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ABSTRACT Purpose: Microperimetry has been used for several years as a form of visual function testing in patients with retinal diseases. Normal microperimetry values obtained with microperimeter MP-3 have not yet been fully published, and baseline values for topographic macular sensitivity and correlations with age and sex are needed to establish degrees of impairment. This study aimed to determine values for light sensitivity thresholds and fixation stability using the MP-3 in healthy individuals. Methods: Thirty-seven healthy volunteers (age, 28-68 years), underwent full-threshold microperimetry using a 4-2 (fast) staircase strategy with the standard Goldmann III stimulus size and 68 test points positioned identically to those in the Humphrey Field Analyzer 10-2 test grid. The fixation stability was simultaneously recorded during the microperimetry test. The relationship between global sensitivity and age was calculated using linear regression analysis. Results: Microperimetry was performed on 37 participants (74 eyes). The global mean sensitivity was 29.01 ± 1.44 (range, 26-31) dB. The mean central sensitivity at 2° measured by the MP-3 was 28.5 ± 1.77 dB in the right eye (OD) and 28.75 ± 1.98 dB in the left eye (OS). The total median fixation stability values within 2° and 4° were 80% and 96%, respectively. The linear regression analysis also revealed an age-related global sensitivity decline per year of -0.051 dB ± 0.018 (OD) and -0.078 dB ± 0.021 (OS). Conclusions: Microperimetry performed with the MP-3 allows for an automatic, accurate, and topography-specific examination of retinal sensitivity thresholds. The results of this study provide a normal and age-matched database of MP-3 microperimetry.
RESUMO Objetivos: A microperimetria tem sido usada há vários anos como uma forma de teste de função visual em pacientes com doenças da retina. Os valores normais de microperimetria obtidos com MP-3 ainda não foram totalmente publicados e os valores basais para sensibilidade macular topográfica e correlações com idade e sexo são necessários para estabelecer graus de comprometimento. O objetivo do trabalho é determinar valores para limiares de sensibilidade à luz e estabilidade de fixação usando o MP-3 em indivíduos normais. Métodos: Trinta e sete voluntários saudáveis (idade: 28-68 anos), submetidos à microperimetria de limiar total usando uma estratégia de escada 4-2 (rápida) com o tamanho de estímulo padrão Goldmann III e 68 pontos de teste posicionados de forma idêntica aos do Humphrey Field Analyzer 10-2 grade de teste. A estabilidade da fixação foi registrada simultaneamente durante o teste de microperimetria. A relação entre a sensibilidade global e a idade foi calculada por meio de análise de regressão linear. Resultados: A microperimetria foi realizada em 37 indivíduos (74 olhos). A sensibilidade média global foi de 29,01 ± 1,44 dB, intervalo: 26-31 dB. A mediana da sensibilidade central a 2° medida pelo MP-3 foi de 28,5 ± 1,77 dB (ER) e 28,75 ± 1,98 dB (OE). Os valores médios totais de estabilidade da fixação em 2° e 4° foram 80% e 96%, respectivamente. A análise de regressão linear também revelou um declínio de sensibilidade global relacionado à idade por ano de -0,051 dB ± 0,018 (ER) e -0,078 dB ± 0,021 (LE). Conclusões: A microperimetria realizada com o MP-3 permite um exame automático, preciso e específico da topografia dos limiares de sensibilidade da retina. Os resultados deste estudo fornecem um banco de dados normal e de idade correspondente da microperimetria MP-3.
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AIM: To observe the changes of macular retinal structure and microcirculation in patients with pituitary adenoma(PA)by optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA).METHODS: Cross-sectional study. A total of 40 PA patients treated at the department of neurosurgery, Affiliated Hospital of Guangdong Medical University from September 2021 to March 2023 were included as PA group, and 42 age- and gender-matched healthy volunteers were selected as normal control group. All patients underwent visual field, OCT and OCTA examinations, and the correlation of ocular parameters in PA patients was analyzed.RESULTS:The vessel density(VD)of each retinal layer in the macular area of the PA group was lower than that of the normal control group, and the superficial vascular complex(SVC)-VD in the macular area was positively correlated with the thickness of the macular ganglion cell complex(mGCC)(except the nasal side of the inner ring and the lower part of the outer ring; P<0.05). The thickness of mGCC in each quadrant of the macular area and the thickness of the circumpapillary retinal nerve fiber layer(CP-RNFL)in each quadrant were negatively correlated with the mean defect(MD)value of the visual field(P<0.05), and the area of the foveal avascular zone(FAZ)was positively correlated with the MD value(P<0.05).CONCLUSION:The combination of OCT and OCTA can fully understand the microscopic changes of retinal structure and microcirculation function in PA patients, which is of great value in evaluating the preoperative visual function of PA patients.
