Evaluation of visual field changes with retinal nerve fiber layer thickness in primary congenital glaucoma

Purpose: To evaluate visual field changes in primary congenital glaucoma (PCG) with retinal nerve fiber layer thickness on optical coherence tomography. Methods: In this cross?sectional, observational study, consecutive PCG children who underwent combined trabeculotomy with trabeculectomy and on regular follow?up were enrolled. All patients were aged over four years and co?operative for RNFL OCT and visual field examination. Perimetry was done on Humphrey visual field (HVF) analyzer using 30?2 and 10?2 SITA standard algorithms as appropriate. If a reliable automated perimetry was not feasible, kinetic perimetry was done. The following were noted at baseline and every follow?up: age, sex, visual acuity, intraocular pressure (IOP), cup–disc ratio (CDR), corneal diameters, refraction, any topical antiglaucoma medications, surgeries underwent, age at surgery and duration between surgery and final examination. Results: Forty?eight eyes of 34 children operated for PCG and 19 eyes of 17 controls were analyzed. A statistically significant thinner average RNFL thickness of 87.2 ± 28 ?m was noted in PCG eyes as compared to controls with 100.6 ± 7.2 ?m (P = 0.04). The mean cup–disc area ratio on OCT in PCG eyes was 0.43 ± 0.2 (0.02–0.93) and in control eyes was 0.23 ± 0.07 (0.1–0.4) (P < 0.001). On RNFL OCT, there was significant focal RNFL loss in temporal superior (P = 0.003), nasal inferior (P = 0.037) and temporal inferior (P < 0.001) quadrants compared to controls. Among PCG eyes, 20/48 eyes (41.7%), had definitive, reproducible glaucomatous VF defects. Mean baseline IOP in PCG eyes with VF defect was 28.7 ± 5.7 mmHg and in eyes with normal VF was 24.6 ± 5.9 mmHg (P = 0.03). On univariate regression analysis, higher baseline IOP was significantly associated with both RNFL loss (odds ratio (OR): ?2.17) and VF defects (OR: 3.35). Fluctuation in follow?up IOP (OR: 3.33) was also significantly associated with the presence of VF defects. On multivariable regression analysis maximum, IOP was significantly associated with RNFL loss and VF defects. Conclusion: Peripapillary RNFL thickness could be used to identify PCG eyes having visual field loss and possibly poor visual function from PCG eyes without visual field defects. Baseline and follow?up IOP, significantly correlated with RNFL thickness in PCG eyes

Rate of progression of visual field loss in primary open angle glaucoma versus primary angle closure glaucoma patients managed in a Tertiary Hospital

@#OBJECTIVES: To compare the rate of progression of visual field loss in mean defect (MD) decibels (dB)/year in primary open angle glaucoma (POAG) versus primary angle closure glaucoma (PACG) patients managed in a tertiary hospital and to assess the impact of baseline age, baseline MD, and intraocular pressure (IOP) on the rate of progression of visual field loss. METHODS: This was a retrospective review of medical records of patients who were seen at the Glaucoma Clinic of a tertiary hospital from August to October 2018. The following data were recorded: diagnosis, number of reliable automated visual fields (AVFs), number of years followed, baseline age, baseline MD, MD of all subsequent AVFs, IOP at the time of each test, and IOP-lowering interventions. Rate of visual field progression expressed in dB/year was calculated using linear regression analysis. T–test was done to compare the baseline data and rates of progression of visual field loss between the POAG and PACG cohorts. Correlation using Pearson’s r and multivariate analyses were performed to evaluate the effect of baseline age, baseline MD, and IOP on rate of progression of visual field loss. RESULTS: The mean rates of progression of visual field loss in POAG and PACG eyes were 0.12 ± 0.68 dB/year and 0.10 ± 0.59 dB/year, respectively (p=0.8525). Despite treatment, 4.35% of the study eyes were identified as fast progressors while 1.09% were catastrophic progressors. In the POAG group (n=33), laser treatment was negatively correlated with rate of progression of visual field loss (r= -0.5072, p=0.0026). Multivariate analysis showed that baseline MD (p=0.017), mean IOP on follow–up (p=0.020), and laser treatment (p=0.004) were significant factorsaffecting the rate of progression of visual field loss in POAG eyes. In the PACG group (n=59), both baseline MD (r= -0.2798, p=0.0318) and mean IOP on follow–up (r= 0.368, p=0.0041) correlated with rate of progression of visual field loss. Only mean IOP on follow–up was found to be significant on multivariate analysis. CONCLUSION: While most glaucoma patients managed in a tertiary hospital have a slow rate of progression of visual field loss, a few were still identified as fast and catastrophic progressors. Factors associated with rate of progression of visual field loss were baseline MD, mean IOP on follow–up, and laser treatment for POAG, and mean IOP on follow–up for PACG.

