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At least 307 records · Page 17Linked to original sources
PubMed2005

Unsupervised machine learning with independent component analysis to identify areas of progression in glaucomatous visual fields.

PURPOSE: To determine whether a variational Bayesian independent component analysis mixture model (vB-ICA-mm), a form of unsupervised machine learning, can be used to identify and quantify areas of progression in standard automated perimetry fields. METHODS: In an earlier study, it was shown that a model using vB-ICA-mm can separate normal fields from fields with six different patterns of visual field loss related to glaucomatous optic neuropathy (GON) along maximally independent axes. In the present study, an independent group of 191 patient eyes (66 with ocular hypertension (OHT), 12 with suspected glaucoma by field, 61 with suspected glaucoma by disc, and 52 with glaucoma) with five or more standard visual fields under observation for a mean of 6.24 +/- 2.65 years and 8.11 +/- 2.42 visual fields were evaluated with the vB-ICA-mm. In addition, eyes with progressive GON (PGON) were identified (n = 39). Each participant had a series of fields tested, with each field entered independently and placed along the axes of the previously developed model. This allowed change in one pattern of visual field defect (along one axis) to be assessed relative to results other areas of that same field (no change along other axes). Progression was based on a slope falling outside the 5th and the 95th percentile limits of all slopes, with at least two axes not showing such a deviation in a given individual's series of fields. Fields were also scored using Advanced Glaucoma Intervention Study (AGIS) and the Early Manifest Glaucoma Treatment Trial (EMGT) criteria. RESULTS: Thirty-two of 191 eyes progressed on vB-ICA-mm by this definition. Of the 32, 22 had field loss at baseline, 7 had only GON, 3 were OHTs and 12 were from the 39 eyes (31%) with PGON. The vB-ICA-mm identified a higher percentage of progressing eyes in each diagnostic category than did AGIS or and the EMGT. CONCLUSIONS: The vB-ICA-mm can quantitatively identify progression in eyes with glaucoma by evaluating change in one or more patterns of the visual field loss while other areas or patterns remain stable. This may enable each eye to contribute to the determination of whether change is caused by true progression or by variability.

Adult↗
PubMed2001

Gaze-evoked amaurosis produced by intraorbital buckshot pellet.

OBJECTIVE: To report the first case of gaze-evoked amaurosis secondary to an intraocular foreign body and to highlight the characteristic clinical findings of patients with this symptom. DESIGN: Case report and review of the literature. METHODS: Case review, clinical history, electrophysiologic testing, and follow-up. MAIN OUTCOME MEASURES: Visual acuity, automated perimetry, and visual fields. RESULTS: A case of gaze-evoked amaurosis as a result of an intraorbital foreign body is described, and 19 additional cases of gaze-evoked amaurosis are reviewed from the English language literature. These cases share certain characteristics including good vision in primary position with deterioration of vision in eccentric gaze; concurrent objective pupillary abnormalities in eccentric gaze; stereotypic onset and recovery of vision; and funduscopic abnormalities consisting of disc edema and chorioretinal folds. CONCLUSIONS: Gaze-evoked amaurosis is a reliable sign of intraconal mass lesion. We report the first case of gaze-evoked amaurosis secondary to an intraorbital foreign body.

Blindness↗
PubMed2004

[Frequency doubling perimetry in diagnosis of early glaucomatous optic nerve fiber damage].

