Kinetic Perimetry Research Articles

The effect of inner limiting membrane peeling on visual fields: Unravelling a source of bias in glaucoma management

Abstract: Pars plana vitrectomy (PPV) with inner limiting membrane (ILM) peeling aims to improve visual function. Previous studies have focused on visual acuity, often neglecting visual field (VF) changes. This systematic review examines VF changes after PPV with ILM peeling in patients with epiretinal membrane (ERM) or macular hole (MH), including those with glaucoma, who have preexisting VF damage, to identify potential biases in glaucoma management. The inclusion criteria were as follows: (A) Patients undergoing ILM peeling for ERM or MH and (B) VF outcomes assessed through standard automated perimetry (SAP) or Goldmann kinetic perimetry. Exclusions were non-English studies and those with fewer than 30 subjects. Data included retinal disease, demographics, VF outcomes (mean deviation [MD], pattern standard deviation, and central VF sensitivity [CVFS]), study design, and use of stains. Out of 612 studies, 23 met our criteria. Of these, four included glaucoma patients and seven involved concomitant phacoemulsification. In glaucoma patients, two studies showed MD improvement in the central 24°, while one showed deterioration in the central 10°, linked to worse preoperative MD and older age. Among studies without glaucoma patients, three of eight using SAP reported increased VF defects (VFDs); two showed lower outer nasal CVFS postoperatively. Indocyanine green staining was linked to higher VFD incidence while triamcinolone acetonide or tryptane blue staining led to no significant VFDs. The nasal half of the central VF was more affected, possibly due to retinal ganglion cell distribution. Further prospective studies, including randomized controlled trials, are needed to better understand ILM-peeling effects.

Extensive Macular Atrophy with Pseudodrusen-like appearance: Progression Kinetics and Late-Stage Findings

To describe the clinical outcome and late-stage findings of extensive macular atrophy with pseudodrusen-like appearance (EMAP). Retrospective cohort study. Seventy-eight patients (156 eyes) affected by EMAP. We collected data on best-corrected visual acuity, kinetic perimetry, OCT, short-wavelength autofluorescence, and near-infrared autofluorescence findings. Genetic testing for the TIMP3 and C1QTNF5 genes was performed via Sanger sequencing for 58 patients, with no pathogenic variants identified. The primary outcomes were best-corrected visual acuity at the last examination, visual field at the last examination, and incidence rates and time-to-event curves for blindness with the United States Social Security Administration and World Health Organization (WHO) criteria, foveal involvement, and atrophy enlargement beyond the 30° and 55° field of view. Imaging findings at the last examination were secondary outcomes. At the most recent visit, mean age was 70.9 ± 5.2 years. Using United States criteria, 58.1% of the patients were blind, and 25.8% were blind according to WHO criteria. All eyes showed large central scotomas, which were associated with visual field constriction in 22.2% of eyes. We detected focal openings or large dehiscences of Bruch's membrane (BM) in 25.4% of eyes. Near-infrared autofluorescence showed increased visibility of the choroidal vessels beyond the atrophy in 87.2% of eyes. The incidence rates for blindness were 3.95 per 100 patient-years with United States criteria and 1.54 per 100 patient-years according to WHO criteria. The incidence rates were 22.8 per 100 eye-years for foveal involvement, 12.0 per 100 eye-years for atrophy enlargement beyond 30°, and 6.6 per 100 eye-years for atrophy enlargement beyond 55°. The estimates were not influenced by the age at onset. We identified characteristic imaging findings, including BM ruptures, in elder patients with EMAP and calculated incidence rates for different functional and anatomic outcomes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Sensitivity and Specificity of Qualitative Visual Field Tests for Screening Visual Hemifield Deficits in Right-Brain-Damaged Stroke Patients.

A timely detection of visual hemifield deficits (VHFDs; hemianopias or quadrantanopias) is critical for both the diagnosis and treatment of stroke patients. The present study determined the sensitivity and specificity of four qualitative visual field tests, including face description, confrontation tests (finger wiggle), and kinetic boundary perimetry, to screen large and dense VHFDs in right-brain-damaged (RBD) stroke patients. Previously, the accuracy of qualitative visual field tests was examined in unselected samples of patients with heterogeneous aetiology, in which stroke patients represented a very small fraction. Building upon existing tests, we introduced some procedural ameliorations (incl. a novel procedure for kinetic boundary perimetry) and provided a scoresheet to facilitate the grading. The qualitative visual field tests' outcome of 67 consecutive RBD stroke patients was compared with the standard automated perimetry (SAP; i.e., reference standard) outcome to calculate sensitivity and specificity, as well as positive and negative predictive values (PPV and NPV), both for each individual test and their combinations. The face description test scored the lowest sensitivity and NPV, while the kinetic boundary perimetry scored the highest. No test returned false positives. Combining the monocular static finger wiggle test (by quadrants) and the kinetic boundary perimetry returned the highest sensitivity and specificity, in line with previous studies, but with higher accuracy (100% sensitivity and specificity). These findings indicate that the combination of these two tests is a valid approach with RBD stroke patients, prompting referral for a formal visual field examination, and representing a quick, easy-to-perform, and inexpensive tool for improving their care and prognosis.

