RESUMEN

Adolescents' extensive use of digital devices raises significant concerns about their visual health. This study aimed to adapt and validate the computer vision syndrome questionnaire (CVS-Q©) for adolescents aged 12-17 years. A mixed-method sequential design was used. First, a qualitative study was involved two nominal groups to assess the instrument's acceptability. A subsequent cross-sectional quantitative study with 277 randomly selected adolescents assessed reliability and validity. Participants completed the adapted CVS-Q©, an ad hoc questionnaire, and the ocular surface disease index (OSDI) questionnaire. Repeatability was tested in 54 adolescents after 7-14 days. The Rasch-Andrich rating scale model was used. Instructions and symptoms were modified to obtain the 14-item CVS-Q teen©. It showed unidimensionality, no local dependence between items, and respected monotonicity. Adequate internal consistency (person reliability = 0.69, item reliability = 0.98) and intraobserver reliability (intraclass correlation coefficient = 0.77, Cohen's Kappa = 0.49) were observed. A significant correlation (0.782, p < 0.001) between CVS-Q teen© and OSDI supported construct validity. A score of ≥ 6 points indicated computer vision syndrome (CVS) (sensitivity = 85.2%, specificity = 76.5%, and area under the curve = 0.879). In conclusion, CVS-Q teen© is a valid and reliable instrument for assessing CVS in adolescents using digital devices, applicable in research and clinical practice for early identification and recommendations for visual health.

Asunto(s)

Trastornos de la Visión , Humanos , Adolescente , Femenino , Masculino , Encuestas y Cuestionarios , Niño , Estudios Transversales , Reproducibilidad de los Resultados , Trastornos de la Visión/diagnóstico , Síndrome

RESUMEN

BACKGROUND: Visual fields are important for postural stability and ability to manoeuvre around objects. OBJECTIVE: Examine the association between visual field loss and falls requiring hospitalisation in adults aged 50 +. METHODS: Older adults aged 50+ with and without visual field loss were identified using a fields database obtained from a cross-section of ophthalmologists' practices in Western Australia (WA). Data were linked to the Hospital Morbidity Data Collection and WA Hospital Mortality System to identify participants who experienced falls-related hospitalisations between 1990 and 2019. A generalised linear negative binomial regression model examined the association between falls requiring hospitalisation for those with and without field loss, based on the better eye mean deviation (mild: -2 to -6 dB, moderate: -6.01 dB to -12 dB, severe < -12.01 dB) in the most contemporaneous visual field test (3 years prior or if not available, 2 years after the fall), after adjusting for potential confounders. RESULTS: A total of 31 021 unique individuals of whom 6054 (19.5%) experienced 11 818 falls requiring hospitalisation during a median observation time of 14.1 years. Only mean deviation index of <-12.01 dB (severe) was significantly associated with an increased rate of falls requiring hospitalisations by 14% (adjusted IRR 1.14, 95% CI 1.0-1.25) compared with no field loss, after adjusting for potential confounders. Other factors included age, with those aged 80+ having an increased rate (IRR 29.16, 95% CI 21.39-39.84), other comorbid conditions (IRR 1.49, 95% CI 1.38-1.60) and diabetes (IRR 1.25, 95% CI 1.14-1.37). Previous cataract surgery was associated with a decreased rate of falls that required hospitalisations by 13% (IRR 0.87, 95% CI 0.81-0.95) compared with those who did not have cataract surgery. CONCLUSION: The findings highlight the importance of continuous clinical monitoring of visual field loss and injury prevention strategies for older adults with visual field loss.

Asunto(s)

Accidentes por Caídas , Hospitalización , Trastornos de la Visión , Campos Visuales , Humanos , Accidentes por Caídas/estadística & datos numéricos , Anciano , Masculino , Femenino , Hospitalización/estadística & datos numéricos , Campos Visuales/fisiología , Trastornos de la Visión/epidemiología , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Persona de Mediana Edad , Australia Occidental/epidemiología , Anciano de 80 o más Años , Factores de Riesgo , Estudios Transversales