PURPOSE: The comparative evaluation results of frequency doubling technology (FDT) in healthy subjects, in patients with glaucoma suspected and glaucoma, as well as analysis influences of selected risk factors onset, and progression of glaucoma (age, gender, intraocular pressure, refractive errors, circulation system disease, diabetes mellitus, vasospastic vascular disease) on FDT-parameters. MATERIAL AND METHODS: Sixty four patients (128 eyes), in age between 13-80, with refraction error from -14.5 to +6.5 D sph and average intraocular pressure 19.8 +/- SEM were included in this study. All patients were previously diagnosed towards glaucoma. The visual field testing with help of FDT Visual Field Instrument were made at least triple at all patients, with capitalize on the THR N-30 threshold program. Global indices: mean deviation (MD) and pattern standard deviation (PSD) and numerical value of mean retinal sensitivity for central visual field 5 degree sector (mean sensitivity to central 5 degrees--MS 5 degrees) come in comparative analysis. All data were analyzed by chi2 and Kruskal-Wallis tests. RESULTS: Comparative analysis examined groups of healthy persons, patients with glaucoma suspect and glaucoma, it proves statistically significant difference between MD, PSD and MS 5 degrees. Statistically no significant difference between PSD and MS 5 degrees at groups of healthy and glaucoma suspect patients was detected. In glaucoma group there did not reveal an influence on selected risk factors on FDT parameters. However, in glaucoma suspect group revealed an influence on most risk factors on perimetry parameters. CONCLUSIONS: FDT is useful for detection of glaucomatous nerve fiber damage. There should be taken precautions of interpretation FDT results at glaucoma suspect patients.

Adolescent↗
PubMed2002

Screening for hydroxychloroquine toxicity by Texas ophthalmologists.

OBJECTIVE: To determine current practice patterns for screening for hydroxychloroquine (HCQ) toxicity by Texas ophthalmologists. METHODS: A survey was sent to all comprehensive ophthalmologists and retina specialists in the state of Texas. Questions included need for baseline examinations, frequency of followup, tests used to monitor for toxicity, and influences on monitoring regimen. RESULTS: Two hundred ninety of 577 surveys were returned correctly completed (response rate = 50.3%). Two hundred fifty-seven respondents (88.6%) felt a baseline examination was necessary prior to beginning HCQ therapy, and 223 (76.9%) followed patients every 6 months during HCQ therapy. Visual acuity, slit lamp examination, and dilated fundus examination were performed on almost all patients, and about three-quarters of respondents also checked visual fields and color vision. While 183 ophthalmologists (63.1%) used the Ishihara pseudoisochromatic plates to check color vision, there was no consensus on the preferred visual field test. One hundred twenty-two respondents (42.1%) stated they had diagnosed a patient with HCQ ocular toxicity. CONCLUSION: Most ophthalmologists in Texas continue to perform baseline examinations and follow HCQ patients semiannually for the development of ocular toxicity despite recent recommendations questioning the need for such close followup. The majority check visual acuity, perform slit lamp and dilated fundus examinations, and test color vision and visual fields, although there is no consensus on the preferred method to test visual fields.

Antirheumatic Agents↗
PubMed2000

Human neural retinal transplantation.

PURPOSE: A pilot study of human neural retinal transplantation was undertaken to investigate three major issues: whether a safe surgical procedure could be devised for transplantation of neural retinal tissue into the subretinal space, whether the transplant would be accepted in the subretinal space, and whether an improvement in vision could be achieved. METHODS: Eight patients with bare light perception (LP) vision due to retinitis pigmentosa (RP) and one patient with bare LP vision due to advanced neovascular age-related macular degeneration (AMD) received subretinal transplants of human fetal retinal microaggregate suspensions without postoperative systemic immunosuppression. The patient with AMD also received a fetal retinal sheet transplant. The ages of the patients ranged from 31 to 94 years (median, 55 years). The pre- and postoperative evaluations included visual function testing, detailed fundus examinations, fundus photography, fluorescein angiography, macular perimetry using a scanning laser ophthalmoscope (SLO), and full field and focal electroretinograms (ERGs). RESULTS: Three of the eight RP patients demonstrated possible improved light sensitivity during the initial months of follow-up. However, visual improvement disappeared between 3 and 13 months of follow-up. After transplantation, no subject showed any changes in the ERG recordings or SLO macular perimetry relative to their preoperative baseline. No patient experienced a retinal detachment, infection, or extensive bleeding. None of the patients developed retinal vasculitis or intraocular inflammation. In one RP patient, fluorescein angiography and fundus photography documented the formation and maturation of new host retinal vessels in the area of the transplant. CONCLUSIONS: Transplantation of fetal retinal photoreceptor suspensions into the subretinal space was achieved safely in nine subjects. Although a definite positive effect on visual function could not be demonstrated, the apparent high tolerance for graft tissue is promising for future efforts in the field of neural retinal transplantation.

