Nasal Visual Field Research Articles

Peripheral myopization using a dominant design multifocal contact lens

Purpose The purpose of this study was to characterize the central and peripheral refraction across the horizontal meridian of the visual field without and with a multifocal dominant design soft contact lens of different add powers (+1.00 D to +4.00 D) in emmetropic eyes. Methods Twenty right eyes from 20 emmetropic patients (mean spherical equivalent central refraction –0.06 ± 0.54 D) with a mean age of 21.6 ± 2.3 years were fitted with Proclear Multifocal dominant design (Coopervision, Pleasanton, CA, USA). Lenses had add powers from +1.00 to +4.00 D in 1.00 D steps. The central and peripheral refraction was measured along the horizontal meridian up to 35° of eccentricity in the nasal and temporal retinal area in 5° steps using a open-field autorefractometer. Results Only the +3.00 and +4.00 D add powers generated a significant change in the peripheral refractive pattern compared to central refraction and compared with the no-lens wearing situation. The average myopic increase with these lenses was –3.00 D and –5.00 (p < 0.001) at the margins of inspected nasal and temporal visual field, respectively. Conclusions Multifocal dominant design soft contact lenses are able to change the peripheral refractive profile in emmetropic eyes increasing relative peripheral myopia. Lenses with +3.00 D add power seem to be the best option to create such effect due to significant peripheral myopization.

Vigabatrin-induced peripheral visual field defects in patients with refractory partial epilepsy

Vigabatrin can cause retinopathy, resulting in bilateral visual field constriction. Previous analyses of results from a prospective, observational study assessing vigabatrin-induced visual field constriction (described below) employed a partially subjective interpretation of static perimetery. To affirm these previous findings through more objective, quantitative methodology, we now report data from a subset analysis of refractory partial epilepsy patients in the study who underwent Goldmann kinetic perimetry. Patients aged ≥ 8 years with refractory partial seizures were enrolled and grouped: those receiving vigabatrin for ≥ 6 months (Group I); those who had received vigabatrin for ≥ 6 months and then had discontinued for ≥ 6 months (Group II); and those naïve to vigabatrin (Group III). Patients underwent static or kinetic perimetry, or both, every 4-6 months for ≤ 3 years. For kinetic perimetry, the temporal and nasal visual fields were measured along the horizontal meridian with the largest (V4e, IV4e) and smallest (I2e, I1e) isopters, respectively. Of 735 patients enrolled, 341 had Goldmann perimetry data. Of these, 258 received vigabatrin. Sixteen percent of vigabatrin-exposed patients had moderate visual field defects (30-60° retained temporal vision), and 3% had severe defects (< 30° retained temporal vision). Visual function questionnaire results indicated a weak correlation between visual field constriction severity and visual symptoms. These results affirm both an analysis of the same study based primarily on static perimetry and findings from cross-sectional studies. The present analysis verifies that visual field constriction, when it occurs, is most often mild or moderate and is not associated with symptoms of abnormal visual function. The clinical decision to prescribe vigabatrin should be based on a benefit-risk analysis for each individual patient.

EVOLUTION OF A TUMOR-LIKE LESION IN CEREBRORETINAL VASCULOPATHY AND TREX1 MUTATION

Cerebroretinal vasculopathy (CRV) is an adult-onset autosomal dominant disorder involving the microvessels of the brain and retina due to frameshift mutations in the gene TREX1 .1,2 Patients present with vision loss, seizures, hemiparesis, apraxia, dysarthria, or memory loss. There is progression to blindness, a neurovegetative state, and death within 5 to 10 years.1 MRI reveals a tumor-like lesion in approximately half of patients, resembling a primary brain malignancy, while in the other half there are multiple small white matter lesions which may be misdiagnosed as demyelinating disease. The purpose of this report is to heighten awareness of this disease and to note near resolution of the tumor-like lesion. ### Case report. A 44-year-old woman had daily tension-type headaches and chronic sinusitis since 2006. In June 2007, she had transient right nasal visual field blurring. Visual acuity remained intact. Neurologic examination had normal results. In 2007, a multi-kindred study2 identified the causative mutation of CRV as frameshifts in the C-terminus of the TREX1 gene. The patient was found to carry the V235fs mutation (3688_3689insG). Her father, paternal grandmother, and extended kindred had CRV (n = 27, 4 with active disease, 23 died due to CRV, major family in reference 1). At the age of 43, her father presented with hemiparesis and a tumor-like lesion. He died of progressive disease complicated by steroid-associated bleeding from gastrointestinal ulcers at age 49. Her paternal grandmother had a brain lesion resected, believed to worsen after radiation, and died in …

