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PubMedDate not supplied

Audiometric and ophthalmological findings in rubella deafness.

In an attempt to study the relevance of ophthalmological changes to the diagnosis of cochlear hearing impairment due to fetal rubella infection, a survey of the literature combined with a clinical investigation was carried out. Based on the investigation of 57 patients, 31% had congenital hearing impairment due to fetal rubella infection. Of these patients, 61% had typical rubella retinal changes. In the remaining 69%, ophthalmoscopy revealed no abnormality, except in 1 patient. As the cause of the hearing impairment in this patient was unknown, it was concluded that the mother had suffered from subclinical rubella infection in the first trimester of her pregnancy. It is concluded that rubella retinitis is found with such a high incidence in rubella children that it can be used as a tool in the diagnosis of cochlear hearing impairment due to fetal rubella infection. Patients with congenital hearing impairment ought to undergo a routine ophthalmoscopy which will detect eventual pigmentary changes.

Adolescent↗
PubMed1997

Accuracy of referral to a glaucoma clinic.

The accuracy of referral to the glaucoma clinic in Edinburgh was evaluated retrospectively by case note analysis. Two hundred and ninety-five patients suspected of having glaucoma were referred during a 6 month period. Optometrists accounted for 96% of referrals with the remainder being referred directly by the GP. The highest overall detection rates (glaucoma + glaucoma suspects) were amongst those optometrists who combined tonometry with either a field assessment, ophthalmoscopy or both (66-78%). Despite this there was a high false positive rate with 36% of referrals being discharged or having conditions unrelated to glaucoma. To improve referral efficiency it is recommended that optometrists should routinely combine tonometry with ophthalmoscopy and perimetry, and tests should preferably be repeated prior to referral if an abnormality is suspected. The accuracy of referrals could be improved by the use of Goldmann applanation tonometry and by better interpretation of perimetric findings.

Aged↗
PubMed1998

Angle-closure glaucoma associated with occult annular ciliary body detachment.

OBJECTIVE: To evaluate the role of annular ciliary body detachment in the development of postoperative angle-closure glaucoma. DESIGN: Case series. SETTING: Tertiary care glaucoma referral center. METHODS: High-resolution, anterior segment ultrasound biomicroscopy, ophthalmoscopy, and B-scan ultrasonography were performed on 6 eyes of 6 patients with a clinical diagnosis of postoperative malignant glaucoma. RESULTS: Each eye had an elevated intraocular pressure, a shallow anterior chamber, 1 or more patent iridectomies, and no ophthalmoscopic or B-scan ultrasound evidence of serous or hemorrhagic ciliochoroidal detachment. Ultrasound biomicroscopy revealed annular ciliary body detachment in each eye. In 4 eyes, observation with topical medical treatment was associated with deepening of the anterior chamber, reduced intraocular pressure, and resolution of the detachment. Drainage of the supraciliary fluid was performed in 2 eyes. CONCLUSION: Occult, annular, serous detachment of the ciliary body may cause postoperative angle-closure glaucoma. This entity is clinically indistinguishable from malignant glaucoma. Ultrasound biomicroscopy facilitates the diagnosis.

Aged↗
PubMed1999

Achromatic and short-wavelength automated perimetry in patients with glaucomatous large cups.

OBJECTIVE: To evaluate visual function and optic disc features in patients with large cup-disc ratios (C/Ds). METHODS: One eye of 86 patients with vertical C/Ds by contour of at least 0.8, who had undergone both standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) testing, was selected retrospectively. Two masked glaucoma specialists independently graded stereoscopic photographs for vertical C/Ds, rim thinning, notching, excavation, optic disc hemorrhages, and nerve fiber layer defects. Visual fields were classified as abnormal if the glaucoma hemifield test result, corrected pattern standard deviation, or mean deviation was outside age-specific normal limits. Confocal scanning laser ophthalmoscopy was used to determine disc area. RESULTS: SAP and SWAP results were abnormal in 44 (51%) and 52 (60%) of 86 patients, respectively. In patients with normal SAP results, SWAP results were abnormal in 14 (33%) of 42 patients. In patients with normal SWAP results, SAP results were abnormal in 6 (18%) of 34 patients. Small discs are associated with an abnormal SAP result (P = .01) and an abnormal SWAP result (P = .09). An increased vertical C/D greater than the qualifying level of 0.8 was associated with an abnormal SAP or SWAP result (P< or =.001). Rim thinning (P = .01) and disc hemorrhages (P = .04) were associated with an abnormal SAP result. CONCLUSIONS: Many patients with large C/Ds have normal SAP and SWAP results. Compared with SAP, SWAP results were abnormal in a higher percentage of these patients. If a patient has a large C/D and normal SAP results, SWAP testing may detect functional loss earlier. If glaucoma is defined by both structural and functional loss, patients with large vertical C/Ds, normal SAP results, and abnormal SWAP results may have glaucoma. Longitudinal studies are needed to assess this hypothesis and determine whether these patients subsequently develop abnormal SAP results as well.