Adult↗
PubMed1984

[What new knowledge has automated perimetry with the Octopus brought on glaucomatous visual field changes?].

The results of studying patients with glaucomatous field defects over a 5-year period using the Octopus automated perimeter are summarized. This instrument relies on a retest logic and problem-orientated adaptation of the test points as well as of the software is possible with it. Automated perimetry offers significant advantages over conventional field testing and has increasing our understanding of glaucoma considerably. (1) The probability of detecting glaucomatous field defects is substantially greater than with manual perimetry; (2) the results of a visual field examination can be treated mathematically and statistically, especially when Bebie and Fankhauser 's Delta program is used; (3) the evaluation of progressive field loss is only possible using threshold perimetry, as supra-threshold stimuli are too crude; (4) increased fluctuations around the normal age-corrected threshold represent the earliest detectable changes in glaucoma; (5) loss of sensitivity is reversible in early relative scotomata; (6) the depth of relative scotomata cannot be sharply defined on account of rapid fluctuations in sensitivity; (7) early visual field changes probably represent late changes in the course of chronic simple glaucoma.

Computers↗
PubMed2003

Examining visual field defects in the paediatric population exposed to vigabatrin.

The antiepileptic drug, vigabatrin, has been linked to a specific pattern of visual field loss. The majority of studies have not included the paediatric population due to difficulties assessing visual field function. This is a particular problem as vigabatrin is effective against infantile spasms. A field-specific visual evoked potential was developed which consisted of a central stimulus (0-5 degrees radius) and a peripheral stimulus (30-60 degrees radius). Both stimuli consist of black and white checks which increase in size with eccentricity. Responses are recorded from occipital electrodes O2 and O1 referred to frontal electrode Fz. Electroretinograms and perimetry was performed were possible as a comparison. Thirty-nine children with epilepsy treated with vigabatrin aged from 3 to 15 years were included in the study; 35/39 children complied with the field-specific VEP, 26/39 complied with the ERG and 11/39 performed perimetry. Of these results, 18 children had normal ERG responses and eight had abnormal response. Visual field testing revealed four children had abnormal and seven had abnormal visual field results. The Field-specific VEP identified three of four abnormal perimetry results and six of seven normal perimetry results, giving a sensitivity of 75% and a specificity of 85.7%. When comparing perimetry results with the ERG parameters only the 30-Hz flicker amplitude, with a cut-off amplitude below 70 microV, gave a useful sensitivity of 75% and a specificity of 71%. The field-specific VEP is a useful alternative method that is both well tolerated by young children and gives a reliable indication of likely peripheral visual field loss associated with vigabatrin. The defect appears to have a similar prevalence in children as it does in adults.

Adolescent↗
PubMed2004

[The usefulness of frequency doubling technology perimetry in glaucoma screening in health-check program].

PURPOSE: Visual field testing has not been used as a screening procedure because it requires too much testing time and manpower. We evaluated the usefulness of Frequency Doubling Technology(FDT) visual field testing as a screening procedure for glaucoma in a health-check screening program. METHODS: A total of 800 eyes of 400 persons were examined for visual acuity, noncontact tonometry, slit-lamp biomicroscopy, funduscopy, and FDT testing of visual fields (N-30-5). The initial screening result was considered positive for glaucoma if any abnormality of FDT perimetry was detected, the intraocular pressure exceeded 21 mmHg, or funduscopy showed glaucomatous disc cupping or retinal nerve fiber layer defect. The re-examination comprised several ophthalmic examinations such as automatic perimetry 9 Humphrey field analyzer). RESULTS: Glaucoma was suspected in 118 eyes; 16 eyes were thus diagnosed after re-examination. FDT detected visual field abnormalities in 15 eyes. There were 40 eyes that were not diagnosed although FDT detected visual field abnormalities. CONCLUSIONS: FDT detected visual field abnormalities in glaucoma patients with high sensitivity and specificity. FDT is a useful screening test for glaucoma.

Adult↗
PubMed2003

Familial idiopathic intracranial hypertension.

