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At least 451 records · Page 25Linked to original sources

Choroidopathy in patients with sarcoidosis observed by simultaneous indocyanine green and fluorescein angiography.

PURPOSE: To examine choroidopathy in patients with sarcoidosis. METHODS: In a prospective clinical study, 10 consecutive patients (20 eyes) with sarcoidosis underwent simultaneous indocyanine green (ICG) and fluorescein angiography (FA) with a double detector of scanning laser ophthalmoscopy. Angiographic findings recorded on videotapes were evaluated, and the relation of ICG angiographic findings with systemic activity and the extent of retinal inflammation was analyzed. RESULTS: Indocyanine green angiographic findings, not evident with fluorescein, were multiple lobular hypofluorescent spots in the posterior pole in 10 eyes of 5 patients, isolated hypofluorescent plaques in 2 eyes of 1 patient, hyperfluorescent spots in 3 eyes of 2 patients, and segmental choroidal vascular wall staining in 6 eyes of 4 patients. The multiple lobular hypofluorescent spots with ICG were observed at a significantly higher rate in eyes with extensive retinal vascular leakage of fluorescein than in eyes with minimal leakage (chi-square test, P = 0.0007). CONCLUSIONS: The patients with sarcoidosis showed choroidal abnormalities that could be revealed by ICG angiography, but not by funduscopy or FA. Simultaneous ICG and FA angiography may be useful for examining choroidal lesions in sarcoidosis.

Adult↗

Evaluation of Jensen procedures by saccades and diplopic fields.

A total of 15 eyes of 13 patients with lateral rectus palsies underwent Jensen procedures; one eye had a medial rectus recession and lateral rectus resection. It was arbitrarily decided to perform a Jensen procedure for patients with less than 40% normal abduction saccadic function. The patients' conditions were evaluated preoperatively and postoperatively by prism cover test. Versions, forced ductions, saccadic velocities, and diplopic field examinations were done. Postoperatively, all patients showed improved saccadic function; 12 of 13 patients acquired a functional range of diplopia-free vision; and 11 of 13 patients had aligned eyes with a good head position. By retrospective analysis we determined that the Jensen procedure gives good results for patients with severe lateral rectus palsy (less than 40% normal saccadic function).

Diplopia↗

Peripheral visual field loss after vitreous surgery for macular holes.

BACKGROUND: Vitreous surgery for Idiopathic macular holes can result in both anatomic closure of the hole and visual improvement. In some patients even normal visual acuity is achieved. Postoperative visual field loss is a newly recognized complication. This prospective study evaluates the frequency and significance of scotomas after vitrectomy with gas tamponade for stage I-IV macular holes. METHODS: Over a period of 10 months, a consecutive series of 30 patients and 31 eyes with macular holes underwent pre- and postoperative automatic perimetry (Octopus 07, 70 degrees) and macular perimetry (Octopus M1, 24 degrees) to characterize the pattern of visual field defects after vitrectomy with gas tamponade. Success rates were evaluated and complications were analyzed. RESULTS: Anatomic success after one surgical procedure was achieved in 85% of cases, visual improvement in 58%. Some 70.1% of patients had peripheral scotomas postoperatively; some of these were highly symptomatic and others were detected by visual field testing only. The most consistently affected areas were the temporal and lower periphery of the visual field. The central visual field, however, was not disturbed. CONCLUSION: Visual field loss after otherwise successful surgery for macular holes is an unexpectedly frequent and serious complication. The authors discuss various factors that may contribute to the postoperative scotomas. From the localization of the scotomas it seems most likely that they are caused by the persistent pressure of the gas bubble on the peripheral retina. Further investigations are necessary to confirm this hypothesis, and ways must be found to avoid this complication in order to be able to proceed with this otherwise promising new indication group for vitreous surgery.

Aged↗

Corneal thickness measurements and visual function abnormalities in ocular hypertensive patients.