Adult↗
PubMed1999

Optic nerve head morphologic characteristics in high-tension and normal-tension glaucoma.

OBJECTIVES: To determine the morphometric parameters in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) with a confocal scanning laser ophthalmoscope, and to determine the relationship to disc size. METHODS: One hundred eighty-six patients with glaucoma were recruited for this study. For each patient, only one eye was randomly chosen. Patients with NTG and HTG were classified using untreated intraocular pressure (IOP) as the variable; the NTG group had IOP less than 22 mm Hg during a diurnal tension curve, while patients with HTG had IOP greater than 21 mm Hg in at least 3 measurements. All the patients were examined with Humphrey perimeter program 30-2 and a Heidelberg Retina Tomograph. Findings were assessed by t test. Patients were then divided by disc area size into 3 subgroups: small discs with an area less than 2 mm2, midsized discs with an area of 2 to 3 mm2, and large discs with an area greater than 3 mm2. RESULTS: One hundred thirty-two HTG eyes and 50 NTG eyes were assessed. Four eyes were excluded because they were classified as having secondary glaucoma. No significant differences were found between HTG and NTG eyes for any Heidelberg Retina Tomograph morphometric parameters, even when patients were divided into subgroups. CONCLUSION: No differences were apparent between HTG and NTG in morphometric parameters as measured by scanning laser ophthalmoscopy.

Glaucoma, Open-Angle↗
PubMed1999

Retinal sparing by selective retinal pigment epithelial photocoagulation.

OBJECTIVE: To investigate whether photocoagulation of the retinal pigment epithelium is possible with sparing of the photoreceptors. METHODS: Mild laser effects of a neodymium:yttrium-lithium-fluoride (Nd:YLF) laser (527 nm) were applied to 17 patients. To establish the necessary energy, test exposures were performed to the lower macula (laser variables: 1.7 microseconds, 100 and 500 pulses applied in a train at 500 Hz, 20-130 microJ, 160 microm). Of 179 test lesions, 73 were followed up at various time intervals up to 1 year by performing microperimetry directly on top of the laser lesions. RESULTS: All of the test lesions were at the threshold of retinal pigment epithelial disruption, and none of the laser effects were visible by ophthalmoscopy during photocoagulation; they were detectable only by fluorescein angiography. After exposure with 500 pulses, retinal defects were detected in up to 73% of the patients (100 microJ) after the first day. Most of these defects were no longer detectable after 3 months. After exposure with 100 pulses, no defects could be detected with 70 and 100 microJ after 1 day. The absence of microscotomas in the follow-up period suggests that retinal damage was minimal or, if it occurred, was functionally repaired. CONCLUSION: By choosing proper energy and number of pulses, it is possible to produce retinal pigment epithelial effects with no subsequent retinal damage detectable by microperimetry.

Adult↗
PubMed1999

Idiopathic polypoidal choroidal vasculopathy in Japanese patients.