Macular dystrophy in Kabuki syndrome due to de novo KMT2D variants: refining the phenotype with multimodal imaging and follow-up over 10 years: insight into pathophysiology

BackgroundKabuki Syndrome is a rare and genetically heterogenous condition with both ophthalmic and systemic complications and typical facial features. We detail the macular phenotype in two unrelated patients with Kabuki syndrome due to de novo nonsense variants in KMT2D, one novel. A follow-up of 10 years is reported. Pathogenicity of both de novo nonsense variants is analyzed.MethodsFour eyes of two young patients were studied by full clinical examination, kinetic perimetry, short wavelength autofluorescence, full field (ff) ERGs, and spectral-domain optical coherence tomography (SD-OCT). One patient had adaptive optic (AO) imaging. Whole exome sequencing was performed in both patients.ResultsBoth patients had de novo nonsense variants in KMTD2. One patient had c.14843C>G; p. (Ser4948ter) novel variant and the second c.11119C>T; p. (Arg3707ter). Both had a stable Snellen visual acuity of 0.2–0.3. The retinal multimodal imaging demonstrated abnormalities at the fovea in both eyes: hyperreflectivity to blue light and a well-delimited gap—disruption of ellipsoid and interdigitation layer on OCT. The dark area on AO imaging is presumed to be absent for, or with structural change to photoreceptors. The ff ERGs and kinetic visual fields were normal. The foveal findings remained stable over several years.ConclusionKabuki syndrome–related maculopathy is a distinct loss of photoreceptors at the fovea as shown by multimodal imaging including, for the first time, AO imaging. This report adds to the literature of only one case with maculopathy with two additional macular dystrophies in patients with Kabuki syndrome. Although underestimated, these cases further raise awareness of the potential impact of retinal manifestations of Kabuki syndrome not only among ophthalmologists but also other healthcare professionals involved in the care of patients with this multisystem disorder.

Mutational Profile and Retinal Phenotypes of PCARE-Related Cone-Rod Dystrophies in a Mexican Cohort.

The aim of the study is to describe the genotype and phenotype of a Mexican cohort with PCARE-related retinal disease. The study included 14 patients from 11 unrelated pedigrees with retinal dystrophies who were demonstrated to carry biallelic pathogenic variants in PCARE. Visual assessment methods included best corrected visual acuity, color fundus photography, Goldmann visual field test, kinetic perimetry, dark/light adapted chromatic perimetry, full-field electroretinography, autofluorescence imaging, and spectral domain-optical coherence tomography imaging. Genetic screening was performed either by gene panel sequencing or by exome sequencing. According to the results of multimodal imaging and functional tests, all 14 patients were diagnosed with cone-rod dystrophy. Six different PCARE pathogenic alleles were identified in our cohort, including three novel mutations: c.3048_3049del (p.Tyr1016∗), c.3314_3315del (p.Ser1105∗), and c.551A > G (p.His184Arg). Notably, alleles p.His184Arg, p.Arg613∗, and p.Arg984∗ were present in 18 of the 22 (82%) PCARE alleles from probands in our cohort. Our work expands the PCARE mutational profile by identifying three novel pathogenic variants causing retinal dystrophy. While phenotypic variations occurred among patients, a cone-rod dystrophy pattern was observed in all affected individuals.