AIM: To analyze the development and occurrence of the idiopathic intracranial hypertension and consequent visual loss in a family affected with idiopathic intracranial hypertension. METHODS: We studied 15 members of the same family and found six of them affected with idiopathic intracranial hypertension, which was accompanied with visual loss as a repercussion of the disease. Idiopathic intracranial hypertension was diagnosed on neurological and radiological examination. Visual examination to establish visual loss included fundoscopy, visual acuity, visual field testing, and ultrasonography of the optic nerve. RESULTS: The construction of a family tree and detailed examination of 15 family members revealed idiopathic intracranial hypertension with visual disturbances, even amaurosis, and different stages of visual field constriction in three members of the family: the mother and her two daughters. Due to the symptoms of idiopathic intracranial hypertension, such as headaches, nausea, vertigo, and the presence of transient visual obscuration and papilledema, in three other members of this family (aged 16, 17, and 25 years), we considered a presumptive diagnosis of idiopathic intracranial hypertension, and the need for thorough follow-up. Medical data on the family grandmother, who died 34 years ago, suggested that she also had symptoms of idiopathic intracranial hypertension. One of the patients underwent surgical treatment by a lumbo-peritoneal shunt operation worsening of the symptoms. CONCLUSION: It is very important to include idiopathic intracranial hypertension in differential diagnosis of papilledema and recognize it in early stages to prevent vision loss. Current successful therapeutic approaches and close follow-up of such patients require teamwork of neurologists, ophthalmologists, and neurosurgeons.

Adolescent↗
PubMed1993

Prediction of postoperative visual acuity in patients with total glaucomatous cupping using the Potential Acuity Meter and automated perimetry.

We evaluated the effectiveness of using the Potential Acuity Meter (PAM) and automated perimetry to predict postoperative vision in 30 advanced glaucoma patients following combined cataract extraction and trabeculectomy. Using the binomial distribution at alpha = 0.05, PAM and automated perimetry individually were significantly useful in predicting postoperative vision of 20/40 or better. Automated perimetry, but not PAM, was useful in predicting worse than 20/40 vision. Used together, automated perimetry and PAM testing were significantly useful in predicting vision worse or better than 20/40.

Aged↗
PubMed1990

[Anamnesis of brain-originated vision disorders].

A questionnaire for the subjective assessment of cerebral visual disorders was administered to 269 brain damaged patients. The patients' subjective complaints were correlated with the outcome of objective diagnostic procedures (visual perimetry, visual search, spatial contrast sensitivity, visual evoked potentials, depth perception, light- and dark-adaptation, reading, colour vision). A significant correlation was found between subjective complaints and objective diagnostic results for all fields. The prediction of visual impairments on the basis of subjective complaints and verified by objective tests was correct in 80 to 98% of the brain damaged patients tested. Interrater reliability was about 0.84. Thus, the questionnaire is suitable for the assessment of cerebral visual disorders because of its simplicity, short administration time (10-15 min) and high predictive value.

Accommodation, Ocular↗
PubMed1999

Residual vision in a subject with damaged visual cortex.

It is well known that a lesion in the optic radiation or striate cortex leads to blind visual regions in the retinotopically corresponding portion of the visual field. However, various studies show that some subjects still perceive certain stimuli even when presented in the "blind" visual field. Such subjects either perceive stimuli abnormally or only certain aspects of them (residual vision) or, in some cases, deny perception altogether even though visual performance can be shown to be above chance (blindsight). Research on monkeys has suggested a variety of parallel extrastriate visual pathways that could bypass the striate cortex and mediate residual vision or blindsight. In the present study, we investigated a subject with perimetrically blind visual areas caused by bilateral brain damage. Black and white stimuli were presented at many locations in the intact and affected areas of the visual field. The subject's task was to state, using confidence levels, whether the target stimulus was black or white. The results revealed an area in the "blind" visual field in which the subject perceived a light flash when the experimental black stimulus was presented. We hypothesize that a spared region in the visual cortex most likely accounts for these findings.

Aged↗
PubMed1994

Quantitative analysis of changes of automated perimetric thresholds after pupillary dilation and induced myopia in normal subjects.