RESUMEN

OBJECTIVE: Congenital cytomegalovirus infection (cCMV) is a common, frequently unrecognized cause of childhood disability. The aim of the present study was to determine the symptoms that raise the suspicion of cCMV, define the neurodevelopmental outcomes, and assess their correlations. METHODS: This longitudinal observational study comprised 78 children with symptomatic cCMV who underwent neuropediatric follow-up for 4 to 17.9 years. RESULTS: Symptoms of central nervous system involvement, hearing/visual impairments, and hepatic involvement were mostly recognized. The average age of disease suspicion was 3.3 months. In terms of outcomes, 10.53% of the children developed complex minor neurological dysfunction and 23.68% developed cerebral palsy. Visual and hearing impairments occurred in 38.16% and 14.47% of patients, respectively. Intellectual disability was present in 30.26% of patients, and epilepsy in 21.05%. Microcephaly and hearing impairment was significantly associated with overall neurodevelopmental outcome. Microcephaly was also associated with poor motor outcomes, hearing impairment, and severe visual impairment. Furthermore, microcephaly and intrauterine growth restriction were significantly associated with poor cognitive outcomes. CONCLUSION: Symptoms that raised the suspicion of cCMV-especially microcephaly, hearing impairment, and intrauterine growth restriction-were important parameters that were associated with outcomes; however, their recognition was often insufficient and/or late.

Asunto(s)

Infecciones por Citomegalovirus , Humanos , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/diagnóstico , Femenino , Masculino , Niño , Preescolar , Lactante , Adolescente , Estudios Longitudinales , Microcefalia/virología , Microcefalia/etiología , Parálisis Cerebral , Pérdida Auditiva/virología , Pérdida Auditiva/etiología , Pérdida Auditiva/diagnóstico , Discapacidad Intelectual/virología , Retardo del Crecimiento Fetal/virología , Trastornos de la Visión/virología , Trastornos de la Visión/etiología , Trastornos de la Visión/diagnóstico , Recién Nacido , Pronóstico , Citomegalovirus/patogenicidad , Estudios de Seguimiento

RESUMEN

In this case report, a 33-year-old pregnant woman with migraine and visual aura complained of headache, nausea, and blurred vision. Clinically, she presented with bilateral dilated and fixed pupils, ptosis, and tearing. She was erroneously diagnosed as having a migraine attack, but after referral to an ophthalmological department she was diagnosed with bilateral acute angle closure. At one-year follow-up her visual acuity was normalized but the severe visual field defects affected her daily activities and prevented her from having a driving licence.

Asunto(s)

Errores Diagnósticos , Glaucoma de Ángulo Cerrado , Campos Visuales , Humanos , Femenino , Adulto , Glaucoma de Ángulo Cerrado/diagnóstico , Embarazo , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Complicaciones del Embarazo/diagnóstico , Enfermedad Aguda , Migraña con Aura/diagnóstico

RESUMEN

We describe the case of a 73-year-old woman presenting with headaches, confusion, and vision disturbances. Brain MRI showed a large T2-hyperintense lesion in the right temporo-occipital region with vasogenic edema and leptomeningeal enhancement. A leptomeningeal biopsy was performed, which led to a definitive diagnosis.

Asunto(s)

Confusión , Trastornos de la Visión , Anciano , Femenino , Humanos , Edema Encefálico/diagnóstico por imagen , Confusión/etiología , Imagen por Resonancia Magnética , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico por imagen , Trastornos de la Visión/etiología , Trastornos de la Visión/diagnóstico , Campos Visuales/fisiología , Sustancia Blanca/patología , Sustancia Blanca/diagnóstico por imagen

RESUMEN

PURPOSE: To describe macular pucker contraction patterns with en face optical coherence tomography (OCT), to provide a correlation with metamorphopsia scores, and to discuss the protective role of the Henle fiber layer (HFL) against tangential traction. METHODS: Retrospective, institutional, observational, and consecutive case series. Clinical charts, M-charts scores, and structural and en face OCT imaging of patients diagnosed with macular pucker were reviewed. RESULTS: A 120 eyes of 114 consecutive patients diagnosed with macular pucker were included. En face OCT patterns of macular pucker contraction were foveal in 51 of 120 eyes (42.5%) and extrafoveal in 69 of 120 eyes (57.5%). Foveal macular puckers had regular, a concentric, circle morphology in the HFL (46/51 eyes, 90.2%), whereas extrafoveal membranes had irregular, distorted, circular HFL morphology (62/69 eyes, 89.8%; P < 0.001). Foveal contraction morphology and regular HFL pattern, as well as extrafoveal contraction morphology and an irregular HFL pattern, highly correlated one with another (P < 0.001 in both cases). Foveal macular puckers with regular HFL patterns had significantly less vertical and horizontal M-charts scores as compared with extrafoveal membranes with irregular HFL (P < 0.001 in both cases). Ellipsoid zone and external limiting membrane defects were rare in the parafoveal region (5/120 eyes, 4.2%). Visual acuity did not correlate with metamorphopsia scores (P = 0.903). CONCLUSION: En face OCT imaging identifies macular pucker contraction patterns that correlate with metamorphopsia scores and that can be used alongside the current structural OCT staging system to guide clinicians in the surgical decision-making process.