Leber hereditary optic neuropathy. The Dutch approach

Aims/Purpose: To share the structure of care for patients with Leber Hereditary Optic neuropathy (LHON) in the Netherlands. This includes the role of Expertise centers in coordinating rapid diagnosis and start of treatment, as well at the introduction of a specific database to track data of patients with LHON.Methods: Dutch LHON Expertise centres are organized to act as central points for patient referrals from regional hospitals with the aim to speed up the diagnostics and treatment of LHON patients. The database of Dutch LHON patients has been created and is online today, to provide demographical, epidemiological, clinical characteristics and effects of treatment with Idebenone on disease progression.Results: Three LHON Expertise centers provide fast diagnostic, coaching and treatment services in the whole of the Netherlands. Patient referral is done easily due to the small geography. A DNA test on primary and non‐primary mtDNA mutations is performed as standard, including the DNAJC30 gen. Additional parameters are obtained to monitor disease progression: Visual Acuity Score by ETDRS letters chart, HRR colour tests, OCT of ganglion cell layer and retinal neurofibral layer, Visual field by Goldmann kinetic perimetry or Humphry static perimetry. All patients have access to a social worker. They are provided with a flyer about LHON disease and contact details of the relevant patient association.Conclusion: A thoroughly organized clinical path for LHON patients provides rapid diagnostics and start of treatment. Patients referrals is done easily and treatment delay minimized. The centralization of Dutch LHON patients in three expertise centres enables us to maintain a central database with important clinical and epidemiological data. This information is relevant to optimize current therapy options with Idebenone and also for supporting future studies on novel therapy options.

The effects of cardiac stenting on the organ of vision in patients with chronic ischemic optic neuropathy

Purpose. To evaluate the effect of coronary artery stenting on the functional state of organ of vision in patients with chronic ischemic optic neuropathy (CION). Material and methods. 33 patients (53 eyes) diagnosed with CION aged 51 to 85 years, average 66.78±1.54 years, who underwent stenting of the coronary arteries. Results. Stenting of the coronary arteries did not affect on BCVA parameters, the percentage of pupil contraction increased from 9.57±0.49 to 9.74±0.46 ms (p<0.05), the recovery of the sympathetic phase of the pupil’s reaction to light accelerated from 83.79±0.44 to 83.56±0.43 ms (p<0.05), a decrease in IACG was recorded from 13.39±4.67 to 7.01±0.56 mm Hg. Art./ mm3 (p<0.05), negative dynamics of CFSM in green color from 33.5±0.8 to 33.06±0.73 after 1 month and to 33.17±0.75 after 3 months from initial values, deterioration of static perimetry after 3 months from 94.60±0.97 to 93.17±1.88 (p<0.05), narrowing of kinetic perimetry to green stimulus after 1 month from 267.48±13.96 up to 267.48±13.96 gr. (p<0.05). Conclusion. In the subjects, cardiac symptoms predominated rather than visual ones. In patients who underwent stenting of the coronary arteries, BCVA did not change and remained at the same level throughout the entire observation period; according to ultrasonography of the orbital vessels, there was an insignificant redistribution of blood flow in the ophthalmic artery basin; IACG significantly decreased by 2 times after 1 month (p<0.05), the indicator of CFSM for green color worsened in long-term follow-up (p<0.05), negative dynamics were recorded according to the program of static perimetry and kinetic perimetry for green color 1 later (p<0.05). Revascularization of the coronary arteries affects the restoration of the sympathetic phase of the pupil’s response to light and the force of pupil contraction (p<0.05). Key words:: chronic ischemic optic neuropathy, the cardiovascular system, cardiac stenting, optic nerve

Optic Disc Drusen Prevalence in Patients With Retinitis Pigmentosa: A Cross-Sectional Study.

Studies of patients with retinitis pigmentosa (RP) have reported an increased prevalence of optic disc drusen (ODD) compared with the ODD prevalence in the general population. The diagnostic gold standard method for identifying ODD is enhanced depth imaging optical coherence tomography (EDI-OCT), but this modality has not previously been used systematically for identifying ODD in patients with RP. This study aimed to estimate the prevalence of ODD in patients with RP using EDI-OCT. In this cross-sectional study, 40 patients with clinically diagnosed RP aged 18 years or older were included. All patients underwent an ophthalmic examination, including kinetic perimetry, EDI-OCT of the optic nerve head, and fundus photography. Genetic testing with a next-generation sequencing panel of retinal dystrophy genes was performed on the RP patients without a prior genetic diagnosis. Twelve patients (30.0%) had at least one ODD. Six patients had bilateral ODD. No significant differences between patients with and without ODD were found according to age, refraction, best-corrected visual acuity, Bruch membrane opening, or visual field. The genetic variation causing RP was found in 11 of 12 cases in the ODD group and in 17 of 28 cases in the group without ODD. We found the prevalence of ODD in patients with RP to be 30.0%. This is 15 times higher than in the general population and much higher than previously estimated in most studies, potentially indicating that the 2 conditions might be pathogenically related.