OBJECTIVE: To describe the vascular nature and clinical features of idiopathic polypoidal choroidal vasculopathy in Japanese patients. METHODS: Patients thought to have idiopathic polypoidal choroidal vasculopathy were examined with binocular ophthalmoscopy, slitlamp biomicroscopy with a contact lens, fluorescein angiography, and indocyanine green angiography. RESULTS: From January 1993 to December 1997, 35 eyes in 32 patients were diagnosed as having idiopathic polypoidal choroidal vasculopathy. Men were predominantly affected (22 patients [69%]). Most patients were unilaterally involved (29 patients [91%]) and elderly, with a mean age of 65.7 years (range, 44-82 years). Ocular manifestations were relatively mild, with serous or hemorrhagic detachments of the retinal pigment epithelium and neurosensory retina in the posterior pole. Most patients had a favorable course, although some experienced recurrence, and a few eyes developed disciform scarring. In all patients, indocyanine green angiograms demonstrated branching vascular networks with polypoidal dilations at terminals of the network beneath the retinal pigment epithelium. These lesions were mostly in the macula (33 eyes [94%]), with a few in the peripapillary area. CONCLUSIONS: Idiopathic polypoidal choroidal vasculopathy in Japanese patients differs from that in American patients. It seems that this disorder occurs in elderly Japanese patients and should be treated as a distinct clinical entity. It is probably a peculiar form of choroidal neovascularization beneath the retinal pigment epithelium. We propose the term "polypoidal choroidal neovascularization" for this disorder.

Adult↗
PubMed1999

A new model of retinal pigment epithelium transplantation with microspheres.

OBJECTIVES: To develop a 3-dimensional carrier system for subretinal transplantation of human fetal retinal pigment epithelial (HFRPE) cells and to assess their growth pattern in the rabbit subretinal space. METHODS: After a standard 3-port vitrectomy, HFRPE cells grown as microspheres on cross-linked fibrinogen were introduced into the subretinal space of rabbits. The eyes were studied at 7, 14, and 30 days after surgery by ophthalmoscopy and light microscopy. RESULTS: Ophthalmoscopically, at day 7, 11 (61%) of the 18 eyes showed radiating hyperpigmentation around the transplanted HFRPE microspheres. The results of a histological examination revealed a monolayer outgrowth of HFRPE cells, overlying host retinal pigment epithelium. The control eyes revealed a patch of chorioretinal atrophy with lymphocytic infiltration around the microspheres. CONCLUSIONS: Human fetal retinal pigment epithelial cells grown as microspheres on cross-linked fibrinogen can be successfully transplanted into the subretinal space. Cells can survive for at least 1 month and form a monolayer over the host retinal pigment epithelium cells, with a mild local inflammatory response. The difference in inflammatory responses between the eyes that underwent transplantation and the control eyes may suggest a modulating effect of the HFRPE cells on inflammation, immunity, or both. This new xenogenic model may have importance in the study of subretinal transplant cell biology and the associated immune response. CLINICAL RELEVANCE: The results of this study may be important for better understanding of the mechanisms of retinal pigment epithelium cell behavior after transplantation. The proposed model may be applicable for future clinical and experimental investigations in the area of retinal pigment epithelium transplantation.

Animals↗
PubMed2000

Retinal toxicity of commercial intravitreal tissue plasminogen activator solution in cat eyes.

BACKGROUND: We previously reported retinal toxic reactions in rabbit eyes receiving intravitreal injections of commercial tissue plasminogen activator (tPA) in concentrations greater than or equal to 50 microg/0.1 mL, and recent clinical experience suggests that intravitreal tPA solution may produce toxic effects in human eyes. We therefore investigated the dose-dependent retinal toxicity of intravitreal commercial recombinant tPA solution in cat eyes, which have a vascularized inner retina and vitreous volume similar to that of human eyes. METHODS: Commercial tPA in L-arginine solution was injected into the mid vitreous cavity of normal cat eyes in doses of 25, 50, 75, and 100 microg/0.1 mL and 200 microg/0.2 mL. Control (fellow) eyes received an equal volume of sterile saline solution. After injection, eyes were evaluated by ophthalmoscopy and electroretinography for 14 days and then enucleated for histopathological evaluation. RESULTS: Fundus pigmentary alterations were observed in eyes receiving doses greater than or equal to 50 microg/0.1 mL. Changes were centered in the area around the injection site, and the area's size increased in proportion to the dosage. Mean electroretinography B-wave amplitude measured at 14 days was significantly reduced in eyes receiving greater than or equal to 50 microg of tPA in a dose-dependent fashion. Light microscopy of the involved areas showed loss of photoreceptor elements with necrosis and proliferation of the retinal pigment epithelium. CONCLUSION: Intravitreal injection of commercial tPA solution results in dose-dependent retinal toxicity in cat eyes. CLINICAL RELEVANCE: Because cat eyes are similar to human eyes regarding retinal vascularity and vitreous volume, intravitreal injections of commercial tPA (with L-arginine vehicle) in concentrations greater than 25 microg/0.1 mL are potentially unsafe in human eyes.