Peripheral Refraction in Myopic Patients After Orthokeratology

The purpose of this study was to characterize the central and peripheral refraction across the horizontal meridian of the visual field before and after myopic corneal refractive therapy (CRT) with contact lenses. Twenty-eight right eyes from 28 subjects (mean age +/- SD = 24.6 +/- 6.3 years) were fitted with Paragon CRT contact lenses to treat myopia between -0.88 and -5.25 D of spherical equivalent. Along with a complete set of examination procedures to assess suitability for treatment, the central and peripheral refractions were measured along the horizontal meridian up to 35 degrees of eccentricity in the nasal and temporal retinal area in 5 degrees steps. Baseline central average spherical equivalent (M) measured by subjective refraction changed from -1.95 +/- 1.27 D to -0.38 +/- 0.67 D. Changes in M component ranged between 1.42 +/- 0.89 D at center and 0.43 +/- 0.88 D at 20 degrees in the temporal retina (p < 0.002). At 25 degrees to both sides of the central refraction measurement, peripheral refraction after treatment was not statistically different from baseline values (p > 0.351). Beyond the 25 degrees limit, M component changed in the myopic direction up to -1.11 +/- 0.88 D at 35 degrees in temporal retina (p < 0.001). Treatment induced was symmetric between nasal and temporal visual field along the horizontal meridian (p > 0.05 for all eccentricities). Furthermore, the degree of myopic increase in spherical equivalent for 30 degrees (r2 = 0.573, p < 0.001) and 35 degrees (r2 = 0.645, p < 0.001) eccentric refraction was highly correlated with axial spherical equivalent at baseline. CRT inverts the pattern of peripheral refraction in spherical equivalent refraction, creating a treatment area of myopic reduction within the central 25 degrees of visual field, and a myopic shift beyond the 25 degrees. In peripheral refraction for 30 degrees and 35 degrees, the amount of myopia induced in terms of spherical equivalent has an almost 1:1 relationship with the amount of baseline spherical equivalent refraction to be corrected.

Fundus Autofluorescence and OCT in the Management of Progressive Outer Retinal Necrosis.

A 41-year-old woman with AIDS presented with progressive nasal visual field loss in her right eye. Ophthalmic examination revealed widespread retinal opacification with hemorrhage consistent with progressive outer retinal necrosis, which was confirmed by polymerase chain reaction for varicella zoster virus DNA. The patient was treated with intravenous and intravitreal foscarnet and ganciclovir with improvement clinically. Optical coherence tomography (OCT) and fundus autofluorescence imaging revealed progressive changes indicative of widespread retinal pigment epithelial (RPE) and outer retinal dysfunction. OCT showed progressive changes in macular architecture, including neurosensory elevation, cystoid macular edema, and severe outer retinal necrosis, at initial examination and 1 week and 1 month of follow-up. Fundus autofluorescence revealed stippled hyperfluorescence within extensive zones of hypofluorescence, which progressed during follow-up. OCT and fundus autofluorescence was useful in the characterization of the RPE and retinal anatomy in this patient with progressive outer retinal necrosis.

