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1.
J Glaucoma ; 30(10): 878-881, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1356729

ABSTRACT

PRECIS: Tape sealing of the face mask can prevent fogging artifacts of visual field testing. Here, we demonstrate that tape sealing can improve visual field scores even when fogging artifacts are not obvious. PURPOSE: The purpose of this study was to demonstrate that visual field scores improve when the face masks are taped to prevent fogging artifacts. METHODS: A Single-center, randomized 2×2 cross-over study. Twenty-six visual fields of 13 patients of the glaucoma outpatient clinic were included. Patients were randomized in either sequence 1 (Octopus visual field examination without tape sealing, followed by examination with tape sealing) or sequence 2 (examination with, followed by without tape sealing). RESULTS: The results for mean defect and square root of loss variance differ significantly in the examination with and without tape sealing [mean difference (without-with) 0.39 dB, 95% confidence interval: 0.07-0.70 dB, P=0.018 and 0.49 dB, 95% confidence interval: 0.19-0.79 dB, P=0.003, respectively]. There was no sequence effect (P=0.967) for mean defect nor the square root of loss variance (P=0.779). A significant effect for period (P=0.023) for mean defect was yielded. CONCLUSION: Tape sealing of face masks during visual field testing prevented fogging artifacts and improved visual field scores even when fogging artifacts were not obvious and should be considered in clinical practice.


Subject(s)
COVID-19 , Visual Fields , Cross-Over Studies , Humans , Intraocular Pressure , Masks , SARS-CoV-2 , Visual Field Tests
3.
BMJ Open ; 11(4): e043130, 2021 04 05.
Article in English | MEDLINE | ID: covidwho-1169874

ABSTRACT

OBJECTIVES: To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. DESIGN: Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. SETTING: Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. PARTICIPANTS: Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). RESULTS: All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. CONCLUSIONS: Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma.


Subject(s)
Glaucoma , Visual Field Tests , Adult , Aged , Female , Glaucoma/diagnosis , Humans , Intraocular Pressure , Pilot Projects , Qualitative Research , Vision Disorders/diagnosis , Visual Fields
5.
J Glaucoma ; 30(3): 219-222, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1147202

ABSTRACT

PRECIS: Designing and demonstrating an experiment that shows the risk of airborne transmission of COVID-19 between patients having visual fields analyzed is low. PURPOSE: The aim was to investigate the possibility of airborne transmission of COVID-19 during Humphrey visual field testing in a real-world scenario. METHODS: A particle counter was placed within the bowl of Humphrey visual field analyzer (HFA) before and after turning on the machine to ascertain the effect of the air current produced by the ventilation system on aerosols. A second experiment was run where the particle counter was placed in the bowl and recorded particulates, in the air, as a 24-2 SITA standard was performed by a mock patient and then again immediately after the patient had moved away. We measured aerosol particle counts sized ≤0.3 µm, >0.3≤0.5 µm, >0.5≤1 µm, >1≤2.5 µm, >2.5≤5 µm, and >5≤10 µm. RESULTS: Particulates of all sizes were shown to be significantly reduced within the bowl after turning the machine on, demonstrating that the air current produced by the HFA pushes air out of the bowl and it cannot stagnate. There was no significant difference in measurement of aerosol while there was a patient performing the test and immediately after they had moved away, suggesting that aerosols breathed out by the patient are not able to remain in suspension in the bowl because of the ventilation current. CONCLUSION: There is no significant difference between aerosol count in the bowl of a HFA before, during and after testing. This suggests the risk of airborne transmission of COVID-19 is low between subsequent patients. This is in keeping with manufacturer's guidance on Humphrey visual field testing.


Subject(s)
Aerosols/adverse effects , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Ocular Hypertension/diagnosis , Visual Field Tests/methods , Visual Fields/physiology , COVID-19/epidemiology , Comorbidity , Humans , Intraocular Pressure/physiology , Ocular Hypertension/epidemiology , Ocular Hypertension/physiopathology , SARS-CoV-2
6.
Indian J Ophthalmol ; 69(4): 989-991, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138825

ABSTRACT

Ocular manifestations of COVID-19 are still being studied. Posterior segment involvement in viral entities is either direct viral involvement or a delayed immune response to the antigen. A 22-year-old woman presented with history of perceiving absolute inferior scotoma in the right eye for 4 days and history of fever and sore throat 10 days ago. Fundus examination revealed disc edema and vessel tortuosity. Humphreys Field Analyzer confirmed inferior field defect and Optical Coherence Tomography showed superior, nasal and inferior retinal nerve fiber layer thickening in the right eye. Patient was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) testing. Patient received three doses of injection methylprednisolone over 3 days. There was subjective resolution of scotoma reported 3 weeks posttreatment. We bring forward the first reported case of parainfectious optic neuritis associated with COVID-19.