Animals↗
PubMed2001

Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography.

OBJECTIVE: To promote understanding of the development of posterior vitreous detachment (PVD) in healthy eyes using optical coherence tomography (OCT). METHODS: We studied 209 eyes of 209 healthy volunteers (165 men and 44 women; mean age, 52.3 years [range, 31-74 years]). In addition to biomicroscopy and ophthalmoscopy, OCT was performed to obtain high-resolution cross-sectional images of the vitreoretinal interface in the posterior fundus. RESULTS: The condition of the posterior vitreoretinal interface was classified as 1 of 5 stages, according to biomicroscopic findings and OCT images relative to discrete linear signals indicating a detached posterior vitreous face: stage 0, no PVD (61 eyes [29.2%]); stage 1, incomplete perifoveal PVD in up to 3 quadrants (100 eyes [47.8%]); stage 2, incomplete perifoveal PVD in all quadrants, with residual attachment to the fovea and optic disc (26 eyes [12.4%]); stage 3, incomplete PVD over the posterior pole, with residual attachment to the optic disc (4 eyes [1.9%]); or stage 4, complete PVD identified with biomicroscopy, but not with OCT because of instrument limitations (18 eyes [8.6%]). Stage 1, 2, and 3 incomplete PVD without subjective symptoms was not recognizable on contact lens biomicroscopy. There was a significant age-related progression in the condition of the vitreoretinal interface from stage 0 to stage 4. The superior quadrant was usually the initial site of incomplete PVD. CONCLUSIONS: Optical coherence tomography demonstrates that healthy human eyes have incomplete or partial PVD beginning as early as the fourth decade of life. Age-related PVD occurs initially as a focal detachment in the perifovea of 1 quadrant, with persistent attachment to the fovea and optic nerve head, with a predilection for the superior quadrant. It extends its range slowly for years and eventually results in complete PVD, associated with release of vitreopapillary adhesion.

Adult↗
PubMed2001

Three-dimensional ultrasound for the measurement of choroidal melanomas.

OBJECTIVE: To evaluate the reliability of 3-dimensional ultrasound (3D-US) for the measurement of choroidal melanomas. DESIGN: Retrospective case series. PARTICIPANTS: Forty-two consecutive cases of choroidal melanoma imaged with 3D-US. METHODS: Tumor measurements obtained with ophthalmoscopy, transillumination, standard ultrasound techniques, 3D-US, and pathological studies. Tumor diameters, heights, and volumes were compared. Our 3D-US tumor measurement techniques were tested for intraobserver and interscan reproducibility. RESULTS: Fifty 3D-US images were studied. The 3D-US tumor measurements were found to be reproducible (height coefficient of variation [CV] < or = 3%; diameter CV < or = 9.7%; volume CV < or = 13.2%). There was significant correlation with the usual methods of tumor measurement (diameter r = 0.76; height r > or = 0.98). Significant differences were found between measurements at pathological examination, as compared with both 2-dimensional and 3D-US height measurements (range, 0.73-0.83 mm). This finding was thought to be due to specimen shrinkage. Three-dimensional ultrasound was found to be at least as reproducible as clinical examination and standard ultrasound techniques used for measurement of diameter and height of choroidal melanomas. It was our impression that the 3D-US volume measurements accounted for the geometry of the tumor better than volume estimates calculated from basal area and tumor height. CONCLUSIONS: Three-dimensional ultrasound measurements of choroidal melanoma were reproducible, correlated well with other tumor measurement techniques, and can be used for measurement of choroidal melanomas.

Choroid Neoplasms↗
PubMed2003

Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study.

