Macular Damage Research Articles

Comparison of 10-2 and 24-2 Perimetry to Diagnose Glaucoma Using OCT as an Independent Reference Standard

To compare the performance of the 10-2 test versus 24-2 standard automated perimetry (SAP) test for the diagnosis of glaucoma using OCT as an independent standard for glaucomatous damage. Cross-sectional study. A total of 1375 pairs of 10-2 and 24-2 SAP tests from 569 eyes of 339 subjects were used for the analysis. A total of 440 (77%) eyes had a diagnosis of glaucoma, and 129 (23%) eyes were normal. All participants underwent 10-2 and 24-2 SAP tests within 30 days. Glaucomatous severity was quantified based on OCT macula ganglion cell layer (mGCL) and circumpapillary retinal nerve fiber layer. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare 10-2 and 24-2 metrics for discriminating healthy eyes from those of glaucoma, at different levels of disease severity. Areas under the ROC curves and sensitivities at fixed specificities of 80% and 95%. The overall AUC for mean deviation (MD) for the 24-2 test (0.808) was significantly higher than that of the 10-2 test (0.742; P < 0.001). When compared at different stages of the disease, the 24-2 test performed generally better than the 10-2 test, notably in the earlier stages of the disease. For early damage (first quartile), the 24-2 MD had an AUC of 0.658 versus 0.590 for 10-2 MD (P= 0.018). For advanced damage (fourth quartile), corresponding values were 0.954 vs. 0.903 (P= 0.013). Similar trends were observed when glaucoma severity was defined based on structural macular damage with mGCL thickness. The 24-2 SAP test had better diagnostic accuracy compared with that of the 10-2 test for detecting equivalent levels of glaucomatous damage, as measured by quantitative assessment of retinal nerve fiber layer and macula by OCT. Proprietary or commercial disclosure may be found after the references.

The ICD-10 Glaucoma Severity Score Underestimates the Extent of Glaucomatous Optic Nerve Damage

To evaluate the International Classification of Disease, Tenth Revision (ICD-10) codes used for glaucoma severity classification, which are based on the location of visual field (VF) defects; given the known poor sensitivity of the 24-2 visual field test to early disease and macular damage, we hypothesized that the ICD-10 codes would not accurately reflect the extent of glaucomatous damage. Retrospective validity and reliability analysis. We evaluated 80 eyes with glaucomatous optic neuropathy (GON). Masked reviewers assigned an ICD-10 severity grade based on 24-2 VF. Two additional masked examiners determined the presence of optical coherence tomography (OCT) structural damage in each hemifield and/or central 5 degrees to define an OCT-based equivalent ICD-10 classification. A total of 80 eyes with GON were classified as mild, moderate and advanced in 15, 23, and 42 cases, respectively, based on the 24-2 VF, and in 6, 7, and 67 cases, respectively, based on OCT. The OCT classifications were more severe in 29 of 80 cases (36%). In 33 cases (41.3%), macular damage detected by OCT was missed by the 24-2. In 4 of 80 cases (5%), the VF overestimated the severity, likely due to variability of the 24-2 test. The ICD-10 system relies solely on damage seen on the 24-2 and as provides a 24-2 functional score rather than a "glaucoma" severity score. OCT revealed wide variation of damage across grades, with a significant proportion of the eyes showing macular structural damage missed with the 24-2 VF. Adding OCT information to the ICD-10 system would help it to more accurately reflect the extent of glaucomatous damage.