PURPOSE: It has been suggested that a considerable subset of patients currently classified as having ocular hypertension may have thicker than average corneas that result in an overestimation of the true intraocular pressure (IOP). As a consequence, ocular hypertension patients with greater corneal thickness may be at a lower risk for functional damage, such as that detected by short-wavelength automated perimetry (SWAP). The purpose of this study was to evaluate the frequency of SWAP deficits in ocular hypertension patients and to correlate these findings with corneal thickness measurements in the same patients. DESIGN: Cross-sectional observational study. METHODS: Sixty-eight ocular hypertension patients with normal optic disks and 63 normal subjects were included in the study. All participants underwent standard automated perimetry (SAP), SWAP, and central corneal thickness measurements using ultrasound pachymeter. Central corneal thickness measurements in ocular hypertension patients with abnormal visual field test results were compared with central corneal thickness measurements in ocular hypertension patients with normal visual field results. In addition, central corneal thickness measurements in ocular hypertension patients were compared with central corneal thickness measurements in normal subjects. RESULTS: Sixteen of 68 patients with ocular hypertension (24%) demonstrated SWAP abnormalities, whereas four of 68 (6%) showed a deficit on SAP. The mean central corneal thickness in ocular hypertension patients with abnormal SWAP results was significantly lower than the mean central corneal thickness in ocular hypertension patients with normal SWAP results (545 +/- 25 microm vs 572 +/- 35 microm; P =.006). The mean central corneal thickness in the normal group was 557 +/- 33 microm. The mean central corneal thickness in ocular hypertension patients with normal SWAP results was significantly higher than in normal subjects (P =.02). There was no significant difference between mean central corneal thickness in normal subjects and in ocular hypertension patients with abnormal SWAP results (P =.19). CONCLUSIONS: The patients classified as having ocular hypertension but with visual field loss detected by SWAP had significantly lower central corneal thickness measurements than the ocular hypertension patients with normal visual field results. These results suggest that central corneal thickness should be taken into account when assessing risk for the development of glaucomatous damage among ocular hypertension patients.

Aged↗

Sequential classification in glaucoma diagnosis.

BACKGROUND: Large-scale screening in glaucoma diagnosis is expensive and time consuming. Sequential classification strategies can provide an effective combination of time-efficiency and diagnostic accuracy for glaucoma screening. METHODS: In a cross-sectional clinical study, a sequential diagnostic strategy, based on several psychophysical and electrophysiological tests, was evaluated on measurements from 595 eyes from 310 patients with primary open-angle glaucoma, and 419 eyes from 213 control subjects (age range 18-70 years in each group). Patients and controls successively underwent up to five psychophysical and electrophysiological diagnostic tests. Optic disc morphometry was taken as gold standard. Adapting group sequential techniques, sensitivity and specificity for the whole diagnostic program were controlled, allotting overall error rates of 10%. The criteria for the diagnostic process were developed in a learning sample (677 eyes) and verified in a validation sample (337 eyes). RESULTS: In the validation sample, 62.0% of the examined eyes could be classified, using a sequential 15-min two-step program. An overall 13.6% "gain" of saved time, compared to non-sequential discriminant analysis, was achieved without loss of diagnostic accuracy. A sequential 45-min five-step program classified 68.8% of the whole sample before morphometry, saving approximately 39% of examination time, compared to taking the complete discriminant score. CONCLUSION: Especially in screening, where the use of time-consuming and complicated diagnostic procedures is restricted, the implementation of testing programs based on group sequential strategies might be a promising means of saving personnel resources and reducing inconvenience for patients.

Adolescent↗

Blue-yellow perimetry in patients with ocular hypertone.

The authors report the data of the blue-yellow (B-Y) perimetry compared with the Standard perimetry in normal subjects with endocular hypertension or with initial glaucoma. With the aim of evaluating the relationship with chromatic sense deficits, precociously found in glaucoma, the F-M 100 Hue test and Lanthony D 15 Desaturé test were done. Checks were made of refraction, visual acuity, pupil diameter and assumption of medications. Sensitivity reduction in eyes with initial glaucoma is highly significant with the B-Y perimetry. Pupil diameter reduction is quite uninfluential while the chromatic sense shows some quantitative and qualitative deficits.

Adult↗

Eye movement perimetry in glaucoma.

Present-day computerized perimetry is often inaccurate and unreliable owing to the need to maintain central fixation over long periods while repressing the normal response to presentation of peripheral stimuli. We tested a new method of perimetry that does not require prolonged central fixation. During this test eye movements were encouraged on presentation of a peripheral target. Twenty-three eyes were studied with an Octopus perimeter, with a technician monitoring eye movements. The sensitivity was 100% and the specificity 23%. The low specificity was due to the technician's inability to accurately monitor small eye movements in the central 6 degrees field. If small eye movements are monitored accurately with an eye tracker, eye movement perimetry could become an alternative method to standard perimetry.

