Normal Visual Fields Research Articles

Validating and updating the OHTS-EGPS model predicting 5-year glaucoma risk among ocular hypertension patients using electronic records

ObjectiveTo validate and update the OHTS-EGPS model predicting risk of conversion from OHT to glaucoma using electronic medical records (EMR). DesignEvaluation and update of a risk prediction algorithm using EMRs and linked visual field (VF) tests. ParticipantsNewly diagnosed OHT patients attending hospital glaucoma services in England. Inclusion criteria: IOP 22-32 mmHg (either eye); normal baseline VF test, defined as Glaucoma Hemifield Test (GHT) ‘within normal range’ in a reliable VF test; at least two VF tests in total; no significant ocular co-morbidities. MethodsRisk factors: age, ethnicity, sex, IOP, vertical cup-to-disc ratio, central corneal thickness, VF pattern standard deviation, family history of glaucoma, systemic hypertension, diabetes mellitus, glaucoma treatment. Glaucoma conversion was defined as two consecutive and reliable VF tests with GHT ‘outside normal limits’ and/or need for glaucoma surgery. For validation, the OHTS-EGPS model was applied to predict a patient’s risk of developing glaucoma in 5 years. In the updating stage, the OHTS-model was re-fitted by re-estimating the baseline hazard and regression coefficients. The updated model was cross-validated and several variants were explored. Main Outcome MeasuresMeasures of discriminative ability (c-index) and calibration (calibration slope) were calculated and pooled across hospitals using random effects meta-analysis. ResultsFrom a total of 138,461 patients from ten hospital glaucoma services in England 9030 patients with OHT fitted the inclusion criteria. A total of 1530 (16.9%) patients converted to glaucoma during this follow-up period. The OHTS-EGPS model provided a pooled c-index of 0.61 (95% confidence interval: 0.60, 0.63), ranging from 0.55 to 0.67 between hospitals. The pooled calibration slope was 0.45 (0.38, 0.51), ranging from 0.25 to 0.64 among hospitals. The overall re-fitted model performed better than the OHTS-EGPS model, with a pooled c-index of 0.67 (0.65, 0.69), ranging from 0.65 to 0.75 between hospitals. ConclusionsWe performed an external validation of the OHTS-EGPS model in a large English population. Re-fitting the model achieved modest improvements in performance. Given the poor performance of the OHTS-EGPS model in our population, one should use caution in its application to populations that differ from those in the OHTS and EGPS.

Visual recovery following pituitary adenoma surgery: prognostic value of optical coherence tomography and suprasellar tumour volume

ObjectiveThe aim of this study is to investigate the effects of preoperative parameters such as retinal nerve fiber layer (RNFL) thickness, visual acuity (VA), visual field (VF), and tumour volume on postoperative outcomes in patients with pituitary adenoma. DesignRetrospective study. ParticipantsTwo-hundred and seventy-six eyes from 142 patients were included. MethodsAll patients underwent a comprehensive ophthalmological evaluation both before and 12 months after the surgery. RNFL thickness was analyzed using optical coherence tomography. VF testing was carried out using the automated Humphrey Visual Field Analyzer 3. Two primary visual field (VF) parameters, mean deviation (MD), and pattern standard deviation (PSD), were recorded. Patients were categorized into 2 groups based on their visual field outcomes: the MD recovery group and the nonrecovery group. MD recovery was defined as an MD value greater than −2 dB at the 12-month postoperative follow-up visit. ResultsThe mean BCVA was significantly improved postoperatively compared with the preoperative values (P = 0.001). Preoperatively, the upper, temporal, and inferior RNFL values were significantly higher in patients with normal visual fields compared to those with abnormal visual fields (P = 0.001 for upper and temporal, P = 0.008 for inferior). Preoperative suprasellar tumour volume was found to be lower in the MD recovery group (P = 0.001). Multivariate logistic regression analyses revealed that preoperative inferior RNFL thickness were significantly associated with MD recovery (P = 0.023), and preoperative temporal RNFL thickness were significantly associated with VA recovery (P = 0.047). ConclusionRNFL thickness, VF parameters, and suprasellar tumour volume can serve as important prognostic indicators in patients with pituitary adenoma.