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Purpose: Glaucoma influences vision?related quality of life (VRQoL) of an individual in various ways. There are very limited studies on the Indian population and the northern part of India. Therefore, we conducted the present study to evaluate VRQoL in glaucoma patients as well as the association between the severity of glaucoma and VRQoL. Methods: An institution?based, cross?sectional, analytical study was conducted from August 2022 to October 2022 involving 190 participants (95 glaucoma patients and 95 controls). The glaucoma quality of life?15 (GQL?15) questionnaire was explained in their vernacular language by the interviewer. The scoring was given according to the validated scoring algorithm for the questionnaire. Results: Mean GQL score in the control group was 19.66 ± 5.5 and in glaucoma cases was 32.8 ± 10.2, whereas the mean score of mild glaucoma cases was 22.3 ± 4.83, moderate glaucoma cases was 36.3 ± 4.09, and severe glaucoma cases was 47.24 ± 3.03. Therefore, as the severity of glaucoma increases, the GQL score also increases, indicating poorer quality of life. Visual field loss was strongly positively correlated (correlation coefficient = 0.759, P < 0.01) with the GQL?15 score, while a weaker positive correlation was found with best corrected visual acuity (BCVA), cup disc ratio, and duration of treatment. Conclusion: Besides controlling or reducing intraocular pressure (IOP) to the target level, the goal of glaucoma treatment should be to provide an individual with good functional vision to maintain an acceptable quality of life. It would also help in providing patients with the best possible treatment, not only in terms of good vision but also in maintaining or improving their overall quality of life.
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Background: Correct mapping of the blind spot is important, as it serves as an estimate of fixation reliability. When the blind spot is not seen in the expected location in Humphrey visual field (HVF) printout, the clinician should give a thought to why this might be the case. Purpose: This video describes a series of cases, in which due to different reasons the blind spot could not be seen in the presumed expected location in the grayscale and numeric data of the HVF printout and the possible explanation behind this. Synopsis: When interpreting perimetry results, it is important to know whether the field test is reliable or not. A stimulus presented at the location of physiologic blind spot should not be seen by a patient with a steady fixation in Heijl– Krakau method. Responses will also occur, however, if the patient has a tendency for false?positive responses, or when the blind spot of the properly fixing eye is not in the location where the test stimulus is presented, because of anatomic variation, or if the patient's head is tilted while performing the test. Highlights: Perimetrist should recognize these potential artifact, during the test and relocate the blind spot. In case, such results are seen after finishing the test, it is recommended for the clinician to repeat the test
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Purpose: To compare central visual field progression using mean deviation and pointwise linear regression (PLR) analysis. Methods: We analyzed the 10?2 Humphrey visual field (HVF) tests for moderate and advanced primary glaucoma who had undergone at least five reliable 10?2 visual field tests with a minimum follow?up of at least two years and best?corrected visual acuity better than 6/12. Regression slope less than ?1 dB/year at P < 0.01 at a point was defined as an individual threshold point progression. Results: Ninety?six eyes of 74 patients were included. The median follow?up duration was of 4 years (±1.97). Median 10?2 mean deviation (MD) at inclusion was ?19.01 dB (interquartile range [IQR] ?13.2, ?24.14) and ?21.90 (IQR ? 13.4, ?27.8) on 24?2 HVF. The median rate of MD change was ?0.13 dB/year (IQR ? 0.46, 0.08) for 10?2. The median rate for visual field index (VFI) change was 0.9% per year (IQR ? 1.5, 0.4). Twenty?eight percent of eyes (27 eyes) showed progression. Twelve percent (12 eyes) showed progression of two or more points in the same hemifield on pointwise linear regression (PLR) analysis, and 16% of eyes (15 eyes) showed progression of one point. The median rate of MD change was significantly more in progressing eyes based on PLR analysis than eyes with no progression (?0.5 vs. ?0.06 dB/year P < 0.001). One patient had likely and the second had possible progression on 24?2. In 24 eyes, event analysis did not show any change; the rest mean deviation was out of range. Conclusion: Central visual field PLR analysis is useful in detecting progression in advanced glaucomatous damage.