Eye Movements↗

Sex differences in the left and right hemifields of normal subjects with computerised static perimetry.

Results of routine perimetric testing of the left and right hemifields in normal subjects have been assumed to be symmetric although asymmetry due to hemispheric dominance has been established for other psychophysical tests. These asymmetries have sometimes been related to sex. With the advent of computerised static perimetry, subtle differences between the left and the right hemifields might be found that were not obvious before. This study investigated differences in retinal sensitivity between the hemifields and the role of sex and eye dominance. Forty three unequivocally right handed and right eye dominant normal adult volunteers, 24 females and 19 males, underwent Humphrey 24-2 testing, half beginning with the left eye, the other half with the right eye. The Peridata program was used to calculate decibel totals per hemifield. Four subjects were excluded because of poor cooperation or test artefacts. In females, the total of the left hemifield was significantly less than the right (p < 0.01) by a mean 18.2 (SD 24) dB equivalent to a difference of 0.34 dB per tested point. No significant difference in hemifields was found for males, between the sexes for both eyes combined, or between the two eyes for either sex. It was concluded that asymmetries in retinal sensitivity with respect to the vertical axis may be physiological and found in females, but not in males.

Adult↗

Automated flicker perimetry in glaucoma using Octopus 311: a comparative study with the Humphrey Matrix.

PURPOSE: We evaluated the clinical usefulness of flicker perimetry in glaucoma and glaucoma suspect patients using the new Octopus 311 automated perimeter. METHODS: A total of 52 eyes of 52 glaucoma patients, 26 eyes of 26 glaucoma suspect patients and 61 eyes of 61 normal subjects were examined using standard automated perimetry (SAP), flicker perimetry and frequency doubling technology (FDT) perimetry. Flicker perimetry was performed using the Octopus 311 and its remote software package. Suprathreshold four-zone probability strategy was used to classify the critical fusion frequency probability level. The classified levels were set at 5% and 1% of probability of normality and 5 Hz. Frequency doubling technology perimetry was performed using 24-2-5, 24-2-1, N-30-5, N-30-1 screening programs using Humphrey Matrix perimetry. Standard automated perimetry was performed using the Humphrey field analyser program 24-2 full threshold. Optical coherence tomography using Stratus OCT was used for evaluating the retinal nerve fibre layer thickness in all glaucoma and glaucoma suspect patients. RESULTS: Receiver operating characteristic (ROC) curves were calculated. In the early stage of glaucoma, the areas under the ROC curve (AUCs) were 0.96 in flicker and 0.90 in Matrix perimetry. In the moderate and advanced stages of glaucoma, the AUCs were almost 1.0 in all tests. In glaucoma suspect patients, the AUC of the 5% probability level in flicker was significantly higher than in Matrix perimetry. CONCLUSION: The four-zone probability strategy using the Octopus 311 is a useful method for evaluating the flicker field in early glaucoma and glaucoma suspect patients.

Adult↗

Automated perimetry in detecting threats to fixation.

PURPOSE: To study in glaucoma patients the threat to fixation on a Humphrey field analyzer program 10-2 when one of the four innermost paracentral points is defective on program 30-2. METHODS: Forty-five eyes of 45 patients with chronic open-angle glaucoma in whom at least one of the innermost four defective paracentral points was reproducibly defective on program 30-2 of the Humphrey perimeter, with a size 3 target, on two consecutive tests, were studied with program 10-2. RESULTS: Of the 45 eyes with an abnormal paracentral point of program 30-2, 30 (66%) also showed involvement of a paracentral point on program 10-2, which was considered a threat to fixation. The remaining 15 were considered not to threaten fixation imminently. CONCLUSIONS: In about one third of glaucomatous fields considered to threaten fixation on the standard programs 30-2 and 24-2, the threat was not imminent. The extra evaluation is therefore useful before making radical and precipitous changes in management of the disease.

Chronic Disease↗

Are high-pass resolution perimetry thresholds sampling limited or optically limited?