Asunto(s)

Tomografía de Coherencia Óptica , Trastornos de la Visión , Agudeza Visual , Humanos , Tomografía de Coherencia Óptica/métodos , Estudios Retrospectivos , Femenino , Masculino , Anciano , Agudeza Visual/fisiología , Persona de Mediana Edad , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Mácula Lútea/diagnóstico por imagen , Mácula Lútea/patología , Anciano de 80 o más Años , Fóvea Central/diagnóstico por imagen , Fóvea Central/patología

RESUMEN

Intraocular pressure is currently the only known reliable, modifiable risk factor for the development and progression of glaucoma. Other risk factors for glaucoma include increasing age, myopia, decreased central corneal thickness, and low corneal hysteresis (CH) measurements. Photoablative keratorefractive surgery including laser assisted in situ keratomileusis (LASIK) has become a common way to treat refractive error, with over 25 million procedures performed in the United States alone. Though myopic LASIK has been associated with a decrease in CH measurements, relatively little is known about the risk of LASIK on glaucoma onset and progression. Here we present an observational study of 4 consecutive relatively young and otherwise healthy glaucoma patients with a history of myopic LASIK who showed progression of paracentral visual field deficits at intraocular pressures of 12 mm Hg or less while being carefully monitored. Therefore, these patients required lower targets of intraocular pressure, in the single-digit range, to slow or halt progression. In this cohort, the average corneal hysteresis was more than 2 standard deviations below normal values. This series suggests that additional study into the association of LASIK and glaucoma is warranted, including the potential risk contribution of diminished CH. These studies may be particularly relevant as patients who underwent LASIK procedures in the early 2000s may now be at increased risk of glaucoma due to the risk factor of age.

Asunto(s)

Progresión de la Enfermedad , Presión Intraocular , Queratomileusis por Láser In Situ , Miopía , Tonometría Ocular , Campos Visuales , Humanos , Queratomileusis por Láser In Situ/efectos adversos , Presión Intraocular/fisiología , Campos Visuales/fisiología , Miopía/cirugía , Miopía/fisiopatología , Masculino , Femenino , Adulto , Córnea/fisiopatología , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Trastornos de la Visión/diagnóstico , Pruebas del Campo Visual , Persona de Mediana Edad , Agudeza Visual/fisiología , Factores de Riesgo , Láseres de Excímeros/uso terapéutico , Adulto Joven

RESUMEN

The Spanish scale symptom questionnaire for visual dysfunctions (SQVD) was sinicized and tested for reliability and validity in the Chinese context, employing both classical measurement theory and item response theory. A meticulous translation was conducted using the modified Brislin translation model, with input from experts for cross-cultural debugging and in-depth review. Following a pre-survey study, the Chinese version of the SQVD was finalized. A convenience sampling method was used to select 270 patients from the target group and 252 valid questionnaires were successfully collected. The Rasch model was employed to assess response category functionality, fit statistics, unidimensionality, person and item reliability, separation, targeting, and differential item functioning. Classical test theory was applied to evaluate internal consistency and retest reliability, supplemented by correlation analysis. Job characteristic curves were also plotted to assess diagnostic accuracy. The Chinese SQVD conformed to a unidimensional structure with excellent reliability and validity. Person and item reliabilities were 0.85 and 0.99, respectively, indicating, high stability. Person and item separation indices were 2.37 and 11.54, respectively, signifying strong differentiation ability. Retest reliability was 0.917, further emphasizing the stability of the scale. The area under the receiver operating characteristic curve was 0.908 (95% CI: 0.854, 0.962), with a cutoff value of 7.5 and Youden index of 0.733, highlighting the scale's high diagnostic accuracy. The translated and culturally adapted Chinese SQVD demonstrated excellent psychometric properties. With streamlined items, short assessment time, and high efficiency, the scale is a stable and reliable clinical tool for detecting a variety of conditions related to refractive, regulatory, and binocular vision dysfunction.