Multimodal Structural and Functional Characterization of Retinal Vasculopathy with Cerebral Leukoencephalopathy

ObjectiveTo describe and quantify the structural and functional consequences of retinal vasculopathy and cerebral leukoencephalopathy (RVCL) on the neurosensory retina. DesignCross-sectional descriptive study from December 2021 to December 2022 ParticipantsRVCL patients (n=9, 18 eyes) recruited from the RVCL Research Center at Washington University in St. Louis MethodsRVCL patients underwent comprehensive ophthalmological evaluation including Optical Coherence Tomography (OCT), Optical Coherence Tomography Angiography (OCT-A), ultra-wide-field (UWF) fundus imaging, retinal autofluorescence, dark adaptation, electroretinography (ERG), Goldmann kinetic perimetry, and fluorescein angiography (FA). Main Outcomes MeasuresComprehensive characterization from various modalities including: best corrected visual acuity, central subfield thickness (μm) from OCT, foveal avascular zone (mm2) from OCT-A, dark adaptation rod intercept (sec), cone response in ERG, and presence or absence of vascular abnormalities, leakage, neovascularization, and nonperfusion on FA. ResultsA total of 18 eyes from 9 individuals were included in this study. The best-corrected visual acuity ranged from 20/15 to 20/70. The mean central subfield thickness from OCT was 275.8 μm (range 217-488 μm). The mean foveal avascular zone (FAZ) from OCT-A was 0.65 mm2 (range 0.18-1.76 mm2). On dark adaptometry, the mean time was 5.02 minutes (range 2.9 - 6.5 min) with 1 individual with impaired dark adaptation. ERG demonstrated mild cone response impairment in 4 eyes. On FA, there was evidence of macular and peripheral capillary non-perfusion in 16 of 18 eyes and notable areas of vascular leakage and retinal edema in 5 of the 18 eyes. ConclusionsThis study illustrates the phenotypic spectrum of disease and may be clinically valuable for aiding diagnosis, monitoring disease progression, and further elucidating the pathophysiology of RVCL to aid in the development of therapies.

Fitness to drive with glaucoma

Glaucoma is one of the eye diseases that are particularly relevant to driving in old age. The ophthalmologist often has to take on the task of traffic medical consultation or medical appraisal. It is essential to distinguish between fitness to drive and driving ability or driving safety and driving capability. The medical examination of fitness to drive can only be carried out over long intervals and basically requires an ophthalmological examination in compliance with all the requirements of the driving license ordinance. This is not ahealthcare task. In the case of clarification of the fitness to drive in people with known glaucoma on behalf of the test persons themselves or adriving license authority, visual field testing must be performed using manual kinetic perimetry according to Goldmann, especially for all borderline case decisions by traffic experts. The ophthalmologist faces the particular difficulty of maintaining abalance between the legal duty of care and patient-centered care in order not to strain the patient-physician relationship.

Kinetic Perimetry on Virtual Reality Headset.

We present a portable automatic kinetic perimeter based on a virtual reality (VR) headset device as an innovative and alternative solution for the screening of clinical visual fields. We compared the performances of our solution with a gold standard perimeter, validating the test on healthy subjects. The system is composed of an Oculus Quest 2 VR headset with a clicker for participant response feedback. An Android app was designed in Unity to generate moving stimuli along vectors, following a standard Goldmann kinetic perimetry approach. Sensitivity thresholds are obtained by moving centripetally three different targets (V/4e, IV/1e, III/1e) along 24 or 12 vectors from an area of non-seeing to an area of seeing and then transmitted wirelessly to a PC. A Python real-time algorithm processes the incoming kinetic results and displays the hill of vision in a two-dimensional map (isopter). We involved 21 subjects (5 males and 16 females, age range 22-73 years) for a total of 42 eyes tested with our proposed solution, and results were compared with a Humphrey visual field analyzer to test reproducibility and efficacy. isopters generated with the Oculus headset were in good agreement with those acquired with a commercial device (Pearson's correlation values r > 0.83 for each target). we demonstrate the feasibility of VR kinetic perimetry by comparing performances between our system and a clinically used perimeter in healthy subjects. proposed device leads the way for a portable and more accessible visual field test, overcoming challenges in current kinetic perimetry practices.