PURPOSE: It has been reported that high-pass resolution perimetry (HRP) provides a means of noninvasively determining retinal ganglion cell density. However, there is evidence to suggest that this may not be true. The purpose of the present study was to determine whether HRP thresholds are sampling limited, which is a necessary condition for being able to determine retinal ganglion cell density psychophysically. METHODS: This study measured resolution and detection performance for a range of grating-based stimuli under the testing conditions that HRP uses and compared these with performance of the ring stimulus. RESULTS: The results show that detection and resolution acuity under HRP test conditions were often equivalent, in accordance with previous investigations. However, the results also show that the thresholds underestimated the true level of resolution acuity in the periphery because increasing stimulus contrast increased performance. CONCLUSION: These findings suggest that HRP thresholds cannot be regarded as sampling limited, but rather they are optically limited. We therefore conclude that HRP thresholds cannot be regarded as a direct measure of the underlying ganglion cell density.

Cell Count↗

No changes in anatomical and functional glaucoma evaluation after trabeculectomy.

PURPOSE: To assess the influence of glaucoma filtration surgery on anatomical and functional tests for glaucoma evaluation. METHODS: Twenty-five eyes (25 patients) with primary open-angle glaucoma were evaluated, prospectively. Data were collected on vision acuity, intraocular pressure, standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry (GDx) and confocal scanning laser ophthalmoscopy (HRT II) before and 3-6 months after surgery. RESULTS: Mean (+/-SD) pre- and postoperative visual acuities (logMAR) were 0.28 (+/-0.18) and 0.30 (+/-0.17), respectively (P=0.346). In a mean time of 4.5 (+/-1.1) months after surgery, the mean preoperative intraocular pressure of 20.7 (+/-5.4) mmHg decreased to 11.04 (+/-2.52) mmHg (P<0.001). The results of the standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy diagnostic methods revealed no significant difference (P>0.162) between pre and postoperative values and no significant correlation (P>0.296) between intraocular pressure reduction and value changes. CONCLUSION: No significant change on any test variable was detected after glaucoma filtration surgery. Trabeculectomy does not appear to influence standard automated perimetry, frequency doubling technology perimetry, scanning laser polarimetry and confocal scanning laser ophthalmoscopy (HRT II) results after a 4.5-month period of surgery in early to moderate glaucoma.

Female↗

Time-related variation in normal automated static perimetry.

The effects of phase of eye test and order of eye examined were investigated in 38 normal subjects using a customized 30-point central threshold program of the Humphrey Field Analyzer 640. This program, designed to be completed within 5 minutes, was successively repeated three times for each eye (i.e., three phases for each eye) at two visits separated by an interval of approximately 2 weeks. Both global and pointwise group mean sensitivity decreased in a time-related manner, deterioration being greater for the second eye at each visit, for both 200 ms and 100 ms stimulus durations.

Adult↗

Clinical and genetic analysis of a family affected with dominant optic atrophy (OPA1)

OBJECTIVES: To refine the dominant optic atrophy locus, OPA1, on chromosome 3q and to characterize the phenotype of a 6-generation family pedigree affected with this disease. METHODS: Fifty-six family members had a complete eye examination. Clinical records of an additional 3 patients were reviewed. Goldmann perimetry and a 21-chip subtest of the Farnsworth-Munsell 100-Hue test were performed on selected patients. Affected patients, unaffected siblings, and potentially informative spouses were genotyped with short tandem repeat polymorphisms located on chromosome 3. The genotypic data were subjected to linkage analysis. RESULTS: Thirty-four family members were found to be clinically affected. Most experienced vision loss (20/40 or poorer) in the first decade of life. Most (9 of the 16 eyes) progressed to 20/800 or poorer visual acuity by age 60 years, while 2 patients maintained visual acuities of 20/40 at that age. Affected patients had a 2- to 10-fold increase in the error score of a 21-chip subtest of the Farnsworth-Munsell 100-Hue test compared with age-matched unaffected family members. The optic nerve examination revealed temporal pallor and excavation in all affected individuals. Linkage analysis revealed significant lod scores with 9 markers. The highest lod score, 10.1 (theta = 0) [corrected], was obtained with marker D3S2305. Analysis of recombinants narrowed the disease interval to approximately 3.8 centimorgans, flanked by D3S3669 (centromeric) and D3S1305 (telomeric). CONCLUSIONS: Most patients affected with dominant optic atrophy in this family progressed to legal blindness by middle age. Color vision testing is a sensitive method for detection of affected patients. The dominant optic atrophy locus, OPA1, has been refined by the identification of new flanking markers: D3S3669 (centromeric) and D3S1305 (telomeric).