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Face mask-wearing practices and their impact on the visual field bear particular importance in the coronavirus disease 2019 (COVID-19) pandemic era. This case series examines 10 participants with no history of ocular impairment or visual field defects who underwent age-corrected visual field testing in both eyes with different types of face masks. Wearing duckbill N95 masks was consistently associated with increased accuracy errors in the inferior altitudinal visual field when compared to wearing surgical masks or no masks. These findings support public health guidance that has previously attributed the risks of falls and accidents to face mask wearing.
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Purpose: To compare the effect of audiovisual and verbal instructions on patient performance while performing automated Humphrey visual field testing. Methods: This was a prospective study. A total 120 patients divided into groups of 40 each were recruited from the glaucoma outpatient department (OPD). All patients were aged 35–75 years with no previous experience of performing HFA. Patients with hearing impairment, any other cognitive impairment, and best?corrected visual acuity (BCVA) ?6/36 on Snellen’s visual acuity were excluded. The first two groups were given strict (conservative) and lenient (liberal) verbal instructions. The instructions were adapted from those listed in the manufacturer’s instruction. and the third group was shown a standard video depicting in detail how perimetry was to be performed. A questionnaire was given to each patient before and after the test to assess the patient’s performance. Results: Patients diagnosed with glaucoma during testing in each group were 29 (72.50%), 30 (75.0%), and 33 (82.5%) in the video instructed, strictly verbal, and leniently verbal groups, respectively. The overall mean deviation (MD) in the right eye (RE) was of ? 3.38 (?4.9 to 1.9) and in the left eye (LE) was ? 3.96 (?6.4 to ? 1.9). Reliable field was slightly higher for the video instructed group (47.5%) and lowest for the strictly verbal group (22.5%) (P = 0.033). A higher number of patients were very motivated in the video instructed group (27%) (P = 0.041). Post?test questionnaires showed that 40% of patients felt they have performed the test with 100% accuracy in video group with less guessing. A higher number of patients in the video instructed group (85%) felt instruction was helpful in performing the test (P = 0.001). Conclusion: The video groups were more motivated and had better confidence to perform the test with less anxiety and stress and with probably better understanding of the procedure due to visual effects enhancing their understanding.
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AIM: To compare the visual function of low-vision patients with primary retinal pigmentosa(RP)before and after wearing amber filter.METHODS: Self-control before and after study. A total of 30 patients(60 eyes)with low vision who were diagnosed with primary RP in the ophthalmology clinic of Xi'an No.1 Hospital from August 2021 to March 2022 were collected. The uncorrected distance visual acuity(UCDVA), best-corrected distance visual acuity(BCDVA), uncorrected near visual acuity(UCNVA), best-corrected near visual acuity(BCNVA), visual field and Farnsworth-Munsell(FM)-100 color visions were recorded before and after wearing amber filter. The contrast sensitivity(CS)in three visual environments including bright room, darkroom and darkroom with glare was measured and recorded respectively, and the changes of those parameters were analyzed before and after wearing filter.RESULTS: UCDVA and BCDVA after wearing the filter were better than those before wearing(t=-2.32, P&#x003C;0.001; t=-6.77, P&#x003C;0.001), while there was no statistically significant difference in UCNVA and BCNVA before and after wearing filter. The visual field index(VFI)after wearing filter was lower than that before wearing(t=8.62, P&#x003C;0.001), and the mean defect(MD)of visual field was greater than that before wearing(t=7.73, P&#x003C;0.001). FM100 color chess test showed that both total error score(TES)and partial error score(PES)in multiple regions were higher than those before wearing filter(P&#x003C;0.001). After wearing, the CS of each frequency band in the environment of bright room and darkroom with glare was higher than that before wearing(P&#x003C;0.001), and there was no statistically significant difference in each frequency band before and after wearing amber filter under the environment of darkroom without glare.CONCLUSION: Patients with low vision of primary RP showed improved UCDVA and BCDVA, but unchanged UCNVA and BCNVA after wearing amber filter, while the visual field and color discrimination were worse than those before wearing filter. The CS of the bright room and darkroom with glare environment was improved than before wearing filter, while there were no significant changes in CS under darkroom without glare.