Peripheral Defocus with Single-Vision Spectacle Lenses in Myopic Children

To determine the impact of wearing single-vision spectacle lenses (SVLs) on the refractive errors at the periphery of the retina in myopic eyes of Chinese children. Twenty-eight children (8 to 15 years) were divided into two groups: one (n = 17) comprising children with low myopia (spherical equivalent between -0.75 D and -3.00 D inclusive) and the other (n = 11), with moderate myopia (spherical equivalent between -3.25 D and -6.00 D inclusive). Cycloplegic autorefraction from right eyes was measured at the fovea and at 20, 30, and 40 degrees in the temporal and nasal visual fields. Measurements were taken on each subject both while uncorrected and while wearing SVLs. Hyperopic peripheral defocus was found with SVLs in both the low and moderate myopia groups. However, the increase in relative peripheral hyperopic defocus when wearing spectacle correction, when compared with the uncorrected state was statistically significant for the moderate myopia group only. In the moderate myopia group, relative peripheral hyperopic defocus when wearing spectacle correction was statistically significantly greater vs. the low myopia group at 40 degrees in the nasal field and at both 30 and 40 degrees in the temporal field (p < 0.038). An increase in astigmatism with correction was observed for J45 (p < 0.05) was also seen in eyes with moderate myopia, but this was limited to the nasal field. Previous investigators have suggested that peripheral hyperopic defocus may play a role in the development and progression of myopia. We have shown that SVLs used to correct myopia can result in increased hyperopic defocus at the peripheral retina in the eyes of Chinese children. The magnitude of this increase tends to escalate with increasing refractive error and eccentricity, especially in cases with moderate levels of myopia.

Population distribution of wavefront aberrations in the peripheral human eye

We present a population study of peripheral wavefront aberrations in large off-axis angles in terms of Zernike coefficients. A laboratory Hartmann-Shack sensor was used to assess the aberrations in 0 degrees, 20 degrees, and 30 degrees in the nasal visual field of 43 normal eyes. The elliptical pupil meant that the quantification could be done in different ways. The three approaches used were (1) over a circular aperture encircling the pupil, (2) over a stretched version of the elliptical pupil, and (3) over a circular aperture within the pupil (MATLAB conversion code given). Astigmatism (c(2)(2)) increased quadratically and coma (c(3)(1)) linearly with the horizontal viewing angle, whereas spherical aberration (c(4)(0)) decreased slightly toward the periphery. There was no correlation between defocus and angle, although some trends were found when the subjects were divided into groups depending on refractive error. When comparing results of different studies it has to be kept in mind that the coefficients differ depending on how the elliptical pupil is taken into consideration.

Einseitiger Arterienastverschluss und retinale „white dots“

Since the 1990s an increase in the incidence of syphilis has been observed. The classical course of syphilis can be subdivided into three stages. Ocular involvement is particularly possible in stage III. The disease can be efficiently treated by antibiotic therapy. We report on the case of a 38-year-old patient who presented with loss of nasal visual field and hazy vision in the left eye which had suddenly appeared 2 weeks previously. The patient had received an intravitreal injection of triamcinolon 6 weeks prior to this for mainly left-sided cystoid macular edema which had been interpreted as the manifestation of hypertensive retinopathy by blood pressures of 200/130. An arterial branch occlusion temporal superior could be detected biomicroscopically as well as multiple sharply defined, whitish-yellow, epiretinal and intraretinal spots and lightly blurred papillary edges. Lues serology revealed very high titers. After 2 weeks of i.v. penicillin G therapy there was a clear regression of the chorioretinal foci but persistence of the reduction in vision and loss of visual field. Because of the increasing incidence of syphilis it is becoming more important to consider this disease in the differential diagnosis not only for unclear symptom complexes but also in apparently obvious situations.

Hipertensão intracraniana idiopática de apresentação atípica com papiledema unilateral

We describe a 56-year-old female patient that presented with headache, unilateral optic disc edema and nasal visual field constriction. Laboratory and imaging investigation, clinical findings and response to treatment lead to the diagnosis of idiopathic intracranial hyperthension. We emphasize that unilateral papiledema can be an unusual clinical presentation of the syndrome and discuss its differential diagnosis and treatment. Unilateral papiledema as an atypical presentating sign of idiopathic intracranial hyperthension

Correlation between Local Glaucomatous Visual Field Defects and Loss of Nerve Fiber Layer Thickness Measured with Polarimetry and Spectral Domain OCT

