Comparison between distance and near visual acuity in amblyopes.

To compare distant visual acuity (DVA) and near visual acuity (NVA) in amblyopia and evaluate if NVA can be used to diagnose amblyopia.A retrospective study was performed on 73 patients diagnosed with amblyopia based on DVA, by measuring their NVA and comparing the DVA and NVA. The NVA was measured by Snellen chart at 30 cm and the DVA was measured by Dr Hahn vision test chart at 5m. The patients' age, type of amblyopia, spherical equivalent, the difference between spherical equivalent and the fellow eye spherical equivalent spherical, and prism diopter (PD) were evaluated and their relationship with the difference between the DVA and NVA was analyzed.The NVA was significantly better than the DVA in amblyopia (P = .000). The difference between the DVA and NVA was not significantly related to the type of amblyopia (P = .600) or the patients' age(P = .351). Also, the difference between the DVA and NVA was not significantly affected by the spherical equivalent (P = .425) or the difference between spherical equivalent and the fellow eye spherical equivalent (P = .212) in anisometropia amblyopia, and also not by the PD (P = .882) in strabismus amblyopia.In amblyopes, the NVA was better than the DVA before amblyopia treatment. The difference between the DVA and NVA was not affected by age, type of amblyopia, spherical equivalent, the difference between spherical equivalent and the fellow eye spherical equivalent spherical, or PD. Therefore, it should be taken into consideration that NVA could underestimate the severity of amblyopia and affect the accuracy at diagnosing amblyopia.

VALIDATION OF THE RECENTLY DEVELOPED ATN CLASSIFICATION AND GRADING SYSTEM FOR MYOPIC MACULOPATHY.

PURPOSE: To validate the recently developed ATN grading system for myopic maculopathy to classify eyes with pathologic myopia. METHODS: Cross-sectional study. A series of consecutive eyes diagnosed with pathologic myopia and signs of myopic maculopathy (grade ≥1 for atrophic, tractional, or neovascular components of the ATN), with a refractive error > -6.0 diopters (D), were included. All patients underwent complete ophthalmological examination including fundus photography and swept-source optical coherence tomography. Six observers graded each eye twice using the ATN system (≥15 days between assessments) based only on the aforementioned data. RESULTS: Sixty eyes from 47 patients (61.7% female) were graded. Mean patient age was 63.2 ± 11.7 years. The mean spherical equivalent was -13.8 ± 6.5 D. Mean axial length was 28.6 ± 2.16 mm. Overall, the mean intraobserver agreement (%) for the same image was 92.0%, and the mean interobserver agreement for the second image was 77.5%. The weighted Fleiss k showed excellent correlation (k > 0.8) for the traction and neovascularization components and good correlation (0.75) for atrophy. Interobserver agreement for each of these three components was 95.2%, 98.4%, 95.0%, respectively. CONCLUSION: Application of the ATN resulted in high intraobserver and interobserver correlation, underscoring the reproducibility of the system.

Validity of a new comprehensive pterygia grading scale for use in clinical research and clinical trial.

PURPOSE: To determine the reliability and agreement of a new comprehensive pterygium grading scale for use in clinical research and clinical trials. METHODS: Thirty eyes with pterygia were enrolled in this study. Primary gaze position and lateral gaze position images were taken of each eye with a modified single-lens reflex camera system. Our grading scale includes five parameters: two hyperemia parameters of pterygia on two different gaze position images and three size parameters, quantifying length, width, and area of the cornea encroachment of pterygium, using ImageJ software. All images were graded on the five parameters by two masked, certified reading center graders. Two graders independently graded all the images to determine inter-grader reliability. One grader regraded the images after 3 days to determine intra-grader reliability. Intraclass correlation coefficient (ICC) and inter-rater agreement statistic (κ) calculations were performed. RESULTS: The intra-grader reliability for hyperemia grading was high on both primary and lateral gazing positions (κ value is 0.93 and 0.96). The inter-grader reliability for hyperemia grading was also good (κ value is 0.85 and 0.87). The mean value of width, length, and area of the cornea encroachment of pterygium was 4.31 ± 2.04 mm, 2.08 ± 1.43 mm, and 7.84 ± 7.62 mm2, respectively. The intra-grader agreement on width, length, and area were excellent, with ICCs of 0.98 (95% CI 0.96-0.99), 0.99 (95% CI 0.98-1.0), and 0.97 (95% CI 0.94-0.99), respectively. The inter-grader agreement on width, length, and area were also excellent, with ICCs of 0.96 (95% CI 0.90-0.98), 0.99 (95% CI 0.98-0.99), and 0.99 (95% CI 0.97-0.99), respectively. CONCLUSIONS: There was excellent intra- and inter-observer reproducibility with the new comprehensive grading scale. This scale could lead to the development of standardized grading assessments and quantification of pterygia that would be valid in clinical research and clinical trials.