9183 Pituitary Metastasis Of Lung Adenocarcinoma Presenting As Anterior Pituitary Dysfunction

Abstract Disclosure: O. faour: None. M. Kinaan: None. S.K. Suryanarayanan: None. Introduction: The pituitary should not be overlooked as a site for metastasis and can be the first presentation of neoplastic disease in some patients. Most common presenting symptoms: headache, ophthalmoplegia, visual field defect and Arginine Vasopressin Deficiency (AVP-D). We present a case of pituitary metastasis of lung adenocarcinoma presenting as anterior Pituitary dysfunction that also showed partial AVP-D unmasked after starting steroids. Case Description: A 63-year-old male with history of tobacco use, COPD, and hypertension presented with syncope. He reported a 30lbs weight loss within prior 2 months, low energy, increased thirst, and polyuria. Physical exam was significant for cachexia, normal visual field on confrontation, and vital signs of BP 100/61, HR 83, and Weighing 180 lbs. Since he had syncope, Cortisol checked was undetectable and Free T4 was low, He was started on hydrocortisone and levothyroxine. CTA chest revealed a right hilar mass measuring 2.7 x 3 cm. Endobronchial biopsy was consistent with lung adenocarcinoma. MRI of pituitary gland revealed solid hypointense lesion with glandular thickening and diffuse heterogeneity involving most of the pituitary gland measuring up to 16 mm. No cavernous sinus invasion. Pituitary infundibulum showed diffuse thickening and enhancement of the pituitary stalk throughout with Intact posterior pituitary bright spot. Labs showed low LH, cortisol, ACTH, GH, TSH, and ADH. Initially, the patient was able to maintain a euvolemic status through increased water intake; however, he was later found to have partial central AVP-D when steroids were introduced. He responded to the use of Desmopressin, developed hyponatremia after 3 doses. He was started on a combination of carboplatin/pemetrexed/pembrolizumab but had no response and was transferred to palliative care/hospice and passed away within 7months after diagnosis.Discussion:Pituitary metastasis is rare and most commonly occurs in lung and breast cancers. Unfortunately, they are associated with poor prognosis. MRI findings of loss of posterior pituitary bright spot, thickening of the stalk, and dumbbell shape can be helpful in distinguishing between primary pituitary tumors and metastases. PET-FDG scan has limited value. Pituitary metastasis commonly presents with posterior pituitary dysfunction due to direct blood supply. Unmasking or worsening of AVP-D can happen with steroid replacement in patients requiring initiation or intensification of Desmopressin therapy. Treatment involves combination of surgery, radiation therapy, and systemic treatment for the primary cancer which can improve symptoms only but does not improve mortality. Presentation: 6/1/2024

A study on correlation between automatedperimetry and optical coherence tomography findings in glaucoma suspects

To evaluate the correlation between optic disc and retinal nerve fiber layer (RNFL) parameters of SD OCT scan of optic disc, and, visual field indices of Humphrey visual field analyzer. This is a prospective, cross-sectional study of 47 patients who are glaucoma suspects. They have been screened for glaucoma by comprehensive ophthalmic examination including visual field testing by automated perimetry and optic nerve head and retinal nerve fiber layer thickness changes assessment by optical coherence tomography. Mean age of the glaucoma suspects was 54.35 ± 10.6 years. Women were having higher (58.7%) mean age as compared to men (41.3%). Mean IOP in glaucoma suspects was 17.97 mmHg. The mean CD ratio was measured as 0.66 ± 0.11 and with significant negative correlation between the mean MD and CD ratio values (p<0.05) and similarly between MD and Vertical CDR. PSD showed significant positive correlation with CDR and also with Vertical CDR. Correlation is noted between MD and average RNFL, with significant positive correlation between MD and superior RNFL. Spectral domain OCT, when used in combination with automated perimetry helps in early diagnosis of glaucoma.SD OCT of Optic disc alone can detect changes of RNFL in patients with normal discs and visual fields. Optic Disc OCT plays a vital role in diagnosing preperimetric glaucoma patients.

