Perimetric Examination Research Articles

A Practical Framework for the Integration of Structural Data Into Perimetric Examinations.

We sought to develop and evaluate a practical framework that supports structurally enhanced perimetric examinations. Two perimetric strategies were compared: standard Zippy Estimation through Sequential Testing (ZEST) procedure, a traditional visual field test with population-based prior distributions, and structural-ZEST (S-ZEST), enhanced with individual optical coherence tomography data to determine the starting parameters. The integration and collection of data was facilitated by a bespoke application developed in Shiny R (R Studio). The test was implemented using the Open Perimetry Interface on the Compass perimeter (CentreVue-iCare, Italy). The strategies were evaluated via simulations and on 10 visually healthy participants. The usability of the application was assessed in a simulated environment with 10 test users. In simulations, the S-ZEST improved test speed in patients with glaucoma. In the practical implementation, there was a statistically significant decrease in the testing time (approximately 26%) and in the number of presentations per test with S-ZEST (P < 0.001). The structure-function relationship was similar between the two strategies. The time taken for users to complete the sequence of actions on the application was 52.9 ± 11.5 seconds (mean ± standard deviation). Structurally enhanced perimetric examination can significantly improve test time in healthy subjects and can be delivered through a user-friendly interface. Further testing will need to assess feasibility and performance of S-ZEST in patients with glaucoma. We have developed a user-friendly web application based within the Shiny environment for R, which implements an automated extraction of optical coherence tomography data from raw files and performs real-time calculations of structural features to inform the perimetric strategy.

Visual field evaluation following brain injury in school-aged children

Introduction. Brain injury may affect both afferent and efferent visual pathways. In children it is quite difficult to determine visual disturbances since they are often non cooperative. Visual field examination is an objective evaluation method that can outline visual pathway alteration in the acute period of head trauma. Materials and methods. Forty-eight patients with persisting visual symptoms after mild traumatic brain injury were examined. A control group of the same size has been evaluated. Results. Patients in the research group showed an obvious alteration of the fixation capacity of more than 20% in 91.7%95.8%, while in the control group the fixation capacity was up to 20% in 68.7%-70.8%. The ability to fix false positive points was up to 20% in 43.8%-45.8% patients in the research group and 70.8%-83.3% in the control group. The rate to fix false negative points was within the range of up to 20% for the research group in 93.7%-95.8% and the control group 91.7%-97.9%. The index of localized defects was up to 3dB in 62.5%-70.8% in the research group and predominantly 91.6%-95.8% for the control group. The average elevation index was within the range of &lt; -3dB, 3dB&gt; in 12.5%-20.8% research group and respectively 54.1%-56.2% control group. The graphic interpretation of changes in the visual field revealed a prevalence of the incidence of diffuse retinal depression with relative paracentral scotomas in 64.6%-68.7%. Conclusions. Based on the results, we can conclude that perimetric examination in the case of brain injured pediatric patients fulfils the requirements of credibility. Perimetric examination could be a landmark in the initial phase of settling post brain injured visual disturbances.