Detection of macular findings in highly myopic eyes with OCT and to correlate it to various visual parameters

: High myopia is when axial length is more than &amp;#62;26 mm and refractive error of atleast 6.00 diopters (D). The definition of pathologic myopia in early studies was not consistent. It revolved around a combination of refractive error and axial length, which simply suggests high myopia. To study the pathological findings in subjects with high axial myopia and their relationship with other visual parameters. In this crosssectional analytical study, 200 eyes from 100 patients were studied. Fundus was evaluated with indirect ophthalmoscope. After pupillary dilatation, multiple OCT scans were performed across the macula area centering the fovea with the help of SD-OCT SD OCT revealed that 46% had normal appearance. Among pathological findings, most common was CNV (10%). Other findings were lamellar macular hole (7%), full thickness macu lar hole (7%), retinal detachment (3%), epiretinal membrane (3%), traction maculopathy (4%), PVD (8%), dome shaped macula (8%)and posterior staphyloma (4%). Fifty four percent eyes had one or more fundus changes observed by bio-microscopy. Most common findings were lattice degeneration (33.33%) and WWP &amp; WWOP (25%). Other findings were posterior staphyloma (7.41%), retinal detachment (5.51%), Chorioretinal degeneration (11.11%), macular hole (8.3%), PVD (3.70%), Retinal hole (0.92%), maculopathy (0.97%) and CNV (3.70%). : OCT can be done in a healthy high myopic population and in symptomatic myopic population who complains of worsening of visual function to look for epiretinal and/or vitreoretinal traction and related macular damage.

CHANGES OF FIXATION STABILITY AND LOCATION AFTER EPIRETINAL MEMBRANE SURGERY.

This study aimed to evaluate fixation stability and position changes after epiretinal membrane (ERM) surgery. This is a retrospective study that included 60 consecutive eyes with idiopathic ERM. All patients received comprehensive ophthalmic examinations preoperatively and 1, 4, and 10 months postoperatively. Main outcome measures included fixation stability and position, bivariate contour ellipse area, and preferred retinal locus. The number of patients with stable fixation and predominantly central fixation was increased significantly after ERM surgery (61.7 vs. 73.3%, P = 0.001; 41.7 vs. 71.7%, P = 0.037). The correlation analysis showed that the preoperative factors associated with improved postoperative fixation stability were a larger bivariate contour ellipse area value (P < 0.001), poorer visual acuity (P = 0.002), advanced stage (P = 0.002), thicker central fovea thickness (P = 0.015), and a longer preferred retinal locus-fovea distance (P = 0.025). As for the improved fixation location, the associated preoperative factors were age (P = 0.003), central fovea thickness (P = 0.044), and preferred retinal locus-fovea distance (P < 0.001). Our observations point to the changes of fixation parameters in patients after ERM surgery. We found that patients with preoperative unstable, eccentric fixation and poor BCVA can significantly benefit from the surgery. This result indicates that even in patients with severe macular damage, the ERM surgery still has great benefits in recovering visual function.

Rhegmatogenous retinal detachment induces more severe macular capillary changes than central serous chorioretinopathy

To investigate hemodynamic changes in macula-off rhegmatogenous retinal detachment (RRD) and its impact on visual prognosis by comparing with central serous chorioretinopathy (CSC). Using optical coherence tomography angiography (OCTA), vascular density in the superficial capillary plexus and deep capillary plexus (DCP) was retrospectively compared with that in contralateral unaffected eyes in macula-off RRD and CSC eyes. In RRD eyes, pre- and postoperative ultra-widefield (UWF) fluorescein angiography (FA) were obtained to analyze vascular changes. In OCTA, both macula-off RRD and CSC eyes showed less density in macular DCP, compared to the unaffected fellow eyes. Compared to CSC, eyes affected by macula-off RRD showed a reduction in DCP vascular density and an increase in foveal avascular zone area, although it had a much shorter macular detachment period. In macula-off RRD, less density of DCP was strongly correlated with longer duration of detachment, greater ellipsoid zone disruption, and poor visual recovery. In UWF-FA, detached retina showed capillary hypoperfusion, venous stasis and leakage, which were improved after reattachment. In conclusion, macular capillary loss of flow, which was associated with photoreceptor disruption, correlated with duration of detachment in RRD. Early reattachment and reperfusion are required for minimizing macular vasculature and photoreceptor damage in macula-off RRD.

Evaluation of the association between macular damage and disability glare in patients with advanced glaucoma.