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Objective:To investigate the association between serum lipid levels and inflammatory indicators in patients with primary open angle glaucoma (POAG).Methods:A case-control study was conducted.A total of 86 POAG subjects were collected as a POAG group at Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong from January 2016 to March 2022.Meanwhile, 86 with age-related cataract only, matched at age, sex and body mass index were collected as a control group.The intraocular pressure (IOP) and the mean defect of visual field (MD) were measured by Goldmann tonometer and Humphrey field analyzer, respectively.Human peripheral blood samples collected from subjects for serum lipid levels, including total cholesterol, total triglycerides, high density lipoprotein (HDL), and low density lipoprotein (LDL), were analyzed using an automated hematology analyzer and inflammatory markers including C-reactive protein, white blood cells (WBC), neutrophils, lymphocytes, monocytes, were analyzed using an automated biochemical analyzer.Indicators with statistically significant differences between the two groups were selected as independent variables, and multiple logistic regression analysis was used to determine the risk factors for POAG.Correlations between risk factors and ocular parameters (IOP and MD) were assessed using Pearson correlation analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong (No.EC20210313[2]-P03). Written informed consent was obtained from each patient before any medical examination.Results:The HDL was (1.59±0.42)mmol/L in the POAG group, which was significantly lower than (1.76±0.50)mmol/L in the control group ( t=2.435, P=0.016). The LDL was (3.34±0.66)mmol/L in the POAG group, which was significantly higher than (3.08±0.71)mmol/L in the control group ( t=2.520, P=0.013). The WBC was (6.91±1.60)×10 9/L in the POAG group, which was significantly higher than (6.11±1.29)×10 9/L in the control group ( t=3.619, P<0.001). Multiple logistic regression analysis showed that high serum LDL level ( P=0.039, OR=2.354, 95% CI: 1.105-5.303) and high WBC level ( P=0.044, OR=1.310, 95% CI: 1.007-1.703) were risk factors for POAG.Pearson correlation analysis showed that the serum LDL and WBC levels of POAG patients were moderately positively associated with IOP ( r=0.610, P<0.001; r=0.358, P=0.001). LDL level was moderately negatively associated with MD ( r=-0.496, P<0.001). WBC level was weakly negatively associated with MD ( r=-0.235, P=0.030). Conclusions:The elevated peripheral blood LDL and WBC levels are risk factors for POAG onset.The elevated LDL and WBC levels are positively correlated with IOP and negatively correlated with MD in POAG patients.
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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
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Purpose: Our trail was to study insulin intravitreal injection’s (IIV) efficacity and safety to treat glaucoma neurodegeneration.Methods: Eleven subjects (11eyes) were recruited;10 patients treated in a double masked randomized sham controlled including 5 patients received one IIV injection 3UI and 5 patients received one injection of balanced salt solution(BSS) 3UI. A follow up during 168days was realized using Optical Coherence Tomography(OCT) and visual field(VF).The eleventh patient received two IIV injection without masking the injection content within one month between each injection and followed up for 877days.All the patients have a correct ocular pressure and no ocular treatment was stopped.Results: The 5 patients who received IIV revealed a swift improvement of decibel (DB), and remains stable during the first month. The average improvement was 6.62DB during 168days.The 5 patients treated with one BSS injection showed no significant improvement regaining 1. 45DB.The last patient who received two injections showed increase from 7.54DB to 17.22DB with a functional amelioration of 9. 68DB.The OCT examination showed a structural improvement during the first month, then returned to the initial value. No complication was observed during and after the treatment.Conclusion: Insulin shows not only efficacity and safety but more than that, the visual field(VF) of the patients became stable and show no deterioration in all the follow up, which confirmed that insulin act to improve the function rather than structure. it means insulin reconnect the stoma and improve the neurite outgrowth This treatment will change the evolution of this pathology and protect the glaucomatous patients against blindness.