Evaluation of Cup Disc Ratio and RNFL Thickness Based on Goldmann Visual Field Test

Introduction and Objective : To assess the relationship between the cup-disc ratio of the optic nerve head and peripapilarry RNFL thickness to the visual field loss in glaucoma patients. Methods : Visual field from Goldmann kinetic perimerty and Ocular Computed Tomography (OCT) records from Yap Eye Hospital, Yogyakarta are used to examine the figure of visual field loss in glaucoma patient. Result: Broad spectrum of glaucoma-related visual field defects were observed from 73 eyes. The most common visual field defects are arcuate defect (23.3%) and followed by general depression. Arcuate defects can already observable in some patients with cup-disk ratio of 0.5 (30%).Arcuate defect occurs in the average RNFL thickness of 69.90 ?m (46.93-118.77). It appears that the pinhole vision appeared on the average RNFL thickness of 44.23 ?m (25.33-63.13), and temporal RNFL thickness remnant occured at 48.64 ?m (46.22-51.06). RNFL thickness with normal visual field was on the thickness of 107.78 ?m (100.27-115.29). Conclusion: Visual field defect that may be observed in glaucoma with Goldmann kinetic perimetry are arcuate defect, and general visual field depression. RNFL thickness may be correlated longitudinally with the worsening of visual field defect.

Transcorneal Electrical Stimulation Dose-Dependently Slows the Visual Field Loss in Retinitis Pigmentosa.

To assess whether transcorneal electrical stimulation (TcES) current-dependently slows progressive loss of visual field area (VFA) in retinitis pigmentosa (RP). Data from 51 patients with RP who received monocular TcES treatment once weekly over 1 year in an interventional, randomized study have been analyzed a posteriori. Current amplitudes were 0.1 to 1.0 mA in the TcES-treated group (n = 31) and 0.0 mA in the sham group (n = 20). VFA was assessed in both eyes (semiautomatic kinetic perimetry, Goldmann targets V4e, III4e). Annual decline rate (ADR) of exponential loss and model-independent percentage reduction of VFA at treatment cessation were correlated to current amplitude. For V4e, mean ADR was -4.1% in TcES-treated eyes, -6.4% in untreated fellow eyes, and -7.2% in placebo-treated eyes; mean VFA reduction in TcES-treated eyes was 64% less than in untreated fellow eyes (P=0.013) and 72% less than in placebo-treated eyes (P=0.103). Individual VFA reductions correlated with current amplitude (P=0.043) and tended toward zero in patients who received 0.8 to 1.0 mA. For III4e, there was a marginally significant current-dependency of interocular difference in reduction (P=0.11). ADR and VFA reduction did not significantly correlate with baseline VFA. Loss of VFA (V4e) in patients with RP was significantly reduced in treated eyes compared to untreated eyes by regular use of TcES in a dose-dependent manner. No dependence of effects on the initial extent of VFA loss was found. TcES provides potential for preservation of visual field in patients with RP.

Observations for Sjögren’s Pigment Epithelial Reticular Dystrophy in a 16-Year-Old Boy—An Extremely Rare Retinal Case Report

The purpose of this publication is to present an extremely rare case of Sjögren's pigment epithelial reticular dystrophy. So far, 10 such publications have been found in world literature. A 16-year-old boy was diagnosed due to a slight loss of visual acuity, confirmed in static perimetry/24-2/. Abnormal dense clusters of retinal pigment epithelium (RPE) cells forming a reticular network pattern (resembling a fishing net) with marked knots were detected by fundoscopy in the macular area and the mid-periphery of the retina. No abnormalities were found in the anterior segment, intraocular pressure, kinetic perimetry, Ishihara or Farnsworth D-15 tests or OCT. Fluorescein angiography confirmed blocked fluorescence from the choroidal vessels caused by the pigment in RPE. An autofluorescence test showed hypofluorescent foci corresponding to symmetrical and bilateral retinal hyperpigmentation with an RPE reticular pattern. Multifocal ERG (mfERG) revealed slight cone photoreceptor and bipolar bioelectrical dysfunction. Electrooculography (EOG) showed significant asymmetry (Arden Ratio 1.8), suggesting bioelectrical dysfunction of RPE/photoreceptors. Flash ERG (ERG) revealed only slight increase in implicit time of the a and b waves of the rod and cone responses and exclude cone-rod dystrophies. This article highlights the importance of the results of ophthalmoscopy, fluorescein angiography, autofluorescence, mfERG, fERG, EOG and genetic tests for Sjögren's reticular dystrophy with a pathogenic variant in the region of the C2 gene-c.841_849+19del (dbSNP rs9332736).