This study aimed to investigate the factors associated with disability glare in patients with advanced glaucoma and evaluate the impact of disability glare on the vision-related quality of life. We prospectively studied 225 eyes (225 patients) with advanced glaucoma. The visual function was evaluated using the 10-2 and 24-2 Humphrey visual field (VF)(Dublin, California) and contrast sensitivity test. Structural parameters were obtained using RTVue optical coherence tomography and angiography(Fremont, California). Significant loss of macular vessel density (mVD) was defined as VD < 30%. Each participant completed the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and questions regarding subjective symptoms of glare. Fifty-six patients (24.9%) experienced glare and had a lower NEI-VFQ-25 composite score (P = 0.017). The average retinal nerve fiber layer and ganglion cell complex thickness and mean deviation (MD) in the 24-2 VF test were not associated with glare. Significant superior or inferior mVD loss (P < 0.001; odds ratio [OR], 3.45; and 95% confidence interval [CI], 1.83-6.55), lower logarithmic contrast sensitivity at 0.75 cycles/degree (P < 0.001; OR, 0.27; and 95% CI, 0.13-0.56), and worse MD in the 10-2 VF test (P < 0.001; OR, 0.93; and 95% CI, 0.89-0.97) showed an association with glare. In advanced glaucoma, central VF defect and mVD loss are associated with disability glare, which negatively impacts vision-related quality of life.

Multimodal Imaging Characterization of Arteriolosclerotic Plaques in Retinal Vein Occlusion.

To investigate the multimodal imaging features and the clinical associations of arteriolosclerotic plaques in patients with retinal vein occlusion (RVO). This was a retrospective case series of patients with RVO. Demographic and clinical characteristics were recorded at the time of RVO for each participant. Best-corrected visual acuity and central macular thickness were collected at baseline and observed for 1 year. Arteriolosclerotic plaques were identified on multimodal imaging, and their imaging features were summarized. Differences in demographic and clinical characteristics between eyes with arteriolosclerotic plaques and those with no arteriolosclerotic plaques were reported. Seventy-five eyes of 75 patients (39 males; mean age, 72.5 years) were included. Arteriolosclerotic plaques were identified in nine eyes (12%) as segmental, yellow, ill-defined creamy lesions in the arterioles' walls. Baseline macular edema was worse in eyes with arteriolosclerotic plaques than in eyes with no plaques (716.5 μm vs 539.7 μm). Arteriolosclerotic plaques did not interfere with blood flow and regressed in three eyes (33%). Eyes with plaques had worse best-corrected visual acuity (P < .001) and lower central macular thickness (P = .02) at 12 months than did eyes with RVO and no plaques. Arteriolosclerotic plaques suggest an ischemic or inflammatory involvement of the arteriolar branches in eyes with RVO and are associated with severe macular damage. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:650-657.].

A Comparison Among Microperimetry, Standard Automated Perimetry and Spectral Domain Optical Coherence Tomography in the Evaluation of the Macula in Glaucoma Eyes with Hemifield Defects.

IntroductionTo evaluate the correlation between macular integrity assessment (MAIA) and standard automated perimetry (SAP) in detecting macular function damage in glaucoma and to explore the relationship between macular structure and functional damage by using spectral domain optical coherence tomography (SD-OCT).MethodsThis was a cross-sectional study. Seventy patients with glaucoma, with hemifield defects verified by Humphrey 24-2 examination, and 60 normal subjects underwent Humphrey 10-2 and MAIA expert 10-2 examinations. Patients with glaucoma with normal hemifields, as detected by SAP, were divided into a normal hemifield group and a visual field (VF) defect group. The difference in the retina and ganglion cell complex (GCC) thicknesses was analyzed between the abnormal and normal hemifields.ResultsAmong the 70 glaucoma eyes, the results of MAIA and SAP were consistent for 66 (66/70, 94.3%). The others showed SAP hemifield defects, while MAIA was normal (4/70, 5.7%). There was a good correlation of the mean sensitivity between MAIA and SAP (P < 0.001). There also was a good correlation between the mean threshold of MAIA and the mean deviation (MD) of SAP (P = 0.008, r = 0.507). Among the patients with glaucoma with a normal hemifield, MAIA showed abnormal results in 50 eyes (50/66, 75.8%), which was consistent with the changes in the inner retina and GCC thicknesses. Meanwhile, MAIA showed normal results; there were no significant differences between patients with glaucoma and the normal group in the thicknesses of the inner retina and GCC.ConclusionMAIA and SAP have good consistency in detecting macular dysfunction. MAIA can also identify abnormal VFs in the macular regions that may not be detected by SAP, which is consistent with the changes in the GCC thicknesses, suggesting that there may be central VF damage in patients with glaucoma that has not been previously identified.

