Mild Visual Loss Research Articles

Visual loss after use of intraocular silicone oil associated with thinning of inner retinal layers

To investigate the incidence and cause of severe visual loss following use and removal of intraocular silicone oil (SiO) after uncomplicated vitrectomy and SiO injection for primary rhegmatogenous retinal detachment (RRD). Consecutive case series of 216 patients operated with vitrectomy for primary RRD in 2004-2005. In 162 eyes, SiO (5500 centiStoke) had been used as intravitreal tamponade and in 54 eyes gas (perflouropropane, C(3) F(8) ) had been used. Following chart review, we identified 16 eyes in 16 patients (nine SiO eyes, seven gas eyes) with macula-on and documented visual acuity ≥6/12 before surgery, where SiO had been removed, cataract surgery performed and no re-detachment had occurred. Examinations included best-corrected visual acuity (BCVA) and high-definition optical coherence tomography (OCT) of the macular area. Preoperative characteristics were identical between SiO and gas eyes. Postoperative BCVA was significantly worse in SiO eyes (>6/24) compared to gas eyes (>6/7.5), p = 0.005. Three of 9 (33%) SiO eyes had final BCVA ≤6/60 and 67% had final BCVA ≤6/12. No gas eyes had final BCVA <6/9. Macular OCT revealed thinning of inner retinal layers in SiO-operated eyes (5148 pixels) compared to gas-operated eyes (6897 pixels), p < 0.002. No other visually significant structural differences were found. Severe visual loss after SiO use was observed in 1/3 of patients with otherwise good visual potential. The visual loss was associated with a significant reduction in inner retinal thickness indicating neuronal cell loss in the macular area as a possible explanation.

Vision Loss and Recovery After Trabeculectomy

To assess the risk of long-term vision loss after trabeculectomy and to determine the course of long-term vision loss vs transient loss and recovery. The medical records of 301 eyes in 262 patients undergoing trabeculectomy between January 1999 and September 2003 were retrospectively reviewed. Postoperative vision loss was categorized as mild or moderate (decrease in Snellen visual acuity of 3-5 lines) vs severe (decrease of >5 lines). Postoperative vision loss was considered permanent if visual acuity did not have a return of 3 lines within a 6-month follow-up period. Permanent vision loss occurred in 24 of 301 eyes (8.0%): 13 (4.3%) had mild or moderate vision loss, and 11 (3.7%) had severe vision loss. Ten eyes (3.3%) with permanent mild or moderate vision loss and 6 eyes (2.0%) with permanent severe vision loss had no identifiable cause. Significant risk factors for permanent severe unexplained vision loss were preoperative split fixation on visual fields, preoperative number of quadrants with split fixation, and postoperative choroidal effusions with eventual resolution. Transient vision loss occurred in 170 of 301 eyes (56.5%): 79 (26.2%) had mild or moderate vision loss, with a mean time to recovery of 88 days (range, 6-720 days), and 91 (30.2%) had severe vision loss, with a mean time to recovery of 78 days (range, 6-720 days). Transient vision loss after trabeculectomy is common and may take up to 2 years for recovery. The risk of permanent vision loss is less common but significant. Two percent of our study population experienced permanent severe unexplained vision loss ("snuff-out"), and risk factors included preoperative split fixation on visual fields, preoperative number of quadrants with split fixation, and postoperative choroidal effusions with eventual resolution.

Factors affecting visual outcome in herpes zoster ophthalmicus: a prospective study