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Purpose: To compare the anxiety levels related to visual field testing and optical coherence tomography (OCT) in patients with glaucoma. Methods: This prospective, comparative study was conducted on patients with glaucoma. The participants’ anxiety traits were assessed using the State-Trait Anxiety Inventory [STAI]. Before visual field testing on Humphrey visual field analyzer (HVF) and retinal nerve fiber analysis on OCT, the participants completed Form Y1 to measure the current pretest level or ‘State’ anxiety [pretest anxiety]. Immediately after testing, participants were administered the Form Y1 questionnaire to assess the induced anxiety level during the testing [Intratest anxiety]. Results: A total of 228 patients were enrolled with 152 participants in the HVF group and 76 in the OCT group. The mean age of the participants in the HVF group was 57.2 ± 20.8 years and in the OCT group was 56.8 ± 20 years. There was no significant difference in trait and pretest anxiety between the HVF group and the OCT group (P = 0.971 and P = 0.716). Intratest test anxiety score was slightly higher in the HVF group (HVF: 42.13 ± 10.63, OCT: 40.71 ± 9.76; P = 0.33). The anxiety scores were higher when the experience of previous HVF tests was <2 and least when the number of tests exceeded five. Conclusion: Automated perimetry induces slightly more anxiety than OCT, which may affect test performance. The measured anxiety reduces as patients gain familiarity with the test with experience. This adds credence to the recommendation of more frequent visual field testing in newly diagnosed glaucoma patients
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Purpose: To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods: This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 ?m (AOD 500) and 750 ?m (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results: The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman’s rank correlation coefficient (r = -0.3329). Conclusion: The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG
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Objetivo: Caracterizar las enfermedades oftalmológicas que causan diversidad funcional visual en los estudiantes del Centro de Recursos y Apoyo "Abel Santamaría Cuadrado". Métodos: Estudio descriptivo, de corte transversal realizado en enero, 2017. Las variables investigadas fueron: edad, sexo, grado de escolaridad, antecedentes prenatales, diagnóstico oftalmológico principal, enfermedades asociadas, síndromes oftalmológicos, agudeza visual mejor corregida, defecto refractivo, ayudas ópticas y no ópticas utilizadas. Resultados: La muestra quedó conformada por 66 estudiantes (95,6 por ciento de los matriculados), predominaron las edades entre 10-14 años, para ambos sexos. De ellos, 24 estudiantes eran ciegos totales (36,4 por ciento). El astigmatismo hipermetrópico compuesto fue la ametropía primaria más frecuente. Las ayudas ópticas y no ópticas son utilizadas por la mayoría de los alumnos. Conclusiones: Las enfermedades oculares más frecuentes causantes de baja visión fueron la catarata congénita y la atrofia del nervio óptico. Las ayudas ópticas y no ópticas son empleadas con la colaboración de la rehabilitadora y los maestros(AU)
Objective: To characterize the ophthalmologic diseases that cause visual functional diversity in students of the "Abel Santamaría Cuadrado" Resource and Support Center. Methods: Descriptive, cross-sectional study conducted in January, 2017. The variables investigated were: age, gender, school grade, prenatal history, main ophthalmologic diagnosis, associated diseases, ophthalmologic syndromes, best corrected visual acuity, refractive defect, optical and non-optical aids used. Results: The sample consisted of 66 students (95.6 percent of those enrolled), predominantly aged 10-14 years, for both genders. Out of these, 24 students were totally blind (36.4 percent). Compound hyperopic astigmatism was the most frequent primary ametropia. Optical and non-optical aids were used by most of the students. Conclusions: The most frequent ocular diseases causing low vision were congenital cataract and optic nerve atrophy. Optical and non-optical aids are used with the collaboration of the rehabilitator and teachers(AU)
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Humans , Male , Female , Child , Adolescent , Vision, Low , Refractive Errors , Epidemiology, DescriptiveABSTRACT
Background: India is among the largest countries to implement the revised national tuberculosis (TB) control program (RNTCP). Ocular toxicity of ethambutol has been known since 1962. It can be halted with early detection and cessation of the contributing drug. Aims and Objectives: This study aims to detect early ocular toxicity of ethambutol in TB patients under directly observed treatment strategy (DOTS). Materials and Methods: This was a prospective cross-sectional study of 30 patients getting AKT including ethambutol along with isoniazid, rifampicin, and pyrazinamide under RNTCP?DOTS center at a tertiary care hospital. The detailed history, best-corrected visual acuity (BCVA), color vision, fundus examination, visual field, retinal nerve fiber layer (RNFL) thickness, and central subfield macular thickness were carried out in all patients pretreatment and then at the 2nd month of treatment. Results: The mean age of patient was 44.87 years. Reduced visual acuity from the baseline was noted at the second in 23.33% of the right eyes (P = 0.01) and 30% of the left eyes (P < 0.01). Mean temporal RNFL thickness was significantly reduced from baseline after 2 months of treatment (P = 0.046). No significant difference was observed with color vision and visual fields pre- and post-treatment. Conclusion: The assessment of BCVA, color vision, visual field, RNFL, and macular thickness is essential at baseline and thereafter at frequent intervals to detect early ethambutol toxicity and probable reversible visual loss.
