Use of the King-Devick Variable Color Contrast Sensitivity Chart to differentiate stages of age-related macular degeneration.

OBJECTIVE: This study aimed to determine which colour contrast sensitivity differences exist in early to advanced age-related macular degeneration (AMD) and examine the potential utility of the King-Devick Variable Color Contrast Sensitivity Chart in detecting AMD severity. METHODS AND ANALYSIS: A total of 85 participants (144 total eyes) were recruited from multiple clinical practices and enrolled in the study. The control group consisted of 57 healthy eyes. The non-exudative AMD (NE-AMD) group consisted of 45 eyes. The exudative AMD (E-AMD) group consisted of 42 eyes. In a single study visit, monocular best-corrected visual acuity (BCVA) at 40 cm with 100% black contrast was determined for each eye. Using the BCVA line, the number of letters correctly identified (out of 10) was recorded for various colour presentations (red, green, blue and yellow) and at decreasing contrast levels (100%, 75%, 50% and 25%). RESULTS: Our results show worse visual performance under various colour contrast settings in E-AMD patients compared with healthy controls and NE-AMD. Colour contrast performance using blue and yellow differentiated more advanced stages of disease in E-AMD from earlier NE-AMD disease. Blue and black colour contrast performance more accurately identified the E-AMD group from healthy controls and the NE-AMD group. CONCLUSION: The findings of this study demonstrate that colour contrast, particularly with black, blue and yellow, is impaired in E-AMD suggesting the potential for colour contrast measures to serve as an adjunctive clinical tool in identifying subtle altered visual function as well as the potential for detecting disease severity.

Efficacy of Retinal Lesion Screening in Von Hippel-Lindau Patients With Widefield Color Fundus Imaging Versus Widefield FA.

BACKGROUND AND OBJECTIVE: Retinal hemangioblastoma is a retinal tumor in patients with Von Hippel-Lindau (VHL). The authors' objective was to determine whether widefield fluorescein angiography (FA) improves lesion detection. PATIENTS AND METHODS: Retrospective case series of VHL patients who underwent widefield fundus imaging and FA. Masked retina specialists graded fundus images as having: 1) definite retinal hemangioblastoma; 2) possible lesion; 3) no lesion. The number of lesions on FA was compared to widefield color imaging. RESULTS: One hundred six eyes of 55 patients were evaluated. A total of 94 lesions were identified on FA in 61.8% patients. Forty-three lesions (45.7%) were not identified on fundus images. Small lesion detection was significantly higher with FA compared to color imaging (P = .013). CONCLUSIONS: This study reports on improved detection of retinal hemangioblastomas with widefield FA compared to widefield fundus images. The authors recommend VHL monitoring guidelines to include periodic widefield FA to adequately screen for smaller lesions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e260-e265.].

Symmetry of peripheral retinal nonperfusion in diabetic retinopathy by ischemic index / Simetría de la no perfusión de la retina periférica evaluada mediante el índice isquémico

Purpose: Diabetic retinopathy is the leading cause of blindness among working-age adults in most developed countries. It affects eyes bilaterally and is generally believed to be symmetrical, yet there are few studies evaluating the symmetry of diabetic retinopathy. The purpose of the present study was to evaluate the symmetry of the amount of peripheral retinal ischemia in patients with diabetic retinopathy. Methods: Ultra-widefield fluorescein angiography images were obtained on both eyes of 54 subjects, mean age 56.4 years, from an urban eye clinic. A single, high quality image from the arteriovenous phase of the angiogram of each eye was selected for analysis. The total area of gradable fundus and area of nonperfusion seen in the arteriovenous phase of the ultra-widefield fluorescein angiogram were determined. An ischemic index (ISI) was calculated by dividing the non-perfused retinal area by the total retinal area and multiplying by 100. Results: The mean ISI OD was 11.27, mean ISI OS was 11.64. The mean absolute value (±SD) of ISI difference between OD and OS was 4.46 ± 6.09. A difference in ISI of 10% or less was found in 92.6% of subjects. A statistically significant correlation was found in the ISI between right and left eyes (rs = 0.80, p < 0.0001) and there was no statistically significant difference in ISI between the right and left eyes (p = 0.85). Conclusion: Asymmetrical retinopathy in diabetic patients is uncommon and additional pathological processes should be considered in the presence of asymmetric DR