To evaluate visual outcome and factors affecting visual outcome in herpes zoster ophthalmicus (HZO). A prospective, longitudinal, observational study was undertaken in 64 consecutive patients with HZO presenting within 72 h of rash onset. Patients underwent detailed ophthalmological and dermatological examinations at presentation, with follow up at first, second and fourth weeks and third and sixth months. All patients received both systemic and topical acyclovir. The main outcome measure was best-corrected visual acuity at 6 months' follow up. Local and systemic factors were correlated with visual outcome using univariate and multivariate analyses. Overall visual outcome was good, with 36/64 (56.3%) patients having a visual acuity of 6/6 or better. Mild visual loss occurred in 22/64 (34.3%), moderate loss in 3/64 (4.7%) and severe loss in 3/64 (4.7%); moderate to severe visual loss was due to severe uveitis (2), neurotrophic keratitis (1) and cataract (3). Increasing age (P = 0.04), positive Hutchinson sign (P = 0.001), absent corneal sensation (P = 0.01), corneal epithelial lesions (P = 0.03) and uveitis (P < 0.001) were significantly associated with visual loss. Uveitis was found to be the best predictor of visual loss in HZO on multivariate analysis. The overall visual outcome is good in HZO patients receiving antiviral therapy. Hutchinson's sign and anterior uveitis were found to be strong predictors of visual loss in HZO. Presence of these predictors calls for close monitoring.

Dysthyroid optic neuropathy (DON): diagnosis and associated features

Abstract Purpose To determine the frequency of occurence and severity of dysthyroid optic neuropathy (DON), in relation to the degree of inflammatory signs, exophthalmos, asymetrical disease and diplopia, among patients with newly diagnosed inflammatory thyroid related ophthalmopathy (TAO) or suffering from the recurrence of the inflammatory phase of previously inactive/fibrotic stage of the disease. Methods 400 subjects with TAO, 76% women and 24% men aged 29.0 to 88.0 (mean 55.5 +/‐ 9.8) years with Clinical activity scores between 2 and 9 ( mean 4.6 +/‐ 2.3) were included into the study. 30 healthy age and sex matched patients served as control. Diagnosis of DON was based on the presence of at least two features related to the optic nerve involvement, different than reduction of visual acuity. Results Two or more clinical features of DON werefound in 27 patients with inflammatory TAO. 20 of whom displayed asymmetrical involvement ( &gt; 2mm difference in exophthalmos and &gt; 2 in CAS scale). There was slight statistical association between neuropathy and diplopia with neuropathy patients being more likely to suffer from constant double vision. There was no correlation between CAS and DON. Visual acuity was reduced from 2 to 7 Snellen lines in patients with DON and from 2 to 6 lines in TAO and not DON. Conclusion Clinical features of DON occour in 6.75% of patients with inflammatory TAO. There is no correlation between the degree of inflammatory involvement and DON, therefore it must be carefully excluded in all patients even with apparently mild ophthalmopathy. Thera numerous other, than DON,causes of visual loss related to TAO. Majority of patients present with mild and moderate visual loss only, which is reversible on immunomodulatory treatment.

Paranasal sinus mucoceles with visual disturbance

Objective Paranasal sinus mucoceles may cause visual disturbance in patients because of their close proximity to the orbit. We aimed to investigate visual prognosis to determine whether it is influenced by the interval before surgery and the severity of visual disturbance, and to heighten the physician's awareness of the occurrence of this disease. Methods We retrospectively reviewed eight surgically treated patients with paranasal sinus mucoceles accompanied by visual disturbances between March 2005 and January 2009, and examined the visual acuity outcome of the patients. Results Four patients with a mild visual acuity loss showed improvement after surgical drainage within 1 month after onset. Two patients with visual disturbances persisting for more than 1 year did not show postoperative improvements. Although two patient's preoperative visual acuity loss was worse than the ability to count fingers, they showed a remarkable improvement after surgery. Conclusions These results show the importance of diagnosing and treating paranasal sinus mucoceles with visual disturbance as soon as possible. In addition, the improvement of visual acuity can be expected if surgery is performed within 1 month after onset, and the patient's preoperative visual acuity loss is mild. However, if patients with severe visual acuity loss consult otolaryngologists at a later date, surgery may still be considered worthwhile.

Should Steroids be Offered to Patients With Nonarteritic Anterior Ischemic Optic Neuropathy?

The treatment of nonarteritic anterior optic neuropathy remains very limited and disappointing. Recent publications have suggested that oral steroids as well as intravitreal injections of steroids might be helpful to accelerate resolution of disc edema and improve visual outcome. However, the use of steroids to treat acute NAION remains largely debated.