P29 A case of paediatric ocular Behcet’s

Abstract Case report - Introduction Bechet’s is a rare chronic inflammatory multisystem disease of unknown cause. It is characterised by recurrent oral ulcerations, genital ulcerations, ocular inflammation and skin involvement. Bechet’s disease is rarely observed during childhood and the clinical picture can be incomplete, thus making the diagnosis challenging. Ocular involvement represents 10—20% of the initial presenting feature. Ocular involvement typically involves anterior and/or posterior uveitis and retinal vasculitis. Severe vision loss can be seen in patients. Prognosis is improving due to enhanced therapeutic options. The use of biologics, particularly anti-TNF drugs, are a positive advance, though more evidence in paediatrics is required. Case report - Case description This young man presented in 2014 at 12 years old to paediatric ophthalmology with a right panuveitis. He was treated with a weaning dose of oral steroids. His right eye became quiet. He reported some oral ulceration, not recurrent, and no genital ulcers. He did not fulfil Bechet’s criteria. Pathergy test and HLA B51 were negative. In 2017 he presented with right macular retinal infiltrate. Vision was reduced to counting fingers. Mycophenolate mofetil (MMF) was started with weaning prednisolone. Despite this, activity was ongoing with inflammation in the anterior chamber and vitreous. Humira was started in August 2017. There was resolution of the inflammation in the right eye but central vision remained poor due to irreversible macular damage. Left eye was normal. Oral steroids were weaned. In 2018, he developed acne and folliculitis type lesions. He reported sore joints and fatigue. He was felt to have probable Behcet’s. Quaternary review by the Bechet’s centre, Liverpool, agreed. A switch from MMF to azathoprine (AZA) was advised. Interferon alpha would have been suitable, but was no longer available. Skin lesions returned when switched to AZA; patient requested switch back to MMF. Over the next 2 years steroids were weaned. MMF and 2-weekly Humira continued. In November 2020 he presented with peripheral retinitis in his left, better-seeing eye, haemorrhaging, with patchy vision. MMF was increased and oral steroids recommenced. In December 2020 visual acuity was hand movements in his right eye and 6/7.5 in his left eye with ongoing inflammation. Adalimumab was increased to weekly. In January 21 there were 3 + of cells in his anterior chamber, extensive haemorrhages and retinal infiltrates in keeping with Behcet’s. He was admitted for pulsed IV methylprednisolone and switched from Humira to infliximab. Eyes are currently quiescent and prednisolone is weaning. Case report - Discussion Bechet’s disease is a multiorgan disease typified by an immune-mediated occlusive vasculitis. The aetiology of Bechet’s remains unclear. HLA-B51 is a major predisposing genetic factor. There is involvement of the innate immune system, propagated by the adaptive immune system. Ophthalmic involvement can be the presenting feature of Bechet’s. Eye disease in Bechet’s is most commonly a non-granulomatous uveitis with necrotising obliterative retinal vasculitis. This can be found in either the anterior or posterior segment or both. Recurrent inflammation in the posterior segment can lead to severe sight loss. Young males typically have the worst ocular prognosis. The treatment of ocular Bechet’s can be challenging as our case emphasises. Treatment follows a step-wise approach. Therapy consists of topical steroid, followed by intravenous or oral steroid. Maintenance therapy of either AZA 2mg/kg/day, MMF (max3 g daily) or ciclosporin max 5mg/kg/day should be commenced. The next step will typically be a TNF inhibitor; in our patient we used adalimumab initially. Infliximab is becoming a popular first choice anti-TNF. Certainly since January 2021 our patient’s eyes have remained quiescent on Infliximab. The alternative to infliximab is interferon alpha but unfortunately this is no longer commercially available. A further treatment that could be offered is rituximab – initially to be given as a one-off cycle. Optimum treatment of ocular Bechet’s involves good multidisciplinary team working between ophthalmology and rheumatology. By early initiation of systemic treatment and regular reviews secondary complications may be avoided/lessened. Case report - Key learning points

