Asunto(s)
Neuritis Óptica/diagnóstico , Neuropatía Óptica Isquémica/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Hemorragia del Ojo/epidemiología , Hemorragia del Ojo/etiología , Dolor Ocular/epidemiología , Dolor Ocular/etiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Papiledema/etiología , Escotoma/epidemiología , Escotoma/etiología , Agudeza VisualRESUMEN
PURPOSE: A descriptive study on visual fields, as part of a 50-year follow-up of high myopia in an unselected cohort-based Danish sample, now aged 66 years. METHODS: In a Copenhagen 1948 birth cohort (n = 9243), 39 individuals aged 14 years were identified with myopia of at least -6 D, and with regular clinical follow-ups since then. In 2002 (n = 34, age 54 years) and 2008 (n = 32, age 60), the individual ambulatory visual field was outlined by kinetic Goldmann large object perimetry (IV or V,4e). At age 66 years, 28 attended for the 2014-2015 follow-up, at which smaller Goldmann objects (II and I,4e) were added, further to identify relative defects. RESULTS: Repeated large object perimetry disclosed statistically significant general peripheral narrowing over the 12-13-year test period, though slight and without practical implications. Two new cases showing absolute defects were however added to the three already known. The addition of small Goldmann objects disclosed relative defects in another eight participants, in some to suggest a refraction-related pattern (fundus ectasia; uncorrected high myopia). However, comparing eyes with and without defects, statistical importance could not be attached to the degree of myopia, fundus ectasia or optic disc morphology (χ2 , n.s.). CONCLUSION: (i) Serial large object Goldmann isopters over the 'senior' decade up to age 66 demonstrated a slight general peripheral narrowing by age of visual fields in high myopia. (ii) Overall 42% of the participants had absolute or relative defects (in 5 and 8, respectively), however, without socio-visual consequences when binocular. (iii) Visual field loss by age still appears a minor issue in clinically unselected high myopia.
Asunto(s)
Predicción , Miopía Degenerativa/epidemiología , Escotoma/epidemiología , Agudeza Visual , Campos Visuales/fisiología , Adolescente , Adulto , Anciano , Dinamarca/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Miopía Degenerativa/complicaciones , Miopía Degenerativa/fisiopatología , Disco Óptico/diagnóstico por imagen , Estudios Retrospectivos , Escotoma/etiología , Escotoma/fisiopatología , Pruebas del Campo Visual , Adulto JovenRESUMEN
BACKGROUND: Eye Movement Perimetry (EMP) uses Saccadic Eye Movement (SEM) responses for visual field evaluation. Previous studies have demonstrated significant delay in initiation of SEMs among glaucoma patients in comparison with healthy subjects. The aim of the current study was to develop an EMP-based screening grid to identify glaucomatous visual field defects. METHODS: An interactive test consisting of 36 locations and two stimulus contrasts (162 cd/m2 and 190 cd/m2 on a background of 140 cd/m2) was evaluated in 54 healthy subjects and 50 primary glaucoma patients. Each subject was presented a central fixation target combined with the random projection of Goldmann size III peripheral targets. Instructions were given to look at each peripheral target on detection and then re-fixate at the central fixation target while the saccades were assessed using an eye tracker. From each seen peripheral target, the Saccadic Reaction Time (SRT) was calculated for contrast level 162 cd/ m2. These values were used to plot Receiver Operating Characteristic (ROC) curves for each test locations and the Area Under the Curve (AUC) values were used to identify the locations with highest susceptibility to glaucomatous damage. Each stimulus location with an AUC less than 0.75 along with its mirrored test location around the horizontal axis were eliminated from the grid. RESULTS: The mean age was 48.1 ± 16.6 years and 50.0 ± 14.5 years for healthy subjects and glaucoma patients respectively. A significant increase of SRT values by 76.5% (p < 0.001) was found in glaucoma patients in comparison with the healthy subjects. From the ROC analysis, ten out of 36 locations meeting the cut-off criteria of AUC were eliminated resulting in a new grid containing 26 test locations. SRT values were significantly different (p < 0.05) between the healthy subjects and glaucoma irrespective of the grids used. CONCLUSIONS: The present study resulted in a screening grid consisting of 26 locations predominantly testing nasal, superior and inferior areas of the visual field. An internal validation of the modified grid showed 90.4% of screening accuracy which makes it a potential approach for population based glaucoma screening.