OBJECTIVE: To investigate the effect of glycosylated hemoglobin, age, sex, hypertension, body mass index, waist-hip ratio, serum lipid levels, and smoking on the incidence of retinopathy in persons with normal and abnormal glucose metabolism. METHODS: The incidence of retinopathy was determined in 233 individuals, aged 50 to 74 years, by ophthalmoscopy and fundus photography at baseline and after an average follow-up of 9.4 years. Relative risks for retinopathy, estimated by odds ratios, were calculated for tertiles of cardiovascular risk factors at baseline. Logistic regression analysis was used, without and with adjustment for age, sex, hypertension, and glucose metabolism. RESULTS: The cumulative incidences of retinopathy among individuals with normal, impaired, and diabetic glucose metabolism were 7.3%, 13.6%, and 17.5%, respectively. Adjusted odds ratios for retinopathy were 2.36 (95% confidence interval, 1.02-5.49) for hypertension and 3.29 (95% confidence interval, 1.11-9.72) and 8.67 (95% confidence interval, 1.85-40.60) for the highest tertiles of glycosylated hemoglobin level and waist-hip ratio, respectively. No consistent or statistically significant associations with retinopathy were present for age, sex, body mass index, smoking, and serum levels of triglycerides and total, high-density lipoprotein, and non-high-density lipoprotein cholesterol (P>.05 for all). CONCLUSION: Glycemia, hypertension, and abdominal obesity are determinants for retinopathy in a general population.

Aged↗
PubMed2003

Retinal microvascular abnormalities in patients treated with external radiation for graves ophthalmopathy.

BACKGROUND: A prospective study was conducted to determine if external ionizing radiation could favorably influence the orbital manifestations of Graves ophthalmopathy. Diabetes and untreated systemic hypertension were exclusion criteria. Radiation was directed to the orbits of 42 affected patients using 0.2 rad (20 Gy) delivered in 10 doses of 0.02 rad (2 Gy). Patients were periodically examined during a 3-year interval. OBJECTIVE: To report retinal microvascular abnormalities observed in our study cohort. METHODS: Fundus findings documented with ophthalmoscopy, stereoscopic color photography, and stereoscopic fluorescein angiography prior to radiation were compared with similarly documented findings approximately 3 years following radiation. RESULTS: Prior to orbital radiation, retinal microvascular abnormalities were identified in 2 patients. The abnormalities were present bilaterally in one patient and unilaterally in the other. During the course of the study, microvascular abnormalities developed de novo in the unaffected retina of the latter patient while the retinopathy in the fellow eye progressed. Retinal microvascular abnormalities and their sequelae developed de novo in both eyes in 2 more patients. In addition to the radiation, other confounding factors known to be associated with microvascular retinopathy (uveitis, inadequately controlled systemic hypertension, and borderline blood glucose levels) were identified among the 3 patients whose eyes developed new retinal microvascular abnormalities. CONCLUSIONS: Whether the retinal microvascular abnormalities observed in these patients were caused or aggravated by external beam irradiation cannot be precisely ascertained. However, the observed progression and de novo development of retinal microvascular abnormalities within 3 years of orbital radiation raise concern that 0.2 rad (20 Gy) delivered to the orbit in 10 doses of 0.02 rad (2 Gy) may aggravate existing retinal microvascular abnormalities or cause radiation retinopathy in some patients with Graves disease. These findings and the failure of external beam radiation with 0.2 rad (2000 cGy) to favorably affect Graves ophthalmopathy, as demonstrated in a previous study, have led us to discourage further treatment of Graves ophthalmopathy with radiation.

Adult↗
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↗
PubMed2004

Prognostic significance and course of retinopathy in children with severe malaria.

OBJECTIVES: To relate retinal findings in children treated for severe malaria to disease outcome and to determine the course of changes in the fundus. METHODS: A prospective study of children with cerebral malaria (CM) and severe malarial anemia admitted to the Malaria Research Project, Blantyre, Malawi, during 2 malaria seasons. Indirect and direct ophthalmoscopy were performed on admission and daily, subject to the patient's cooperation. RESULTS: Three hundred twenty-six patients (91%) with complicated malaria were recruited. Two hundred seventy-eight patients had CM and of these 170 (61%) had some degree of retinopathy; 25 (53%) of 47 with severe malarial anemia had retinopathy. In CM, retinopathy was associated with subsequent death (relative risk, 3.7; 95% confidence interval, 1.6-8.5) and papilledema conferred the highest risk (relative risk, 4.5; 95% confidence interval, 2.7-7.6). Increasing severity of retinal signs was related to increasing risk of a fatal outcome (P<.05), independent of papilledema. In survivors, retinal signs were associated with prolonged time to recover consciousness (P<.001). Patients with severe malarial anemia had better outcomes and less severe retinopathy than those with CM. In 116 patients with CM, fundi were followed up longitudinally during admission and in 27 patients after hospital discharge. A large increase in retinal hemorrhages was associated with death (P =.02). Retinal signs resolved over 1 to 4 weeks without retinal sequelae. CONCLUSIONS: In childhood CM, severity of retinopathy is related to prolonged coma and death. Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology.