Evaluation of Macular and Retinal Ganglion Cell Count Estimates for Detecting and Staging Glaucoma.

Purpose: To investigate the clinical significance of macular estimated retinal ganglion cell (mRGC) and estimated retinal ganglion cell (eRGC) in the diagnosis and staging of glaucoma.Methods: This is a cross-section study. All enrolled subjects underwent standard automated perimetry (SAP) and optical coherence tomography (OCT) examination. Swedish Interactive Threshold Algorithm (SITA)-FAST detection strategy and 24-2, 10-2 detection programs were employed in SAP assessment. The visual-field parameters and OCT parameters were calculated according to three formulas to obtain the eRGC and mRGC1 or mRGC2. The efficiency of eRGC, mRGC1, and mRGC2 estimates for the staging of glaucoma was compared. The sensitivity and specificity of each parameter for diagnosis of glaucoma were analyzed using the receiver operating characteristic (ROC) curve.Results: A total of 119 eyes were included in the analysis. Compared with the healthy controls, eRGC, mRGC1, and mRGC2 estimates were significantly decreased in patients with glaucoma. As glaucoma progressed, eRGC, mRGC1, and mRGC2 estimates were gradually reduced. In preperimetric glaucoma, mRGC1, mRGC2, and eRGC were reduced by 13.2, 14.5, and 18%, respectively. In the mild stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 28, 34, and 38%, respectively. In the advanced stage of glaucoma, mRGC1, mRGC2, and eRGC were reduced by 81, 85, and 92% respectively. The proportion of retinal ganglion cell (RGC) loss in the macula was close to that outside the macula. The specificity at 95% gave a sensitivity of 95.51, 86.52, and 87.64% for eRGC, mRGC1, and mRGC2, respectively. The sensitivity of structural parameters macular ganglion cell complex thickness and retinal nerve fiber layer (RNFL) were 98.88 and 95.51%, respectively. The sensitivity of functional parameters mean deviation (24-2) and visual field index (VFI) were 80.90 and 73.03%, respectively. The area under ROC curve of mRGC1, mRGC2, and eRGC were 0.982, 0.972, and 0.995 (P < 0.0001), respectively.Conclusion: Estimated retinal ganglion cell, mRGC1, and mRGC2 provide value to the staging of glaucoma and better diagnostic performance. Macular RGC estimatesthat integration of both structural and functional damages in macular may serve as a sensitive indicator for assessing macular damage in glaucoma and are of importance for the diagnosis and progression management of glaucoma.

Superficial Macula Capillary Complexity Changes Are Associated With Disability in Neuromyelitis Optica Spectrum Disorders.