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Objective:To compare the change of macular microvasculature in early primary open-angle glaucoma (POAG) patients with central visual field defects (CVFDs) and peripheral visual field defects (PVFDs).Methods:A cross-sectional study was performed.Sixty-six eyes of 66 consecutive patients with early POAG were enrolled in Beijing Tongren Hospital from June to December 2020.The patients were divided into CVFDs group (25 eyes) and PVFDs group (41 eyes) according to their visual field defect.Another 55 eyes of 55 age-, gender- and spherical equivalent-matched healthy people were set as a normal control group.All subjects underwent routine ophthalmic examination.Humphrey 24-2 visual field test was carried out.Macular vessel density (VD) and perfusion density (PD) of an area of 6 mm×6 mm were measured by optical coherence tomography angiography (OCTA), and the area was divided into 3 rings and 9 zones, including center, inner ring (superior, inferior, temporal and nasal sectors), and outer ring (superior, inferior, temporal and nasal sectors) according to ETDRS ring.The relationship among VD, PD, and visual field defect was analyzed.This study adhered to the Declaration of Helsinki.The research protocol was approved by an Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2020-103). Written informed consent was obtained from each subject before any examination.Results:The total macular VD of normal control group, CVFDs group and PVFDs group was 18.20 (17.50, 18.50), 17.10 (16.30, 17.85), and 17.20 (16.25, 17.90)mm/mm 2, respectively, and there was a significant difference ( H=20.84; P<0.001). The total macular PD of normal control group, CVFDs group and PVFDs group was 0.45 (0.43, 0.46), 0.42 (0.40, 0.44), and 0.43 (0.40, 0.44)mm 2/mm 2, respectively, with a significant difference ( H=16.15; P<0.001). The total macular VD and PD of CVFDs and PVFDs groups were significantly lower than those of normal control group, with statistically significant differences (all at P<0.05). Significant differences were found in VD and PD of superior, inferior, temporal, and nasal sectors of the outer ring among three groups (all at P<0.05). VD of the outer ring and PD of superior, inferior, and nasal sectors of the outer ring were reduced in CVFDs group than normal control group, showing significant differences (all at P<0.05). VD and PD of the superior, inferior, and temporal sectors of the outer ring were reduced in PVFDs group compared with normal control group, with significant differences (all at P<0.05). A significant difference was found in macular PD of the outer-nasal sector between CVFDs and PVFDs groups ( P=0.035). Conclusions:Macular VD and PD are reduced in early POAG.Compared with POAG patients with CVFDs, the macular PD of the outer-nasal sector of POAG patients with CVFDs is lower.
