Methylphenidate (Ritalin)-associated cataract and glaucoma.

Methylphenidate hydrochloride (Ritalin) is the drug of choice for attention deficit hyperactivity disorder (ADHD). However, an association of Ritalin with glaucoma has been reported. We report a case of Ritalin-associated cataract and glaucoma. A 10-year-old boy was diagnosed with ADHD and had received methylphenidate hydrochloride, 60 mg/day for 2 years. He presented with blurred vision. Best-corrected visual acuity was 6/60 in both eyes. Ocular examinations revealed intraocular pressure (IOP) of 30 mmHg under medication, dense posterior subcapsular opacity of lens, pale disc with advanced cupping, and marked constriction of visual field. Despite maximal anti-glaucomatous medication, IOP still could not be controlled. The patient then received combined cataract and glaucoma surgery. Visual acuity improved and IOP was within normal limits in both eyes postoperatively. Large dose of methylphenidate may cause cataract and glaucoma. The mechanism remains unclear. Doctors should be aware of the possible ocular side effects of methylphenidate.

Patterns of visual field defects in chronic angle-closure glaucoma with different disease severity.

PURPOSE: To evaluate the patterns of visual field defects in patients with chronic angle-closure glaucoma (CACG) with varying extent of optic nerve damage. DESIGN: Prospective, consecutive, observational case series. PARTICIPANTS: One hundred forty-six Asian patients with well-controlled CACG. METHODS: Visual field tests were performed using program 24-2 of the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA) with the Swedish interactive thresholding algorithm standard. One hundred ten eligible visual fields were scored with the system adopted by the Advanced Glaucoma Intervention Study and were categorized into 4 groups accordingly: mild, moderate, severe, and end-stage. Each hemifield was divided into the nasal, paracentral, and arcuate areas, and field loss that involved respective areas was defined as nasal step, paracentral scotoma, and arcuate scotoma. MAIN OUTCOME MEASURES: The distribution of field defect patterns in each group was evaluated. The mean deviation (MD) was compared among the 3 areas within one hemifield and between each pair of corresponding areas across the median raphe. RESULTS: The nasal area was the most commonly damaged area in the mild group, being noted in 52% of eyes in the superior hemifield and 58% of eyes in the inferior hemifield. In the moderate group, field loss involving both the nasal and arcuate areas dominated the superior hemifield, whereas field loss involving all three areas dominated the inferior hemifield. The MD of the nasal area was the worst among the three areas in each hemifield of the mild and moderate groups, as well as in the inferior hemifield of the severe group (all P < 0.001). There were no significant differences in the MD of each area between the superior hemifield and their inferior counterparts. However, the superior hemifield as a whole showed a better MD than the inferior hemifield (P=0.034) in the mild group. CONCLUSIONS: Visual field loss that involved the nasal area was the most common pattern in the early stage of CACG. The MD of the nasal area was worse than those of the arcuate and the paracentral areas within the same hemifield in the mild, moderate, and severe groups of CACG patients.

The efficacy and safety of brimonidine 0.2% compared with timolol 0.5% in glaucoma: a randomized clinical trial on Taiwanese patients.

BACKGROUND: Brimonidine is a highly selective alpha-2 adrenergic receptor agonist with intraocular pressure (IOP) reducing effect. We conducted this study in Taiwan to compare the safety and efficacy ofbrimonidine 0.2% with timolol 0.5% for the treatment of glaucoma. METHODS: A prospective, randomized, single-masked, 1-month clinical efficacy and safety trial was conducted from March to September 2000. Forty glaucoma patients were enrolled--29 in the brimonidine group and 11 in the timolol group. Patients instilled their study medications twice daily for 4 weeks, and were followed at baseline visit, weeks 2 and 4. Demographic data, reduction of IOP, safety and adverse events were obtained and analyzed. RESULTS: Both drugs showed sustained ocular hypotensive efficacy in the study period. At baseline, the mean IOP was 24.48 +/- 2.29 mmHg in the brimonidine group and 23.32 +/- 0.82 mmHg in the timolol group. The IOP readings after treatment were significantly lower than their baseline levels in both groups at all visits (p < 0.001). At peak, the mean decreases from the baseline IOP ranged from 5.22 +/- 0.30 mmHg to 6.96 +/- 0.33 mmHg for brimonidine and from 4.55 +/- 0.49 mmHg to 6.64 +/- 0.53 mmHg for timolol. At trough, the mean decreases from baseline ranged from 3.72 +/- 0.32 mmHg to 4.55 +/- 0.32 mmHg for brimonidine and 3.82 +/- 0.52 mmHg to 4.27 +/- 0.51 mmHg for timolol. No significant between-group differences were seen at peak or trough at all visits. The clinical success rate was 86.2% in the brimonidine group and 81.8% in the timolol group, making no statistically significant difference between them (p = 0.817). 17.2% of patients in brimonidine group and 9.0% patients in timolol group reported mild adverse events. Ocular allergy occurred in 10.3% of patients in brimonidine group. No significant changes in visual acuity, biomicroscopy or ophthalmoscopy were observed in both groups. Mean systolic and diastolic blood pressure remained relatively stable in both groups except in week 2 (p = 0.016) when brimonidine had lower systolic blood pressure. However, brimonidine showed no significant difference in week 4 from baseline. The mean heart rate in the brimonidine group was relatively unchanged over the study period. Patients receiving timolol experienced statistically significant mean heart rate decreases from baseline (p = 0.020) in week 4. CONCLUSIONS: Topically applied twice daily for one month, brimonidine tartrate 0.2% has clinical effectiveness equivalent to timolol 0.5% in Taiwanese patients with glaucoma. It has a safe systemic profile with minimum effect on the heart.

Comparisons of risk factors and visual field changes between juvenile-onset and late-onset primary open-angle glaucoma.

PURPOSE: To identify the differences in risk factors and visual field (VF) changes between juvenile primary open-angle glaucoma (JOAG) and late-onset chronic open-angle glaucoma (COAG). METHODS: The demographic and presenting clinical data of 27 JOAG and 30 COAG patients were retrospectively reviewed. Comparisons between the two groups were performed using Mann-Whitney U test, Wilcoxon signed-rank test, and Fisher's exact test. RESULTS: A family history of glaucoma (37%) and a history of steroid usage (14.8%) were identified in JOAG patients only. The JOAG patients had a longer axial length (p < 0.001) and more often a myopic refractive state (p < 0.001) than the COAG patients. Patients with COAG showed a deeper (p = 0.016) and a more extensive (p = 0.008) defect in the superior than in the inferior hemifield, as well as a deeper (p = 0.016) and a more extensive (p = 0.001) defect in the superior than in the inferior arcuate area, while JOAG patients showed symmetric VF defects between the superior and inferior hemifields. Purely diffuse VF depression is more common in JOAG than in COAG patients (p = 0.03). CONCLUSIONS: JOAG patients demonstrated more axial myopic changes than patients with COAG as well as a pattern of superior-inferior symmetric VF defects. Axial myopia may play a critical role in the pathogenesis of JOAG.