To compare central visual field progression using mean deviation and pointwise linear regression analysis

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.

Therapeutic effect of two methods of internal limiting membrane dissection on MHCI < 0.7 idiopathic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical effects of different methods of internal limiting membrane peeling in vitrectomy in treatment of idiopathic macular hole(IMH)with macular hole closure index(MHCI)<0.7. <p>METHODS: Totally 88 patients(88 eyes)with MHCI<0.7 IMH admitted from May 2014 to May 2017 were randomly divided into group A(44 eyes underwent extended internal limiting membrane dissection)and group B(44 eyes underwent standard internal limiting membrane dissection). The closure of macular hole, best corrected visual acuity(BCVA), central scotoma and complications were observed between the two groups. <p>RESULTS: At 6mo after operation, the closure rate of macular hole in group A was significantly higher than that in group B(91% <i>vs</i> 75%, <i>P</i><0.05). At 6mo after operation, BCVA in group A was better than that in group B(0.47±0.05 <i>vs</i> 0.74±0.14, <i>P</i><0.05). The percentage of central scotoma eyes was lower than that in group B(4% <i>vs</i> 23%, <i>P</i><0.05), but there was no significant difference in the incidence of complications between the two groups(11% <i>vs</i> 9%, <i>P</i>>0.05).<p>CONCLUSION: Extended internal limiting membrane dissection is more effective than standard internal limiting membrane dissection in the treatment of IMH with MHCI < 0.7, and the former is better for the recovery of retinal function.

Macular Ganglion Cell Layer Assessment to Detect Glaucomatous Central Visual Field Progression

PURPOSE: To investigate the use of ganglion cell inner plexiform layer (GC-IPL) thickness, as measured by spectral domain optical coherence tomography, to detect central visual field (VF) progression. METHODS: This study included 384 eyes from 384 patients (219 preperimetric and 165 perimetric glaucomatous eyes; average follow-up, 4.3 years). Photographic assessment of retinal nerve fiber layer (RNFL) and serial VF analysis were performed to detect glaucoma progression in the central (within 10°) area. Study inclusion required at least five serial spectral domain optical coherence tomography exams at different visits. The long-term test-retest variability of average GC-IPL thicknesses was calculated in 110 stable preperimetric glaucomatous eyes. The sensitivity and specificity of GC-IPL measurements for the detection of central VF progression were calculated in an event-based analysis using the calculated variability as a cut-off and were compared with those of central RNFL photographic assessment. RESULTS: The intersession test-retest variability, defined as the 95% confidence interval, was 1.76 µm for average GC-IPL thickness. The sensitivity and specificity of the average GC-IPL thickness for detecting central VF progression were 60.7% and 78.9%, respectively. Among six sectors, the inferonasal GC-IPL sector showed the highest sensitivity (53.6%). The sensitivity of the ≥1 sector GC-IPL to detect central VF progression was significantly higher than that of central RNFL photographic progression (p = 0.013). Other GC-IPL parameters showed comparable sensitivity and specificity to detect central VF progression compared with RNFL photographic progression. CONCLUSIONS: Serial GC-IPL measurements show comparable performance in the detection of central glaucomatous VF progression to RNFL photographic assessment.

Asymptomatic Unexplained Visual Field Loss Diagnosed as Early Retinitis Pigmentosa without Pigmentation: A Case Report

PURPOSE: We report a case of asymptomatic unexplained visual field loss diagnosed as early retinitis pigmentosa (RP) without pigmentation. CASE SUMMARY: A 33-year-old woman was referred to us with a constricted visual field (C24-2) before laser-assisted in-situ keratomileusis surgery. The visual field test (C30-2) revealed significantly decreased sensitivity between 15 to 25 degrees in both eyes. Close fundus examination revealed a subtle greyish retinal atrophic lesion along the vascular arcade and fluorescein angiography revealed a window defect in accordance with a retinal atrophic lesion in both eyes. Optical coherence tomography showed decreased retinal thickness around the macula. Electroretinogram revealed decreased b waves in rod response. Based on these findings, we diagnosed the patient with early RP without pigmentation. CONCLUSIONS: The possibility of early RP without pigmentation presenting as slight atrophy around the macula without significant pigmental degeneration should also be considered if a patient presents with peripheral visual field constriction without other symptoms. The ophthalmologist should ensure that the location of the visual field defect matches the location of the lesion. In addition, a detailed fundus examination with macular optical coherence tomography can be helpful to diagnose such a lesion.