Normalization of generalized retinal function and progression of maculopathy after cessation of therapy in a case of severe hydroxychloroquine retinopathy with 19 years follow-up

A 40-year-old Caucasian female was first seen 20 years ago for a routine ocular screening in relation to hydroxychloroquine treatment for systemic lupus erythematosus. Her daily dose was 600 mg (or 12 mg/kg of body weight/day) of hydroxychloroquine. Three years later, she complained of mild visual loss in the right eye. Her best-corrected visual acuity was 0.9 in the right (RE) and 1.0 in the left eye (LE). In addition, she had a central scotoma (RE > LE) on automated visual field analysis (Humphrey central 30 degrees ). On fundoscopy and fluorescein angiography, the first signs of a bilateral bull's eye maculopathy were detected. A decreased Arden ratio on EOG (<1.50) was found with an accompanying decreased amplitude of the scotopic b-wave on full-field electroretinography in both eyes. Consequently, the treatment was immediately stopped. During the following years, the patient was retested regularly. After more than 18 years after cessation of the drug, most tests showed a further deterioration, including best-corrected visual acuity (RE: 0.1; LE: 0.7). On visual field testing, a progressive evolution to a total and absolute central scotoma in the RE (central 10 degrees ) and an annular scotoma in the LE became apparent. In contrast, a partial recovery of the Arden ratio of the EOG to 1.8 in both eyes was seen. In addition, a partial recovery of the scotopic b-wave full-field ERG was noted 19 years after cessation of treatment. At retest visits respectively 18, 19 and 20 years after cessation of hydroxychloroquine, a multifocal electroretinogram was performed in combination with colour vision tests and contrast sensitivity measurements.

Mediterranean spotted fever: a report of 200 cases in Tunisia

Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, TunisiaINTRODUCTIONMediterranean spotted fever (MSF) is a tick-bornezoonosis caused by Rickettsia conorii. Its firstdescription was made by Conor and Brush inTunisia in 1910, where this disease is the mostcommon rickettsiosis.The characteristic symptoms are fever and rashwith the presence of a black eschar ‘tache noire’ inthe majority of cases. Early empiric therapy withtetracycline is the standard care for any caseconsidered consistent with a MSF infection whileconfirmatory laboratory results are pending.The aim of our study is to assess the effective-ness of a short course of antibiotic treatment inMSF.MATERIALS AND METHODS

Visual Field Loss and Risk of Fractures in Older Women

To evaluate the associations between visual field loss and nonspine fractures. Prospective cohort study. Community. Four thousand seven hundred seventy-three community-dwelling white and African-American women aged 65 and older with no previous history of hip fracture at the time of recruitment. Radiographically confirmed hip and nonspine, nonhip fractures identified from September 1997 to April 2008. Visual field loss was measured using a Humphrey Field Analyzer suprathreshold screening test of the peripheral and central vision of each eye and was classified into an ordinal rating of no, mild, moderate, or severe binocular visual field (BVF) loss. For hip and nonspine, nonhip fractures and in unadjusted and covariate-adjusted analyses, the highest incidence of fractures was seen in women with the most-severe BVF loss. In covariate-adjusted analysis, women with mild, moderate, and severe BVF loss had a 49% (hazard ratio (HR)=1.49, 95% confidence interval (CI)=1.18-1.88), 25% (HR=1.25, 95% CI=0.87-1.80), and 66% (HR=1.66, 95% CI=1.19-2.32) greater risk, respectively, for hip fractures than women without BVF loss. Similarly, women with mild visual field loss had a 12% (HR=0.88, 95% CI=0.75-1.04) lower risk for nonspine, nonhip fractures, whereas women with moderate and severe visual field loss had a 18% (HR=1.18, 95% CI=0.92-1.52) and 59% (HR=1.59, 95% CI=1.24-2.03) greater risk of nonspine, nonhip fractures than women without BVF loss. BVF loss is independently associated with hip and nonspine, nonhip fractures in older female volunteers.