Transvenous embolization of a carotid-cavernous fistula via the inferior ophthalmic vein: illustrative case.

A 49-year-old woman with a history of hypertension presented to the emergency department with right eye redness, proptosis, orbital fullness, and blurry vision. She had initially been diagnosed with an orbital pseudotumor, and the symptoms worsened over a course of steroids. Computed tomography angiography raised concern for a carotid-cavernous fistula (CCF), which was subsequently confirmed by digital subtraction angiography. She underwent fistula coil embolization via the internal maxillary artery and inferior ophthalmic vein (IOV). At the 2-month follow-up, she reported complete resolution of diplopia, orbital fullness, and proptosis. An ophthalmology examination revealed normal visual fields bilaterally. CCF embolization is rarely performed through the IOV, with only 5 reported cases in the literature. This case demonstrates that the procedure can be easily performed if the anatomy is favorable over the superior ophthalmic vein, with the illustration of good cosmetic outcomes. https://thejns.org/doi/10.3171/CASE24183.

Homonymous Hemiatrophy of Macular Ganglion Cell Layer as a Marker of Retrograde Neurodegeneration in Multiple Sclerosis-A Narrative Review.

Retrograde axonal neurodegeneration along the visual pathway-either direct or trans-synaptic-has already been demonstrated in multiple sclerosis (MS), as well as in compressive, vascular, or posttraumatic lesions of the visual pathway. Optical coherence tomography (OCT) can noninvasively track macular and optic nerve changes occurring as a result of this phenomenon. Our paper aimed to review the existing literature regarding hemimacular atrophic changes in the ganglion cell layer identified using OCT examination in MS patients without prior history of optic neuritis. Homonymous hemimacular atrophy has been described in post-chiasmal MS lesions, even in patients with normal visual field results. Temporal and nasal macular OCT evaluation should be performed separately in all MS patients, in addition to an optic nerve OCT evaluation and a visual field exam.

Diagnostic ability of macular nerve fiber layer thickness measured by swept-source optical coherence tomography in preperimetric glaucoma.

We evaluated the diagnostic ability of macula retinal nerve fiber layer (mRNFL) thickness in preperimetric glaucoma (PPG) patients. This prospective study included 83 patients with PPG and 83 age- and refractive error-matched normal control subjects. PPG was defined as a localized RNFL defect corresponding to glaucomatous optic disc changes with a normal visual field test. We used spectral-domain (SD) optical coherence tomography (OCT) to measure the circumpapillary RNFL (cpRNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Swept-source (SS) OCT was used to measure cpRNFL thickness, macular ganglion cell layer + inner plexiform layer (IPL) thickness (GCL+), and macular ganglion cell layer + IPL+ mRNFL thickness (GCL++). The mRNFL thickness was defined as GCL++ minus GCL+. To evaluate the diagnostic power of each parameter, the area under the receiver operating characteristics curve (AUROC) was analyzed to differentiate PPG from the normal groups. Using SD-OCT, all GCIPL parameters and most cpRNFL parameters, except at the nasal and temporal quadrant, were significantly lower in PPG versus normal controls. PPG eyes had significantly smaller values than normal controls for all cpRNFL and GCL parameters measured by SS-OCT, except mRNFL at the superonasal area. The inferotemporal GCL++ had the largest AUROC value (0.904), followed by inferotemporal GCL+ (0.882), inferotemporal GCIPL thickness (0.871), inferior GCL++ (0.866), inferior cpRNFL thickness by SS-OCT (0.846), inferior cpRNFL thickness by SD-OCT (0.841), and inferotemporal mRNFL thickness (0.840). The diagnostic performance was comparable between inferotemporal mRNFL thickness and the best measures of GCL (inferotemporal GCL++, p = 0.098) and cpRNFL (inferior cpRNFL thickness by SS-OCT, p = 0.546). The diagnostic ability of mRNFL thickness was comparable to that of the best measures of cpRNFL and GCL analysis for eyes with PPG. Therefore, mRNFL thickness could be a new parameter to detect early structural changes in PPG.