Development of Definitive and Reliable Grading Scales for Meibomian Gland Dysfunction.

PURPOSE: To develop and validate grading scales for meibomian gland dysfunction (MGD) that allow consistent diagnosis of MGD and are suitable for clinical studies. DESIGN: Development and validation study of grading scales. METHODS: Lid margin and meibomian gland photographs were taken in the multicenter, prospective cross-sectional study for MGD and control subjects. New grading scales for MGD signs (abnormal lid margin findings of vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, partial glands, and gland dropout) in both upper and lower eyelids were developed. Three MGD experts, 3 general ophthalmologists, and 3 non-physicians independently tested the scales by evaluating photographs. The levels of interrater and intrarater agreement for each grading scale were estimated with the use of kappa statistics. RESULTS: Thirty-eight patients with MGD and 20 control subjects were enrolled and photographed. New grading scales were developed using a total of 226 photographs. The interrater kappa values for MGD experts and for general ophthalmologists and non-physicians with reference to an MGD expert ranged from 0.36 to 0.87 (median of 0.66), 0.41 to 0.73 (0.60), and 0.30 to 0.77 (0.59), respectively. Those for intrarater reliability for 2 MGD experts ranged from 0.49 to 0.93 (0.82). CONCLUSIONS: New grading scales for MGD signs were developed and found to have appropriate inter- and intrarater reliabilities for grading MGD. These grading scales are suitable for MGD diagnosis and application to multicenter trials.

Medical Devices; Ophthalmic Devices; Classification of the Diurnal Pattern Recorder System. Final order.

The Food and Drug Administration (FDA) is classifying the diurnal pattern recorder system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the diurnal pattern recorder system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Evaluation of Nonmydriatic Hand-held Optic Disc Photography Grading in the Philadelphia Glaucoma Detection and Treatment Project.

PURPOSE: To determine the reproducibility of optic disc photograph grading obtained by a hand-held fundus camera and to determine the diagnostic value of these photographs in detecting patients with glaucoma in a community-based glaucoma-detection program. MATERIALS AND METHODS: Patients underwent slit-lamp examination by an ophthalmologist who graded each patient's optic discs using 2 methods: cup-to-disc ratio (CDR) and disc damage likelihood scale (DDLS). After a comprehensive glaucoma evaluation, patients were diagnosed as having "glaucoma," "glaucoma suspect," or "no glaucoma." Nonmydriatic, monoscopic optic disc photographs were then taken with a portable digital imaging device. On a different day, the same examiner and a second observer graded the disc photographs in a masked manner and determined a diagnostic impression based only on the disc photographs. RESULTS: Of the 1649 patients examined, 119 subjects were randomly selected according to 3 groups of diagnoses: "glaucoma" (n=36), "glaucoma suspect" (n=50), and "no glaucoma" (n=33). For CDR, the intraobserver agreement was 0.71 and the interobserver agreement was 0.69. For disc DDLS, the intraobserver agreement was 0.65 and the interobserver agreement was 0.67. The area under the receiver-operating characteristic distinguishing between normal and glaucoma was 0.88 and 0.86 for CDR and disc DDLS, respectively. CONCLUSIONS: Nonmydriatic, monoscopic disc photographs obtained by a hand-held camera had only moderate disc grading reproducibility. This could be due to a reduced quality of images, making interpretation more challenging, due to taking photographs through small pupils by a hand-held camera and the high percentage of patients with significant cataracts.