Asunto(s)
Movimientos Oculares , Glaucoma/complicaciones , Escotoma/diagnóstico , Selección Visual/métodos , Pruebas del Campo Visual/métodos , Campos Visuales/fisiología , Adulto , Anciano , Femenino , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Escotoma/epidemiología , Escotoma/etiología , Adulto JovenRESUMEN
PURPOSE: To identify patterns and rates of visual field (VF) loss in primary open-angle glaucoma (POAG) across different levels of severity. DESIGN: Retrospective, observational case series. PARTICIPANTS: Visual fields of 278 eyes of 139 patients with POAG (9 years of follow-up with â¼17 visits) from the Rotterdam Eye Hospital in The Netherlands were analyzed to identify patterns and rates of VF loss. MAIN OUTCOME MEASURES: Rate of VF decline for the entire VF, each region, and test point. Hemifield asymmetric rate if VF decline for each region and test point. METHODS: Total deviation (TD) values were extracted from the Humphrey VF Analyzer (Carl Zeiss Meditec, Dublin, CA). Eyes were stratified into 3 glaucoma stages by means of the mean deviation (MD): better than -6 decibels (dB), worse than -6 dB and better than -12 dB, and worse than -12 dB. Each hemifield was divided into 5 regions according to the Glaucoma Hemifield Test (GHT): central, paracentral, nasal, and peripheral arcuates 1 and 2. Point-wise and region-wise asymmetric patterns of VF loss and rate of VF loss were identified by comparing the values in the superior hemifield and the inferior hemifield at each severity level using a generalized estimating equation. RESULTS: The mean age of the patients was 60.2±10.3 years (mean ± standard deviation [SD]). The rate of MD loss, for all eyes taken together, was -0.11 dB/year. In the cross-sectional analysis, in eyes in the early and moderate stages, central and peripheral arcuate 2 regions in the superior hemifield were worse than their inferior counterpart, whereas in the advanced stage all GHT regions in the superior hemifield were significantly worse than the corresponding regions in the inferior hemifield (P ≤ 0.05). In the longitudinal analysis, there was no significant difference in the rate of VF loss between the GHT regions in the superior and inferior hemifields. CONCLUSIONS: Our findings suggest that in POAG, VF damage is worse in the superior hemifield than in the inferior hemifield.
Asunto(s)
Glaucoma de Ángulo Abierto/complicaciones , Presión Intraocular/fisiología , Escotoma/epidemiología , Campos Visuales/fisiología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Escotoma/diagnóstico , Escotoma/etiología , Pruebas del Campo VisualRESUMEN
BACKGROUND: Trabeculectomy is frequently performed in patients with glaucoma who are deteriorating, although its effects on rates of visual field (VF) progression are not fully understood. We studied the rate of VF progression post trabeculectomy comparing with medically treated patients matched for VF loss. METHODS: Medical records of patients who underwent trabeculectomy alone or combined with cataract extraction were reviewed. Patients with 5 or more 24-2 VF examinations post trabeculectomy were selected. The rate of mean deviation (MD) change after surgery was calculated for each patient. These patients were pairwise matched based on baseline MD with patients with glaucoma who were treated medically and had at least 5 VF tests. RESULTS: 180 surgical patients were identified and matched with 180 medically treated patients (baseline MD of -8.72 (5.24) dB and -8.71 (5.22) dB, respectively). Surgically and medically treated patients were followed for 7.4 (2.9) and 6.8 (3.1) years respectively. The MD slopes were -0.22 (0.55) dB/year and -0.08 (1.10) dB/year in the surgically and medically treated patients, respectively, and not statistically different (p=0.13, 95% CI -0.31 to 0.04). More patients in the surgical group had fast progression (rates worse than -1â dB/year) than in the medical group (17 and 7 patients, respectively, p=0.05). CONCLUSIONS: Our findings suggest that most patients who undergo trabeculectomy demonstrate relatively slow rates of VF progression postoperatively, similar to patients treated medically, although some patients can continue to progress despite adequate surgical control of intraocular pressure.
Asunto(s)
Glaucoma/cirugía , Complicaciones Posoperatorias , Escotoma/epidemiología , Trabeculectomía/efectos adversos , Campos Visuales/fisiología , Anciano , Femenino , Estudios de Seguimiento , Glaucoma/fisiopatología , Humanos , Incidencia , Presión Intraocular , Masculino , Persona de Mediana Edad , Nueva Escocia/epidemiología , Estudios Retrospectivos , Escotoma/etiología , Escotoma/fisiopatología , Agudeza Visual , Pruebas del Campo VisualRESUMEN
PURPOSE: In many medical conditions 'late presentation' of disease is more of a problem for men than women. Risk of sight loss from glaucoma is certainly greater in those detected with advanced disease. We performed a retrospective study to test the hypothesis that men are more likely than women to have advanced visual field loss at referral to glaucoma clinics. METHODS: We used 152 918 Humphrey visual fields from 32 147 patients from three regionally different hospitals in England; no other clinical data were made available apart from patient's age, sex and examination dates. The study population was defined as patients with measureable visual field loss in at least one eye at referral to glaucoma clinics. Cases of advanced visual field loss as defined by the Enhanced Glaucoma Severity Staging method at the first visit to secondary care were used as a proxy measure for late presentation of glaucoma. Age-adjusted relative risk (RR) was calculated as the ratio of the proportion of men to women with this proxy measure. RESULTS: Median (interquartile range) age and MD (worse eye) for 3733 men and 4264 women was 72 (63, 79) and 74 (64, 81) years and -6.4 (-11.7, -3.8) and -6.3 (-11.0, -3.8) dB respectively. Overall proportion of patients with advanced visual field loss at referral to glaucoma clinics was slightly higher in men (25.0%) than in women (22.3%); this difference was statistically significant (p < 0.01). Overall age-standardised RR was statistically significant (1.16; p < 0.001); a person with late presentation of glaucoma is 16% (95% confidence interval: 7-25%) more likely to be a man than a woman. CONCLUSIONS: A large number of patients with glaucomatous visual field defects are estimated to have advanced loss in at least one eye on referral to secondary care in England; risk for men more likely presenting with late disease is slightly greater than for women.