Clinical Characteristics of Acute Zonal Occult Outer Retinopathy

PURPOSE: To investigate the clinical characteristics of patients with acute zonal occult outer retinopathy (AZOOR). METHODS: Medical records of 13 patients who visited Seoul National University Bundang Hospital from May, 2003 to May, 2015 and diagnosed with AZOOR were retrospectively reviewed. RESULTS: Thirteen patients (11 women and 2 men), with a mean age of 28.5 ± 11.4 years were followed for 42.8 ± 30.3 months. Visual field loss, photopsia, and blurred vision were common complaints. Initially, four patients had bilateral disease and seven patients showed bilateral involvement at the last visit. Mean best corrected visual acuity of involved eyes (BCVA) was 0.75 ± 0.32 (log MAR). Among 20 eyes with AZOOR, BCVA was 20/40 or better in 17 eyes (85.0%). The mean spherical equivalent was -4.59 ± 3.23 diopters (D), and 15 eyes (75.0%) had myopia less than -2.00 D. Nine eyes of seven patients (34.6%) had abnormal fundus findings. All patients underwent full field electroretinogram (ERG) or multifocal ERG and a visual field test. Thirteen patients (100.0%) showed a decreased response in ERG and visual field defects presented in every patient. With respect to the visual field test, 10 eyes (50.0%) showed improvement, 6 eyes (30.0%) had stationary status, and the progression of the visual field defect was observed in 4 eyes (20.0%). Among 13 patients, 4 (30.8%) patients showed flu-like symptom, 4 (30.8%) patients had fatigue, 2 (15.4%) patients had nausea, and 2 (15.4%) patients showed headache. CONCLUSIONS: AZOOR should be considered as one of the differential diagnoses, especially in female patients with myopia who show photopsia or visual field defects. ERG and visual field tests are necessary to confirm a decrease in retinal function and visual field loss. Central vision is preserved in most cases and recovery of visual field defect occurs often.

Comparison of Optic Ne rve Head Blood Flow in Normal-tension Glaucoma with Asymmetric Visual Field Loss

To evaluate intraindividual, interocular differences in blood flow of the optic nerve head in normal-tension glaucoma(NTG)patients with interocular asymmetric visual field loss, thirty-eight eyes of 19 NTG patients(mean age+/-SD, 56.1+/-15.0 years)with interocular asymmetric visual field loss of >3dB in the mean deviation or corrected pattern standard deviation were measured for the blood flow parameters(Volume, Velocity, Flow)at the temporal rim of the optic nerve head using scanning laser Doppler flowmetry(Heidelberg Retina Flowmeter or HRF). Measurements for peripapillary atrophy(area of zone beta)were performed using scanning laser tomography (Heidelberg Retina Tomograph). Visual field defects were evaluated by automated static threshold perimetry. The mean+/-standard deviation of the mean defect of the visual field indices was -1.38+/-3.02dB for the less affected eyes, and -6.23+/-3.84dB for the more affected eyes. All blood flow parameters were significantly smaller in the less affected eyes(0.004