Evaluation of Optic Nerve Head Microcirculation in Open-Angle Glaucoma Patients with Unilateral Visual Field Defect

Introduction: Microcirculation of optic nerve head (ONH) in open-angle glaucoma (OAG) patients with unilateral visual field (VF) loss has yet to be fully investigated, especially the perimetrically unaffected fellow eyes. Methods: Thirty-eight OAG patients with VF defect in one eye and normal VF in the other eye, and thirty-one healthy participants were analyzed. All participants underwent laser speckle flowgraphy (LSFG), spectral-domain optical coherence tomography (SD-OCT) imaging, and VF test for further analyses. LSFG measurements included mean blur rate in all area of ONH (MA), big vessel area of ONH (MV), and tissue area of ONH (MT). SD-OCT parameters included circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macula thicknesses. The difference of LSFG and SD-OCT indices between glaucoma patients and healthy controls were compared. The diagnostic accuracy was analyzed with the areas under the receiver operating characteristic curves (AROCs). Results: Global cpRNFL thickness and macular thickness in unaffected eyes of OAG patients were higher than their fellow eyes and lower than healthy eyes. MA and MV in healthy eyes and unaffected eyes were significantly higher than in affected eyes. MT in unaffected eyes of OAG patients was higher than in their fellow affected eyes but lower than in healthy eyes. The AROCs were highest for cpRNFL (0.925), followed by macular thickness (0.838), and MT (0.834). Conclusions: ONH microcirculation in perimetrically unaffected fellow eyes was decreased in OAG patients with unilateral VF loss. LSFG can detect changes of ONH in high-risk eyes before detectable VF damage, which may reflect the vascular pathophysiology for glaucoma.

Distal Nasal Part of the Visual Field and RNFL in Primary Open-Angle Glaucoma.

The aim of this study was to compare changes in the conventionally undiagnosed distal nasal visual field with RNFL in patients with early primary open-angle glaucoma (POAG). 59 eyes of 32 patients (18 women, 14 men) with early stage POAG were included. All eyes were found to have a normal visual field (fast threshold program of 50 degrees nasally and 22 degrees temporally) with the Medmont M700. Visual acuity was 1.0 (with a possible correction ±3 D), and they had no other ocular pathology except glaucoma. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli in a range of 0-120 degrees nasally. Nerve fiber layer (RNFL) and vessel density (VD) was measured using the in-built software of the Avanti RTVue XR instrument. Using Pearson's correlation coefficient, the results of visual field examination with RNFL without and after correction (by subtracting VD from total RNFL value) in the superior-nasal (SN-5) and inferior-nasal (IN-8) segments were compared. In all eyes, changes were found in the distal periphery of the nasal part of the visual field. No correlation was noted by comparison with RNFL. After adjusting RNFL for VD, we observed no correlation in the SN segment (5) (r=-0.03) and a very weak correlation in the IN segment (8) (r=-0.16). With a normal visual field tested by the rapid threshold glaucoma program, changes in the distal part of the nasal periphery of the visual field were found in the entire cohort and did not correlate with the RNFL and RNFL results after correction from VD.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma and comparison to retinal nerve fiber layers.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma (PPG) and comparison to retinal nerve fiber layers. This study was a prospective hospital-based study. A total of 30 PPG and control patients were studied for retinal nerve fiber layer thickness (RNFL) and ganglion cell-inner plexiform layer complex (GC-IPL) by spectral-domain optical coherence tomography. PPG was defined as eyes with a normal visual field and one or more localized RNFL defects that were associated with a typical glaucomatous disc appearance. Diagnostic abilities of GC-IPL, optic nerve head (ONH), and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity, and specificity. GC-IPL parameters showed significant changes in PPG cases as compared to normal subjects in each region ( P value < 0.001). RNFL parameters also differed significantly from normal subjects in all quadrants ( P value 0.003 to < 0.001). Within GC-IPL parameters, the superotemporal region had the maximum area under the curve (AUC), followed by inferior, superior, and inferotemporal regions. Within RNFL parameters, the inferior quadrant had the maximum AUC, followed by superior and nasal quadrants. the GC-IPL parameters in PPG showed that the AUC of the GC-IPL parameters was much higher than those of the ONH and RNFL values. Although both the parameters RNFL and GC-IPL showed significant changes in PPG patients compared to healthy subjects, a higher AUC of GC-IPL points toward the higher sensitivity of GC-IPL than RNFL for detecting glaucoma in early stages.