Classification of semi-automated flare readings using the Kowa FM 700 laser cell flare meter in patients with uveitis.

PURPOSE: To propose a classification system to grade semi-automated flare readings and assess its correlation with clinical flare grading and also to explore the utility of an additional step in clinical flare assessment between grades 0 and 1. METHODS: Semi-automated flare readings from 103 eyes with uveitis were taken using the Kowa FM 700 laser flare meter and classified into two models (LFCM and LFCM_1), and introduction of a 0.5 step in flare grading was explored. RESULTS: Good correlation was present between the conventional SUN clinical flare and the proposed clinical classification for flare (weighted kappa (WK) = 89.64%, p < 0.001). Semi-automated flare grading (LFCM and LFCM_1) had WK agreement of 82.52% and 79.85% (p < 0.001) with conventional SUN clinical flare grading. CONCLUSIONS: The proposed classification system for semi-automated laser flare readings (LFCM) allows stratification of measurements into grades analogous to clinical flare grades and correlates well with conventional clinical flare grading.

Lista especial para la codificación de la morbilidad en Oftalmología / Special list for the morbidity coding in ophthalmology

Objetivo: complementar y perfeccionar la clasificación estadística internacional de enfermedades para la especialidad de Oftalmología en el Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el año 2013. Métodos: se realizó una investigación de servicios de salud clasificada, descriptiva y retrospectiva en la que se identificaron por grupos de expertos los diagnósticos que están incluidos en códigos inespecíficos o que no están representados en ningún código.Resultados: se elaboró la propuesta de nuevos códigos, a los cuales se les incluyó un quinto o sexto carácter y se aplicó a la codificación de los diversos diagnósticos en pacientes egresados durante el año 2013. Se recodificaron 432 historias clínicas y se propusieron nuevos códigos para la uveítis crónica y recurrente, la necrosis retinal aguda, la clasificación de la endoftalmitis, los traumas, el glaucoma, la úlcera corneal y las cataratas congénitas, no representadas en la lista tabular vigente.Conclusión: la mayor utilidad de los códigos propuestos depende de la claridad en el diagnóstico al egreso, reflejado por los especialistas en las historias clínicas de los pacientes. Con la utilización de estos códigos se garantiza una mayor calidad en el resumen de la información referente al diagnóstico, lo que permitirá una mejor evaluación de los protocolos asistenciales y de la utilización de los recursos con que se cuenta actualmente para la especialidad(AU)

Objective: to supplement and upgrade the International Statistical Classification of Diseases for ophthalmology at Ramon Pando Ferrer Cuban Institute of Ophthalmology during 2013. Methods: retrospective, descriptive and classified research on health services in which the expert groups identified the diagnoses that are included in unspecified codes or are not represented in any code. Results: new codes were suggested to which a fifth or sixth character was added and the coding of several diagnoses was used in patients discharged in 2013. Four hundred twenty two medical histories were re-coded whereas new codes were suggested for chronic and recurrent uveitis, acute retinal necrosis, endophthalmitis classification, traumas, glaucoma, corneal ulcer and congenital cataracts since they were not represented in the current listing.Conclusions: Greater usefulness of the suggested codes will depend on the classification of diagnoses on discharge from hospital, which will be written down by specialists in the medical histories of the patients. These codes will assure higher quality of summarized information related to diagnosis and this will allow better assessment of the assistance protocols and the utilization of the resources available for this specialty at present(AU)

Lista especial para la codificación de la morbilidad en Oftalmología / Special list for the morbidity coding in ophthalmology