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Objective:To observe the changes of visual acuity and fixation properties of eyes with idiopathic macular hole (IMH) before and after surgery.Methods:A prospective clinical study. From September 2019 to December 2020, 25 patients with 25 eyes of IMH diagnosed in Department of Ophthalmology of The Fourth People's Hospital of Shenyang were included in the study. All patients underwent pars plana vitrectomy (PPV) combined with internal limiting membrane stripping. All eyes underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and microperimetry before and after surgery. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into logarithmic minimum resolution angle (logMAR) visual acuity during statistics. The 12° macular sensitivity (MS) and bivariate contour ellipse area (BCEA) were measured by MP-3 microperimetry. The minimum diameter (MIN) and base diameter (BASE) of the macular hole were measured by OCT; the distance between the preferred retinal location (PRL) and the center of the fovea was measured by Image-proplus 6.0 image processing software. At 1 and 3 months follow-up after surgery, the same equipment and methods as before surgery were used to conduct related examinations. The changes of BCVA, PRL distance from the fovea, MS, BCEA, and macular hole shape before and after surgery were compared and observed. One-way analysis of variance was used to compare the indicators before and after surgery. Pearson correlation analysis was used for the correlation between BCVA and preoperative BCVA, PRL and foveal center distance at 3 months after surgery. The correlation between MIN, BCVA, PRL and foveal center before surgery distance, MS, BCEA and BCVA at 3 months after surgery were analyzed by multiple linear regression.Results:Among 25 eyes of 25 cases, 1 male had 1 eye, and 24 females had 24 eyes. The macular hole in stage Ⅲ and Ⅳ were 11 eyes and 14 eyes, respectively. MIN and BASE were 537.68±200.09 and 905.48±278.79 μm, respectively. One month after surgery, the hiatus was closed. Before surgery and 1 and 3 months after surgery, the logMAR BCVA of the affected eyes were 0.80±0.17, 0.70±0.21, 0.60±0.25, and the MS were 22.20±3.86, 23.60±3.14, 24.38±2.68 dB, the distances between PRL and the center of the fovea were 537.72±426.05, 402.00±395.06, 236.80±219.54 μm, and BCEA were 7.90±3.43, 6.40±2.67, 4.80±2.32 deg 2. Compared with before operation, BCVA ( F=7.047, 20.104) and MS ( F=1.980, 5.390) were significantly improved at different time after operation, the distance between PRL and fovea center ( F=1.265, 9.530), BCEA ( F=2.762, 13.617) were decreased, the difference were statistically significant ( P<0.05). The results of correlation analysis showed that BCVA at 3 months after surgery was significantly associated with preoperative MIN ( r=0.810), BASE ( r=0.664), BCVA before surgery and 1 month after surgery ( r=0.854, 0.940), preoperative and surgical MS at 1 month after surgery ( r=-0.548, -0.578), distance between PRL and foveal center before surgery and at 1 month after surgery ( r=0.833, 0.915), BCEA before surgery and at 1 month after surgery ( r=0.636, 0.732) were significantly correlated ( P<0.05). The results of multiple linear regression analysis showed that the distance between PRL and foveal center before surgery and BCVA were risk factors for poor prognosis of BCVA at 3 months after surgery. Conclusions:The BCVA and MS of eyes with IMH are significantly improved after surgery, and the distance between PRL and foveal center and BCEA decreased. BCVA, PRL and foveal center distance before surgery are risk factors for poor visual acuity after surgery.
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ABSTRACT The rate of visual field progression is an essential factor in determining risk of visual disability or blindness in glaucoma patients. Knowledge of the rate of progression of a particular patient, in combination with an estimation of their longevity and other clinical factors, allows clinicians to optimize management by providing appropriately aggressive treatment. Despite decades of research on the treatment of glaucoma, the natural history of glaucomatous visual field progression in untreated and treated patients remains unclear. The purpose of this review is to provide a comprehensive summary of the literature surrounding the rate of visual field progression in glaucoma. Most of the available data pertains to primary open angle glaucoma, but we will also review progression rates in other subtypes of open angle glaucoma, such as pseudoexfoliative glaucoma and normal tension glaucoma, as well as in primary angle closure glaucoma. Specifically, we will cover methods to identify rates of progression, rates of progression in treated versus untreated patients, factors that may influence progression, and lastly, suggest some parameters that might help clinicians in determining acceptable rates of visual field deterioration in patients with glaucoma.