To study the correlation between local perimetric field defects and glaucoma-induced thickness reduction of the nerve layer measured in the peripapillary area with scanning laser polarimetry (SLP) and spectral domain optical coherence tomography (SOCT) and to compare the results with those of a theoretical model. The thickness of the retinal nerve fiber layer was determined in 32 sectors (11.25 degrees each) by using SLP with variable cornea compensation (GDxVCC; Laser Diagnostics, San Diego, CA) and the newly introduced high-resolution SOCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany). Eighty-eight healthy subjects served as control subjects, to determine the thickness deviation in patients with glaucoma. The relationship between glaucomatous nerve fiber reduction and visual field losses was calculated in six nerve fiber bundle-related areas. Sixty-four patients at different stages of open-angle glaucoma and 26 patients with ocular hypertension underwent perimetry (Octopus G1; Haag-Streit, Köniz, Switzerland) and measurements with the two morphometric techniques. Sector-shaped analyses between local perimetric losses and reduction of the retinal nerve fiber layer thickness showed a significant association for corresponding areas except for the central visual field in SLP. Correlation coefficients were highest in the area of the nasal inferior visual field (SOCT, -0.81; SLP, -0.57). A linear model describes the association between structural and functional damage. Localized perimetric defects can be explained by reduced nerve fiber layer thickness. The data indicate that the present SOCT is useful for determining the functional-structural relationship in peripapillary areas and that association between perimetric defects and corresponding nerve fiber losses is stronger for SOCT than for the present SLP. (ClinicalTrials.gov number, NCT00494923.).

Protocole de surveillance ophtalmologique des patients traités par antipaludéens de synthèse ou par vigabatrin au long cours

Treatment with the antimalarials chloroquine or hydroxychloroquine rarely causes retinopathy. Chloroquine and hydroxychloroquine toxicity are untreatable and can progress to legal blindness. Since 1957, there has been a consensus on the need to monitor patients on long-term chloroquine or hydroxychloroquine therapy. Currently, the procedure for follow-up includes collection of patient information, complete ophthalmological exam with automated central perimetry, and retinal electrophysiology. Screening should take place before treatment or no more than 6 months after initiation of antimalarial therapy. During treatment, monitoring relative to the baseline should be at a frequency determined by whether there are risk factors for development of toxicity, such as a cumulative dose greater than 1.8 kg, a daily dose greater than 6.5mg of hydroxychloroquine/kg/day, concurrent or past ophthalmological diseases, hepatic or renal insufficiency, age older than 65 years, and chloroquine intake. Retinopathy can occur in the absence of risk factors. The risk/benefit ratio favors therapy despite the time and expense of screening. Vigabatrin (VGB) is an effective drug for treatment of epilepsy and has been used in the treatment of West syndrome and epilepsy resistant to other drugs. VGB treatment improves quality of life, but it can induce characteristic bilateral nasal visual field defects and changes in retinal electrophysiology. Currently, the recommended procedure is to screen these patients before treatment, if possible, with a complete ophthalmological exam including perimetry and retinal electrophysiology every 6 months. It may be necessary to rely on retinal electrophysiology since some patients may not be able to undergo perimetry. The risk/benefit ratio sill clearly favors VGB treatment. Patients whose seizure incidence is reduced and have only minimal visual changes could continue VGB with strict monitoring. The others must discontinue VGB.

Primary Retinal Detachment

A 57-year old man noted flashing lights in his right eye, followed two days later by a cluster of dark floaters that mildly interfered with his vision. He initially ignored these symptoms, but over the course of the next week, he noted a progressive loss of the nasal visual field in that eye, beginning inferiorly and spreading superiorly, with an eventual striking loss of central acuity that prompted him to seek ophthalmologic evaluation. Examination of the fundus with the pupil dilated showed a retinal detachment involving the temporal retina, including the macula, with peripheral retinal tears at the 10:30 and 11:30 positions. How should his case be managed?

Naso-Temporal Asymmetry for Signals Invisible to the Retinotectal Pathway

Monocular viewing conditions show an asymmetry between stimuli presented in the temporal and nasal visual fields in their efficiency for automatically triggering eye saccades and grasping attention. For instance, observers free to make a saccade to one of two stimuli presented together orient preferentially to the temporal stimulus. Such naso-temporal asymmetry (NTA) has been assumed to reflect the asymmetry in the retinotectal pathway to the superior colliculus. We tested this hypothesis using S cone stimuli, which are invisible to the magnocellular and retinotectal pathways. The observed NTA in choice saccades to bilateral stimuli was no less present for S cone stimuli than for luminance stimuli. Additionally, the amplitude of the NTA can be enhanced when S cone signals are added to luminance signals. These results suggest that behavioral NTA in humans is not diagnostic of retinotectal mediation. Furthermore, we found no asymmetries in latency, suggesting that the NTA in saccade choice does not originate simply from a bottom-up asymmetry in any low level visual pathways.

