Visual field defect classification in the Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Registry Study.

PURPOSE: To describe a new combined myopia and glaucoma visual field classification system in order to report the visual field defects in a population of mostly young Chinese high myopes aged 7-70 years. METHODS: A total of 1434 visual fields (including confirmatory repeats of abnormal defects) from 487 high myopes (sphere ≤-6.0 D) were analysed from the prospective Zhongshan Ophthalmic Center-Brien Holden Vision Institute (ZOC-BHVI) High Myopia Registry Study. The predefined classification definitions covering high myopia and glaucoma categories were: normal, enlarged blind spot, abnormal suspect and abnormal with nine subtypes. Two independent graders reviewed the first 150 of 1434 fields for initial grading calibration and the remaining 1284 fields were used to assess intergrader agreement. For the percentage distribution of visual fields, the repeats and unreliable fields were excluded, leaving 894 fields. RESULTS: The intergrader agreement of this combined classification system was a κ value of 0.61 (95% CI 0.59 to 0.63). Among the 894 unique fields, the most common visual field was normal at 33.7% followed by enlarged blind spot at 25.6%. The per cent of 'arcuate-like' field defects (combining nasal step, early arcuate and advanced arcuate) was 16.1% with advanced arcuate at 3.4%. CONCLUSIONS: A proposed combined visual field classification for high myopia and glaucoma demonstrates acceptable intergrader agreement. A total of 16.1% of defects in young high myopes were found to mimic classic glaucomatous defects. These subjects are being followed prospectively to assess which ones will progress to differentiate myopic from glaucomatous field defects.

Structure-Function Relationship in Glaucoma Patients With Parafoveal Versus Peripheral Nasal Scotoma.

PURPOSE: We evaluated whether the structure-function relationship in glaucoma patients with parafoveal scotoma or peripheral scotoma differs with the use of frequency doubling technology (FDT) or short-wavelength automated perimetry (SWAP) compared to standard automated perimetry (SAP). METHODS: Glaucoma patients with isolated parafoveal scotoma (PFS) within the central 10° of fixation in 1 hemifield and those with an isolated peripheral nasal step (PNS) within the nasal periphery outside 10° of fixation in one hemifield were studied. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured using spectral-domain optical coherence tomography. The topographic relationships between structure and function were investigated. RESULTS: In the PNS group, superotemporal (r(2) = 0.300, P = 0.001) and inferotemporal (r(2) = 0.302, P = 0.001) RNFL thickness showed significant correlations with the corresponding visual field (VF) sensitivity using linear regression model in SAP. In the PFS group, temporal RNFL thickness was not correlated with nasal mean sensitivity (MS) on SAP (r(2) = 0.103, P = 0.065). Using FDT, however, the temporal RNFL thickness was correlated with nasal MS in the PFS group (r(2) = 0.277, P = 0.001). Using SWAP, the temporal RNFL thickness was not significantly associated with regional VF sensitivity in the PFS group (r(2) = 0.052, P = 0.192). CONCLUSIONS: In glaucoma with peripheral scotoma, the RNFL thickness was associated significantly with the corresponding VF loss in SAP, FDT, and SWAP. In eyes with PFS, however, the topographic structure-function relationships were not distinct with SAP or SWAP. Frequency doubling technology performed well in terms of structure-function correlation in glaucoma with PFS.

Acute zonal occult outer retinopathy: a classification based on multimodal imaging.

IMPORTANCE: We describe the multimodal imaging in a group of patients showing a distinct clinical entity that best represents acute zonal occult outer retinopathy (AZOOR). OBJECTIVE: To propose a classification of AZOOR based on clinical fundus and multimodal imaging. DESIGN, SETTING AND PARTICIPANTS: A retrospective review of patients diagnosed as having AZOOR at 2 centers. After reviewing more than 400 cases diagnosed or referred to us as AZOOR or AZOOR complex, we assembled 30 cases that fit our current definition; (48 eyes) with a median age at diagnosis of 47 years (age range, 17-86 years) and a mean follow-up period of 39 months. Twenty patients were female. Eighteen patients had initially been seen with bilateral lesions, mostly asymmetric (4 cases were symmetric). Most patients had no remarkable medical or ocular history. The median visual acuity at the time of presentation was 20/25 (range, 20/20 to 20/400). MAIN OUTCOMES AND MEASURES: Multimodal imaging, including fundus photography, fluorescein and indocyanine green angiography, fundus autofluorescence imaging, and corresponding eye-tracked spectral-domain coherence tomography imaging. RESULTS: Each patient was initially seen with visual symptoms of photopsia and scotoma, and most had a detectable lesion in the fundus evident clinically or detected on multimodal imaging. The clinical appearance of the AZOOR lesions varied depending on their duration and location, but some features were characteristic, including a demarcating line of the progression at the level of the outer retina and a trizonal pattern of sequential involvement of the outer retina, retinal pigment epithelium, and choroid, as well as frequent zonal progression. Advanced cases of AZOOR demonstrated disruption of the inner and outer retina and severe damage or loss of the retinal pigment epithelium and the choroid. CONCLUSIONS AND RELEVANCE: A specific definition of AZOOR based on multimodal imaging is proposed to help physicians distinguish it from other diseases of the posterior fundus, including white spot syndromes and autoimmune, hereditary, paraneoplastic, toxic, and other inflammatory retinopathies.