Asunto(s)
Glaucoma/complicaciones , Hospitales/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Escotoma/epidemiología , Campos Visuales/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Inglaterra/epidemiología , Femenino , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Escotoma/etiología , Escotoma/fisiopatología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores Sexuales , Pruebas del Campo Visual/métodosRESUMEN
IMPORTANCE: Patients with glaucoma and a history of fast visual field loss might be at an increased risk for falls compared with those with a history of slow visual field loss, but, to date, this association has not been previously investigated in the literature. OBJECTIVE: To evaluate the association between self-reported falls and past rate of visual field loss in a cohort of patients with glaucoma followed up over time. DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included patients diagnosed as having glaucoma who had been followed up at the Visual Performance Laboratory, University of California, San Diego, at 6-month intervals for a mean (SD) of 7.5 (2.6) years from January 1, 2005, through December 31, 2015. Self-reported number of falls during the past year was obtained at the last follow-up visit. Integrated binocular fields were estimated from the monocular fields. Linear mixed models were used to calculate rates of change in binocular mean sensitivity over time. Poisson models were used to evaluate the association between the self-reported number of falls and rates of visual field loss. The models adjusted for the current level of visual field damage and other confounding variables. MAIN OUTCOMES AND MEASURES: Association between rates of binocular visual field loss and self-reported number of falls. RESULTS: The study included 116 patients with glaucoma with a mean (SD) age of 73.1 (10.7) years (55 women [47.4%], 84 white individuals [72.4%], and 32 black individuals [27.6%]). Of the 116 patients, 29 (25.0%) reported at least 1 fall in the previous year. The mean rate of change in binocular mean sensitivity was faster for patients who reported a history of falls vs those who did not (-0.36 vs -0.17 dB/y; mean difference, 0.20 dB/y; 95% CI, 0.09-0.31 dB/y; P < .001). History of fast visual field loss was significantly associated with falls (rate ratio, 2.28 per 0.5 dB/y faster; 95% CI, 1.15-4.52 db/y; P = .02), even after adjusting for confounding factors. CONCLUSIONS AND RELEVANCE: The rate of visual field loss was associated with a self-reported history of falls in the past year even after taking into account the magnitude of visual field defect. However, although a positive association was found, further studies are necessary to establish whether a cause-and-effect relationship exists between rate of visual field loss and self-reported history of falls.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Glaucoma/complicaciones , Escotoma/etiología , Visión Binocular/fisiología , Agudeza Visual , Campos Visuales/fisiología , Anciano , California/epidemiología , Femenino , Estudios de Seguimiento , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Humanos , Incidencia , Presión Intraocular , Masculino , Estudios Prospectivos , Escotoma/epidemiología , Escotoma/fisiopatología , Autoinforme , Perfil de Impacto de Enfermedad , Factores de Tiempo , Pruebas del Campo VisualRESUMEN
We determined whether binocular central scotomas above or below the preferred retinal locus affect detection of hazards (pedestrians) approaching from the side. Seven participants with central field loss (CFL), and seven age-and sex-matched controls with normal vision (NV), each completed two sessions of 5 test drives (each approximately 10 minutes long) in a driving simulator. Participants pressed the horn when detecting pedestrians that appeared at one of four eccentricities (-14°, -4°, left, 4°, or 14°, right, relative to car heading). Pedestrians walked or ran towards the travel lane on a collision course with the participant's vehicle, thus remaining in the same area of the visual field, assuming participant's steady forward gaze down the travel lane. Detection rates were nearly 100% for all participants. CFL participant reaction times were longer (median 2.27s, 95% CI 2.13 to 2.47) than NVs (median 1.17s, 95%CI 1.10 to 2.13; difference p<0.01), and CFL participants would have been unable to stop for 21% of pedestrians, compared with 3% for NV, p<0.001. Although the scotomas were not expected to obscure pedestrian hazards, gaze tracking revealed that scotomas did sometimes interfere with detection; late reactions usually occurred when pedestrians were entirely or partially obscured by the scotoma (time obscured correlated with reaction times, r = 0.57, p<0.001). We previously showed that scotomas lateral to the preferred retinal locus delay reaction times to a greater extent; however, taken together, the results of our studies suggest that any binocular CFL might negatively impact timely hazard detection while driving and should be a consideration when evaluating vision for driving.