«Ландшафт» глаукомы в России, странах СНГ и Восточной Европы: что поменялось за 15 лет? Результаты многоцентрового международного исследования

Aim: to assess the changes in clinical and epidemiological characteristics, diagnostic and treatment options of primary open-angle glaucoma (POAG) in the Russian Federation and multiple near- and far-abroad countries over the period of 2005–2020. Patients and Methods: the final protocol of this retrospective multi-center research and clinical study included 289 patients with POAG from 7 states (Russia, Belarus, Serbia, Moldova, Kyrgyzstan, Slovakia, and Slovenia). The authors analyzed the methods used for establishing POAP diagnosis, clinical and demographic patient characteristics (gender, age and place of residence), as well as the process of glaucoma development (age of onset, disease duration and stages, intraocular pressure, ocular hypotensive medications, and the used laser and surgical procedures). All patients were divided into four groups depending on the time of making the initial diagnosis: 2004–2005, 2009–2010, 2014–2015, 2019–2020. Results: tonometry with Maklakov and Goldmann tonometers is still considered the gold standard for measuring intraocular pressure (IOP) (95% of cases). The percentage of pneumotonometry increased from 40% in 2005 to 60% in 2020. Approximately a third of clinics are still using electronic tonography as a supplementary method. Static automated perimetry is a basic tool for diagnosis and follow-up of patients with POAG (more than 95% of cases). Manual kinetic perimetry (Foerster's perimetry) is used in less than 10% of cases. Ophthalmoscopy (direct and binocular) was involved in the diagnostic process in all clinics and in all cases. The range of instrumental visualization technologies includes optical coherence tomography (OCT), Heidelberg Retina Tomography (HRT), and scanning laser polarimetry. Currently, OCT is utilized in 90% of clinics. It was found out that in 2005 the standard of initial POAG diagnosis encompassed a set of Maklakov/Goldmann tonometry, ophthalmoscopy and kinetic perimetry. In 2020, this list includes Maklakov/ Goldmann tonometry, pneumotonometry as a supplemental tool, static automated perimetry, ophthalmoscopy and OCT. The percentage of newly diagnosed POAG at the early stage has increased twofold over the past 15 years (from 20% in 2005 to 38% in 2020). The mean age of patients at the time of initial POAG diagnosis in 2005 was 62 (52; 67) years, in 2020 — 65 (50; 70) years, respectively (р=0.694). The proportion of prostaglandins in medication therapy increased by 20% over the past 15 years, while the proportion of beta-blockers reduced by the same percentage. The use of cholinomimetic drugs was almost discontinued. The total number of glaucoma laser surgeries has grown, and in the last decade the top priority has been given to selective laser trabeculoplasty, while the share of argon laser trabeculoplasty has decreased by 10%. The rate of primary glaucoma surgeries (trabeculectomy) keeps going down. Conclusion: a gradual and consistent implementation of high-tech diagnostic methods (static automated perimetry and OCT) in the routine practice occurred over 2005–2020. Also, there was a clear trend in more extensive use of objective data. The evolution of pharmaceutical "landscape" in the disease management is associated with an increasing proportion of more effective and safe drugs (prostaglandin analogues) and a diminishing role of beta-blockers as drugs of choice for starting therapy. The share of glaucoma surgeries as a starting strategy of POAG management was running down steadily from 2005 to 2010. Keywords: glaucoma, intraocular pressure, tonometry, perimetry, optical coherence tomography, trabeculectomy. For citation: Brezhnev A.Yu., Egorov E.A., Erichev V.P. et al. Glaucoma "landscape" in Russia, CIS and Eastern European countries: what has changed over 15 years? Russian Journal of Clinical Ophthalmology. 2023;23(2):73–79 (in Russ.). DOI: 10.32364/2311-7729- 2023-23-2-73-79.

Importance of two-dimensional gaze analyses in the assessment of reading performance in patients with retinitis pigmentosa.

The causes of reading difficulties in people with peripheral visual field loss are not fully understood. We conducted a two-dimensional gaze analysis on eye movements during reading in patients with retinitis pigmentosa to investigate the causes of reading difficulties in relation to the central visual field using a binocular eye mark recorder (EMR-9). Twenty-seven patients with retinitis pigmentosa whose central visual field narrowed to ≤ 20° using Goldmann kinetic perimetry (I/4 target) and this present study included eight healthy participants. The participants' visual acuities were corrected to better than +0.4 logMAR. Correlations and multivariate regression analyses were investigated between the number of letters read correctly, the I/4 central visual field, V/4 perifoveal and peripheral visual field, and visual acuity. Multivariate regression analysis revealed that all these parameters played almost equal roles in the number of letters read correctly. In the two-dimensional gaze analysis, the task performance time of patients during reading increased as the I/4 central visual field narrowed. The task performance time was more clearly correlated with the rotation saccade (r = 0.428, p <0.05) and the distance of the vertical direction (ΣY) of eye movements (r = 0.624, p < 0.01), but not with regressive saccade and the distance of the horizontal direction (ΣX). Visual acuity was correlated with the task performance time (-0.436, <0.05) but not with eye movement directionality. Reading difficulties in patients with retinitis pigmentosa result from impaired eye movement directionality. Understanding eye measurements for people with tunnel vision required a two-dimensional gaze analysis. The two-dimensional gaze analysis also showed that the involvement of the perifoveal and peripheral visual fields, visual acuity, and I/4 central visual field was important for reading in people with tunnel vision.