Appearance of an Illusory Object in the Blind Spot

We report a phenomenon showing new aspects of perceptual filling-in at the blind spot. When two and three discs were presented below the blind spot, observers perceived them as three and four discs, respectively, but when they were presented in the nasal visual field as a control, the perceived numbers were veridical. The phenomenon demonstrates that the visual system produces an illusory object in the blind spot even when the inducing objects presented on only one side of the blind spot are clearly discrete and countable.

Validation of aberrometry‐based relative peripheral refraction measurements

To validate aberrometry-based relative peripheral refraction (RPR) measurements and to examine RPR differences in the nasal and temporal horizontal visual field. Thirty subjects underwent cycloplegia in the right eye. Ten measurements each were made centrally, 30 degrees nasally on the retina and 30 degrees temporally on the retina using the Complete Ophthalmic Analysis System (COAS) aberrometer and the Grand Seiko WR-5100K autorefractor in random order. A 2-mm COAS analysis diameter was used to approximate the Grand Seiko autorefractor measurement beam diameter. Nasal and temporal RPR were calculated as the difference between the average nasal or temporal spherical equivalent and the average central spherical equivalent. Repeated measures ANOVAs were used to test for significant differences between the RPR readings of each instrument in each retinal location (nasal or temporal) and to examine refractive error in each direction of gaze for both instruments. Central spherical equivalent refractive error as measured by the Grand Seiko autorefractor ranged from +0.63 D to -8.41 D (mean +/- S.D. = -2.63 D +/- 2.05 D). There were no significant differences between the instruments for RPR measurements (p = 0.34). The nasal RPR was significantly more hyperopic than the temporal RPR (mean +/- S.D. = +0.45 D +/- 1.04 D, p = 0.02). Spherical equivalent refractive error in all directions of gaze was more myopic with the COAS than with the Grand Seiko autorefractor (mean +/- S.D. = -0.41 D +/- 0.61 D, p < 0.0001). RPR measurements with the COAS are feasible and equivalent to those made with the Grand Seiko autorefractor. The COAS can be used to simultaneously collect RPR and peripheral aberration data. Nasal and temporal RPR measurements were significantly different in our sample.

Visual loss associated with accidental subretinal injection of triamcinolone acetonide.

To describe a complication of and possible retinal toxicity associated with sub-Tenon space injection of triamcinolone acetonide (TA). An interventional case report is presented. During attempted sub-Tenon space injection of TA suspension (40 mg/mL), ≈0.3 mL was inadvertently injected into the temporal subretinal space. Potential sequelae of subretinal TA were assessed with fundus photography and visual field testing. Although subretinal TA resorbed quickly, a dense nasal visual field defect and retinal pigment epithelial changes corresponding to the area of initial subretinal TA deposition persisted for at least 18 months. Subretinal TA may exert retinal and retinal pigment epithelial toxicity.

Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia.

To evaluate refractive error, axial length, and relative peripheral refractive error before, during the year of, and after the onset of myopia in children who became myopic compared with emmetropes. Subjects were 605 children 6 to 14 years of age who became myopic (at least -0.75 D in each meridian) and 374 emmetropic (between -0.25 D and +1.00 D in each meridian at all visits) children participating between 1995 and 2003 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Axial length was measured annually by A-scan ultrasonography. Relative peripheral refractive error (the difference between the spherical equivalent cycloplegic autorefraction 30 degrees in the nasal visual field and in primary gaze) was measured using either of two autorefractors (R-1; Canon, Lake Success, NY [no longer manufactured] or WR 5100-K; Grand Seiko, Hiroshima, Japan). Refractive error was measured with the same autorefractor with the subjects under cycloplegia. Each variable in children who became myopic was compared to age-, gender-, and ethnicity-matched model estimates of emmetrope values for each annual visit from 5 years before through 5 years after the onset of myopia. In the sample as a whole, children who became myopic had less hyperopia and longer axial lengths than did emmetropes before and after the onset of myopia (4 years before through 5 years after for refractive error and 3 years before through 5 years after for axial length; P < 0.0001 for each year). Children who became myopic had more hyperopic relative peripheral refractive errors than did emmetropes from 2 years before onset through 5 years after onset of myopia (P < 0.002 for each year). The fastest rate of change in refractive error, axial length, and relative peripheral refractive error occurred during the year before onset rather than in any year after onset. Relative peripheral refractive error remained at a consistent level of hyperopia each year after onset, whereas axial length and myopic refractive error continued to elongate and to progress, respectively, although at slower rates compared with the rate at onset. A more negative refractive error, longer axial length, and more hyperopic relative peripheral refractive error in addition to faster rates of change in these variables may be useful for predicting the onset of myopia, but only within a span of 2 to 4 years before onset. Becoming myopic does not appear to be characterized by a consistent rate of increase in refractive error and expansion of the globe. Acceleration in myopia progression, axial elongation, and peripheral hyperopia in the year prior to onset followed by relatively slower, more stable rates of change after onset suggests that more than one factor may influence ocular expansion during myopia onset and progression.