Asunto(s)
Conducción de Automóvil , Escotoma/epidemiología , Pruebas del Campo Visual , Campos Visuales , Accidentes de Tránsito , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peatones , Tiempo de Reacción , Retina/patología , Escotoma/diagnósticoRESUMEN
IMPORTANCE: Juvenile open-angle glaucoma (JOAG) is a severe neurodegenerative eye disorder in which most of the genetic contribution remains unexplained. OBJECTIVE: To assess the prevalence of pathogenic CYP1B1 sequence variants in an Australian cohort of patients with JOAG and severe visual field loss. DESIGN, SETTING, AND PARTICIPANTS: For this cohort study, we recruited 160 patients with JOAG classified as advanced (n = 118) and nonadvanced (n = 42) through the Australian and New Zealand Registry of Advanced Glaucoma from January 1, 2007, through April 1, 2014. Eighty individuals with no evidence of glaucoma served as a control group. We defined JOAG as diagnosis before age 40 years and advanced JOAG as visual field loss in 2 of the 4 central fixation squares on a reliable visual field test result. We performed direct sequencing of the entire coding region of CYP1B1. Data analysis was performed in October 2014. MAIN OUTCOMES AND MEASURES: Identification and characterization of CYP1B1 sequence variants. RESULTS: We identified 7 different pathogenic variants among 8 of 118 patients with advanced JOAG (6.8%) but none among the patients with nonadvanced JOAG. Three patients were homozygous or compound heterozygous for CYP1B1 pathogenic variants, which provided a likely basis for their disease. Five patients were heterozygous. The allele frequency among the patients with advanced JOAG (11 in 236 [4.7%]) was higher than among our controls (1 in 160 [0.6%]; P = .02; odds ratio, 7.8 [95% CI, 0.02-1.0]) or among the control population from the Exome Aggregation Consortium database (2946 of 122 960 [2.4%]; P = .02; odds ratio, 2.0 [95% CI, 0.3-0.9]). Individuals with CYP1B1 pathogenic variants, whether heterozygous or homozygous, had worse mean (SD) deviation on visual fields (-24.5 [5.1] [95% CI, -31.8 to -17.2] vs -15.6 [10.0] [95% CI, -17.1 to -13.6] dB; F1,126 = 5.90; P = .02; partial ηp2 = 0.05) and were younger at diagnosis (mean [SD] age, 23.1 [8.4] [95% CI, 17.2-29.1] vs 31.5 [8.0] [95% CI, 30.1-33.0] years; F1,122 = 7.18; P = .008; ηp2 = 0.06) than patients without CYP1B1 pathogenic variants. CONCLUSIONS AND RELEVANCE: Patients with advanced JOAG based on visual field loss had enrichment of CYP1B1 pathogenic variants and a more severe phenotype compared with unaffected controls and patients with nonadvanced JOAG.
Asunto(s)
Citocromo P-450 CYP1B1/genética , Predisposición Genética a la Enfermedad/epidemiología , Glaucoma de Ángulo Abierto/genética , Mutación , Escotoma/genética , Campos Visuales/genética , Adolescente , Adulto , Factores de Edad , Australia , Niño , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Regulación de la Expresión Génica , Glaucoma de Ángulo Abierto/epidemiología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Incidencia , Presión Intraocular/genética , Presión Intraocular/fisiología , Masculino , Sistema de Registros , Medición de Riesgo , Escotoma/epidemiología , Escotoma/fisiopatología , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto JovenRESUMEN
PURPOSE: To investigate the risk factors for initial central scotoma (ICS) compared with initial peripheral scotoma (IPS) in normal-tension glaucoma (NTG). METHODS: Fifty-six NTG patients (56 eyes) with an ICS and 103 NTG patients (103 eyes) with an IPS were included. Retrospectively, the differences were assessed between the two groups for baseline characteristics, ocular factors, systemic factors, and lifestyle factors. Also, the mean deviation of visual field was compared between the two groups. RESULTS: Patients from both ICS and IPS groups were of similar age, gender, family history of glaucoma, and follow-up periods. Frequency of disc hemorrhage was significantly higher among patients with ICS than in patients with IPS. Moreover, systemic risk factors such as hypotension, migraine, Raynaud's phenomenon, and snoring were more prevalent in the ICS group than in the IPS group. There were no statistical differences in lifestyle risk factors such as smoking or body mass index. Pattern standard deviation was significantly greater in the ICS group than in the IPS group, but the mean deviation was similar between the two groups. CONCLUSIONS: NTG Patients with ICS and IPS have different profiles of risk factors and clinical characteristics. This suggests that the pattern of initial visual field loss may be useful to identify patients at higher risk of central field loss.