The Far Nasal Part of the Field of Vision – Part II – Contribution to the Timely Diagnosis of Glaucoma

Aim: The aim of this study was to examine possible changes in the conventionally undiagnosed nasal visual field in patients diagnosed with early primary open angle glaucoma. Material and Methods: Examination of the far nasal part of the visual field was performed in 30 patients (60 eyes) with early stage of primary open angle glaucoma (preperimetric stage of changes). The cohort consisted of 16 women (mean age 46.5 years) and 14 men (mean age 44.7 years). In all eyes, the glaucoma program (rapid threshold program of 50 degrees nasally and 22 degrees temporally) was performed with the Medmont M700 instrument to determine the physiological visual field. Visual acuity was 1.0 with a possible correction less than or equal to ±3 diopters and they had no other ocular defect except glaucoma disease. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli and a range of 0–120 degrees nasally. Results: The far nasal limit of the visual field reached 100° in 13.33% of eyes, 105° in 20% of eyes and up to 110° in 66.67% of eyes. Conclusion: In all eyes, depression of the distal periphery of the nasal part of the visual field was found to range from 50 to 95 degrees, with a normal visual field examined by the glaucoma program.

Improvement of optic nerve head perfusion and reversible visual field defect following XEN Gel Stent implant

Background: Patients with juvenile onset ocular hypertension (OHT) have high intraocular pressure (IOP) and may develop early glaucomatous disc damage.&#x0D; Case presentation: A 26-year-old woman with family history of glaucoma was diagnosed with OHT at age 18. Her vision was 6/6, with a bilateral cup-to-disc ratio of 0.5, normal visual field (VF), and IOP in the mid-teens on 2 topical antiglaucoma medications. The patient started having IOP spikes (20–48 mmHg) in her left eye despite maximum tolerable medical therapy, associated with intermittent headache and nasal step defect on VF test. XEN Gel Stent was implanted and IOP reduced to 10–14 mmHg without medical therapy. Optical coherence tomography angiography showed improvement in optic nerve head (ONH) perfusion density and flux, while the VF defect disappeared.&#x0D; Conclusion: Improvement in ONH perfusion and reversibility of early glaucomatous VF defect is feasible with prompt XEN Gel Stent implant in juvenile OHT.