The Neuro-Ophthalmology Research Disease Investigator Consortium (NORDIC)

The Neuro-Ophthalmology Research Disease Investigator Consortium (NORDIC)

CERKLMutations Cause an Autosomal Recessive Cone-Rod Dystrophy with Inner Retinopathy

To define the phenotype of the retinal degeneration associated with mutations in the CERKL gene. Six patients (ages, 26-54 years) from three unrelated families with CERKL mutations were studied clinically and by electroretinography, kinetic, and chromatic static perimetry, autofluorescence (AF) imaging, and optical coherence tomography (OCT). Three siblings were homozygotes for p.R257X mutation; two siblings were compound heterozygotes for p.R257X and a novel p.C362X mutation; and one patient had only p.R257X mutation identified to date. There was a spectrum of severity: from mild visual acuity loss to light perception; from full kinetic fields with relative central scotomas to remnant peripheral islands; from reduced ERGs (some with negative waveforms) to nondetectable signals. Maculopathy showed residual foveal islands or extensive central rod and cone scotomas. With AF imaging, there was evidence of hyperautofluorescence at earlier and hypoautofluorescence at later disease stages. Peripheral function was generally less affected than central function. With OCT there were small foveal islands of outer nuclear layer (ONL) in those with preserved acuity. Eccentric to an annular region with no discernible ONL, there could be ONL in the midperiphery. At early disease stages, ganglion cell layer thickness was less affected than ONL. Later disease stages were accompanied by inner nuclear layer and nerve fiber layer abnormalities. CERKL mutations are associated with widespread retinal degeneration with prominent maculopathy. The clinical presentation is that of an autosomal recessive cone-rod dystrophy. Photoreceptor loss appears at all stages of disease and inner laminopathy complicates the phenotype at later stages.

Visual Impairment and Vision-Related Quality of Life in Working-Age Adults: Findings in the 1958 British Birth Cohort

To describe the prevalence of impaired vision and its relative burden, together with the prevalence of impaired vision-related quality of life (VRQOL), and investigate associations with social outcomes in a contemporary and nationally representative population of working age adults. Population-based cross-sectional study. We included 9330 members of the 1958 British birth cohort at age 44 and 45 years. "Habitual" and "best achieved" distance visual acuity in each eye, binocular near vision acuity and stereoacuity (three dimensional/depth perception) were tested during a broader biomedical examination. VRQOL was assessed using the Vision-related Quality of Life Core Measure 1 (VCM1), a validated, 10-item, self-complete instrument. Logistic and proportional odds ordinal logistic regression were used to calculate odds ratios (ORs) of the association of VRQOL with visual acuities and social outcomes. Distance, near, and stereo acuities and VRQOL and social outcomes. Of the 1.3% (124) of those with visual loss that precluded driving, a further 0.75% (70) were visually impaired or severely visually impaired and 0.15% (14) blind, the latter accounting for 19% total population (all ages) burden of blindness. Impairment of VRQOL is strongly associated with impaired distance, near, and stereo vision, as well as with adverse occupational and other social outcomes. However, VRQOL impairment is also sometimes reported with unilateral or mild bilateral visual loss. Although impaired vision in working age adults is relatively uncommon, it confers important adverse consequences for the "health and wealth" of the public. This may be captured best by assessment of VRQOL in addition to objective visual function. Ophthalmic disorders occurring or impacting in middle life should be given a higher priority than currently in national and international strategies against avoidable visual disability. Proprietary or commercial disclosure may be found after the references.

Total Deviation Probability Plots for Stimulus Size V Perimetry

To compare empirical probability plots in patients with glaucoma for size V and III perimetry testing. We computed empirical probability plot percentile limits after testing 60 age-matched controls tested with both size III (Swedish interactive thresholding algorithm) and size V (full threshold) perimetry twice. Probability plots of 120 patients with glaucoma tested in the same way were computed. We compared the number of abnormal test locations in the 2 stimulus sizes; we then compared these results with those from size III StatPac software (Zeiss Humphrey Systems, Dublin, California) using 2-way repeated-measures analysis of variance. We found a similar number of abnormal test locations (P < or = .05) for the size III and size V testing conditions identified by the probability plots (no significant difference); there were significantly fewer abnormal locations using StatPac (size III) than from our size III database. When results were stratified by mean deviation, the mild visual loss group again did not show any significant differences between sizes III and V. Size V full-threshold testing gives a similar number of abnormal test locations in patients with glaucoma compared with the size III Swedish interactive thresholding algorithm standard test. Size V testing, with its greater dynamic range and lower variability, may be a viable alternative to size III testing in patients with glaucoma.

