adolescent↗

PubMed1995

Automated perimetry and malingerers. Can the Humphrey be outwitted?

BACKGROUND: Through detailed strategies and sophisticated analysis, the Humphrey automated visual field analyzer attempts to indicate if visual field loss is artefactual. Can these measures be outwitted by malingerers? METHODS: The author investigated the ease with which motivated individuals (such as are malingerers) could simulate visual field defects consistent with organic neurologic disease on the Humphrey visual field analyzer. Visual field test results were analyzed for characteristic features and compared with visual field tests from patients with documented pituitary tumors. RESULTS: Volunteers, given only broad suggestions as to the visual field they were to simulate, produced consistent, convincing, neurologic-type field defects, according to textbook descriptions of such fields. These plotted fields were only distinguishable from genuine pituitary tumor Humphrey field tests, in that they more convincingly fitted the classic descriptions of visual fields seen with chiasmal compression. CONCLUSIONS: The author concludes that single routine Humphrey visual field tests do not show malingerers. An incidental finding of this study was the extent to which Humphrey visual fields from patients with genuine neurologic disease contain field defects with characteristics different from those of the (kinetic) visual field test appearances described in the textbooks.

Artifacts↗

PubMed1998

Frequency doubling perimetry in glaucoma early diagnosis.

Frequency-doubling perimetry (FDP) is a new, out-of-the-ordinary, visual field testing method. Its sensitivity and reliability was tested in 16 patients (32 eyes) with ocular hypertension and 21 patients (37 eyes) with early chronic glaucoma. Significant defects were found in almost 10% of hypertensive eyes and in 67.7% of glaucomatous eyes. FDP is an effective and sensitive technique for glaucoma functional loss assessment.

Adult↗

PubMed1995

HPR perimetry and Humphrey perimetry in glaucomatous children.

Fifteen children aged less than 11 years, affected by congenital glaucoma, underwent visual field testing using two different methods: conventional computerized perimetry (24-2 Humphrey program) and High Pass Resolution perimetry (Ring test). The aim of the study was to discover which of the two perimetric techniques was more suitable for younger patient. Results showed that HPR perimetry is more suitable to children. Reasons include the short duration of the test (5 min), and the appearance like a pleasant game to 80% of the subjects tested. In addition it proved to be better than Humphrey test because of the minimal possibilities of memorisation with a reproducibility factor of 68% in our sample and because of the reliable results and satisfactory evaluation in 76% of the eyes examined.

Child↗

PubMed1997

Is blindsight like normal, near-threshold vision?

Blindsight is the rare and paradoxical ability of some human subjects with occipital lobe brain damage to discriminate unseen stimuli in their clinically blind field defects when forced-choice procedures are used, implying that lesions of striate cortex produce a sharp dissociation between visual performance and visual awareness. Skeptics have argued that this is no different from the behavior of normal subjects at the lower limits of conscious vision, at which such dissociations could arise trivially by using different response criteria during clinical and forced-choice tests. We tested this claim explicitly by measuring the sensitivity of a hemianopic patient independently of his response criterion in yes-no and forced-choice detection tasks with the same stimulus and found that, unlike normal controls, his sensitivity was significantly higher during the forced-choice task. Thus, the dissociation by which blindsight is defined is not simply due to a difference in the patients' response bias between the two paradigms. This result implies that blindsight is unlike normal, near-threshold vision and that information about the stimulus is processed in blindsighted patients in an unusual way.

Adult↗

PubMed1991

Visual field examination during transient migrainous visual loss.

A transient episode of bilateral amaurosis fugax, or transient visual loss, occurred in a patient with ophthalmic migraine associated with mitral valve prolapse while computerized visual field testing was performed. This fortunate finding illustrated characteristic defects which are compared with the patient's visual field tested 24 hours later. Statistical analysis of both examinations is stressed here.

Adult↗

PubMed2004

Clinical features of a Japanese family with autosomal dominant retinitis pigmentosa associated with a Thr494Met mutation in the HPRP3 gene.

PURPOSE: To determine the clinical features of a Japanese family with autosomal dominant retinitis pigmentosa (ADRP) associated with a Thr494Met mutation in the HPRP3 gene. METHODS: Mutational screening by direct sequencing was performed on 96 unrelated patients with ADRP. The clinical features were determined by visual acuity, slit-lamp biomicroscopy, electroretinography, fluorescein angiography, and kinetic visual field testing. RESULTS: A Thr494Met mutation in the HPRP3 gene was found in one family and it cosegregated with ADRP in the three affected members. The ophthalmic findings were those of typical retinitis pigmentosa with rapid progression after 40-years-of-age. One patient also had retinoblastoma as a child. CONCLUSION: We conclude that the Thr494Met mutation in the HPRP3 gene causes ADRP in Japanese patients. This mutation was found in 1% of patients with ADRP in Japan.

Adult↗

PubMed1995

The Glenn A. Fry Award Lecture. Early losses of visual function in glaucoma.