Structurally enhanced perimetric examination

Aims/Purpose: To assess the use of structural data to guide perimetric examination.Methods: Two perimetric strategies were tested on ten healthy participants: standard ZEST with population‐based prior distributions and Structural‐ZEST (S‐ZEST), enhanced with OCT data to determine the starting parameters. Both strategies were tested twice, in random order. The Compass Automated Perimeter (CMP, iCare) was used to collect the perimetric data through the Open Perimetry Interface and bespoke Shiny user interface (UI). The UI was used to import the Spectralis SD‐OCT scans (Heidelberg Engineering, Germany) and align the OCT data with the fundus image captured by the CMP. A 10–2 grid was centred on the fovea of each participant, aligned with the fovea‐disc axis. The UI calculated the Ganglion Cell Layer (GCL) thickness corresponding to each test location, after accounting for ganglion cell displacement. The starting priors for S‐ZEST were modelled using an independent dataset of glaucoma and healthy subjects. Bland–Altman plots were used to quantify test–retest variability. Bootstrap was used to calculate confidence intervals (CIs) and p‐values to compare the widths of the 95%‐Limits of Repeatability (LoR). Correlation between GCL thickness and sensitivity (dB) and the difference in test duration was calculated using linear mixed effect models. Agreement was quantified with the mean difference between the results of the two strategies.Results: 95%‐LoRs for S‐ZEST of the two devices were similar (p = 0.829). The structure–function correlation was significant for both (p &lt; 0.001), and very similar between S‐ZEST (R2 = 0.24) and ZEST (R2 = 0.23). There was a small but statistically significant mean difference in sensitivity between S‐ZEST and ZEST (0.56 [0.35, 0.77] dB, p = 0.034). S‐ZEST was 2.7 [1.2, 3.5] min faster than ZEST (p &lt; 0.001).Conclusions: S‐ZEST significantly shortened testing time without reducing repeatability in healthy observers.

Ethambutol-induced optic neuropathy.

A case report of a 40-year-old patient with tuberculosis treated with ethambutol is described. Within six months of starting treatment, there was a painless sudden decline in visual function. Despite the known complications of ethambutol treatment, it was discontinued after another three months. In the case report, we highlight the damage to the dominantly peripheral visual pathways. Using electrophysiological examinations, we showed a significant alteration in the optic nerves. Optical Coherence Tomography (OCT) showed progressive loss of vessel density and nerve fibre layer of retinal ganglion cells. Perimetric examination showed both a central decrease in sensitivity and mainly scotomas in the temporal parts of the visual fields. Although there was improvement in visual fields over time, OCT findings indicated progression of ethambutol-induced optic neuropathy (EON). Magnetic Resonance Imaging confirmed the alteration in the peripheral part of the visual pathway (intraorbital, intracranial parts of optic nerves, chiasma, and optic tracts). Even though EON is not an unknown complication, new cases still occur and, unfortunately, with an irreversible course. Therefore, it is important to draw attention constantly to this complication and to consider it not only in ophthalmologists' surgeries.

Клинический случай диагностики первичной открытоугольной глаукомы у пациентки после ранее выполненной передней радиальной кератотомии

The article describes a clinical case of diagnosis and detection of primary open-angle glaucoma (POAG) in a patient after previously performed anterior dosed radial keratotomy (ADRK). The reasons that hampered the primary diagnosis of POAG in the presented patient at an outpatient appointment with an ophthalmologist were: inadequate assessment of the ratio of the state of the lenses and low vision; a falsely underestimated level of tonometric intraocular pressure (IOP), as well as the absence of an in-depth ophthalmoscopic assessment of the condition of the optic nerve head, failure to comply with the mandatory perimetric examination in such cases. It should be especially remembered that there is a high likelihood of underestimation of applanation tonometry indices after performing ADRK, therefore, the assessment of its results should be treated with caution, identifying other clinical signs characteristic of glaucoma. This will make it possible to diagnose glaucoma in time and prescribe pathogenetic treatment in a timely manner. Key words: anterior dosed radial keratotomy, primary open-angle glaucoma, intraocular pressure.

Temporal Visual Field Border.

PurposeThe aim of the study was to determine the physiological temporal visual field border, based on theoretical calculations and by perimetric examination itself.Materials and MethodsA perimetry test was performed on 15 healthy subjects – seven women (27–30 years old) and eight men (28–46 years old), all of whom had healthy eyes with a visual acuity value of 1.0. The visual field was evaluated using a Medmont M700 with nasal displacement of the fixation point of 40 degrees. In total, 179 examined points of visual field were included. The model of the entry of temporal rays into the eye was created on the basis of the measured biometric values of the eye and with the help of the AD systems AutoCad and SolidWorks. RayViz for SolidWorks was able to simulate the passage of light rays through the model.ResultsThe temporal part of the subjective visual field border was up to 110 degrees in all eyes. Modelling of the input rays based on geometric optics in one of the participants in the testing revealed a theoretical temporal boundary of the visual field of 102 degrees.ConclusionTheoretical calculations of geometric optics have shown that the temporal boundary of the visual field reaches up to 102 degrees in a healthy individual. By perimetric examination, this limit reached 110 degrees.