Two types of acute zonal occult outer retinopathy differentiated by dark- and light-adapted perimetry.

PURPOSE: To assess the results of perimetry recorded under dark- and light-adapted (DA and LA) conditions in patients with acute zonal occult outer retinopathy (AZOOR) and to compare the results of electroretinography (ERG) and spectral-domain optical coherence tomography (SD-OCT) in two groups of AZOOR patients. METHODS: Twelve patients with AZOOR were studied. The diagnosis of AZOOR was based on the results of ophthalmoscopy, Goldmann kinetic perimetry, and multifocal ERGs. In addition, DA and LA perimetry, ERG, and SD-OCT were performed. The patients were followed for 1-9 years. RESULTS: The patients were classified into two types: type A patients (3) had a scotoma detected by both DA and LA perimetry, normal or equally abnormal cone and rod ERGs, atrophy of the outer nuclear layer (ONL), and disruption of the inner segment/outer segment (IS/OS) junction line in the OCT images. Type B patients (7) had a scotoma that was more prominent in LA than in DA perimetry and a continuous IS/OS junction line in the OCT images. Two patients had characteristics of both type A and type B AZOOR. CONCLUSIONS: Our findings suggest that eyes with type A AZOOR have focal and severe impairment of both the rods and cones, and eyes with type B AZOOR have focal and specific impairment of the cones.

Visual field profile of optic neuritis: a final follow-up report from the optic neuritis treatment trial from baseline through 15 years.

OBJECTIVE: To evaluate visual field abnormalities after an episode of optic neuritis among participants in the Optic Neuritis Treatment Trial. METHODS: Three readers independently evaluated 10 443 visual fields from 454 patients and classified visual field abnormalities into 21 different monocular categories representing 3 general types of visual loss: diffuse, localized, and artifactual. Classification frequency was determined and reader agreement was evaluated. The association of visual field abnormality classifications with mean deviation, pattern standard deviation, visual acuity, and foveal threshold was assessed. RESULTS: At baseline, diffuse loss accounted for 66.2% of the abnormalities in the affected eyes but only 6.2% of the abnormalities in the fellow eyes. During years 1 through 15, the affected and fellow eyes exhibited predominantly localized loss in the nerve fiber bundle region (partial arcuate, paracentral, and arcuate defects). At year 1, 35.7% of the abnormalities in the affected eyes and 34.4% in the fellow eyes consisted of localized defects. At year 15, 39.5% of abnormalities in the affected eyes and 26.3% in the fellow eyes consisted of localized defects. Foveal threshold was highly correlated with visual acuity and contrast sensitivity in the affected eye at baseline (-0.82 vs 0.79, respectively), 6 months (-0.84 vs 0.81), and 1 year (-0.84 vs 0.79). CONCLUSIONS: Diffuse and central loss were more predominant in the affected eye at baseline, and nerve fiber bundle defects (partial arcuate, paracentral, and arcuate) were the most predominant localized abnormalities in both the affected and fellow eyes during the study.

Classifying patterns of localized glaucomatous visual field defects on automated perimetry.

AIM: To classify the classic patterns of glaucomatous visual field defects on automated perimetry and to study their proximity to fixation. STUDY DESIGN: Cross-sectional observational study. MATERIALS AND METHODS: About 1120 full threshold 30-2 reliable visual fields of glaucoma patients were analyzed by 2 glaucomatologists. Classically described patterns of visual field defects were identified on the pattern deviation plot and definitions proposed. Interreader agreement between 3 independent (not involved in the classification) readers was determined. Proximity to fixation of the different patterns was assessed. RESULTS: Interreader agreement with 3 readers was found to be 93% or more between any 2 readers using the present system of classification. Central fixation was seen to be involved in 45% of the glaucomatous visual field defects studied overall. CONCLUSIONS: The proposed definitions of topographical glaucomatous field defects based on the pattern deviation probability plot are simple to use in clinical practice with good interreader agreement.

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.

[Comparative study of 2 classifications of glaucomatous perimetric deficits]. / Etude comparative de deux classifications des déficits périmétriques glaucomateux.