FRI292 Asymptomatic TSH Secreting Pituitary Macroadenoma

Abstract Disclosure: B. Gautam: None. M.S. Hossain: None. H. liao: None. K. Mandal: None. D.S. Rosenthal: None. S.C. Kumar: None. Introduction: TSH-producing adenoma is a rare disorder accounting for 0.5-2% of all pituitary adenomas with prevalence of 1-2 cases/million, often diagnosed at the stage of invasive macroadenoma hence challenging to manage. Case Presentation: A 36 years old male with no PMH referred to endocrine clinic for the evaluation of insomnia with abnormal thyroid panel for last 4 years. He denied skin or hair changes, diaphoresis, tremor, change in appetite, weight or bowel habits, cold/heat intolerance, palpitations, recent use of biotin or x-ray contrast exposure. Patient denied headache, visual or hearing impairment, galactorrhea, sexual dysfunction, change in facial appearance or size of gloves &amp; shoes. Patient also denied childhood history of developmental delay, learning disability and family history of thyroid disorder. Unremarkable physical exam with normal vitals. Thyroid was normal without palpable nodule. No thyroid bruit. Normal visual field by confrontation. No tremors, gynecomastia or galactorrhea noted. Laboratory results showed normal CBC, CMP, TSH 5.2 (0.55-4.78 uIU/ml) with FT4 2.1 (0.8-1.8 ng/dl), FT3 5.4 (2.3-4.2 pg/ml), FT4 by dialysis 3.1 (0.9-2.2 ng/dl), FT3 by dialysis 433 pg/dl, Thyroglobulin ab &amp;lt;1 (&amp;lt;1 IU/ml), TPO ab 3 (&amp;lt;9 IU/ml), TSI &amp;lt;89 (&amp;lt;140%), TBII &amp;lt;1 (&amp;lt;2 IU/L), HAMA &amp;lt;6 (&amp;lt;74 ng/ml). Normal ACTH 17 (6-50 pg/ml), serum cortisol level 10.5 (5.2-22.4 ug/dl), prolactin 9.2 (2-18 ng/dl), GH 0.1 (&amp;lt;7.1 ng/ml), IGF-1 183 (53-331 ng/ml), LH 4.7 (1.5-9.3 mIU/ml), FSH 5.9 (1.6-8 mIU/ml), free testosterone 120 (35-155 pg/ml) and total testosterone 1100 (250-1100 ng/dl), SHBG 82 (10-50 nmol/L), alpha-subunit 0.8 (0.1-0.5 ng/ml) &amp; alpha/TSH molar ratio 1.5. MRI brain with pituitary protocol showed an expansile round enhancing soft tissue mass filling the sellar cavity measuring 1.5 x 1.5 x 1.3 cm tenting the optic chiasm without cavernous sinus involvement. Patient was diagnosed with TSH secreting pituitary adenoma and referred to Neurosurgery. Patient had successful trans-sphenoidal adenectomy. Post-surgery TFTs: TSH 2.18 (0.55-4.78 uIU/ml), FT4 1.2 (0.8-1.8 ng/dl). Pathology report showed pituitary adenoma, IM stains positive for FSH, GH patchy and TSH (patchy and weak), negative for prolactin and ACTH. Rare tumor cells positive for LH Discussion: Our case highlights the importance of early diagnosis and appropriate treatment of TSH secreting adenoma to prevent complications such as hyperthyroidism, visual field defect and pan-hypopituitarism. Diagnosis in our case was particularly challenging as the patient was completely asymptomatic, therefore emphasize the importance of correlating TSH level with FT4 and early evaluation of central cause in the presence of biochemical evidence suggesting central thyroid disorder. Presentation: Friday, June 16, 2023

THU226 Pituitary Hyperplasia With Optic Chiasm Compression Secondary To Levothyroxine Non-adherence In An Adolescent Patient