Assessing Participation in Daily Living and the Effectiveness of Rehabiliation in Age Related Macular Degeneration Patients Using the Impact of Vision Impairment Scale

Purpose: To assess if the Impact of Vision Impairment (IVI) is a valid instrument to measure participation in daily activities and rehabilitation in patients with age-related macular degeneration (AMD) and varying levels of visual impairment. Methods: Participants, recruited from a public eye hospital and low vision centers, completed the IVI questionnaire. The IVI and its three subscales were assessed for fit to the Rasch model. Unidimensionality, item fit, response category performance, and targeting of items to patients were assessed. Confirmatory factor analysis (CFA) was used to assess the three-factor model of the IVI in this sample of AMD patients. Results: 219 patients (mean ± SD age = 83.5 ± 7.4 yr) were recruited. Of these, 22%, 55% and 23% had mild (< 6/12–6/18), moderate (< 6/18–6/60) and severe (< 6/60) vision loss, respectively. The IVI total and three subscales displayed discrete thresholds indicating that the respondents understood the response categories. The IVI items fitted the scale and unidimensionality was established. Person separation reliability for the IVI score was substantial (0.94) indicating that the scale can discriminate between several groups of AMD patients. The IVI items were significantly targeted to the AMD patients with the means of the two distributions shown to be very close (0.0 and 0.1, respectively). Substantial targeting was also evident for the subscales. Poorer visual acuity was significantly associated (ANOVA; F (2, 216) = 23.4; p < 0.001) with greater restriction of participation suggesting that the IVI has substantial construct validity. CFA supported the IVI three-factor model which includes items from the “emotional well-being, “reading and accessing information” and “mobility and independence” subscales. Conclusions: Clinicians and researchers can reliably use the IVI to assess the impact on daily life and the effectiveness of clinical trials and rehabilitation interventions in patients with AMD across a range of vision loss.

Visual Acuity in 3422 Consecutive Eyes With Choroidal Nevus

To evaluate visual acuity in eyes with choroidal nevus. This was an observational case series. Of 3422 consecutive eyes with choroidal nevus, vision loss at 15 years occurred in 2% of eyes with extrafoveolar nevus and in 26% of eyes with subfoveolar nevus, particularly those with overlying retinal pigment epithelial detachment and foveal edema. A retrospective medical record review was conducted, with evaluation of visual acuity at presentation and at final examination. The main outcome measure was visual acuity. The median visual acuity at presentation was 20/20 for eyes with either extrafoveolar or subfoveolar choroidal nevus. Using Kaplan-Meier estimates, vision loss of 3 or more logarithm of the minimum angle of resolution (logMAR) lines at 5, 10, and 15 years occurred in less than 1%, 1%, and 2% of eyes with extrafoveolar nevus compared with 15%, 20%, and 26% of eyes with subfoveolar choroidal nevus, respectively. By multivariate analysis, factors predictive of visual loss of 3 or more logMAR lines included subfoveolar nevus location (relative risk [RR], 15.52), juxtapapillary nevus location (RR, 4.52), initial visual acuity of 20/50 or worse (RR, 15.40), overlying retinal pigment epithelial detachment (RR, 22.16), and foveal edema (RR, 9.02). Factors predictive of poor final visual acuity of 20/200 or worse included subfoveolar nevus location (RR, 11.32), overlying orange pigment (RR, 3.68), overlying retinal pigment epithelial detachment (RR, 12.80), and foveal edema (RR, 18.72). Mild vision loss over many years should be anticipated in patients with subfoveolar choroidal nevus, particularly those with overlying retinal pigment epithelial detachment, orange pigment, and foveal edema.