Purpose: We examined the macular microvascular changes of the macula in neuromyelitis optica spectrum disorder (NMOSD) patients and its association with their disability and other clinical variables.Methods: Thirty-four NMOSD (13 patients without optic neuritis, NMOSD-NON, and 21 patients with a history of optic neuritis, NMOSD-ON) and 44 healthy controls (HCs) were included in the study. Optical coherence tomographic angiography (OCTA) was used to image the superficial (SCP), deep (DCP), and whole capillary plexus (WCP) in a 2.5-mm-diameter concentric circle [excluding the foveal avascular zone (FAZ)]. An algorithm (Dbox) was used to quantify the complexity of the three capillary layers by fractal analysis. We also evaluated the expanded disability scale status (EDSS).Results: Dbox values were significantly reduced in SCP (p < 0.001), DCP (p < 0.001), and WCP (p = 0.003) of NMOSD when compared with HCs. Dbox values were significantly reduced in NMOSD eyes with optic neuritis when compared with healthy controls (p < 0.001) and eyes without optic neuritis (p = 0.004) in the SCP. In the DCP, eyes with optic neuritis showed significantly reduced Dbox values when compared with eyes without optic neuritis (p = 0.016) and healthy controls (p < 0.001); eyes without optic neuritis showed significantly reduced Dbox values (p = 0.007) in the DCP when compared with healthy controls. A significant negative correlation (Rho = −0.475, p = 0.005) was shown between the superficial macula Dbox values and the EDSS in NMOSD patients. Additionally, a negative correlation (Rho = −0.715, p = 0.006) was seen in the superficial Dbox values in [e]eyes without optic neuritis and EDSS.Conclusions: Macular microvascular damage in the superficial plexus is associated with disability in NMOSD. Macular microvascular alterations arise independently of the occurrence of ON in NMOSD.

Macular Structure and Microvasculature Changes in AIDS-Related Cytomegalovirus Retinitis Using Optical Coherence Tomography Angiography.

Background: Cytomegalovirus retinitis (CMVR) is a crucial blind-causing disease of AIDS-related ocular opportunistic infection. The CMVR lesions produced retinal necrosis. It is not entirely clear whether CMVR eyes without macular-involved necrotic lesions may have subtle macular damage. In this study, we conducted a cross-sectional study using optical coherence tomography angiography (OCTA) to evaluate macular microvasculature and structure in eyes with AIDS-related CMVR.Methods: Acquired immune deficiency syndrome (AIDS)-related CMVR patients (active and inactive CMVR) and healthy controls treated in the Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University between August 25, 2019, and October 18, 2019, were recruited. All OCTA parameters, including the foveal avascular zone (FAZ), retinal vessel density (VD), choroidal vascularity index (CVI), retinal thickness, and choroidal thickness, were compared between groups after the signal strength was corrected.Results: Signal strength in the 3 × 3 and 6 × 6 mm scan patterns was significantly weaker in the inactive CMVR group than in the control group (both p < 0.001). After adjusting for signal strength, heterogeneity in the central fovea and parafoveal quadrants was present with a shift toward lower macular chorioretinal vasculature, decreased full choroidal thickness, and thicker retinal thickness in the active and inactive CMVR groups. The retinal nerve fiber layer (RNFL) and inner nuclear layer (INL) were significantly thicker in the active and inactive CMVR groups than in the control group (all p < 0.05). For photoreceptor-retinal pigment epithelium (PR-RPE) thickness, no significant differences were found in any quadrant between groups. Foveal avascular zone areas were not significantly different among the three groups (p = 0.053).Conclusions: Subtle macular structure and microvasculature damage still existed in CMVR eyes without macular-involved necrotic lesions. The results of our study are helpful for a deep understanding of the damage caused by CMVR.

Higher contrast thresholds for vanishing optotype recognition in macular visual fields among glaucoma patients: a structure–function analysis

Background/aimsWe aimed to explore the impact of glaucomatous macular damage, specifically retinal ganglion cell (RGC) loss, on macular pattern vision measured by the vanishing optotype (VO) recognition contrast threshold.MethodsSeventy-two patients...

Brilliant Blue G toxicity in macular hole surgeries: A report on combined phototoxicity and dye-induced macular damage

ABSTRACT Purpose: Vitrectomy with brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling is the standard operational technique in macular hole surgeries. However, BBG dye, though considered safe and nontoxic, can also occasionally lead to macular toxicity. This study aims to describe the clinical features and characteristics of four eyes who developed macular toxicity after following surgery for macular hole repair. Methods: Retrospective review of four consecutive cases of macular toxicity after conventional BBG assisted ILM peeling. All the cases reviewed, their operative surgical notes were retrieved and analyzed. The ILM was stained twice during surgery with prolonged intraoperative surgical time. Results: All four cases had a prolonged surgical time and the ILM was stained twice during surgery in all cases. The area of macular toxicity was corresponding to the area of ILM peeling which had been exposed to repeated staining by BBG dye. By the end of one month, all four cases had foveal thinning along with choriocapillary atrophy. The mean BCVA was 20/80 before surgery and the final mean visual acuity was <20/800. Conclusion: This report highlights the occurrence of macular and choriocapillary atrophy due to prolonged focal endoillumination and the increased risk of toxicity with repeated dye staining.