Abstract Disclosure: C. Hawco: None. L. Bursztyn: None. P. Gallego: None. S. Van Uum: None. Background: Pituitary hyperplasia is a rare complication of primary hypothyroidism in pediatric patients. There have been multiple reports of unnecessary surgical procedures for this medically treatable condition. Clinical Case: A 16-year-old female was referred for pituitary enlargement. She had presented to a community hospital following an unwitnessed syncopal event, complicated by retrograde amnesia and headache. At the age of 2 she was diagnosed with primary hypothyroidism during work up for similar syncopal episodes. Past medical and developmental history was otherwise non-contributory. She had a long-standing history of medication non-compliance, and had not taken Levothyroxine during the previous 11 months. On her presentation to hospital, a CT scan revealed pituitary enlargement with a hypodensity suspicious for hemorrhage. Pituitary panel was significant for TSH greater than 1000 (0.51-4.30) mIU/L, free T4 of 4 (13-21) pmol/L and Prolactin 98 ng/mL (&amp;lt25) ng/mL. She was subsequently transferred to our tertiary care pediatric hospital for admission and ongoing care. An MRI of the sella identified a 1.0 x 2.3 x 1.7 cm pituitary mass with suprasellar extension and mass effect on the optic chiasm and nerves. There was no associated hemorrhage. The thyroid gland was diffusely enlarged. Visual acuity was 20/60 in both eyes at the time of hospital admission, compared to 20/20 the previous week at her optometrist. Formal visual field testing was abnormal, but unreliable with no clear defects. She was initiated on Levothyroxine 100 mcg daily and closely monitored for adherence and symptom resolution. After two months on this dose, repeat MRI sella showed a decrease of the pituitary mass to 0.8 x 2.1 x 1.0 cm in size, consistent with a diagnosis of pituitary hyperplasia secondary to untreated primary hypothyroidism. After treatment for 3 months, her visual acuity returned to 20/20 in both eyes with normal visual fields. With ongoing adherence to medical therapy, she remained clinically euthyroid with further decrease in her pituitary size, and normalization of both thyroid indices and prolactin[SV1]. Conclusion: This case is a rare presentation of pituitary hyperplasia in the setting of treatment nonadherence in primary hypothyroidism. It emphasizes the importance of monitoring for signs and symptoms of pituitary enlargement when low or non-adherence for levothyroxine treatment is suspected. The resolution of pituitary enlargement with Levothyroxine treatment also reinforces that this condition is best managed medically, avoiding unnecessary surgical procedures. Reference: (1) Sapkota, S., Karn, M., Sapkota, S. Pituitary hyperplasia in childhood primary hypothyroidism: a review. Childs Nerv Syst. 2021;37;749-762. [SV1] Presentation: Thursday, June 15, 2023

Associations of smoking and alcohol consumption with the development of open angle glaucoma: a retrospective cohort study

ObjectivesTo investigate the associations of alcohol consumption and smoking with the development of perimetric glaucoma in patients with suspected glaucoma.DesignA retrospective cohort study of patients suspected to have glaucoma enrolled...

Impact of primary glaucoma on health-related quality of life in China: the handan eye study

BackgroundWe assessed health-related quality of life (HRQOL) and its determinants among rural glaucoma participants compared to age-matched normal controls in the population-based Handan Eye Study (HES), in rural Yongnian County, northern China.MethodsWe enrolled 99 adults with glaucoma (mean age 63.0 ± 11.0 years), including primary open-angle glaucoma (POAG, n = 67) and primary angle-closure glaucoma (PACG, n = 32) and 102 controls (mean age 58.5 ± 5.3 years) with normal visual acuity and visual field and no history of glaucoma. Results of ophthalmic examinations and socioeconomic data were recorded. HRQOL was measured using the EQ-5D (converted to utility valves, UVs), and visual function (VF) and vision-related quality of life (VRQOL) were evaluated using the visual function-quality of life (VF-QOL) instrument.Primary and secondary outcome measuresEQ-5D and VF-QOL scores.ResultsThe mean UVs, VF, and VRQOL scores for glaucoma cases were 0.98 ± 0.04, 87.9 ± 15.2, and 95.5 ± 12.8, respectively, significantly worse than VF (94.4 ± 4.4) and VRQOL (100.0 ± 0.0) among controls, even after adjusting for age, gender, educational level, and family income (P = 0.015, P = 0.033). UVs were significantly lower among glaucoma participants with impaired VRQOL (55.4 ± 11.5) compared to those with normal VRQOL scores (99.1 ± 2.8) (UVs: 0.92 ± 0.08 vs. 0.99 ± 0.03, P = 0.036), also after adjustment for age and family income (P = 0.006). Participants with PACG had significantly lower VF and VRQOL scores compared to POAG (77.8 ± 21.4 vs. 92.9 ± 6.8, P < 0.001; 89.0 ± 18.1 vs. 98.7 ± 7.5, P < 0.001).ConclusionParticipants with glaucoma have worse visual function and related quality of life compared to age-matched normal population controls. Participants with PACG have lower VF and VRQOL compared to those with POAG. UVs can be used for cost-effectiveness research and to support public health strategies for glaucoma in rural China.