Objetivo: complementar y perfeccionar la clasificación estadística internacional de enfermedades para la especialidad de Oftalmología en el Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el año 2013. Métodos: se realizó una investigación de servicios de salud clasificada, descriptiva y retrospectiva en la que se identificaron por grupos de expertos los diagnósticos que están incluidos en códigos inespecíficos o que no están representados en ningún código. Resultados: se elaboró la propuesta de nuevos códigos, a los cuales se les incluyó un quinto o sexto carácter y se aplicó a la codificación de los diversos diagnósticos en pacientes egresados durante el año 2013. Se recodificaron 432 historias clínicas y se propusieron nuevos códigos para la uveítis crónica y recurrente, la necrosis retinal aguda, la clasificación de la endoftalmitis, los traumas, el glaucoma, la úlcera corneal y las cataratas congénitas, no representadas en la lista tabular vigente. Conclusión: la mayor utilidad de los códigos propuestos depende de la claridad en el diagnóstico al egreso, reflejado por los especialistas en las historias clínicas de los pacientes. Con la utilización de estos códigos se garantiza una mayor calidad en el resumen de la información referente al diagnóstico, lo que permitirá una mejor evaluación de los protocolos asistenciales y de la utilización de los recursos con que se cuenta actualmente para la especialidad(AU)

Objective: to supplement and upgrade the International Statistical Classification of Diseases for ophthalmology at Ramon Pando Ferrer Cuban Institute of Ophthalmology during 2013. Methods: retrospective, descriptive and classified research on health services in which the expert groups identified the diagnoses that are included in unspecified codes or are not represented in any code. Results: new codes were suggested to which a fifth or sixth character was added and the coding of several diagnoses was used in patients discharged in 2013. Four hundred twenty two medical histories were re-coded whereas new codes were suggested for chronic and recurrent uveitis, acute retinal necrosis, endophthalmitis classification, traumas, glaucoma, corneal ulcer and congenital cataracts since they were not represented in the current listing. Conclusions: Greater usefulness of the suggested codes will depend on the classification of diagnoses on discharge from hospital, which will be written down by specialists in the medical histories of the patients. These codes will assure higher quality of summarized information related to diagnosis and this will allow better assessment of the assistance protocols and the utilization of the resources available for this specialty at present(AU)

International photographic classification and grading system for myopic maculopathy.

PURPOSE: To develop a classification and grading system for myopic maculopathy. DESIGN: Development and evaluation of a classification system for myopic maculopathy based on observational case series. METHODS: A comprehensive set of myopic macular lesions was defined via literature review and through consensus meetings among retinal specialists and clinician scientists. A classification of myopic maculopathy was formulated based on fundus photographs and a modified Delphi process and consensus. Inter- and intraobserver reproducibility, assessed as agreement (%) and weighted kappa values, were evaluated. One hundred retinal photographs with myopia and myopic macular lesions were selected from case series at the High Myopia Clinic of the Tokyo Medical and Dental University, Tokyo, Japan. RESULTS: We defined 5 categories of myopic maculopathy including "no myopic retinal degenerative lesion" (Category 0), "tessellated fundus" (Category 1), "diffuse chorioretinal atrophy" (Category 2), "patchy chorioretinal atrophy" (Category 3), and "macular atrophy" (Category 4). Three additional features to supplement these categories were defined as "plus" lesions, namely, lacquer cracks, myopic choroidal neovascularization, and Fuchs spot. Posterior staphyloma was considered as a further, important sign of myopic retinopathy. The intraobserver agreement was ≥85% and the corresponding weighted kappa statistic was ≥0.6 between observations. After a brief training session, interobserver kappa statistics reached the predefined satisfactory level (≥0.4), considered as above moderate agreement. CONCLUSIONS: We propose a classification system for myopic maculopathy that was found to be reproducible. Applying a uniform classification in different studies will facilitate communication and comparison of findings from clinical trials and epidemiologic studies.

[Methods of ocular microcirculation assessment in experimental animals].

The review discusses some of the most common methods of ocular microcirculation assessment in animals: fluorescent and indocyanine green angiography, scanning laser ophthalmoscopy with various dyes, laser Doppler flowmetry and velocimetry, color and power Doppler imaging, and pulsed-wave spectral Doppler ultrasonography. Each method possesses certain advantages and disadvantages, thus, the choice between them depends on the purposes and objectives of the given experimental study.