Low-Contrast High-Pass Visual Acuity Might Help to Detect Glaucoma Damage: A Structure-Function Analysis.

Purpose: The conventional visual acuity (VA) test is not sensitive enough to detect glaucoma macular damage. We aimed to investigate whether VA measurements using low-contrast high-pass optotypes are more sensitive to macular dysfunction in glaucoma and to find the potential structural basis of this difference.Methods: A total of 147 subjects were recruited, including 118 patients with glaucoma (mean age: 46.08 ± 14.64 years) and 29 healthy controls (mean age: 39.83 ± 9.81 years). For each participant, monocular best-corrected VA was measured using a conventional chart and six high-pass charts at 100, 50, 10, 5, 2.5, and 1.25% contrast levels, respectively. The macular retinal thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness of all the glaucoma patients were obtained by spectral-domain optical coherence tomography (SD-OCT).Results: Compared with healthy subjects, glaucoma patients with normal vision demonstrated worse VAs in high-pass acuity measurements (0.22–0.93 vs. 0.28–1.08, p < 0.05). Receiver operating characteristic curve (ROC) showed that 1.25% low-contrast high-pass VA was optimal for discriminating between the controls and glaucoma patients (AUC: 0.918, p < 0.001; sensitivity: 77.33%; specificity: 96.55%). Compared with conventional VA, 1.25% high-pass VA correlated better with nasal-side macular retinal ganglion cell (RGC)-related parameters (r = −0.419 to −0.446 vs. r = −0.538 to −0.582; Fisher's Z transformation, pz < 0.05). There was no difference in the strength of correlations between the VAs measured using different charts and cpRNFL thickness (Fisher's Z transformation; pz > 0.05).Conclusions: VA measurement taken with low-contrast (1.25%) high-pass acuity chart is more sensitive in detecting central visual loss in glaucoma than that taken with the conventional chart. Macular RGC damage appears to be associated with low-contrast (1.25%) high-pass visual loss in glaucomatous eyes.

High-Pass Visual Acuity Loss and Macular Structure-Function Relationship in Patients With Primary Open-Angle Glaucoma.

PurposeThe Logarithm of the Minimum Angle of Resolution (logMAR) chart is the most common clinical test for assessing central visual function in glaucoma. However, based on the use of these charts, visual acuity (VA) often remains normal even when severe macular damage exists. Here, we aim to investigate the potential advantages of high-pass VA in detecting glaucoma compared with conventional VA.MethodsMonocular best-corrected VA measurements were compared for a novel high-pass electronic VA chart (e-chart) and a conventional e-chart in 113 primary open-angle glaucoma (POAG) patients with normal logMAR VA and 65 age-similar healthy controls. One hundred thirty-nine POAG patients underwent spectral-domain optical coherence tomography (SD-OCT) for measurement of macular ganglion cell layer plus inner plexiform layer (GCL+IPL) thickness. Structure-function relationships between OCT measurements and the two VAs were compared. The enrolled eyes were divided into two groups for further analyses according to macular visual field (MVF) defects, specifically two or more adjacent abnormal points within the 12 central sites of 30-2 VF.ResultsThe mean deviation (MD) of 30-2 VF test was −12.77 ± 7.47 dB for glaucoma group and −1.70 ± 1.12 dB for control group. The mean difference of the two VAs was slightly larger in glaucoma group (0.29 logMAR) than in control group (0.22 logMAR). The area under the receiver operating characteristic curve of the high-pass e-chart was larger than that of conventional e-chart (0.917 vs. 0.757, P < 0.001). Significant correlations between high-pass VA and GCL+IPL thickness were found only in the MVF-damaged group. Compared with conventional VA, high-pass VA demonstrates stronger correlations with nasal-side macular GCL+IPL thickness (Fisher's Z-test, two-tailed, P2mm in diameter = 0.033 and P3mm in diameter = 0.005).ConclusionsCompared with conventional VA, high-pass VA displays slightly higher sensitivity to visual loss in glaucoma and has a stronger correlation with the nasal-side macular GCL+IPL thickness.Translational RelevanceThe high-pass acuity test has the potential to be used as an ancillary tool to monitor glaucoma over time.