Asunto(s)
Presión Intraocular , Glaucoma de Baja Tensión/complicaciones , Disco Óptico/patología , Medición de Riesgo/métodos , Escotoma/epidemiología , Campos Visuales/fisiología , Femenino , Humanos , Incidencia , Glaucoma de Baja Tensión/diagnóstico , Glaucoma de Baja Tensión/fisiopatología , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Escotoma/diagnóstico , Escotoma/etiologíaRESUMEN
PURPOSE: We explored whether risk factor associations differed by primary open-angle glaucoma (POAG) subtypes defined by visual field (VF) loss pattern (i.e., paracentral or peripheral). METHODS: We included 77,157 women in the Nurses' Health Study (NHS) and 42,773 men in the Health Professionals Follow-up Study (HPFS 1986-2010), and incident medical record confirmed cases of paracentral (n = 440) and peripheral (n = 865) POAG subtypes. We evaluated African heritage, glaucoma family history, body mass index (BMI), mean arterial blood pressure, diabetes mellitus, physical activity, smoking, caffeine intake, and alcohol intake. We used competing risk Cox regression analyses modeling age as the metameter and stratified by age, cohort, and event type. We sequentially identified factors with the least significant differences in associations with POAG subtypes ("stepwise down" approach with P for heterogeneity [P-het] < 0.10 as threshold). RESULTS: Body mass index was more inversely associated with the POAG paracentral VF loss subtype than the peripheral VF loss subtype (per 10 kg/m2; hazard ratio [HR] = 0.67 [95% confidence interval (CI): 0.52, 0.86] versus HR = 0.93 [95% CI: 0.78, 1.10]; P-het = 0.03) as was smoking (per 10 pack-years; HR = 0.92 [95% CI: 0.87, 0.98] versus HR = 0.98 [95% CI: 0.94, 1.01]; P-het = 0.09). These findings were robust in sensitivity analyses using a "stepwise up" approach (identify factors that showed the most significant differences). Nonheterogeneous (P-het > 0.10) adverse associations with both POAG subtypes were observed with glaucoma family history, diabetes, African heritage, greater caffeine intake, and higher mean arterial pressure. CONCLUSIONS: These data indicate that POAG with early paracentral VF loss has distinct as well as common determinants compared with POAG with peripheral VF loss.
Asunto(s)
Glaucoma de Ángulo Abierto/complicaciones , Personal de Salud , Medición de Riesgo/métodos , Escotoma/etiología , Campos Visuales/fisiología , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/epidemiología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Incidencia , Masculino , Estudios Prospectivos , Factores de Riesgo , Escotoma/diagnóstico , Escotoma/epidemiología , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
Objetivo: demostrar la utilidad de la microperimetría pre y posoperatoria en operados de agujero macular idiopático entre 2010-2012, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Métodos: en una investigación longitudinal-prospectiva de 17 operados de agujero macular, se estudiaron la agudeza visual corregida y la microperimetría preoperatoria y posoperatoria. Se estableció como mejoría de la agudeza visual corregida si mejoraban dos líneas o más y como mejoría de la microperimetría si cumplían al menos dos de los parámetros: desaparición de escotoma absoluto, desaparición de escotoma relativo y mejoría de la sensibilidad retineana. Se efectuó el examen oftalmológico y la tomografía óptica coherente pre y posoperatorios, en los que se precisó la presencia y el cierre del agujero. Resultados: en la microperimetría preoperatoria presentaban escotoma absoluto el 64,71 por ciento, y escotoma relativo el 94,12 por ciento; la sensibilidad retiniana media fue de 8,40 ± 4,39 y la fijación era estable en el 81,82 por ciento de los pacientes. La sensibilidad retineana media preoperatoria presentó significación estadística respecto a la mejoría de la agudeza visual (p= 0,012). De los pacientes con cierre del agujero (64,71 por ciento), el 72,73 por ciento mejoró la agudeza visual (p= 0,006), y el 54,55 por ciento mejoró la microperimetría (p= 0,002). Se encontró significación estadística entre el cierre del agujero macular y la mejoría de la agudeza visual corregida (p= 0,009) y entre el cierre y la mejoría de la microperimetría (p= 0,043). Conclusiones: la sensibilidad retineana preoperatoria puede constituir un factor predictivo para la recuperación funcional del agujero macular. La recuperación de la agudeza visual tras el cierre del agujero conlleva la mejoría de la microperimetría. Esta última constituye un punto de apoyo para continuar la recuperación funcional(AU)