Asunto(s)

Psicometría , Trastornos de la Visión , Humanos , Psicometría/métodos , Femenino , Masculino , Encuestas y Cuestionarios/normas , Reproducibilidad de los Resultados , Persona de Mediana Edad , China , Adulto , Trastornos de la Visión/diagnóstico , Traducciones , Anciano , Comparación Transcultural

RESUMEN

Purpose: To investigate the long-term patterns and risk factors of visual field defect (VFD) development in nonpathologic high myopia (HM) over an 8-year follow-up. Methods: This was an observational cohort study. The VFD classification adhered to the Glaucoma Suspects with High Myopia Study Group. Logistic regression models with generalized estimating equations were used to identify risk factors for VFD development. Results: A total of 330 eyes from 194 patients were included. Among them, 49.4% of eyes developed VFD, with enlarged blind spot and nonspecific defect ranked as the most common VFDs, followed by partial arcuate defect, vertical step, nasal step, paracentral defect, and combined defects. Longer axial length (odds ratio [OR] = 1.43 per 1-mm increase; 95% CI, 1.04-1.95; P = 0.026), thinner central corneal thickness (OR = 1.01 per 1-µm decrease; 95% CI, 1.003-1.02; P = 0.013), worse mean deviation of visual field (OR = 1.51 per 1-dB decrease; 95% CI, 1.14-2.00; P = 0.004), and the presence of peripapillary γ-zone (OR = 5.57; 95% CI, 3.06-10.15; P < 0.001) at baseline correlated with the development of any VFD. By incorporating these factors, the prediction models achieved area under the curves of 0.789 (95% CI, 0.726-0.853) and 0.828 (95% CI, 0.714-0.943) for discriminating the development of any VFD and moderate/severe VFD, respectively, with good calibration power. Conclusions: The development of VFD occurred frequently in individuals with nonpathologic HM and can be effectively predicted using relevant metrics. The findings will aid in expanding our knowledge of optic neuropathy in HM.

Asunto(s)

Miopía Degenerativa , Pruebas del Campo Visual , Campos Visuales , Humanos , Campos Visuales/fisiología , Femenino , Masculino , Factores de Riesgo , Persona de Mediana Edad , Estudios de Seguimiento , Miopía Degenerativa/complicaciones , Miopía Degenerativa/diagnóstico , Adulto , Incidencia , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Presión Intraocular/fisiología , Anciano

RESUMEN

Purpose: To predict 10-2 Humphrey visual fields (VFs) from 24-2 VFs and associated non-total deviation features using deep learning. Methods: We included 5189 reliable 24-2 and 10-2 VF pairs from 2236 patients, and 28,409 reliable pairs of macular OCT scans and 24-2 VF from 19,527 eyes of 11,560 patients. We developed a transformer-based deep learning model using 52 total deviation values and nine VF test features to predict 68 10-2 total deviation values. The mean absolute error, root mean square error, and the R2 were evaluation metrics. We further evaluated whether the predicted 10-2 VFs can improve the structure-function relationship between macular thinning and paracentral VF loss in glaucoma. Results: The average mean absolute error and R2 for 68 10-2 VF test points were 3.30 ± 0.52 dB and 0.70 ± 0.11, respectively. The accuracy was lower in the inferior temporal region. The model placed greater emphasis on 24-2 VF points near the central fixation point when predicting the 10-2 VFs. The inclusion of nine VF test features improved the mean absolute error and R2 up to 0.17 ± 0.06 dB and 0.01 ± 0.01, respectively. Age was the most important 24-2 VF test parameter for 10-2 VF prediction. The predicted 10-2 VFs achieved an improved structure-function relationship between macular thinning and paracentral VF loss, with the R2 at the central 4, 12, and 16 locations of 24-2 VFs increased by 0.04, 0.05 and 0.05, respectively (P < 0.001). Conclusions: The 10-2 VFs may be predicted from 24-2 data. Translational Relevance: The predicted 10-2 VF has the potential to improve glaucoma diagnosis.