RESUMO A taxa de progressão do campo visual é um fator essencial para determinar o risco de incapacidade visual ou cegueira em pacientes com glaucoma. Conhecer a taxa de progressão de um determinado paciente, em combinação com uma estimativa de sua longevidade e outros fatores clínicos, permite que os médicos otimizem a conduta, fornecendo um tratamento adequadamente agressivo. Apesar de décadas de pesquisa sobre o tratamento do glaucoma, a história natural da progressão do campo visual glaucomatoso em pacientes não tratados e tratados permanece pouco clara. O objetivo desta revisão é fornecer um resumo abrangente da literatura sobre a taxa de progressão do campo visual do glaucoma. A maioria dos dados disponíveis diz respeito ao glaucoma de ângulo aberto primário, mas também revisaremos as taxas de progressão em outros subtipos de glaucoma de ângulo aberto, como o glaucoma pseudoexfoliativo e o glaucoma de tensão normal, bem como o glaucoma primário de ângulo fechado. Especificamente, iremos cobrir métodos para identificar taxas de progressão, taxas de progressão em pacientes tratados versus não tratados, fatores que podem influenciar a progressão e, finalmente, sugerir alguns parâmetros que podem ajudar os médicos a determinar taxas aceitáveis de deterioração do campo visual em pacientes com glaucoma
Subject(s)
Humans , Visual Fields , Glaucoma/complications , Glaucoma/diagnosis , Linear Models , Glaucoma/physiopathology , Blindness/etiology , Risk Factors , Disease Progression , Visual Field Tests/methods , Intraocular PressureABSTRACT
Objective:To observe the changes of macular visual function after myopic foveoschisis (MF) and pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and air filling.Methods:A single-center, retrospective study. From October 2018 to October 2019, 29 MF inpatients (32 eyes) in Tianjin Eye Hospital were included in this study. There were 3 males (4 eyes) and 26 females (28 eyes). The age was 63.00±3.45 years old. Equivalent spherical lens degree was -14.16±2.54 D, and axial length was 29.14±1.04 mm. Among them, 3 patients (3 eyes) had lamellar macular holes. All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling. Before surgery and at 1, 3, and 6 months after surgery, macular microperimetry was performed with a macular integrity assessment instrument, and the mean retinal sensitivitie (MS) within 10° of the macula, fovea 2° and 4° fixation rates (P1, P2), 63% and 95% bivariate contour ellipse area (BCEA) were recorded. The comparison of MS, P1, P2, 63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test; the comparison of fixation stability rate was performed by χ 2 test. Results:Compared with before surgery, there were significant differences in the improvement of MS in affected eyes at 1, 3 and 6 months after surgery ( t=-2.208, -3.435,-4.919; P=0.038, 0.002, 0.000). In the pairwise comparison at different times after surgery, only 6 months after surgery and 1 month after surgery were significantly different ( P=0.036). Compared with the preoperative P1, P2, 63%BCEA and 95%BCEA, the P1 and P2 of the eyes gradually increased after surgery, while the 63%BCEA and 95%BCEA gradually decreased, however, the difference was not statistically significant (P1: t=-1.595,-1.698,-1.966; P=0.125, 0.104, 0.062. P2: t=-1.622,-1.654,-1.707; P=0.119, 0.112, 0.102. 63%BCEA: t=1.410, 1.409, 1.553; P=0.172, 0.173, 0.135. 95%BCEA: t=1.412, 1.408, 1.564; P=0.172, 0.173, 0.132). Six months after surgery, all the eyes underwent anatomical repositioning of the macular area, and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found. Conclusions:PPV with internal limiting membrane peeling and air filling is an effective and safe method for MF, and the macular function improved significantly within 6 months postoperatively.
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Transsynaptic retrograde degeneration of optic neuropathy (TRDON) refers to the degeneration and/or apoptosis of presynaptic neurons (retinal ganglion cells) caused by damage to the lateral geniculate body and post-geniculate visual pathway. At present, the pathogenesis of TRDON is secondary apoptosis of P β-type retinal ganglion cells, resulting in the atrophy of optic tract, thinning of the retinal nerve fiber layer and retinal ganglion cell layer thickness and declining of retinal microvascular density, which are consistent with the visual field defect attributed to the primary disease. Of which, the thinning of the retinal ganglion cell layer thickness is considered as the characteristic of TRDON. Now, there is little understanding and related research on TRDON in China. Clinicians should pay attention to the characteristics and severity, occurrence time and location of the above structural changes in these patients through optical coherence tomography, and monitor the activity and progress of the lesions, so as to determine the cut-off point for drug intervention and the drug targets for developing new treatment methods, and bring benefits for patients in partial visual function recovery and disability reduction.