Subject(s)
COVID-19/diagnosis , Eye Infections, Viral/diagnosis , Papilledema/diagnosis , SARS-CoV-2 , Scotoma/diagnosis , Visual Fields/physiology , COVID-19/drug therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Glucocorticoids/therapeutic use , Humans , Methylprednisolone/therapeutic use , Papilledema/drug therapy , Papilledema/virology , Scotoma/drug therapy , Scotoma/virology , Tomography, Optical Coherence , Visual Acuity , Visual Field Tests , Young Adult
7.
Klin Monbl Augenheilkd ; 238(2): 191-192, 2021 02.
Article in German | MEDLINE | ID: covidwho-1132143
8.
Semin Ophthalmol ; 36(4): 310-314, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1125541

ABSTRACT

Technological advances provide a number of options for glaucoma monitoring outside the office setting, including home-based tonometry and perimetry. This has the potential to revolutionize management of this chronic disease, improve access to care, and enhance patient engagement. Here, we provide an overview of existing technologies for home-based glaucoma monitoring. We also discuss areas for future research and the potential applications of these technologies to telemedicine, which has been brought to the forefront during the ongoing COVID-19 pandemic.


Subject(s)
Diagnostic Techniques, Ophthalmological/trends , Glaucoma/diagnosis , Monitoring, Ambulatory , Telemedicine/trends , Telemetry/instrumentation , Biomedical Technology/trends , Glaucoma/physiopathology , Humans , Intraocular Pressure/physiology , Ophthalmology/trends , Self Care/methods , Tomography, Optical Coherence/methods , Tonometry, Ocular/methods , Visual Field Tests/methods
9.
Br J Ophthalmol ; 106(7): 947-951, 2022 07.
Article in English | MEDLINE | ID: covidwho-1088212

ABSTRACT

AIMS: To assess visual field (VF) pseudoprogression related to face mask use. METHODS: We reviewed a total of 307 VFs performed with a face mask (FPP2/KN95 or surgical masks) and compared them with prior VFs, performed before the pandemic. VFs with suspected pseudoprogression due to mask artefacts (VF test 1) were repeated with a surgical mask and an adhesive tape on its superior border (VF test 2) to distinguish from true VF loss. Several parameters including reliability indices, test duration, VF index (VFI), mean defect (MD) and pattern deviation probability plots were compared among last pre-COVID VFs, VF tests 1 and VF tests 2, using the Wilcoxon signed-rank test. RESULTS: We identified 18 VFs with suspected progression artefact due to masks (5.8%). In all of them, the median VFI and MD significantly improved after fitting the superior border of the mask, showing no significant differences with pre-COVID tests. The median fixation losses were significantly higher when wearing the unfitted mask (13% vs 6%,p=0.047). The inferior hemifield was the most affected, either as a new scotoma or as an enlargement of a prior defect. CONCLUSION: Unfitted masks can simulate VF progression in around 6% of cases, mainly in the inferior hemifield, and increase significantly the rate of fixation losses. A similar rate of artefacts was observed using FPP2/KN95 or surgical masks. The use of a surgical mask with an adhesive tape covering the superior border may reduce mask-related artefacts, although concomitant progression cannot be ruled out in all cases.


Subject(s)
COVID-19 , Visual Field Tests , Artifacts , COVID-19/epidemiology , Humans , Intraocular Pressure , Pandemics , Reproducibility of Results
10.
J Glaucoma ; 30(4): 287-292, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1066454

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. MATERIALS AND METHODS: All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. RESULTS: A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. CONCLUSIONS: Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.