Asunto(s)

Aprendizaje Profundo , Glaucoma , Tomografía de Coherencia Óptica , Pruebas del Campo Visual , Campos Visuales , Humanos , Pruebas del Campo Visual/métodos , Campos Visuales/fisiología , Femenino , Masculino , Persona de Mediana Edad , Glaucoma/fisiopatología , Glaucoma/diagnóstico , Tomografía de Coherencia Óptica/métodos , Anciano , Adulto , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico

RESUMEN

Purpose: Compare the use of optic disc and macular optical coherence tomography measurements to predict glaucomatous visual field (VF) worsening. Methods: Machine learning and statistical models were trained on 924 eyes (924 patients) with circumpapillary retinal nerve fiber layer (cp-RNFL) or ganglion cell inner plexiform layer (GC-IPL) thickness measurements. The probability of 24-2 VF worsening was predicted using both trend-based and event-based progression definitions of VF worsening. Additionally, the cp-RNFL and GC-IPL predictions were combined to produce a combined prediction. A held-out test set of 617 eyes was used to calculate the area under the curve (AUC) to compare cp-RNFL, GC-IPL, and combined predictions. Results: The AUCs for cp-RNFL, GC-IPL, and combined predictions with the statistical and machine learning models were 0.72, 0.69, 0.73, and 0.78, 0.75, 0.81, respectively, when using trend-based analysis as ground truth. The differences in performance between the cp-RNFL, GC-IPL, and combined predictions were not statistically significant. AUCs were highest in glaucoma suspects using cp-RNFL predictions and highest in moderate/advanced glaucoma using GC-IPL predictions. The AUCs for the statistical and machine learning models were 0.63, 0.68, 0.69, and 0.72, 0.69, 0.73, respectively, when using event-based analysis. AUCs decreased with increasing disease severity for all predictions. Conclusions: cp-RNFL and GC-IPL similarly predicted VF worsening overall, but cp-RNFL performed best in early glaucoma stages and GC-IPL in later stages. Combining both did not enhance detection significantly. Translational Relevance: cp-RNFL best predicted trend-based 24-2 VF progression in early-stage disease, while GC-IPL best predicted progression in late-stage disease. Combining both features led to minimal improvement in predicting progression.

Asunto(s)

Progresión de la Enfermedad , Glaucoma , Disco Óptico , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Tomografía de Coherencia Óptica/métodos , Femenino , Disco Óptico/diagnóstico por imagen , Disco Óptico/patología , Masculino , Campos Visuales/fisiología , Persona de Mediana Edad , Glaucoma/diagnóstico por imagen , Glaucoma/fisiopatología , Células Ganglionares de la Retina/patología , Aprendizaje Automático , Anciano , Fibras Nerviosas/patología , Área Bajo la Curva , Mácula Lútea/diagnóstico por imagen , Mácula Lútea/patología , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico por imagen , Trastornos de la Visión/diagnóstico

RESUMEN

PURPOSE OF REVIEW: Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1 ▪▪ ] . The objective of this review is to review management options for symptomatic vitreous floaters. RECENT FINDINGS: Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2] . Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1 ▪▪ ,3,4] . SUMMARY: This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making.

Asunto(s)

Trastornos de la Visión , Vitrectomía , Cuerpo Vítreo , Desprendimiento del Vítreo , Humanos , Terapia por Láser/métodos , Láseres de Estado Sólido/uso terapéutico , Tomografía de Coherencia Óptica , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/patología , Trastornos de la Visión/cirugía , Vitrectomía/métodos , Cuerpo Vítreo/cirugía , Cuerpo Vítreo/patología , Desprendimiento del Vítreo/diagnóstico , Desprendimiento del Vítreo/patología , Desprendimiento del Vítreo/terapia

RESUMEN

Neuro-ophthalmic evaluation is a crucial component of the diagnostic and prognostic assessment of pituitary disease and compressive chiasmopathy, and can inform the timing of vision-restoring tumour resection surgery. The most common disease affecting the pituitary with neuro-ophthalmic implications are pituitary adenomas. Neuro-ophthalmic manifestations include decreased vision, abnormal colour vision and impaired visual field or diplopia. The recognition of these syndromes is critical to achieve early diagnosis and treatment and to improve prognosis. The pattern of vision loss in chiasmal compression is determined by the anatomical relationship between the pituitary lesion and optic chiasm, and potential visual field defects include bitemporal deficits, junctional scotomas, monocular cecocentral defects, and incongruous homonymous hemianopias. Rarer neuro-ophthalmic manifestations of pituitary disease include ophthalmoplegia, nystagmus, and obstructive hydrocephalus. There is growing evidence that demonstrates the strong diagnostic utility of optical coherence tomography (OCT) parameters in detecting the presence of compressive chiasmopathy, as well as the prognostic ability to predict the rate and degree of visual recovery following decompression surgery. Long-term neuro-ophthalmic monitoring is critical for detecting delayed vision loss following resection surgery, which may represent tumour recurrence or secondary complications.