Adolescent↗
PubMed2005

Visual field abnormalities in nonarteritic anterior ischemic optic neuropathy: their pattern and prevalence at initial examination.

OBJECTIVE: To evaluate the pattern of various types of visual field defects and their prevalence at initial examination of nonarteritic anterior ischemic optic neuropathy (NA-AION). METHODS: The data were compiled from 312 consecutive eyes (in 265 patients) that fulfilled our inclusion and exclusion criteria. A comprehensive ophthalmic evaluation was performed, including recording of visual acuity, visual fields with a Goldmann perimeter (using I-2e, I-4e, and V-4e targets regularly), and intraocular pressure; slitlamp examination of the anterior segment; ophthalmoscopy; color fundus photography; and in acute cases, fluorescein fundus angiography. The visual field defects were divided into 2 groups: (1) general field defects and (2) various types of scotoma in the central 30 degrees . The prevalence of various types of visual field defects was estimated for I-2e, I-4e, and V-4e isopters by dividing the total number of eyes with the defect by the total number of eyes that could see that particular target. Exact 95% confidence limits for the prevalence were computed. RESULTS: Of the 265 patients, 169 (63.7%) were male and the mean +/- SD patient age was 55.0 +/- 9.1 years. The median interval between the first visual field test and the onset of NA-AION was 2 weeks. Of the 312 eyes, the I-2e target was seen by 75.3%, the I-4e target by 90.7%, and the V-4e target by 100%. Overall prevalence of general visual field defects was 83.4% with I-2e, 78.8% with I-4e, and 68.9% with V-4e, whereas the prevalence of scotoma(s) within the central 30 degrees was 55.3%, 49.5%, and 36.2%, respectively. Central scotoma was seen in 48.5% with I-2e, 43.8% with I-4e, and 29.2% with V-4e. A detailed prevalence of various types of visual field defects is given. Relative inferior altitudinal defect was most common (34.9% with I-2e and 22.3% with I-4e), but the absolute inferior altitudinal defect was seen in only 8.0%. By contrast, absolute inferior nasal sector visual loss was the most common defect detected in NA-AION (22.4%), but it occurred in only 3.4% with I-2e and 11.0% with I-4e. Overall, loss of the nasal part of the visual field was the most common occurrence. CONCLUSIONS: Our study demonstrated that NA-AION eyes may initially show a variety of optic nerve-related visual field defects. Our study also showed that an absolute inferior nasal visual field defect is much more common (22.4%) than an absolute inferior altitudinal visual field defect (8.0%) in NA-AION and could be considered the most characteristic single field defect in NA-AION. We found that a combination of relative inferior altitudinal defect with absolute inferior nasal defect is usually the most common pattern in NA-AION.

Adult↗
PubMed2006

The ISNT rule and differentiation of normal from glaucomatous eyes.

OBJECTIVE: To determine whether the ISNT rule (that normal eyes show a characteristic configuration for disc rim thickness of inferior > or = superior > or = nasal > or = temporal), widely used for clinical evaluation of the optic nerve head, can differentiate normal from glaucomatous eyes. METHODS: All subjects underwent complete eye examination, including achromatic automated perimetry, simultaneous stereoscopic disc photography, and confocal scanning laser ophthalmoscopy. Subjects with normal eyes had no evidence of glaucoma or ocular hypertension and had normal perimetry measurements. Subjects with glaucoma had a reproducible visual field defect. One eye from each subject was randomly enrolled. The ISNT rule was assessed by masked evaluation of disc photographs at the 3, 6, 9, and 12 o'clock positions. RESULTS: Sixty-six subjects with normal eyes (33 black and 33 white individuals) and 43 with open-angle glaucoma (15 black and 28 white individuals) were enrolled. The ISNT rule was intact in 52 (79%) of 66 normal eyes and 12 (28%) of 43 glaucomatous eyes (P<.001). Multiple logistic regression indicated that the odds ratio for glaucoma associated with violation of the ISNT rule was 6.04 (95% confidence interval, 1.74-20.95) after adjustment for age; race was not a confounder of this association. CONCLUSION: The ISNT rule is useful in differentiating normal from glaucomatous optic nerves and is unaffected by race.

Adult↗