Subject(s)
Glaucoma/diagnosis , Intraocular Pressure , Masks/adverse effects , Visual Field Tests/adverse effects , Visual Field Tests/methods , Aged , Artifacts , COVID-19/epidemiology , Electronic Data Processing , Female , Humans , Male , Middle Aged , Prospective Studies , Reference Standards , Reproducibility of Results , Visual Fields
12.
J Glaucoma ; 29(12): 1184-1188, 2020 12.
Article in English | MEDLINE | ID: covidwho-894677

ABSTRACT

PURPOSE: The coronavirus (COVID-19) pandemic has changed how outpatient care is delivered in ophthalmology clinics, particularly with glaucoma care. This case series highlights the need for awareness of fogging and improper face mask fit as causes of standard automated perimetry artifacts in patients with ocular hypertension and glaucoma. CLINICAL PRESENTATIONS: Six patients with the diagnosis of ocular hypertension, glaucoma suspect, or glaucoma underwent standard automated perimetry (24-2 or 10-2 SITA, Humphrey Field Analyzer) while wearing ear-loop surgical face masks. Due to patient complaints of fogging during the testing, low test reliability, and unexpected results, the tests were repeated after taping securely the mask to the bridge of the nose. CLINICAL FINDINGS: Fogging may reduce visual field (VF) test reliability and induce artifacts that mimic glaucomatous defects. VF test reliability can be improved and artifacts minimized following mask taping. In 1 case there was worsening of VF defects after mask taping. This suggests that fogging may also disguise true VF defects. CONCLUSIONS: Fogging can result in unreliable VF testing with glaucoma-like artifacts. Secure taping of the face mask to the nose bridge may minimize this problem and reduce unnecessary additional testing and follow-up visits.


Subject(s)
Artifacts , COVID-19/prevention & control , Glaucoma, Open-Angle/diagnosis , Optic Nerve Diseases/diagnosis , Respiratory Protective Devices/adverse effects , SARS-CoV-2 , Visual Fields/physiology , Aged , Aged, 80 and over , Algorithms , COVID-19/epidemiology , Female , Glaucoma, Open-Angle/physiopathology , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Ocular Hypertension/diagnosis , Ocular Hypertension/physiopathology , Optic Nerve Diseases/physiopathology , Pandemics , Reproducibility of Results , Visual Field Tests
13.
J Glaucoma ; 29(10): 989-991, 2020 10.
Article in English | MEDLINE | ID: covidwho-648474

ABSTRACT

PURPOSE: The coronavirus (COVID-19) pandemic has had a profound impact on how glaucoma care is delivered, necessitating reduced clinic flow, social distancing, and use of face coverings by patients and staff. This case highlights the need to be aware of improperly fitted face masks as a cause of artifact on standard automated perimetry (SAP). CLINICAL PRESENTATION: A 32-year-old female underwent SAP with the 24-2 SITA Fast test of the Humphrey Field Analyzer wearing an ear-loop surgical face mask. At the end of testing, it was noted that the mask had ridden up the patient's face. Small amounts of condensate were noted on the perimeter lens. CLINICAL FINDINGS: SAP demonstrated good reliability indices but in both eyes, there was a marked reduction in sensitivity inferiorly. The glaucoma hemifield test was outside normal limits. It was ensured the upper border of the mask was well sealed with the loops secured around the ears and nasal strip of the mask pinched down. Visual fields were repeated and were found to be normal. CONCLUSIONS: Poorly fitting face masks represent a new cause of visual field artifact which may mimic pathologic field defects. Without careful attention during testing, the cause of such artifacts may not be apparent, especially as reliability indices may be normal. Adjustments to the fit of face masks may help prevent fogging or mask slippage and increase test reliability.


Subject(s)
Artifacts , Betacoronavirus , Coronavirus Infections/prevention & control , Glaucoma/diagnosis , Masks/adverse effects , Optic Nerve Diseases/diagnosis , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Visual Field Tests , Adult , COVID-19 , False Positive Reactions , Female , Humans , Intraocular Pressure , Predictive Value of Tests , SARS-CoV-2 , Visual Fields/physiology
17.
Eur J Endocrinol ; 183(1): G17-G23, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-205229

ABSTRACT

Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.


Subject(s)
Adenoma/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Coronavirus Infections , Dopamine Agonists/therapeutic use , Neurosurgical Procedures , Pandemics , Pituitary Apoplexy/therapy , Pituitary Neoplasms/therapy , Pneumonia, Viral , Adenoma/diagnosis , COVID-19 , Cabergoline/therapeutic use , Disease Management , Hormone Replacement Therapy , Human Growth Hormone/analogs & derivatives , Human Growth Hormone/therapeutic use , Humans , Octreotide/therapeutic use , Peptides, Cyclic/therapeutic use , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , Practice Guidelines as Topic , Radiotherapy , Somatostatin/analogs & derivatives , Somatostatin/therapeutic use , Telemedicine , Time Factors , Visual Field Tests
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