Oxygen metabolic retinal function in retinitis pigmentosa correlates with disease severity

AbstractPurpose: The aim of our study was to evaluate retinal function with white light dark‐adapted full‐field sensitivity threshold (FST) and find possible correlations with metabolic function measured with retinal oximetry (RO) in patients with retinitis pigmentosa (RP).Methods: In this prospective observational study (BASEC 2020–00122), FST and RO measurements were performed on 66 RP eyes (33 subjects, 12♀ 21♂) aged between 18 and 80 years (mean 43.2 years); all eyes were graded for disease severity. Main outcome parameters were white FST thresholds using the Diagnosys Espion system with the ColorDomeTM LED full‐field stimulator (Diagnosys LLC, Lowell, MA) as well as the main RO parameters: the mean arterial (A‐SO2; %), venular (V‐SO2; %) oxygen saturation, their difference (A‐V SO2; %), and the corresponding mean diameters of the peripapillary retinal arterioles (D‐A; μm) and venules (D‐V; μm) recorded with the oxygen saturation tool of the Retinal Vessel Analyser (RVA; IMEDOS Systems UG, Jena, Germany). In addition, semi‐automated kinetic perimetry (V4e, III4e, I4e, III3e isopters, Octopus 900®, Haag‐Streit AG Bern, Switzerland) was performed and included in the linear mixed‐effects models analysis calculated with SPSS®.Results: Neither the oxygen saturation parameters (p &gt; 0.21) nor the D‐A and D‐V (p &gt; 0.13) showed significant correlations with the FST. However, when compared systematically with the visual field (VF) areas of the different isopters, RO parameters V‐SO2 (p = 0.024) and A‐V SO2 (p &lt; 0.02) showed significant correlations. Furthermore, both V‐SO2 and A‐V SO2 showed gradual changes with more pronounced impairment in oxygen metabolic function in advanced stages of RP when analysed in subgroups of disease severity grades.Conclusions: In advanced stages of RP, RO showed a significant association with standardized VF testing parameters and presented with gradual changes of more pronounced impairment in retinal oxygen metabolic function. Unlike standardized VF parameters, white dark‐adapted FST does not appear to correlate with retinal oxygen metabolic function in RP patients, implying that the two examinations may capture unrelated aspects of the retinal pathological process.

Одномоментная хирургия катаракты и глаукомы с использованием модифицированной антиглаукомной операции

Purpose. To develop a modified antiglaucoma operation (MAO) for the combined simultaneous surgical treatment of glaucoma and cataracts and to evaluate the effectiveness of this antiglaucoma component in comparison with trabeculectomy and non-penetrating deep sclerectomy. Material and methods. 61 patients (65 eyes) with a combination of incomplete complicated cataract and previously unoperated POAG stages I–III. The patients were divided into 3 groups: 1st group (control) – 17 patients, 17 eyes with ultrasonic cataract phacoemulsification (PEC) and non-penetrating deep sclerectomy (NPDS); 2nd (control) group (25 patients, 28 eyes) of patients with PE and trabeculectomy (TE); 3rd (main) group (19 people, 20 eyes) – FEC with developed MAO (based on the NGSE technique with cyclodialysis, also including elements of iridocycloretraction and autosclercyclostomy). All patients underwent a comprehensive ophthalmological examination, which included the determination of visual acuity, kinetic perimetry, non-contact tonometry, biomicroscopy, ophthalmoscopy, and optical coherence tomography (OCT). Hypotensive and visual results were assessed a week later and in the long term after surgery. The maximum follow-up period for patients did not exceed 1.5 years (average 12.4 months). Results. Approximately equal hypotensive results in the long-term period were shown by combined operations, which included FEC with TE (absolute effect, i.e. without additional medication – in 65 % of cases) and MAO (respectively, in 60 %). A more modest result was recorded after FEC and NGSE – 41.7 %. However, the number of early postoperative complications after the latter turned out to be almost 2 times less than after simultaneous intervention with penetrating TE (28.5 %), and was quite comparable with that after FEC and NGSE (15 % and 11.8 %). At the same time, the best visual results in the studied terms were observed in the main (0.78 ± 0.06) and 1st control (0.70 ± 0.07) groups, the worst – after FEC (0.64 ± 0.05). Conclusion. Modified antiglaucoma surgery in combination with FEC in POAG surgery and complicated cataract in the long term provides a higher absolute hypotensive effect (60 %) than simultaneous surgical intervention using non-penetrating deep sclerectomy (41.7 %). At the same time, the developed operation is practically not inferior in this indicator to fistulizing trabeculectomy (65 %), but significantly exceeds it both in safety (the number of complications is almost 2 times less) and in visual acuity in the long term (0.78 ± 0.06 versus 0.64 ± 0.05, p &lt; 0.05). Keywords: cataract, glaucoma, simultaneous combined surgery, phacoemulsification, modified antiglaucoma surgery