Preservation of retinal sensitivity in central visual field after panretinal photocoagulation in diabetics

Changes in retinal sensitivity within central 30 degrees following panretinal photocoagulation (PRP) for more severe diabetic retinopathy were investigated. Twenty-five eyes with visual acuity of 0.4 or better and minimal maculopathy were studied prospectively. All underwent PRP in two sittings, and Humphrey field analyzer 30-2 threshold test was done before and 1 week, 1 and 3 months after the treatment. The mean retinal sensitivity threshold was obtained from each hemifield between 15 and 30 degrees and from the central 15 degree area, and the changes in the values were analyzed. Mean sensitivity threshold in the upper visual field at pre-PRP, post-PRP 1 week, 1, 3 months were 15.62, 13.81, 14.31, 14.85, respectively. Values in the lower field were 18.71, 17.25, 17.10, 18.17. Difference between pre-PRP and post-PRP was statistically significant at 1 week but no longer thereafter. Retinal sensitivity within the central 15 degrees remained stable. The data show that retinal sensitivity decreases significantly 1 week after PRP but recovers upto 95% of pre-PRP level over the following 3 months.

Visual Prognosis in Advanced Glaucoma

Many surgeons have noted that when the visual field is markedly constricted, immediate and permanent loss of central vision may follow otherwise successful glaucoma surgery. The present study was undertaken to assess the relative risk of surgical therapy in the loss of central vision in patients with advanced glaucoma. We reviewed the records of 44 eyes(including 8 macular split eyes) of 36 patients who had undergone trabeculectomy. The patients were followed for a minimum of 4 months with an average follow-up of 4.1 years. None of the patients suddenly lost visual field following surgery when central vision was spared at the time of the operation. There was good preservation of preoperative visual acuity except in 3 eyes which developed lens opacity. There was no progression of visual field loss when the intraocular pressure was controlled below 21 mmHg. There was good control of intraocular pressure in 43 out of 44 operated eyes. However, in one of the 2 reoperated eyes, we could not control the intraocular pressure below 21 mmHg.

Visual prognosis in advanced glaucoma

Many surgeons have noted that when the visual field is markedly constricted, immediate and permanent loss of central vision may follow otherwise successful glaucoma surgery. The present study was undertaken to assess the relative risk of surgical therapy in the loss of central vision in patients with advanced glaucoma. We reviewed the records of 44 eyes (including 8 macular split eyes) of 36 patients who had undergone trabeculectomy for intraocular pressure (IOP) control. The patients were followed for a minimum of 4 months with an average follow-up of 4.1 years. None of the patient suddenly lost visual field following surgery when central vision was spared at the time of operation. There was good preservation of preoperative visual acuity except in 3 eyes which developed lens opacity. There was no progression of visual field loss when the IOP was controlled below 21 mmHg. There was good control of IOP of 43 eyes in 44 eyes operated. However, in one of the 2 reoperated eyes, we could not control the IOP below 21 mmHg.

Changes of retinal sensitivity of central visual field in juveniles after correction with spectacles / 第三军医大学学报

Objective To compare the changes of retinal sensitivity of central 30? visual field after correction with spectacles with those before correction in juveniles and to provide data for the necessity of correction with spectacles in the measurement of juvenile central visual field. Methods The changes of the retinal sensitivity of central 30? visual field after correction with spectacles in 122 eyes of juveniles were measured using Humphrev 750 Ⅱ perimeter, and were compared with those before correction. Results All the myopic eyes of 122 juveniles passed the reliability of parameters. Among the detected eyes, 110 eyes showed degree dependent changes of the retinal sensitivity of central visual field. Conclusion Correction with spectacles should be used for the measurement of central visual field in juveniles. Otherwise, the results might be unreliable, especially in the cases with moderate and high myopia.