The purpose of this retrospectively study is to compare the results obtained using the unquestionable criteria, recommended by American Academy of Ophthalmology versus the minimum criteria proposed by HODAPP. The first are founded on the degree of the depth of the deficits in dB, the second take into account the statistically significant loss. One hundred glaucomatous visual fields screened with the Humphrey perimeter, with program 24-2, are retained for their correct indices of reliability, a MD better than -12 dB, and experience of the automated perimetry. This population was divided into two groups of 50:index MD greater than -6 dB. And index MD between -6 and -12 dB. The deficits were analyzed on the graph of individual deviation. Arcuate scotoma and nasal step were the majority of defects: 86 to 90% at the stage of mild deficit; 98% at the stage of moderate deficit. The deficits prevailed in the superior hemifield in 60% of cases. Nasal projection accounted for less than half of the deficits when MD was > -6 dB its frequency fell to less than 10% when MD worsened. Conversely the frequency of arcuate scotoma increased. The isolated deficits decreased with the MD aggravation, but even when the deficit was mild, they accounted for already less than half of the cases. Most of the associated deficits were located in the hemifield opposite to the principal defect. Defects were larger and more frequently multiple with the AAO classification than with the HODAPP. The minimum criteria of the classification of glaucomatous visual field defects proposed by HODAPP appear more specific than the unquestionable criteria of the AAO, and also appear easier to use.

Campimetria computarizada con el analizador de campos visuales humphrey: estudio de 350 casos / Computarized perimetry with the of humphrey visual field: study of 350 cases

Se reportan 350 historias médicas de pacientes referidos a una consulta privada en el Centro Médico de Cracas, para evaluación del campo visual mediante campimetria computarizada, entre 1992 y 1995. Un total de 700 ojos fueron evaluados. Se utilizo el analizador computarizado de campos visuales humphrey. Del total de pacientes, 63 por ciento correspondieron al sexo femenino y 37 por ciento masculino. La edad promedio fue de 47,3 años. El motivo de consulta más frecuente fue el control de glucoma (50 por ciento), seguido de pacientes a los cuales no se les preciso el motivo de consulta (24 por ciento) y sospecha de glaucoma (21 por ciento). En cuanto a los hallazgos, 59 por ciento correspondieron a campos visuales normales, seguido de escotomas paracentrales con 13 por ciento, escotoma arcuato en área de Bjerrum con 12 por ciento, aumento de la mancha ciega con un 6 por ciento. 174 pacientes fueron evaluados para control de glaucoma (348 ojos), 59 por ciento con hallazgos positivos (40 por ciento de escotomas arcuatos en áreas de Bjerrum, 32 por ciento de escotomas o defectos paracentrales, 15 por ciento aumento de la mancha ciega). 74 pacientes (148 ojos) fueron evaluados por sospecha de glaucoma, 27 por ciento con hallazgos positivos en la campimetria (39 por ciento de escotomas o defectos paracentrales, 19 por ciento de aumento de la mancha ciega, 13 por ciento escotomas arcuatos en área de Bjerrum, 8 por ciento escalón nasal, 8 por ciento campos visuales tubulares y 8 por ciento de cambios en la sensibilidad retiniana)

[The F-L test for determining alternating central scotoma]. / Der F-L-Test zur Feststellung eines alternierenden Zentralskotoms.

BACKGROUND: Based on their experiences several authors consider an alternating central scotoma as the main reason for reading difficulties due to dyslexia. METHODS: Searching for a simple and reliable method for determination of an alternating central scotoma we used a pair of synoptophore fusion images, in the center of which we added the letter F respectively L as central control signs. A spontaneously perceived and persisting E means a perfect and stable orthophoria. A persisting F or L with fusion of the images means a one sided central scotoma. Alternation of F and L with fusion of the images means an alternating central scotoma. RESULTS: By examining normal readers, untreated asthenopic and untreated dyslexic patients, we found mostly rapid alternation of F and L in the latter two groups, whereas most of the normal readers saw F, L and E alternating at longer intervals. CONCLUSIONS: Thus undisturbed reading seems not to demand perfect orthophoria. On the other hand a rapidly alternating central scotoma may be considered as an important factor causing reading difficulties.

Migraine visual auras. A medical update for the psychiatrist.

Auras of visual aberrations as well as other neurological disturbances including somatosensory and perceptual symptoms that precede a headache distinguish migraine with aura (classic migraine) from migraine without an aura (common migraine) and other varieties of headache. Visual auras that characterize migraine with aura can be classified and distinguished from other neurologic and psychiatric causes of visual aberrations. Examples of migraine visual auras, which are often described but rarely shown in the medical literature, are presented and their mechanism is discussed.

Myopia and glaucoma.

2,528 visual fields of patients with glaucoma were examined. All atypical nerve fibre bundle defects (NFBD) were selected and all myopes. Myopic defects are a) enlargement of the blind spot, occurring in 18% to 30% of the myopic eyes depending in the degree of myopia, b) super-temporal refraction defect (2-6%) and c) irregular defects due to myopic choroidal dystrophy. Atypical NFBD were found in only a few non-myopes but in a large number of myopes. Temporal NFBD occurred in 16% and cecocentral NFBD in 9 to 18% of myopic glaucoma (MG). It is difficult to predict the existence of an atypical defect from optic disc evaluation.