IAPO20 A patient with mental retardation and mild visual loss: Susac syndrome

IAPO20 A patient with mental retardation and mild visual loss: Susac syndrome

Aqueous Humor sCD44 Concentration and Visual Field Loss in Primary Open-angle Glaucoma

To correlate aqueous humor soluble CD44 (sCD44) concentration, visual field loss, and glaucoma risk factors in primary open-angle glaucoma (POAG) patients. Aqueous samples were obtained by paracentesis from normal and glaucoma patients who were undergoing elective surgery and analyzed for sCD44 concentration by enzyme-linked immunosorbent assay. In normal aqueous (n=124) the sCD44 concentration was 5.88+/-0.27 ng/mL, whereas in POAG aqueous (n=90) the sCD44 concentration was 12.76+/-0.66 ng/mL, a 2.2-fold increase (P<0.000001). In POAG patients with prior successful filtration surgery (n=13), the sCD44 concentration was decreased by 43% to 7.32+/-1.44 (P=0.001) in comparison with POAG patients without filtration surgery; however, the sCD44 concentration in the prior successful filtration subgroup with no medications and normal intraocular pressure was 12.62+/-3.81 (P=0.05) compared with normal. The sCD44 concentration of normal pressure glaucoma patients was 9.19+/-1.75 ng/mL, a 1.6-fold increase compared with normal (P=0.02). Race and intraocular pressure pulse amplitude were significant POAG risk factors in this cohort of patients. In both normal and POAG patients with mild and moderate visual field loss, sCD44 concentration was greater in African Americans than in whites (P=0.04). sCD44 concentration in the aqueous of POAG patients correlated with the severity of visual field loss in all stages in white patients and in mild to moderate stages in African American patients. sCD44 concentration in aqueous is a possible protein biomarker of visual field loss in POAG.

Isolated paraneoplastic optic neuropathy associated with small-cell lung cancer and anti-CV2 antibodies

Sirs: Paraneoplastic neurological syndromes (PNS) are disorders that occur in patients with systemic cancer, which are not due to direct tumour invasion or metastasis, chemotherapy or radiotherapy-induced neurotoxicity, coagulopathy, infection or metabolic or nutritional deficits. They are mediated by immunological mechanisms related to onconeural antigens expression by cancer cells [1]. Paraneoplastic optic neuropathy is an uncommon disorder [2–8]. We describe a patient with an isolated optic neuropathy associated with small-cell lung cancer and anti-CV2 antibodies. The patient was a 64-year-old heavy-smoker male who developed painless, progressive vision loss in his left eye, with only perception of movement 5 days after onset and mild visual loss in his right eye 2 days later. General and neurological examination revealed no abnormalities. Visual acuity was 0.4 in the right eye and only movement perception in the left one; a left relative afferent pupillary defect was present. Funduscopy showed right eye papilledema, whereas the left papilla was pale. Fluorescein angiography showed vitreous turbidity and dye enhancement in both papillae; no signs of retinitis or vasculitis were found. Blood analysis, including ESR, thyroid function tests, angiotensin-converting enzyme levels, autoantibodies and tumour markers (including neuron-specific enolase), were negative. CSF showed five mononuclear cells/ mm, a protein level of 78 mg/dl and no oligoclonal bands. Cytological examination was negative. Anti-CV2 antibodies were found in serum (1/8,000) and CSF (1/400), but not in aqueous humour. Brain MRI showed no abnormalities. Visual evoked potentials showed reduced amplitudes and mildly prolonged P100 latencies. Electroretinography was normal. A thorax CT scan revealed a 3-cm cystic nodule in the right superior lobe. Video-assisted thoracoscopy with lung biopsy was done; smallcell lung cancer was diagnosed. Methylprednisolone (1 g iv. daily for 5 days) was given and chemotherapy (cisplatin plus etoposide) was started after diagnosis of limited-stage disease. Fifteen months after diagnosis visual acuity was 0.7 in both eyes and no further relapses nor new neurological symptoms or signs developed over follow-up. Anti-CV2 antibodies remained in the serum sample at the same titer of 1/8,000. We report a patient with a seven-day history of painless, progressive, asymmetric, optic neuropathy as the only manifestation of small-cell lung cancer associated with anti-CV2 antibodies. Anti-CV2 (also called CRMP5-IgG) is an IgG autoantibody specific for the 62 kDa collapsing response-mediator protein 5 (CRMP-5) [9, 10]. Both the retina and the optic nerve contain full-length CRMP-5 protein. AntiCV2/CRMP-5 antibodies are markers of paraneoplastic autoimmunity related to lung cancer (mainly small-cell type) or thymoma [9, 10]. Graus et al. [11] have recently recommended diagnostic criteria for PNS. Although optic neuropathy is not a classical syndrome, our patient fulfills criteria for PNS as a non-classical syndrome with onconeural antibodies (anti-CV2/CRMP-5) and cancer (small-cell carcinoma). Response to therapy (steroids and chemotherapy) can be interpreted as an additional data supporting the diagnosis. Optic neuropathy is an uncommon paraneoplastic manifestation of cancer. Up to date, only 42 patients with paraneoplastic optic neuropathy have been reported in the English literature. However, nearly always patients had other neurological symptoms or signs, such as neuropathy, cerebellar ataxia, dementia, other cranial nerve abnormalities, A. Ares-Luque (&) L.A. Garcia-Tunon AE B.C. Cabezas L.E. Hernandez-Echebarria AE J. Tejada Neurology Dept. Hospital de Leon C/ Altos de Nava sn. 24071 Leon, Spain Tel.: +34-98/7237400 Fax: +34-98/7240503 E-Mail: adrianares@telefonica.net

