Expediency of the Automated Perimetry Using the Goldmann V Stimulus Size in Visually Impaired Patients with Glaucoma.

INTRODUCTION: White-on-white standard automated perimetry (AP) uses a white round stimulus with 0.43° diameter and 4.0 mm2 area (Goldmann size III). Patients with low vision have difficulty seeing such a small stimulus and are often tested with perimetry using the size V stimulus with 1.72° diameter and 64 mm2 area. We undertook an observational case-control study to compare the performance of patients on AP using two differently sized stimuli. METHODS: Patients with glaucoma and visual acuity worse than 20/100 underwent AP using the standard size III stimulus Swedish Interactive Threshold Algorithm (SITA) standard test and size V stimulus full threshold test. All patients were familiar with the procedure, having done the test at least twice previously. Another group of glaucoma patients with visual acuity better than 20/40 served as controls. The main outcome measures included test time, mean retinal sensitivity (MRS), foveal sensitivity (FS), fixation loss (FL), false positive (FP), false negative (FN), and the patient's subjective preference. RESULTS: Fifty patients were included in the study. Most preferred the size V stimulus target size test. For glaucoma patients, test time was shorter with size III; MRS and FS were higher with size V; FL, FP, and FN did not differ between the tests. CONCLUSION: AP with stimulus size V may be a good alternative to standard size III in selected visually debilitated patients who report difficulty undergoing a standard SITA 24-2 test.

Comparative Evaluation of the Prognostic Value Between the Ocular Trauma Score and the Pediatric Penetrating Ocular Trauma Score.

Controversy exists about the utility of the Ocular Trauma Score (OTS) in children. A new score was developed specifically for children-the Pediatric Penetrating Ocular Trauma Score (POTS)-which proved to be of prognostic value in young patients with penetrating eye injuries. The purpose of the study was to compare the prognostic value of OTS and POTS in children with open-globe injuries in a cohort of Brazilian children. This was a retrospective, interventional case series and included 37 children with open-globe injuries seen at the Santa Casa de Sao Paulo Emergency Service. Mean age was 8.0 ±â€Š3.9 years; 28 were male and 9 female. All patients were reviewed on the basis of time and circumstance of injury, time of surgery, type of penetrating injury, initial and final visual acuity (VA), and concomitant eye disease. Both OTS and POTS categories were calculated based on specific variables. The final achieved VA was compared with the predicted VA for both scores with Kendall's test for significant association; the agreement between the predicted VA for both OTS and POTS was accessed with the Cohen kappa coefficient. The association between OTS and achieved VA was good (Kendall Tau-b = 0.511, P = 0.001), as well as between POTS and achieved VA (Kendall Tau-b = 0.422, P = 0.002). The agreement between the predicted VA for OTS and POTS was fair (kappa = 0.400). In conclusion, in this small cohort of Brazilian children with open-globe injuries, there was no superiority of one score over the other and both OTS and POTS underestimated the potential best-corrected VA after treatment.