Objetive: to demonstrate utility of microperimetry to the surgery of idiopathic macular hole, among 2010-2012, in the "Ramón Pando Ferrer" Cuban Ophthalmology Institute. Methods: a longitudinal-prospective study of 17 patients who underwent surgery for idiopathic macular hole was carried out. The corrected visual acuity and microperimetry were studied before and after the surgery. If patient improved 2 lines or more of corrected visual acuity and if they having 2 of the items: disappearance of absolute scotoma, disappearance of scotoma relative, improvement of retinal sensitivity; were established improvement of them. Oftalmology exam and optic coherent tomography were studied before and after surgery, specifying the presence and close of the hole. Results: 64,71 percent of patients presented absolute scotoma and 94,12 percent of them had relative scotoma. The mean retinal sensitivity was 8,40 ± 4,39 and fixation was stable in 81,82 percent of them. Better preoperative mean retinal sensitivity showed statistical significance to best corrected visual acuity (p= 0,012). 72,73 percent of patients with close surgical of the hole (64,71 percent) improved corrected visual acuity (p= 0,006), and 54,55 percent of them improved the microperimetry (p= 0,002). The anatomical closing of hole showed statistical significance for the improvement of corrected visual acuity (p=0,009) and for the improvement of microperimetry (p= 0,043). Conclusions: the preoperative retinal sensitivity can predict the functional recovery of the macular hole. After close of the hole, the recovery of visual acuity can precede to improvement of microperimetry. Microperimetry can constitute a support point to continue the functional recovery(AU)
Asunto(s)
Humanos , Perforaciones de la Retina/cirugía , Escotoma/epidemiología , Tomografía Óptica/estadística & datos numéricos , Vitrectomía/métodos , Estudios Longitudinales , Estudios ProspectivosRESUMEN
PURPOSE: To determine the rate of glaucomatous visual field change in routine clinical care. METHODS: Mean deviation (MD) rate was computed in one randomly selected eye of all glaucoma patients and suspects with ≥5 examinations in a tertiary eye-care center. Proportions of "fast" (MD rate, <-1 to -2 dB/y) and "catastrophic" (<-2 dB/y) progressors were determined. The MD rates were computed in tertile groups by the number of examinations, baseline age, and MD. The MD rates were compared to the Canadian Glaucoma Study (CGS), a prospective study with IOP interventions mandated by visual field progression, by pairwise matching of patients by baseline MD. RESULTS: There were 2324 patients with median (interquartile range) baseline age and MD of 65 (56, 74) years and -2.44 (-5.44, -0.86) dB, and follow-up of 7.1 (4.8, 10.2) years with 8 (6, 11) examinations. The median MD rate was -0.05 (0.13, -0.30) dB/y, while the mean follow-up IOP was 17.1 (15.0, 19.7) mm Hg. The MD rate was progressively worse, with a doubling of fast and catastrophic progressors, with each tertile of increasing age. Worse MD rate was associated with lower follow-up IOP. Neither MD rate nor the number of fast and catastrophic progressors was significantly different in clinical care patients matched to CGS patients. CONCLUSIONS: Most patients under routine glaucoma care demonstrate slow rates of visual field progression. The MD rate in the current study was similar to an interventional prospective study, but considerably less negative compared to published studies with similar design.
Asunto(s)
Glaucoma/fisiopatología , Escotoma/fisiopatología , Campos Visuales/fisiología , Anciano , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Glaucoma/complicaciones , Glaucoma/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Escocia/epidemiología , Prevalencia , Pronóstico , Escotoma/epidemiología , Escotoma/etiología , Pruebas del Campo VisualRESUMEN
BACKGROUND: The aim of the study was to evaluate the relationship between the area of isopters obtained using semi-automated kinetic perimetry (SKP) and Vigabatrin dosage in epilepsy patients with pretreatment baseline examination during 2-years of the follow-up. METHODS: 29 epilepsy patients were included into the study, but 15 individuals were excluded due to cognitive impairment, intracranial pathologies or eye diseases. Finally, 14 patients were examined with SKP before VGB treatment and after 6, 12, 18, and 24 months. Reaction time (RT)-corrected areas of three isopters (III4e, I4e and I2e) were measured for each of five examinations and compared intra-individually during 2-years period. Additionally, six epilepsy patients on other antiepileptic drugs were examined five times with SKP as a control. RESULTS: There was a significant decrease of I2e, I4e and III4e isopters' area during the follow-up of two years. Correlation was found between the I2e isopter's area and both cumulative dose and mean daily dose of VGB. With increasing RT, there was decreasing of all isopters' area in patients receiving VGB. In epilepsy patients who were not receiving VGB, there were no significance differences in isopters' area during follow-up. CONCLUSION: There was attenuation of area of III4e, I4e and I2e isopters obtained with SKP during a period of 2 years. RT, the cumulative dose and the mean daily dose of VGB influenced isopters' area obtained with SKP.