Macular Cone Abnormalities in Behçet's Disease Detected by Adaptive Optics Scanning Light Ophthalmoscope.

Investigations of morphological changes in photoreceptors in Behçet's disease (BD) using adaptive optics scanning light ophthalmoscope (AOSLO) are lacking. The authors aimed to evaluate macular cone density and regularity in BD patients with or without a history of uveitis with good visual acuity (VA). The authors included 16 patients (29 eyes) with BD and 12 healthy volunteers (12 eyes) as controls. All subjects had VA of 20/20 or higher. Subjects underwent AOSLO to evaluate the photoreceptor status including cone density (numbers/mm2) and proportion of hexagonal Voronoi domains. Hyporeflective patches that were not detected in color fundus photograph or optical coherence tomography were observed by AOSLO in BD patients both with and without past uveitis history; these were not detected in the control group. Cone density was significantly reduced in BD patients with a history of uveitis compared to controls (P = .002). The proportion of hexagonal Voronoi domains was significantly reduced in BD eyes both with and without history of uveitis relative to controls (P < .001). Macular photoreceptor damage was observed in BD patients with and without a history of uveitis. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:218-225.].

Association of Macular Optical Coherence Tomography Measures and Deficits in Facial Recognition in Patients With Glaucoma

This study investigates the association between facial recognition and macular structural damage, as measured by spectral-domain ocular coherence tomography retinal ganglion cell and inner plexiform layer.

Clinical cases of laser-induced macular damage in children

Purpose: To study the features of the clinical and functional state of the eyes in children after laser damage to the retina.&#x0D; Material and methods: We examined six patients who incurred retinal photodamage (nine eyes) after using a laser pointer.&#x0D; Results: It was shown that laser-induced damage to the macula led to a decrease in vision in five of the nine eyes, which correlated with changes in the parameters of the rhythmic and macular electroretinogram. The main pathognomonic symptom of photo damage to the macula is the presence of signs of local destruction of the pigment epithelium and the ellipsoid zone of the retina, according to optical coherence tomography (OCT). In two cases, after a macular burn, a neovascular membrane formed, which led to an irreversible decrease in vision.&#x0D; Conclusion: Uncontrolled use of household laser devices (pointers) by children can lead to severe visual impairment. For this reason, the main priority should be prevention, conducting active sanitary and educational work, informing teachers, parents, and children about the potential harm, and timely detection and treatment of retinal photodamage.

Eclipse retinopathy injury scale (ERIS): A classification of acute macular damage resulting from unprotected solar eclipse viewing

Abstract Introduction. Eclipse retinopathy occurs due to unprotected viewing of a solar eclipse. It is a long-recognized condition. The damage inflicted to the macula is due to a photochemical and photothermal effect caused by sunlight that enters the eye and is focused by the crystalline lens. Animal studies into eclipse retinopathy have been previously carried out. Retinal irradiance levels leading to macular damage have been established in rabbits. Limited data from studies on primates are also available. However, the exact values for humans have not yet been established with confidence. Methods. Here we present a simple method for estimation of the retinal irradiance dose in humans and a classification of macular damage. Results. As an example, the retinal irradiance dose of a theoretical patient observing the solar eclipse of March 20, 2015, is given along with the grade of macular damage according to the developed classification. Discussion. The retinal irradiance values given in the classification are provisional for the time being. With more widespread use among ophthalmologists the developed classification should become useful for prognostic purposes.