Asunto(s)

Quiasma Óptico , Humanos , Quiasma Óptico/patología , Enfermedades de la Hipófisis/diagnóstico , Enfermedades de la Hipófisis/terapia , Tomografía de Coherencia Óptica , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Trastornos de la Visión/fisiopatología , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/terapia , Neoplasias Hipofisarias/complicaciones , Campos Visuales/fisiología

Asunto(s)

Investigación Biomédica , Trastornos de la Visión , Humanos , Investigación Biomédica/tendencias , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Optometría

RESUMEN

Nowadays many patients are choosing EDOF or multifocal lenses for replacement of natural lens in cataract surgery. This can result in issues such as presence of dysphotopsias, namely halo and glare. In this work, we propose a new perimetry method to describe dysphotopsias in far-field region in a presence of bright, point-like light source. We constructed a custom device and designed measurement procedure for quantitative measurement of dysphotopias in the center of visual field and used it to examine patients with mild cataracts or implanted IOLs. Our approach may help in establishing an objective method to study and compare dysphotopsias.

Asunto(s)

Catarata , Humanos , Catarata/fisiopatología , Anciano , Masculino , Femenino , Persona de Mediana Edad , Extracción de Catarata , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Lentes Intraoculares , Campos Visuales/fisiología , Pruebas del Campo Visual/métodos , Implantación de Lentes Intraoculares

RESUMEN

PURPOSE: The aim of this study was to explore the potential benefits of retinal pigment epithelium replacement therapy in patients with Bietti crystalline dystrophy (BCD) by assessing the disease pathology with the distinctive relationship between fundus autofluorescence (FAF) abnormality and visual field defect. METHODS: Sixteen eyes from 16 patients with BCD and 16 eyes from 16 patients with RHO-associated retinitis pigmentosa were included. Fundus autofluorescence, optical coherence tomography, and Goldmann perimetry results were retrospectively reviewed and assessed using image analyses. RESULTS: In patients with BCD, the FAF abnormality area was not correlated with the overall visual field defect area and median overall visual field defect area (57.5%) was smaller than FAF abnormality area (98.5%). By contrast, the ellipsoid zone width was significantly correlated with the central visual field area (r = 0.806, P < 0.001). In patients with RHO-associated retinitis pigmentosa, the FAF abnormality area and ellipsoid zone width were significantly correlated with the overall visual field defect area (r = 0.833, P < 0.001) and central visual field area (r = 0.887, P < 0.001), respectively. CONCLUSION: The FAF abnormality shown in patients with BCD involves retinal pigment epithelium degeneration without complete loss of photoreceptors or visual function. These results suggest that patients with BCD are good candidates for retinal pigment epithelium replacement therapy for preservation of residual visual function.

Asunto(s)

Distrofias Hereditarias de la Córnea , Angiografía con Fluoresceína , Fondo de Ojo , Epitelio Pigmentado de la Retina , Tomografía de Coherencia Óptica , Agudeza Visual , Pruebas del Campo Visual , Campos Visuales , Humanos , Campos Visuales/fisiología , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Tomografía de Coherencia Óptica/métodos , Distrofias Hereditarias de la Córnea/diagnóstico , Distrofias Hereditarias de la Córnea/fisiopatología , Angiografía con Fluoresceína/métodos , Adulto , Epitelio Pigmentado de la Retina/patología , Anciano , Agudeza Visual/fisiología , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/fisiopatología , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Imagen Óptica , Retinitis Pigmentosa/fisiopatología , Retinitis Pigmentosa/diagnóstico , Adulto Joven

