ABSTRACT
PURPOSE: Enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD OCT) has been recognized as the most sensitive tool to diagnose optic nerve head drusen (ONHD). The relationship between OCT characteristics and visual loss has not been well documented. This study compares EDI SD OCT-determined morphologic characteristics of drusen in eyes with or without visual field (VF) defects. DESIGN: Descriptive study of patients attending the neuro-ophthalmology service of Moorfields Eye Hospital between January 2013 and October 2014. SUBJECTS: Patients with diagnosed ONHD and EDI SD OCT imaging of the optic nerve head. METHODS: Eyes with and without VF defects were compared with regard to retinal nerve fiber layer (RNFL) thickness, drusen morphology, size, extent, visibility on funduscopy, ultrasound, and fundus autofluorescence. MAIN OUTCOME MEASURES: Difference in OCT characteristics of ONHD between patients with or without VF defects. RESULTS: Of 38 patients, 69 eyes with ONHD were included. Thirty-three eyes had a normal VF with average mean deviation (MD) -0.96 (±1.2) dB and pattern standard deviation (PSD) 1.6 (±0.3) dB (group I), and 36 eyes had VF defects with MD -13.7 (±10.4) dB and PSD 7.2 (±3.6) dB (group II). Mean global RNFL thickness was 62 (±20.9) µm in the latter group and 99.0 (±12.9) µm in group I. In group I, the predominant drusen type was peripapillary drusen, of variable size. In group II, most eyes had confluent (P < 0.02) and large (>500 µm; P < 0.003) drusen, and drusen were more commonly visible on funduscopy (P = 0.001), ultrasound (P = 0.013), and autofluorescence (P = 0.002). Differences between the 2 groups reached statistical significance in a clustered analysis. RNFL thinning and autofluorescence showed relative sparing of the temporal sector. Sixty-four percent of patients with a VF defect in 1 eye also had a VF defect in their fellow eye. CONCLUSIONS: Drusen size and drusen type as classified by OCT morphologic characteristics are significantly different in patients with or without VF defects. Confluent, large, and autofluorescent drusen were more commonly found in patients with VF defects. These findings may assist in clarifying how drusen give rise to visual loss, which is currently not known.
Subject(s)
Optic Disk Drusen/diagnostic imaging , Optic Disk Drusen/physiopathology , Optic Disk/diagnostic imaging , Tomography, Optical Coherence/methods , Vision Disorders/physiopathology , Visual Fields/physiology , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Visual Acuity , Visual Field TestsABSTRACT
The double dissociation involving person-specific and general semantic knowledge is supported by numerous patient studies, though cases with preservation of the former are few. In this paper, we report longitudinal data from two cases. Their knowledge in both domains was preserved at the start of the investigation, but progressive deterioration was primarily observed on tests of general semantics. These data strengthen the evidence-base for preservation of person-specific knowledge in semantic memory disorder, and support its separate representation from object knowledge.
Subject(s)
Dementia/complications , Knowledge , Memory Disorders/etiology , Recognition, Psychology/physiology , Semantics , Aged , Association Learning , Brain/pathology , Chi-Square Distribution , Dementia/diagnosis , Dementia/psychology , Humans , Longitudinal Studies , Magnetic Resonance Imaging , Male , Memory Disorders/diagnosis , Memory Disorders/psychology , Neuropsychological Tests , VocabularySubject(s)
Encephalitis/diagnosis , Encephalitis/virology , Herpes Simplex/diagnosis , Acyclovir/therapeutic use , Adult , Antiviral Agents/therapeutic use , Diagnosis, Differential , Diagnostic Imaging , Electroencephalography , Encephalitis/drug therapy , Herpes Simplex/drug therapy , Humans , Lymphocyte Count , Male , Polymerase Chain Reaction , Spinal PunctureSubject(s)
Cavernous Sinus , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/diagnosis , Meningitis/complications , Meningitis/diagnosis , Aged , Brain/diagnostic imaging , Brain/pathology , Cavernous Sinus/diagnostic imaging , Cavernous Sinus/pathology , Fluorodeoxyglucose F18 , Humans , Magnetic Resonance Imaging , Male , Radionuclide Imaging , Tomography, X-Ray ComputedABSTRACT
Type 2 diabetes is responsible for considerable morbidity, mortality and cost to society. There is good evidence that lifestyle modification and pharmacological intervention are effective means of delaying, and possibly preventing, the onset of type 2 diabetes in individuals with impaired glucose regulation. The aim of this study was to estimate the number of patients treated at our district general hospital over a 28-day period who had impaired glucose regulation and so would be suitable candidates for intervention. The results reveal that 518 patients passed through our hospital during this period with evidence of impaired glucose regulation, but only 95 of these patients were formally investigated for diabetes. Of those who were investigated further, over one fifth were shown to have impaired glucose regulation. We suggest that a random plasma glucose test may provide a useful means to identify a population for formal screening for diabetes.