Asunto(s)
Epilepsia/tratamiento farmacológico , Enfermedades del Nervio Óptico/inducido químicamente , Escotoma/etiología , Vigabatrin/administración & dosificación , Campos Visuales/efectos de los fármacos , Adulto , Anticonvulsivantes/administración & dosificación , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Enfermedades del Nervio Óptico/complicaciones , Enfermedades del Nervio Óptico/fisiopatología , Polonia/epidemiología , Estudios Prospectivos , Factores de Riesgo , Escotoma/epidemiología , Escotoma/fisiopatología , Factores de Tiempo , Pruebas del Campo Visual , Adulto JovenRESUMEN
PURPOSE: To investigate rates of visual field progression and factors associated with progression rate in open-angle glaucoma in clinical glaucoma care. METHODS: We performed a retrospective chart review of all patients with manifest primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) followed ≥ 5 years with ≥5 SITA Standard fields. Exclusion criteria were minimal. Demographics, intraocular pressure values (IOP), treatment and treatment changes, and visual field (VF) data were recorded. VF progression rates were calculated as slopes of mean deviation (MD) over time. RESULTS: Five hundred and eighty-three patients were eligible. Three hundred and sixty-seven (62%) had POAG and 221 (38%) PEXG. Median MD at study start was -10.0 dB. Mean follow-up time was 7.8 years (SD ± 1.2); mean number of VF tests was 8.9 (SD ± 2.8). Progression rates varied very much among patients with a mean of -0.80 dB/year (SD ± 0.82; median rate, -0.62), and 5.6% of patients progressed at rates worse than -2.5 dB per year A negative slope of MD values was observed in 89% of patients. Mean IOP of all visits decreased over the study period from 20.15 to 18.10 mmHg. Higher age and mean IOP, and more intensive treatment were associated with more rapid progression, while PEXG and IOP variation were not, if treatment intensity was taken into account. CONCLUSION: Rates of visual field progression in manifest glaucoma with field loss in ordinary clinical care were highly variable. Progression rates rapid enough to influence quality of life were common.
Asunto(s)
Síndrome de Exfoliación/complicaciones , Glaucoma de Ángulo Abierto/complicaciones , Escotoma/epidemiología , Campos Visuales , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Síndrome de Exfoliación/diagnóstico , Síndrome de Exfoliación/fisiopatología , Femenino , Estudios de Seguimiento , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Retrospectivos , Factores de Riesgo , Escotoma/etiología , Escotoma/fisiopatología , Suecia/epidemiología , Pruebas del Campo Visual/métodosRESUMEN
AIMS: To compare the retinal sensitivity and frequency of microscotomas found by spectral domain optical coherence tomography (SD-OCT) combined with scanning laser ophthalmoscopy (SLO) microperimetry after idiopathic macular hole closure, in eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not. METHODS: This was a retrospective, non-randomised, comparative study. Combined SD-OCT and SLO microperimetry was performed in 16 consecutive eyes after closure of an idiopathic macular hole. A customised microperimetry pattern with 29 measurement points was used. The ILM was peeled in 8/16 eyes. The main outcome measure was mean retinal sensitivity. RESULTS: Mean retinal sensitivity (in dB) was lower after peeling: 9.80 ± 2.35 dB with peeling versus 13.19 ± 2.92 without (p=0.0209). Postoperative microscotomas were significantly more frequent after ILM peeling: 11.3 ± 6.6 points with retinal sensitivity below 10 dB in eyes that underwent peeling versus 2.9 ± 4.6 in those that did not (p=0.0093). CONCLUSIONS: These results suggest that ILM peeling may reduce retinal sensitivity, and significantly increase the incidence of microscotomas. Until a prospective trial confirming or not these results, it seems justified to avoid peeling the ILM when its potential benefit seems minor or unproved, and when peeling is carried out, to limit the surface peeled to the bare minimum.
Asunto(s)
Retina/fisiopatología , Perforaciones de la Retina/cirugía , Escotoma/epidemiología , Campos Visuales/fisiología , Vitrectomía/métodos , Anciano , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oftalmoscopía , Retina/patología , Retina/cirugía , Perforaciones de la Retina/complicaciones , Perforaciones de la Retina/fisiopatología , Estudios Retrospectivos , Escotoma/etiología , Tomografía de Coherencia Óptica , Agudeza Visual , Pruebas del Campo VisualRESUMEN
PURPOSE: To compare the retinal nerve fiber layer (RNFL) defects in early glaucomatous eyes between highly and non-highly myopic eyes. METHODS: Sixty-one highly myopic eyes (< -6.0 diopters [D]) of 61 patients and 55 non-highly myopic eyes of 55 patients with early visual field (VF) defects were studied. The angular locations and widths of the RNFL defects were measured from red-free fundus photographs. The RNFL defect closest to the fovea was designated the "nearest RNFL defect" of each hemisphere. RESULTS: In total, 131 RNFL defects were found in highly myopic eyes and 82 in non-highly myopic eyes. Twenty-seven (44.3%) of the 61 highly myopic eyes, but only 8 (14.5%) of the 55 non-highly myopic eyes had their nearest RNFL defects between 0° and 10° (P < 0.001). Although the frequencies of paracentral scotomas were comparable between the two groups, the rate of inferotemporal paracentral scotomas was significantly higher in the high myopia group (P = 0.02). The numbers of nearest RNFL defects in the superior hemisphere or extending over both hemispheres were significantly higher in the high-myopia group. Multiple logistic regression analyses showed that high myopia and the nearest RNFL defect involving the papillomacular bundle were significantly associated with paracentral scotomas (odds ratio [OR]: 4.78, P < 0.05, and OR: 5.31, P < 0.001, respectively). High myopia was significantly associated with the nearest RNFL defect involving the papillomacular bundle (OR: 2.95, P < 0.05). CONCLUSIONS: These findings suggest that highly myopic eyes are more susceptible to papillomacular bundle damage in early glaucoma.