Getting back to the questions raised by Dr. Enoch 12 years ago, I believe that we have made significant progress in the early psychophysical detection of glaucoma and that we are either on the right track or considerably closer to it. The continuing progress in conventional automated perimetry has improved the overall quality of visual field testing in the ophthalmic community, as well as providing standardization and state-of-the-art analysis procedures for everyone. We have certainly not solved the problem of early detection of glaucoma, but we now have more sensitive procedures that are available for existing clinical instrumentation. SWAP has clearly shown that it is able to detect glaucomatous losses several years before they are evident by conventional automated perimetry, and results from the other test procedures mentioned earlier are also very encouraging. Thus, although we may not yet have the pot of gold, we have been able to pick up a few valuable nuggets along the way. This leads me to believe that the current approaches are on the right track. However, Dr. Enoch's message should also serve to remind us that there are few panaceas for early detection of functional loss in glaucoma. Our progress to date has been influenced by our greater understanding of the properties of visual mechanisms and the pathophysiology of glaucoma. It has also been driven by clever and innovative approaches and new test procedures, as well as advances in technology. However, it has also been based on a considerable amount of research effort in the form of long-term prospective longitudinal studies of large populations of normal observers, patients with various stages of glaucomatous damage, and patients at risk of developing glaucoma. Answers to all of the issues pertaining to the ultimate clinical value of psychophysical procedures for early detection of glaucoma do not come quickly, but they are of vital importance to ocular health care. I hope that my brief discussion of new developments in psychophysical detection of glaucoma has convinced you that significant progress has been made, and that some of you will be motivated to join in this important research endeavor.

Awards and Prizes↗

PubMed2003

Exfoliation syndrome in black South Africans.

BACKGROUND: Data on exfoliation syndrome (XFS) in Africans are scarce. OBJECTIVE: To determine the prevalence and clinical features of XFS among black South Africans. DESIGN: Random cross-sectional samples of the black population aged 40 years or older from 2 districts in South Africa: Hlabisa, in northern KwaZulu-Natal Province, and Temba, North West Province. METHODS: Standardized examination, including slitlamp biomicroscopy with pupil dilatation, gonioscopy, pachymetry, tonometry, binocular indirect ophthalmoscopy, and visual field testing. RESULTS: Among 1840 participants, the prevalence of XFS was 7.7% (95% confidence interval, 5.4%-10.5%) in Hlabisa and 6.0% (95% confidence interval, 4.1%-8.4%) in Temba. The prevalence increased with age, with 18.9% (Hlabisa) and 16.5% (Temba) of those 70 or older affected. The clinical appearance was similar to that reported in other ethnic groups. Exfoliative glaucoma accounted for approximately one fourth of open-angle glaucoma cases (OAG). Open-angle glaucoma was associated with XFS; the age-adjusted and sex-adjusted odds ratios were 2.3 (95% confidence interval, 1.0-5.2) and 2.8 (95% confidence interval, 1.2-6.3) for Hlabisa and Temba, respectively. The relationship with OAG was absent when adjusting for intraocular pressure. Exfoliative glaucoma was characterized in this predominantly untreated population by high intraocular pressure and severe visual loss. Among subjects with XFS and OAG, 16 of 18 were blind in 1 or both eyes. CONCLUSIONS: Exfoliation syndrome occurs at a high prevalence among black South Africans and incurs a moderate increase in risk of glaucoma. In this untreated population, this increased risk was dependent on raised intraocular pressure. Open-angle glaucoma in association with XFS appears to be associated with a poor prognosis.

Adult↗

PubMed1996

Acquired unilateral night blindness associated with a negative electroretinogram waveform.

PURPOSE: The authors performed clinical, electrophysiologic, psychophysical, and immunologic studies in a patient who presented with an acquired night blindness in one eye to better define the clinical and functional changes in this rare disorder. METHODS: In addition to an ophthalmologic examination, the patient underwent the measurement of electroretinogram responses, dark-adapted thresholds using a Tübingen perimeter (Oculus, Tubingen, Germany), color vision assessment, kinetic visual-field testing using a Goldman perimeter, and immunologic testing to determine if the serum contained autoantibodies to retinal bipolar cells. RESULTS: Fundus examination showed no clinically apparent abnormality in either eye. The patient showed a selective reduction in the b-wave amplitude of the rod electroretinogram and an abnormality of the cone electroretinogram ON response in the affected left eye, whereas the rod and cone electroretinograms of the right eye were normal. Rod thresholds in the affected eye were elevated markedly, whereas rod thresholds in the right eye were normal centrally and slightly elevated in the far periphery. Immunologic testing did not show circulating autoantibodies to retinal cells. CONCLUSIONS: The patient examined in this study showed phenotypic similarities to patients with congenital stationary night blindness and to patients with an acquired form of night blindness associated with cutaneous melanoma (MAR syndrome). The electroretinogram findings from the patient are consistent with an acquired defect in signal transmission from photoreceptors to ON-type bipolar cells. However, the etiology of this unique form of unilateral night blindness remains obscure.

Adult↗

PubMed2001

Optic perineuritis: clinical and radiographic features.

BACKGROUND: Optic perineuritis is an uncommon variety of orbital inflammatory disease that is distinct from demyelinating optic neuritis. OBJECTIVE: To describe the clinical and radiographic features of idiopathic optic perineuritis, with particular emphasis on those features that help to distinguish this condition from optic neuritis. METHODS: We reviewed the medical records of 14 patients with optic perineuritis who were seen in 2 neuro-ophthalmology clinics. RESULTS: Patients ranged in age from 24 to 60 years; 5 were older than 50 years. All patients had visual loss, eye pain, or both. The visual acuity was 20/20 or better in 8 of the 15 eyes. The results of visual field testing were normal in 2 eyes, and a paracentral scotoma or an arcuate defect was seen in 7. Magnetic resonance imaging scans demonstrated circumferential enhancement around the optic nerve, sometimes with intraorbital extension. Response to corticosteroids was dramatic; however, 4 patients had a relapse with lowering of the dose. CONCLUSIONS: In contrast to those with optic neuritis, patients with optic perineuritis are often older at onset and are more likely to show sparing of central vision. Magnetic resonance imaging scans demonstrate enhancement around, rather than within, the optic nerve. Response to corticosteroids is more dramatic than in patients with optic neuritis, and patients are more likely to experience recurrence after stopping treatment.

Adult↗