Proposed diagnostic criteria for obstructive meibomian gland dysfunction.

PURPOSE: To compare clinical findings between patients with obstructive meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic criteria for obstructive MGD. DESIGN: Cross-sectional, observational case series. PARTICIPANTS: Fifty-three eyes of 53 patients (18 men, 35 women; age [mean +/- standard deviation] 71.4 +/- 10.0 years) who were diagnosed with obstructive MGD and 60 eyes of 60 healthy volunteers (22 men, 38 women; 71.0 +/- 9.3 years) as a control group. METHODS: Ocular symptoms were scored from 0 to 14 according to the number of existing symptoms. Lid margin abnormality was scored from 0 to 4 depending on the number of existing abnormalities. Meibomian gland changes were scored from 0 to 6 based on noncontact meibography (meibo-score). Superficial punctuate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3 depending on the volume and quality. Tear film production was evaluated by Schirmer's test. Receiver operating characteristic curves with calculations of area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate obstructive MGD from normal eyes. MAIN OUTCOME MEASURES: Ocular symptom score, lid margin abnormality score, meibo-score, meibum score, SPK score, tear film breakup time (BUT), and the Schirmer value. RESULTS: Ocular symptom score, lid margin abnormality score, meibo-score, meibum score, and SPK score were significantly higher in the obstructive MGD group than in the control group (P<0.0001 for all scores). The BUT was significantly shorter in the obstructive MGD group than in the control group (P<0.0001). The AUC values indicated that the ocular symptom score had the highest diagnostic power as a single parameter, followed by the lid margin abnormality score, meibo-score, and BUT. CONCLUSIONS: Based on these findings, we recommend that physicians use the ocular symptom score, lid margin abnormality score, and meibo-score to diagnose MGD. Obstructive MGD should be suspected when any 2 of the 3 scores are abnormal. Obstructive MGD is very likely when all 3 scores are abnormal.

[Diagnostic methods for chloroquine diphosphate induced retinopathy in systemic lupus erythematosus]. / Métodos diagnósticos para retinopatia induzida pelo difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico.

PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. METHODS: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4%) were female. The mean age was 39.9 +/- 9.8 years and the disease duration was 13.9 +/- 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9% of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.

Métodos diagnósticos para retinopatia induzida pelo difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico / Diagnostic methods for chloroquine diphosphate induced retinopathy in systemic lupus erythematosus

OBJETIVOS: Avaliar diferentes métodos diagnósticos para a avaliação de pacientes portadores de lúpus eritematoso sistêmico, usuários crônicos do difosfato de cloroquina (DFC) e, portanto, com alto risco para retinopatia tóxica. MÉTODOS: Foram analisados 72 olhos de 36 pacientes consecutivos, seguidos no Serviço de Reumatologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, de julho de 2007 a abril de 2008. Dados demográficos e clínicos foram avaliados com o intuito de estudar os fatores de alto risco e comparar os seguintes métodos oftalmológicos: acuidade visual, biomicroscopia da córnea, biomicroscopia do fundo, retinografia, angiofluoresceinografia da retina, campo visual macular com mira branca. RESULTADOS: Dos 36 pacientes, 34 (94,4 por cento) eram mulheres. A média de idade foi 39,9 ± 9,8 anos, com tempo de doença igual a 13,9 ± 6,6 anos. Além do uso crônico da cloroquina, os pacientes apresentaram altas doses diárias (>3 mg/kg) e cumulativas. Não foi observada relação entre estes fatores de alto risco e maior prevalência de retinopatia. Foi encontrada prevalência de retinopatia igual a 38,9 por cento, confirmada por alterações bilaterais, centrais ou paracentrais e reprodutíveis no exame de campo visual. Outros exames indicados para seguimento, como acuidade visual, biomicroscopia de fundo e angiofluoresceinografia não foram capazes de diagnosticar a maioria das alterações confirmadas pelo campo visual. CONCLUSÃO: Foi observada alta prevalência de retinopatia por cloroquina entre os pacientes com alto risco, usuários crônicos do DFC, segundo os achados do campo visual. A avaliação desses pacientes deve considerar a realização do exame de campo visual em intervalos menores que os propostos, mesmo quando não há suspeita clínica.

PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. Methods: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4 percent) were female. The mean age was 39.9 ± 9.8 years and the disease duration was 13.9 ± 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9 percent of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.

Optical coherence tomography machine learning classifiers for glaucoma detection: a preliminary study.

PURPOSE: Machine-learning classifiers are trained computerized systems with the ability to detect the relationship between multiple input parameters and a diagnosis. The present study investigated whether the use of machine-learning classifiers improves optical coherence tomography (OCT) glaucoma detection. METHODS: Forty-seven patients with glaucoma (47 eyes) and 42 healthy subjects (42 eyes) were included in this cross-sectional study. Of the glaucoma patients, 27 had early disease (visual field mean deviation [MD] > or = -6 dB) and 20 had advanced glaucoma (MD < -6 dB). Machine-learning classifiers were trained to discriminate between glaucomatous and healthy eyes using parameters derived from OCT output. The classifiers were trained with all 38 parameters as well as with only 8 parameters that correlated best with the visual field MD. Five classifiers were tested: linear discriminant analysis, support vector machine, recursive partitioning and regression tree, generalized linear model, and generalized additive model. For the last two classifiers, a backward feature selection was used to find the minimal number of parameters that resulted in the best and most simple prediction. The cross-validated receiver operating characteristic (ROC) curve and accuracies were calculated. RESULTS: The largest area under the ROC curve (AROC) for glaucoma detection was achieved with the support vector machine using eight parameters (0.981). The sensitivity at 80% and 95% specificity was 97.9% and 92.5%, respectively. This classifier also performed best when judged by cross-validated accuracy (0.966). The best classification between early glaucoma and advanced glaucoma was obtained with the generalized additive model using only three parameters (AROC = 0.854). CONCLUSIONS: Automated machine classifiers of OCT data might be useful for enhancing the utility of this technology for detecting glaucomatous abnormality.

Visual field defects in optic neuritis and anterior ischemic optic neuropathy: distinctive features.

BACKGROUND: We analyzed the value of visual-field defects in the differential diagnosis of optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (AION). METHODS: Ninety-nine consecutive patients with acute-onset optic neuropathy formed the basis for this study. Compressive and vasculitic neuropathies were excluded. Eighty-six patients fulfilled the criteria for either ON (50 patients): < or = 35 years, normal disk, recovery of visual function, or AION (36 patients): > or = 60 years, swelling of the disk, no recovery of visual function. Without knowledge of other clinical data, visual fields obtained by Gold-mann perimetry were classified into five types of defects (forced choice). With the correct diagnosis at hand, fields were reviewed for characteristic features. RESULTS: Forced-choice classification into defect types [%]: Central scotoma ON 68, AION 18; superior altitudinal defect ON 13 AION 7; inferior altitudinal defect ON 8, AION 52; peripheral defect ON 1, AION 5; diffuse defect ON 10, AION 18. Search for pathognomonic defects: a scotoma centered on the fixation point with a sloping border occurred exclusively in ON (25 of 50 patients). An inferior altitudinal defect with a sharp border along the horizontal meridian, particularly in the nasal periphery, occurred only in AION (10 of 36 patients). A steep centrocecal scotoma occurred in 3 of the 36 AION cases and not at all in the ON cases. Scotomas in the center breaking through to the periphery, superior altitudinal defects (with a sloping border along the horizontal meridian) and diffuse depressions verging on blindness occurred in both ON and AION. CONCLUSION: A sctoma centered on the fixation point with a sloping border is highly characteristic of ON, while an inferior altitudinal defect with a sharp border along the horizontal meridian, particularly in the nasal periphery, is highly characteristic of AION. To identify these diagnostic criteria, it can be necessary to examine full fields. With restriction of perimetry to 30 degrees a large central scotoma can be mistaken for a diffuse defect and the border in the nasal periphery can be missed.