Evaluation of visual field changes with retinal nerve fiber layer thickness in primary congenital glaucoma.

To evaluate visual field changes in primary congenital glaucoma (PCG) with retinal nerve fiber layer thickness on optical coherence tomography. In this cross-sectional, observational study, consecutive PCG children who underwent combined trabeculotomy with trabeculectomy and on regular follow-up were enrolled. All patients were aged over four years and co-operative for RNFL OCT and visual field examination. Perimetry was done on Humphrey visual field (HVF) analyzer using 30-2 and 10-2 SITA standard algorithms as appropriate. If a reliable automated perimetry was not feasible, kinetic perimetry was done. The following were noted at baseline and every follow-up: age, sex, visual acuity, intraocular pressure (IOP), cup-disc ratio (CDR), corneal diameters, refraction, any topical antiglaucoma medications, surgeries underwent, age at surgery and duration between surgery and final examination. Forty-eight eyes of 34 children operated for PCG and 19 eyes of 17 controls were analyzed. A statistically significant thinner average RNFL thickness of 87.2 ± 28 μm was noted in PCG eyes as compared to controls with 100.6 ± 7.2 μm (P = 0.04). The mean cup-disc area ratio on OCT in PCG eyes was 0.43 ± 0.2 (0.02-0.93) and in control eyes was 0.23 ± 0.07 (0.1-0.4) (P < 0.001). On RNFL OCT, there was significant focal RNFL loss in temporal superior (P = 0.003), nasal inferior (P = 0.037) and temporal inferior (P < 0.001) quadrants compared to controls. Among PCG eyes, 20/48 eyes (41.7%), had definitive, reproducible glaucomatous VF defects. Mean baseline IOP in PCG eyes with VF defect was 28.7 ± 5.7 mmHg and in eyes with normal VF was 24.6 ± 5.9 mmHg (P = 0.03). On univariate regression analysis, higher baseline IOP was significantly associated with both RNFL loss (odds ratio (OR): -2.17) and VF defects (OR: 3.35). Fluctuation in follow-up IOP (OR: 3.33) was also significantly associated with the presence of VF defects. On multivariable regression analysis maximum, IOP was significantly associated with RNFL loss and VF defects. Peripapillary RNFL thickness could be used to identify PCG eyes having visual field loss and possibly poor visual function from PCG eyes without visual field defects. Baseline and follow-up IOP, significantly correlated with RNFL thickness in PCG eyes.

Clinical-genetic findings in a group of subjects with macular dystrophies due to mutations in rare inherited retinopathy genes.

To describe the results of clinical and molecular analyses in a group of patients suffering from inherited macular dystrophies, in which next-generation sequencing (NGS) efficiently detected rare causative mutations. A total of eight unrelated Mexican subjects with a clinical and multimodal imaging diagnosis of macular dystrophy were included. Visual assessment methods included best corrected visual acuity, color fundus photography, Goldmann visual field tests, kinetic perimetry, dark/light adapted chromatic perimetry, full-field electroretinography, autofluorescence imaging, and spectral domain-optical coherence tomography imaging. Genetic screening was performed by means of whole exome sequencing with subsequent Sanger sequencing validation of causal variants. All patients exhibited a predominantly macular or cone-dominant disease. Patients' ages ranged from 12 to 60years. Three cases had mutations in genes associated with autosomal dominant inheritance (UNC119 and PRPH2) while the remaining five cases had mutations in genes associated with autosomal recessive inheritance (CNGA3, POC1B, BEST1, CYP2U1, and PROM1). Of the total of 11 different pathogenic alleles identified, three were previously unreported disease-causing variants. Macular dystrophies can be caused by defects in genes that are not routinely analyzed or not included in NGS gene panels. In this group of patients, whole exome sequencing efficiently detected rare genetic causes of hereditary maculopathies, and our findings contribute to expanding the current knowledge of the clinical and mutational spectrum associated with these disorders.