Effect of YAG Laser Iridotomy on IOP in Chronic Angle-closure Glaucoma

The effect of YAG laser iridotomy on intraocular pressure was investigated in 24 eyes of 19 patients with chronic angle-closure glaucoma prospectively for 3 months. In most cases(75%) the intraocular presure was reduced and the mean amount of reduction was 4.33mmHg. The amount of pressure reduction has no significant correlation with the extent of peripheral anterior synechiae and visual field loss. This result shows that laser iridotomy should be considered in the management of chronic angle-closure glaucoma irrespective of the extent of peripheral anterior synechiae and visual field loss and some amount of intraocular pressure reduction may be expected after laser iridotomy.

Optic Disc and EarIy Glaucomatous Visual Field Loss

In the early stages of glaucoma the disc changes prior to the visual field loss, so assessment of the optic disc is very important for the evalutation of the glaucoma patient. The most senstitive techniques for detecting changes of the optic disc require highly sophisticated instruments, such as computerized image analyzer, which are expensive and not generally available in clinical practice. Less expensive, but reliable, is color stereoscopic photography. The aim of this topic is to assess glaucomatous discs and look for the features of the optic disc that are commonly associated with early visual field defect. Forty-three eyes of 28 patients were included in this investigation. The criteria for inclusion were a cup/disc(C/D) ratio more than 0.4 by direct ophthalmoscopy, no visual field defect with Goldmann perimetry, and open anterior chamber angle. Each optic disc was photographed with a Canon fundus camera with Polaroid 600 Plus. Each photographic set was then examined stereoscopically for morphologic parameters: 1) comparison of vertical versus horizontal C/D ratio; 2) presence of nasal cupping; 3) presence of overpassing vessels; 4) presence of baring of circumlinear vessles; 5) presence of peripapillary atrophy; 6) ratio of the thinnest neuroretinal rim(NRR) width in the vertical sectors to the NRR width of the temporal sector. All subjects were examined for central visual field with the automated static perimeter, Humphrey program C 30-2 with STATPAC. The C/D ratio estimated by direct ophthalmoscopy consistently showed smaller C/D ratio than that by the stereophotographic method. Parameter with highest probability value to differentiate between the optic disc of early visual filed loss and the optic disc of normal subjects was "Ratio of the thinnest NRR width in the vertical sectors to the NRR width of the temporal sector

Optic disc and early glaucomatous visual field loss

In the early stages of glaucoma, the disc changes prior to visual field loss, so assessment of the optic disc is very important for the evaluation of the glaucoma patient. The aim of this study is to assess the glaucomatous disc and to look for the features of the optic disc that are commonly associated with early visual field loss. Forty-three eyes of 28 patients were included in this investigation. The criteria for inclusion were a cup/disc(C/D) ratio of more than 0.4 by direct ophthalmoscopy, no visual field defect with Goldmann perimetry, and open anterior chamber angle. Each optic disc was photographed with a Canon fundus camera with Polaroid 600 Plus film. Each photographic set was then examined stereoscopically for morphologic parameters: 1) comparison of vertical versus horizontal C/D ratio; 2) presence of nasal cupping; 3) presence of overpassing vessels; 4) presence of baring of circumlinear vessels; 5) presence of peripapillary atrophy; 6) ratio of the thinnest neuroretinal rim(NRR) width in the vertical sectors of the NRR width of the temporal sector. All subject's central visual fields were examined with an automated static perimeter, Humphrey program C30-2 with STATPAC. The C/D ratio estimated by direct ophthalmoscopy consistently showed a smaller C/D ratio than that found by the stereophotographic method. The parameter with the highest probability value to differentiate between the optic disc of the early visual field loss and the optic disc of normal subjects was "Ratio of the thinnest NRR width in the vertical sectors to the NRR width of the temporal sector < or = 85%". Although it has less resolving power than slide film, a stereo disc photograph with Polaroid film is a quick and simple method of recording changes, and the ratio of the thinnest NRR width in the vertical sectors to the temporal sector is a good predictive parameter for detection of early visual field loss.