Multifocal Electroretinography, Color Discrimination and Ocular Toxicity in Tamoxifen Use

Purpose: To study prospectively retinal function, color discrimination, and ocular toxicity in women treated with standard-dosage tamoxifen for breast cancer. Methods: Thirty visually asymptomatic patients with at least 2 years of continuous tamoxifen therapy underwent multifocal electroretinography (ERG), color discrimination testing, and ophthalmic examination. The results were compared with 17 patients who were not taking tamoxifen after breast cancer surgery and to an additional age-matched group of 21 healthy women. Results: Multifocal electroretinogram amplitudes and latencies were comparable among the three studied groups, and individual recordings were within age norms from our own lab. In the treated group, mild diffuse color vision loss was found in two patients with normal fundi. Three other patients had ocular toxic effects, with two cases of refractile retinal crystals and one case of keratopathy. Conclusions: The aspects of central retinal function that are assessed by multifocal ERG were not affected even after at least 2 years of tamoxifen use, suggesting that the multifocal ERG is not sufficiently sensitive to detect tamoxifen-associated change that might occur. Some degree of color vision loss and ocular toxic effects were found in a few cases of this cohort suggesting that women using tamoxifen should receive an eye exam at least as often as recommended for middle-aged people.

Artérite à cellules géantes révélée par des nodules cotonneux

Giant cell arteritis is the most common vasculitis in the elderly. Visual loss is established as the most dreaded and irreversible complication of the disease, which makes giant cell arteritis an ophthalmic emergency. It is important to recognize its various ocular manifestations; isolated cotton wool spots are one of them. We describe a patient with constitutional symptoms and mild visual loss who was found to have giant cell arteritis. The ophthalmic examination was significant for only isolated cotton-wool spots. A delay in arm-to-retina circulation time was demonstrated by fluorescein angiography. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots. Common ophthalmologic presentations include anterior ischemic optic neuropathy or choroidal ischemia when short posterior ciliary arteries are involved, and central retinal artery occlusion. Retinal ischemia has also been recognized as a possible manifestation. Because the disease concerns medium-size and larger arteries, it cannot involve terminal retinal arterioles to produce cotton-wool spots. These are probably caused by platelet microembolization from the partially thrombosed regional arteries. Isolated cotton-wool spots can be an early ophthalmoscopic finding in giant cell arteritis and precede severe irreversible visual loss. Their detection is essential because it allows the ophthalmologist to establish a prompt treatment and preserve vision.