Crowding between first- and second-order letter stimuli in normal foveal and peripheral vision

Evidence that the detection of first- and second-order visual stimuli is processed by separate pathways abounds. This study asked whether first- and second-order stimuli remain independent at the stage of processing where crowding occurs. We measured thresholds for identifying a first-order (luminance defined) or second-order (contrast defined) target letter in the presence of two second- or first-order flanking letters. For comparison, we also measured thresholds when the target and flanking letters were all first or second order. Contrast of the flankers was 1.6 times their respective contrast thresholds. Measurements were obtained at the fovea and 10 degrees in the lower visual field of four normally sighted observers. Two observers were also tested at 10 degrees nasal visual field. As expected, in both the fovea and periphery, the magnitude of crowding (threshold elevation) was maximal at the closest letter separation and decreased as letter separation increased. The magnitude of crowding was greater for second- than for first-order target letters, independent of the order type of flankers; however, the critical distance for crowding was similar for first- and second-order letters. Substantial crossover crowding occurred when the target and flanking letters were of different order type. Our finding of substantial interaction between first- and second-order stimuli suggests that the processing of these stimuli is not independent at the stage of processing at which crowding occurs.

Visual Field Defects After Macular Hole Surgery With Indocyanine Green–assisted Internal Limiting Membrane Peeling

To report visual field defects after macular hole surgery with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling. Interventional consecutive case series. A retrospective review of 140 eyes with macular hole after vitrectomy with ILM peeling. The group with 0.25% of ICG for ILM peeling consisted of 96 eyes. The group without ICG consisted of 44 eyes. Nasal visual field defects occurred in 11 eyes, temporal visual field defects in seven eyes, and concentric visual field defects in one eye. In the group with ICG, nasal visual field defects were far higher in the left eye than in the right eye. We speculate that the postoperative nasal visual field defects were caused by the enhanced toxicity of ICG resulting from the exposure to illumination.

Peripheral Refraction in Orthokeratology Patients

The purpose of this study is to measure refraction across the horizontal central visual field in orthokeratology patients before and during treatment. Refractions were measured out to 34 degrees eccentricity in both temporal and nasal visual fields using a free-space autorefractor (Shin-Nippon SRW5000) for the right eyes of four consecutively presenting myopic adult patients. Measurements were made before orthokeratology treatment and during the course of treatment (usually 1 week and 2 weeks into treatment). Refractions were converted into mean sphere (M), 90 degrees to 180 degrees astigmatism (J180), and 45 degrees to 135 degrees astigmatism (J45) components. Before treatment, subjects had either a relatively constant mean sphere refraction across the field or a relative hypermetropia in the periphery as compared with the central refraction. As a result of treatment, myopia decreased but at reduced rate out into the periphery. Most patients had little change in mean sphere at 30 degrees to 34 degrees . In all patients, the refraction pattern altered little after the first week. Orthokeratology can correct myopia over the central +/- 10 degrees of the visual field but produces only minor changes at field angles larger than 30 degrees . If converting relative peripheral hypermetropia to relative peripheral myopia is a good way of limiting the axial elongation that leads to myopia, orthokeratology is an excellent option for achieving this.