We quantitatively analyzed the changes of the (retinal) threshold sensitivities between normal status and dilated emmetropic status, and between dilated emmetropic status and -1.0D induced myopic status. Three consecutive visual field examinations by Humphrey Field Analyzer C-30-2 threshold test and STATPAC program were performed in 36 eyes of 21 normal subjects who ranged in age from 23 to 40 years. The results were as follows: 1) There was a statistically significant decrease (0.87 +/- 0.91dB)in the mean threshold sensitivity within the central 30 degrees at the dilated emmetropic status (27.90dB) as compared with the normal status (28.77dB)(p = 0.0001). 2) There was a statistically significant decrease(0.99 +/- 0.61dB) at -1.0D induced myopic status(26.91dB) as compared with the dilated emmetropic status(27.90dB)(p = 0.0001). 3) After dilation, the mean threshold sensitivity between 20 and 30 degrees of field showed statistically significant decrease as compared with those within the central 20 degrees of visual field(p < 0.05). In case of -1.0D induced myopia, there were uniform decreases in the mean threshold sensitivities within the central 30 degrees of visual field (p > 0.05). Therefore, we emphasize the importance of consistent pupillary size and correct refractive state in performing the serial automated visual field tests.

Adult↗
PubMed2000

Scanning laser entoptic perimetry for the screening of macular and peripheral retinal disease.

OBJECTIVE: To determine the effectiveness of scanning laser entoptic perimetry as a noninvasive platform for screening for retinal damage in visually asymptomatic patients within the central 120 degrees (diameter) of vision. DESIGN: A masked study comparing entoptic perimetry with fundus photographs. SETTING: The Shiley Eye Center and the AIDS Ocular Research Unit at the University of California, San Diego. PATIENTS: Fifty-eight patients recruited during ophthalmologic visits for treatment or follow-up of ocular disease. MEASUREMENTS: For each testing session, we compared the presence of a disturbance in the entoptic stimulus with the presence of retinal disease within the central 120 degrees of vision, centered on the fovea. RESULTS: Scanning laser entoptic perimetry has a sensitivity and specificity of more than 90%, a positive predictive value of 100%, and a negative predictive value of 89% for screening retinal lesions within the central 120 degrees diameter of vision. CONCLUSION: Scanning laser entoptic perimetry may be an effective and inexpensive screening test for diagnosing retinal disease in hospitals and community clinics. Arch Ophthalmol. 2000;118:1205-1210

False Positive Reactions↗
PubMed2001

Laser in situ keratomileusis-induced optic neuropathy.

OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery. DESIGN: Observational case report. METHODS: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits. MAIN OUTCOME MEASURES: Optic nerve status, visual field status, and visual acuity. RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified. CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.

Adult↗
PubMed1997

Apparent glaucomatous visual field defects caused by dermatochalasis.

We have studied the effects of dermatochalasis on Humphrey automated perimetry of the central 24 degrees visual field. Fifteen visual fields of 9 ocular hypertensive patients (18 eyes) were found to be incongruous with their apparently healthy optic discs. Examination revealed dermatochalasis, which was felt to be responsible for the field defects. This was confirmed by reversal of the defects on repeating the field test (programme 24-2) with the redundant upper lid skin taped up, or in 2 cases following blepharoplasty. The defects always involved the superior visual field. The deepest and largest defects were sited in the supero-temporal quadrant in 13 of the 15 affected fields and the supero-nasal quadrant in 2 fields. The most common pattern was a temporally skewed defect which reflected the tendency of the loose upper lid skin to be greater in extent temporally than nasally. In 7 fields the supero-temporal defect extended to fuse with the blind spot, mimicking a superior arcuate scotoma. Temporal extension of the field defects below the horizontal meridian occurred in 5 fields. In cases where visual field testing was repeated without taping up the lid inter-test fluctuation in scotoma size and depth was observed, although the position of scotomas when present within the visual field remained constant. We conclude that dermatochalasis has the potential to confound diagnostic automated visual field testing for glaucoma.

Aged↗