Asunto(s)
Glaucoma/patología , Miopía/patología , Fibras Nerviosas/patología , Retina/patología , Adulto , Anciano , Progresión de la Enfermedad , Diagnóstico Precoz , Femenino , Glaucoma/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Miopía/epidemiología , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/patología , Estudios Retrospectivos , Factores de Riesgo , Escotoma/epidemiología , Escotoma/patologíaRESUMEN
To investigate the vision-related quality of life (VRQOL) in relation to the type of existing visual field (EVF) in the presence of visual field defect. We evaluated the VRQOL of 95 patients by using Visual Function Questionnaire-25 (NEI VFQ-25). Patients fulfilled the following criteria: (1) they underwent a Goldmann perimetry (GP) test within 3 months of the initial visit, (2) the results of the GP test could be classified into three categories, and (3) the best-corrected decimal visual acuity (VA) was ≤0.3. The EVF was assessed by composite measurement of both eyes for the V-4e or I-4e isopters, as obtained using the GP test. We compared the VFQ-25 scores between three groups: (1) the "center and peripheral" group in which the EVF of the V-4e area was >30º and the I-4e area was <30º, (2) the "central VF" group in which the EVF of the V-4e area was <20º, and (3) the "central VF loss" group in which the central scotoma was >5º and the EVF of the V-4e area was >30º in peripheral vision. There were significant differences between the three groups (P = 0.02, ANOVA). The total score of the "central VF loss" group was significantly lower than those of the "center and peripheral" and "central VF" groups. The central vision influenced the VRQOL to a greater extent than peripheral vision.
Asunto(s)
Calidad de Vida , Escotoma/fisiopatología , Agudeza Visual , Campos Visuales/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Escotoma/epidemiología , Escotoma/psicología , Encuestas y Cuestionarios , Pruebas del Campo VisualRESUMEN
Acute zonal occult outer retinopathy (AZOOR) is a rare unilateral or bilateral disease of unknown etiology characterized by focal degeneration of photoreceptors. A total of 131 cases of AZOOR (205 eyes), including the variant known as acute annular outer retinopathy, have been reported in the English language literature. In this group of predominantly white individuals, average age at presentation was 36.7 years, and the male:female ratio was 1:3.2. The majority of patients complained of the acute onset of a scotoma, which was associated with photopsia. Visual acuity was 20/40 or better in 74% of tested eyes, and fundus examination was unremarkable in 76% of eyes. Blind spot enlargement, with or without other field defects, was observed in 75% of the visual fields examined, and electroretinographic abnormalities were recorded in 99% of patients tested. Typically patients retained good visual acuity, although retinal pigment epithelial disturbances commonly developed over time. It was unusual for visual field loss to continue beyond six months. Various treatments have been attempted in patients with AZOOR--including systemic corticosteroids, other systemic immunosuppressive agents, and different antimicrobials--but none have been proven effective.
Asunto(s)
Escotoma , Adulto , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Escotoma/diagnóstico , Escotoma/epidemiología , Escotoma/terapia , Síndromes de Puntos BlancosRESUMEN
BACKGROUND: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that predominantly affects the optic nerves and the spinal cord, and is possibly mediated by an immune mechanism distinct from that of multiple sclerosis (MS). Central scotoma is recognized as a characteristic visual field defect pattern of optic neuritis (ON), however, the differing pathogenic mechanisms of NMO and MS may result in different patterns of visual field defects for ON. METHODS: Medical records of 15 patients with NMO and 20 patients with MS having ON were retrospectively analyzed. A thorough systemic and neurological examination was performed for evaluating ON. The total number of relapses of ON and visual fields was investigated. Visual fields were obtained by Goldmann perimeter with each ON relapse. RESULTS: All MS patients experienced central scotoma, with 90% of them showing central scotoma with every ON relapse. However, 53% of NMO patients showed central scotoma with every ON relapse (p = 0.022), and the remaining 47% of patients experienced non-central scotoma (altitudinal, quadrant, three quadrant, hemianopia, and bitemporal hemianopia). Thirteen percent of NMO patients did not experience central scotoma during their disease course. Altitudinal hemianopia was the most frequent non-central scotoma pattern in NMO. CONCLUSIONS: NMO patients showed higher incidence of non-central scotoma than MS, and altitudinal hemianopia may be characteristic of ON occurring in NMO. As altitudinal hemianopia is highly characteristic of ischemic optic neuropathy, we suggest that an ischemic mechanism mediated by anti-aquaporin-4 antibody may play a role in ON in NMO patients.