RESUMEN

PURPOSE: To evaluate the impact of baseline and change in vision on the risk of developing dementia. DESIGN: Retrospective cohort study. METHODS: This longitudinal analysis utilized data from the 2021 and 2022 National Health and Aging Trends Study. Binocular presenting vision was assessed, including distance (DVA) and near (NVA) visual acuity, and contrast sensitivity (CS). Dementia status was defined based on: (1) medical diagnosis of dementia, (2) dementia score, or (3) poor cognitive test performance. RESULTS: Of the 2,159 adults included in this study, weighted mean (SD) age was 77.9 years (5.2), with the majority being female (weighted: 54%), and White (88%). The baseline median (interquartile range [IQR]) DVA was 0.08 (0-0.20) logMAR, NVA was 0.17 (0.09-0.26) logMAR, and CS was 1.80 (1.65-1.85) logCS. Over the 1-year follow up period, 192 (6.6%) adults developed dementia. In time-to-event analyses, baseline DVA (HR: 1.08 [95% CI: 1.02-1.14], per 0.1 logMAR), NVA (HR: 1.07 [95% CI: 1.01-1.13], per 0.1 logMAR), and CS (HR: 1.09 [95% CI: 1.03-1.15], per 0.1 logCS) were associated with greater likelihood of incident dementia. Further, change in CS (HR: 1.14 [95% CI: 1.04-1.25], per 0.1 logCS worse/year), but not VA, was associated with greater likelihood of incident dementia. CONCLUSIONS: Worse baseline VA and CS are associated with greater likelihood of incident dementia. Further, worsening CS over time, but not VA, was associated with higher likelihood of incident dementia. Future work is needed to study interventions targeted at improving vision deficits and examine their impact on decreasing dementia risk.

Asunto(s)

Sensibilidad de Contraste , Demencia , Agudeza Visual , Humanos , Femenino , Masculino , Demencia/epidemiología , Demencia/fisiopatología , Demencia/diagnóstico , Anciano , Agudeza Visual/fisiología , Sensibilidad de Contraste/fisiología , Estudios Retrospectivos , Incidencia , Anciano de 80 o más Años , Estudios de Seguimiento , Estados Unidos/epidemiología , Factores de Riesgo , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/epidemiología , Visión Binocular/fisiología

RESUMEN

Impairments of object recognition are core features of neurodegenerative syndromes, in particular posterior cortical atrophy (PCA; the 'visual-variant Alzheimer's disease'). These impairments arise from damage to higher-level cortical visual regions and are often missed or misattributed to common ophthalmological conditions. Consequently, diagnosis can be delayed for years with considerable implications for patients. We report a new test for the rapid measurement of cortical visual loss - the Graded Incomplete Letters Test (GILT). The GILT is an optimised psychophysical variation of a test used to diagnose cortical visual impairment, which measures thresholds for recognising letters under levels of increasing visual degradation (decreasing "completeness") in a similar fashion to ophthalmic tests. The GILT was administered to UK Biobank participants (total n=2,359) and participants with neurodegenerative conditions characterised by initial cortical visual (PCA, n=18) or memory loss (typical Alzheimer's disease, n=9). UK Biobank participants, including both typical adults and those with ophthalmological conditions, were able to recognise letters under low levels of completeness. In contrast, participants with PCA consistently made errors with only modest decreases in completeness. GILT sensitivity to PCA was 83.3% for participants reaching the 80% accuracy cut-off, increasing to 88.9% using alternative cut-offs (60% or 100% accuracy). Specificity values were consistently over 94% when compared to UK Biobank participants without or with documented visual conditions, regardless of accuracy cut-off. These first-release UK Biobank and clinical verification data suggest the GILT has utility in both rapidly detecting visual perceptual losses following posterior cortical damage and differentiating perceptual losses from common eye-related conditions.

Asunto(s)

Enfermedad de Alzheimer , Humanos , Femenino , Masculino , Anciano , Reino Unido , Persona de Mediana Edad , Enfermedad de Alzheimer/fisiopatología , Enfermedad de Alzheimer/diagnóstico , Adulto , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/fisiopatología , Bancos de Muestras Biológicas , Anciano de 80 o más Años , Pruebas Neuropsicológicas , Biobanco del Reino Unido

Asunto(s)

Trastornos de la Visión , Humanos , Diagnóstico Diferencial , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Cefalea/etiología , Migraña con Aura/diagnóstico , Migraña con Aura/complicaciones , Femenino , Imagen por Resonancia Magnética , Masculino

RESUMEN

An epiretinal membrane (ERM) is a frequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. A distinction is made between an idiopathic form caused by age-related changes of the vitreous body and a secondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays a major role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or a reduction of metamorphopsia can be achieved, with a number of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.

Asunto(s)

Membrana Epirretinal , Tomografía de Coherencia Óptica , Vitrectomía , Humanos , Membrana Epirretinal/cirugía , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/patología , Vitrectomía/métodos , Trastornos de la Visión/etiología , Trastornos de la Visión/cirugía , Trastornos de la Visión/diagnóstico , Agudeza Visual/fisiología