Adolescent↗

Joint application of hyperacuity perimetry and gap tests to assess visual function behind cataracts: initial trials.

We have developed two related clinical tests that offer potential in better assessing visual function behind an ocular opacity. The tests are resistant to the effects of opacities because they utilize a localization task (vernier acuity) rather than a resolution task. In this paper we report the initial trials in which we apply the two tests together. Results from six case studies (some with actual opacities and some with simulated opacities) illustrate both the conduct of the tests and their potential capabilities in detecting even very modest retinal dysfunction in the presence of opacities. These techniques offer considerable potential in the separation of a given acuity loss observed in the presence of cataract into a portion due to the opacity and a portion due to retinal dysfunction.

Aged↗

The influence of alcohol on the outcome of automated static perimetry.

It is well known that perimetric findings fluctuate within a single examination. There is additional fluctuation between perimetric examinations. The cause of this fluctuation is not yet fully understood, but such things as changes in attention, patient cooperation, or drugs have been discussed. To study such possible factors, we carried out perimetry on subjects who had consumed alcohol and who had not. The results indicate that alcohol, at a blood concentration of approximately 0.08%, barely influences the results of static automated perimetry. Differential light sensitivity remained unchanged by alcohol at all eccentricities tested. A decrease in the ability to cooperate was manifested by a significant higher score of false-positives in catch trials. There was also a tendency toward an increase in false-negative responses in catch trials, an increase in the number of stimuli presentations required, and higher short-term fluctuation. Lack of the influence of alcohol on the differential light threshold does not necessarily mean that alcohol has no influence on visual function. It indicates, however, that differential light sensitivity, as measured with the automated perimeter Octopus, is not influenced by moderate alcohol ingestion.

Adolescent↗

Case presentations of retinal artery occlusions.

BACKGROUND: Retinal artery occlusions typically result in sudden, unilateral painless loss of vision and may have varying presentations. They are associated with systemic diseases such as atherosclerosis, hypertension, and valvular heart disease. Additional risk factors include diabetes mellitus, cigarette smoking, giant-cell arteritis, and hyperlipidemia. They most often occur in persons 60 to 80 years of age. METHODS: Four patients have come to our clinics with varying degrees of visual loss as a result of retinal artery occlusions. The types of arteriolar occlusions presented include: precapillary arteriole occlusion, cilioretinal artery occlusion, branch retinal artery occlusion, and central retinal artery occlusion. RESULTS: Patients were followed for their ocular involvement, but also included was medical management of the underlying systemic disease condition. Workup of retinal artery occlusion included laboratory testing, carotid duplex scans, and echocardiograms to uncover the possible systemic etiologies of the artery occlusion. CONCLUSION: Optometrists should recognize the signs and symptoms of the various arterial obstructions and refer patients for systemic treatment as indicated. Patients who manifest retinal or pre-retinal artery occlusions should undergo thorough systemic evaluations for vascular disease, including: atherosclerotic disease, hypertension, and valvular heart disease.

Aged↗

[Short-term fluctuation of blue-on-yellow perimetry in normal eyes].

PURPOSE: To evaluate short term fluctuation (SF) of blue-on-yellow perimetry (B/Y) as compared with white-on-white perimetry (W/W) in normal eyes. SUBJECTS AND METHOD: One eye each of 25 healthy persons underwent B/Y and W/W perimetry repeated 5 times each. The test subjects had no previous experience of perimetry. An automated perimeter, Humphrey Field Analyzer, model 750, was used throughout. RESULTS: The SF at the first session of B/Y perimetry averaged 2.02 dB. This value was significantly different from those of the subsequent 4 sessions. Each of SF of B/Y perimetry at the first two sessions was significantly different from that of W/W perimetry at the first two sessions. The SF of B/Y perimetry showed wider fluctuations than those of W/W perimetry at each session. CONCLUSION: B/Y perimetry in normal eyes showed individual differences as well as fluctuations between the initial and consecutive sessions. This feature has to be considered in interpretation of the findings.

Adolescent↗