A new static visual field test algorithm: the Ambient Interactive ZEST (AIZE)

Visual field (VF) test is one of the most vital tests in the diagnosis of glaucoma and to monitor the disease worsening. In the past couple of decades, the standard automated perimetry (SAP) test takes a major role in VF test for glaucoma patients. The SAP has been demanded to finish a test in short time without sacrificing accuracy. In this study, we developed and evaluated the performance of a new perimetric algorithm (ambient interactive zippy estimation by sequential testing (ZEST): AIZE) by computer simulation. AIZE is a modification of the ZEST procedure that utilizes the spatial information (weighted likelihood: WL) of neighboring test locations, which varies from the distance to the tested location, to estimate a visual threshold. Ten glaucomatous and 10 normal empirical visual field (VF) test results were simulated with five error conditions [(3% false positives (FP), 3% false negatives (FN)), (9% FP, 9% FN), (15% FP, 15% FN), (3% FP, 15% FN), (15% FP, 3% FN)]. The total number of test presentations and the root mean square error (RMSE) of the estimated visual sensitivities were compared among AIZE, the non-weighted test (WL = 0) and the fixed-weighted test (WL = 0.33). In both glaucomatous (G) and normal (N) VFs, the fixed-weighted test had the lowest number of test presentations (median G 256, N 139), followed by the AIZE (G 285, N 174) and the non-weighted test (G 303, N 195). The RMSE of the fixed-weighted test was lower (median 1.7 dB) than that of the AIZE (1.9 dB) and the non-weighted test (1.9 dB) for normal VFs, whereas the AIZE had a lower RMSE (3.2 dB) than the fixed-weighted test (4.5 dB) and the non-weighted test (4.0 dB) for glaucomatous VFs. Simulation results showed that AIZE had fewer test presentations than the non-weighted test strategy without affecting the accuracy for glaucomatous VFs. The AIZE is a useful time saving test algorithm in clinical settings.

Letter to the Editor: Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields.

Letter to the Editor: Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields.

Response to Letter to the Editor: Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields.

Response to Letter to the Editor: Longitudinal Assessment of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses in Patients With Large Optic Disc Cups and Normal Intraocular Pressure and Visual Fields.

An Exploratory Assessment of Self-Reported Satisfaction with Infrastructure and Out-of-Home Activities for People with Vision Impairments.

The purpose of this study is to assess the satisfaction levels of people with VI with regard to infrastructure and outdoor activities. Furthermore, this study aims to develop an assessment model for the levels of difficulty in using public transport. Participants in a standardized survey questionnaire included 74 participants with VI. Three assessment-ordered probit models were estimated based on self-reported responses. Estimation results revealed that the use of public transport is extremely difficult for 83.47% of older participants. In addition, 84.2% of people with albinism have extreme difficulty using public transport. Furthermore, 53.98% of people with restricted horizontal and vertical fields face extreme difficulty using public transport. There was dissatisfaction with outdoor activities among 97.40% of people with macular disease. The results show that 51.70% of people with normal or near-normal horizontal visual fields and restricted vertical planes are satisfied with their level of outdoor activity while 72.65% of people with retinal diseases expressed dissatisfaction with the existing infrastructure. This study revealed that the experiences of people with VI are heterogeneous and depend on their eye condition, access to assistive technology, and socioeconomic characteristics. Results clearly show evidence of heterogeneity among individuals with VI. The combination of horizontal and vertical restrictions yields random parameters, underscoring the heterogeneous experiences of people with VI, influenced by their eye condition and access to assistive devices. Our results have important implications for developing targeted interventions to enhance the mobility of people with VI.