A new method for eyelid elevation in glaucoma patients with ptosis during automated perimetry testing.

PURPOSE: Ptosis is a well-recognized confounding factor when interpreting superior visual field defects. As the current technique for eyelid elevation during automated perimetry is cumbersome and inconsistent, we developed a new technique. To evaluate its efficacy and feasibility, we studied a group of glaucoma patients with ptosis and superior visual field defects that had been attributed to nerve fiber layer defects. PATIENTS AND METHODS: A 24-2 SITA-fast visual field was performed without eyelid elevation. Then, it was repeated either with elevation (group A, 14 eyes, 7 patients) or without (group B, 9 eyes, 5 patients). Elevation was achieved by the following method: a 4-0 silk suture (needle removed) was wrapped around a micropore strip, attached to the upper eyelid margin. Suture edges were pulled and attached to the forehead creating a slinglike elevation. Mean thresholds of upper and lower hemifields were calculated. Mean deviation and pattern standard deviation were recorded for each visual field. Results of the first and second tests were compared. RESULTS: Eyelid elevation resulted in significant improvement in mean thresholds for upper hemifield in group A: values increased by 28% in OD and 22% in OS. Lower hemifield values did not change. Significant improvement also was observed in mean deviation and pattern standard deviation. In group B, there were no significant differences between the 2 sets of tests. CONCLUSIONS: This new method of eyelid elevation significantly improves visual field testing by reducing the confounding effect of ptosis on interpretation of visual field defects in glaucoma patients.

Headaches as the main presenting symptom of subacute angle closure glaucoma.

The diagnosis of subacute angle closure glaucoma is suspected in patients with narrow angles of the anterior chamber of the eye, presenting with periodic ocular, or periocular pain. However, some patients may present with headaches in the absence of significant ocular discomfort, which often leads to misdiagnosis and delay in specific therapy. The clinical features of 9 such patients are described. Subacute angle closure glaucoma should always be considered in the differential diagnosis of adult-onset headaches.

Frequency doubling technology threshold testing in the pediatric age group.

PURPOSE: To evaluate the feasibility of performing visual field with the Frequency Doubling Technology (FDT) in children aged 5 to 10 years. PATIENTS AND METHODS: Forty healthy children and fifteen healthy adults, all with no previous experience with visual field testing, underwent visual field testing with the C20 threshold test of the Carl Zeiss Meditec FDT analyzer in both eyes. The subjects were divided into three groups. Group A (age 5-7), group B (age 8-10), and group C (adults). RESULTS: The mean explanation time for the test was 83 +/- 43 seconds for group A, 68 +/- 31 seconds for group B, and 37 +/- 15 seconds for group C (P < 0.001 for the difference between group C and groups A and B). Test performance time for the right eye was 347 +/- 57 seconds, 301 +/- 21 seconds, and 298 +/- 35 seconds for groups A to C, respectively (P < 0.001 for the difference between group A and groups B and C). Forty percent of the children, but none of the adults required two demonstrations prior to initiation of the test. In children fixation losses for the right and left eye were 10% and 37% respectively. No fixation losses occurred in adults. In both eyes a mean deviation <0.5% occurred significantly more often in group A than in group C (P = 0.013). CONCLUSION: Visual field testing with FDT in the young age group is feasible. Test reliability was similar between children aged 5 to 7 and 8 to 10. Pre-selection of children is suggested to achieve reliable results.