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.

Occlusive retinal vasculitis in a patient with West Nile virus.

BACKGROUND: West Nile virus (WNV) was first identified in the United States in 1999. In addition to a spectrum of systemic manifestations, several ocular conditions secondary to the virus have been reported, including chorioretinitis, uveitis and optic neuritis. Age and diabetes mellitus (DM) have been reported to be associated risk factors for the more severe forms of the systemic disease. Only seven cases of occlusive retinal vasculitis have been reported in patients with WNV infection. CASE HISTORY: A 60-year-old Asian male presented with complaints of decreased vision in his left eye. He had been hospitalised approximately seven weeks earlier with meningo-encephalitis secondary to presumed WNV infection, at which time he was also diagnosed with DM. The visual loss coincided with the manifestation of systemic WNV infection. Old peripheral chorioretinal lesions without active inflammation in both eyes were consistent with WNV infection. In addition, retinal haemorrhage and cotton wool spots were noted in the posterior pole of both eyes with severe macular ischaemia in the left eye. CONCLUSION: Occlusive retinal vasculitis is an uncommon ocular manifestation of WNV, which should be suspected in patients with meningitis or encephalitis who reside in endemic areas with ocular findings of the disease.

Cystic maculopathy with normal capillary permeability secondary to docetaxel.

BACKGROUND: Cystic maculopathy without leakage on fluorescein angiography has been described in cases of toxicity to niacin. We present a similar case of cystic maculopathy due to docetaxel (Taxotere) in the treatment of breast cancer. CASE REPORT: A 53-year-old Asian female presented with complaints of decreased vision soon after the initiation of treatment for breast cancer with docetaxel. A cystic maculopathy with a normal fluorescein angiogram was found on examination. Significant improvement in visual acuity along with resolution of the cystic maculopathy was found after changing to an alternate antineoplastic agent. CONCLUSION: Docetaxel may be associated with cystic maculopathy that does not display angiographic evidence of abnormal capillary permeability.

Visual changes secondary to initiation of amiodarone: a case report and review involving ocular management in cardiac polypharmacy.

BACKGROUND: Amiodarone is a benzofuran derivative used to treat cardiac arrhythmias. The most-common ocular symptom is colored rings around lights. Common ocular findings include comeal micro-deposits and lens opacities. An amiodarone optic neuropathy has been described. Digoxin is a cardiac glycoside used to treat cardiac arrhythmias and heart failure. It is known to cause dyschromatopsia, visual disturbances, and visual-field defects. Digoxin serum levels and toxicity risks increase with the addition of amiodarone. CASE REPORT: Soon after initiation of amiodarone HCl (200 mg/day), a 76-year-old man came to us with symptoms of visual "shining," glare, color vision anomalies, and gradually decreased vision. Best-corrected visual acuity was 20/50 O.D. and 20/60 O.S. Ishihara color plates showed a marked, acquired color vision defect O.D., O.S. Biomicroscopy revealed amiodarone corneal deposits. The optic nerve appeared healthy, with no visible swelling in each eye. Amiodarone was discontinued after discussion with the cardiologist. On followup, the patient reported disappearance of symptoms. Visual acuity had improved to 20/30(+2) O.D. and 20/30 O.S. Ishihara color plates showed normal color vision. CONCLUSIONS: As the elderly population and the incidence of heart disease increase in the United States, more people will probably be using heart drug therapy. Our case presents some of the challenges involved with managing ocular toxicity of these cardiac drugs. While both amiodarone and digoxin can cause permanent visual changes, the ocular effects are often reversible. Therefore, ocular examination at baseline and every 6 months is indicated for patients receiving a regimen of amiodarone and/or digoxin therapy.