Objetivo: La retinopatía diabética constituye la causa principal de ceguera entre los adultos en edad productiva en muchos países desarrollados. Afecta a los ojos bilateralmente, y por lo general se piensa que es simétrica, aunque existen pocos estudios que evalúen la simetría en esta situación. El objetivo del presente estudio fue evaluar la simetría de la cantidad de isquemia en la retina periférica en pacientes con retinopatía diabética. Métodos: Se obtuvieron imágenes de ambos ojos mediante angiografía fluoresceínica de campo ultra-amplio, en 54 sujetos, con edad media de 56,4 años, en una clínica ocular urbana. Se seleccionó para análisis una única imagen de gran calidad de la fase arteriovenosa del angiograma de cada ojo. Se determinaron el área total de fondo graduable y el área de no perfusión observados en la fase arteriovenosa de la angiografía fluoresceínica de campo ultra-amplio. Se calculó el índice isquémico (ISI) dividiendo el área de la retina no perfundida entre el área total de la retina, multiplicado por 100. Resultados: El ISI OD medio fue de 11,27, el ISI OS medio fue de 11,64. El valor absoluto medio (± SD) de la diferencia de ISI entre OD y OS fue de 4,46 ± 6,09. Se encontró una diferencia de ISI del 10% o menos en el 92,6% de los sujetos. Se encontró una correlación estadísticamente significativa de ISI entre los ojos derecho e izquierdo (rs = 0,8, p < 0,0001), y no se encontró diferencia estadísticamente significativa de ISI entre los ojos derecho e izquierdos (p = 0,85). Conclusión: La retinopatía asimétrica en pacientes diabéticos es infrecuente, por lo que deberán considerarse procesos patológicos adicionales en presencia de RD asimétrica

Symmetry of peripheral retinal nonperfusion in diabetic retinopathy by ischemic index.

PURPOSE: Diabetic retinopathy is the leading cause of blindness among working-age adults in most developed countries. It affects eyes bilaterally and is generally believed to be symmetrical, yet there are few studies evaluating the symmetry of diabetic retinopathy. The purpose of the present study was to evaluate the symmetry of the amount of peripheral retinal ischemia in patients with diabetic retinopathy. METHODS: Ultra-widefield fluorescein angiography images were obtained on both eyes of 54 subjects, mean age 56.4 years, from an urban eye clinic. A single, high quality image from the arteriovenous phase of the angiogram of each eye was selected for analysis. The total area of gradable fundus and area of nonperfusion seen in the arteriovenous phase of the ultra-widefield fluorescein angiogram were determined. An ischemic index (ISI) was calculated by dividing the non-perfused retinal area by the total retinal area and multiplying by 100. RESULTS: The mean ISI OD was 11.27, mean ISI OS was 11.64. The mean absolute value (±SD) of ISI difference between OD and OS was 4.46±6.09. A difference in ISI of 10% or less was found in 92.6% of subjects. A statistically significant correlation was found in the ISI between right and left eyes (rs=0.80, p<0.0001) and there was no statistically significant difference in ISI between the right and left eyes (p=0.85). CONCLUSION: Asymmetrical retinopathy in diabetic patients is uncommon and additional pathological processes should be considered in the presence of asymmetric DR.

Exudative retinopathy and detachment: a late reactivation of retinopathy of prematurity after intravitreal bevacizumab.

A 25-week postmenstrual age premature infant was treated with bilateral intravitreal bevacizumab for retinopathy of prematurity at 35 weeks' PMA. Postinjection, the retinal vessels progressed anteriorly within the retina. The patient presented 1 year after injection with bilateral exudative retinal detachments. The right eye was treated with intravitreal bevacizumab, laser ablation, and scleral buckling, resulting in resolution of the exudation and detachment. The left eye was treated with vitrectomy and lensectomy, but persistent exudation and detachment remained. This case demonstrates the rare complication of exudative retinal detachment in the setting of retinopathy of prematurity, which may become more common with increasing use of bevacizumab. Importantly, it also demonstrates the need not only for frequent examination after bevacizumab injection for retinopathy of prematurity but long-term follow-up as well, until either the retina is fully vascularized or peripheral ablation is performed.