Viability of Performing Multiple 24-2 Visual Field Examinations at the Same Clinical Visit: The Frontloading Fields Study (FFS)

To assess the viability, in terms of time taken for testing and repeatability, of frontloading (performing multiple perimetric examinations) in a single clinic visit. Reliability enhancement analysis. A total of 329 healthy glaucoma suspect and glaucoma subjects within a glaucoma clinic undergoing perimetric testing using SITA-Faster twice for each eye within the same session were included. Global indices, pointwise sensitivity and probability scores, test duration, and reliability metrics were analysed. For both tests 9.1% of right eye and 6.7% of left eye results were unreliable, with 58.4% and 67.5% of right and left eyes achieving reliable results, respectively; 83.8% of all subjects spent less than 20 minutes performing all tests. Differences in global indices, pointwise sensitivity and probability scores showed no systematic or clinically significant difference between tests one and two for each eye. There was also no systematic difference in the number of test locations identified as defective at the P < .05 level between tests. Test results that were unreliable tended to show more instances of a failed "cluster" criterion that were not repeatable. Frontloading using SITA-Faster was viable for obtaining sets of reliable, repeatable perimetric data in terms of conventional outputs, overcoming practical issues regarding low test reliability using singleton results and confirmation of visual field defects. Despite the need to remain cognisant of the reliability of SITA-Faster, frontloading using this algorithm may be a practical method for meeting recommendations for multiple perimetric data required to make confident inferences about glaucoma state and progression.

Axenfeld\u2010Rieger syndrome combined with a foveal anomaly in a three\u2010generation family: a case report

BackgroundAxenfeld-Rieger syndrome (ARS) is a rare autosomal dominant eye disorder that can also affect other organs of the human body. The condition is primarily characterized by the anterior segmental abnormalities of the eye. Here, we present an observational case series of a three-generation family with ARS and unexpected foveal anomaly.Case presentationA 33-year-old woman was admitted to an Ophthalmology Clinic in Bialystok for left eye congenital cataract surgery. The patient (proband) was diagnosed with visual deterioration, multiple defects of iris, corectopia, displacement of the Schwalbe’s line, and phenotypic characteristics of ARS. A perimetric examination indicated peripheral visual field loss and signs typical for glaucoma. Based on the phenotypic symptoms and genetic test, the patient was diagnosed with Axenfeld Rieger Syndrome. However, the optical coherence tomography of the macula showed foveal anomaly (absence of the physiological pit), which is not typically associated with this genetic disorder. The patient’s family history revealed that her two daughters were undergoing treatment for congenital glaucoma, and one of the daughters also had foveal anomaly the same as her mother. Interestingly, an examination of the patient’s mother showed typical phenotypic features of ARS such as a defect of the iris, posterior embryotoxon, and coloboma, as well as foveal anomaly. A genetic test confirmed PITX2 mutation in both, proband’s two daughters and mother.ConclusionsThis study highlights the occurrence of ARS with unusual ophthalmic features such as foveal anomaly (absence of the physiological pit) in a three-generation family. Although ARS is known to represent the developmental defects of the anterior segment of the eye, it is very important to perform fundus evaluation to identify associated posterior segment anomalies that may affect visual acuity. The presence of ocular defects not typically associated with ARS suggests a wide spectrum of mutations within PITX2 gene which are required to identify in order to determine genotype- phenotype correlation in ARS affected individuals.

Neuroprotective role of phosphoserine in primary open-angle glaucoma patients.

To evaluate the neuroprotective role of phosphoserine (P-Ser) in primary open-angle glaucoma (POAG) patients and to compare its therapeutic effectiveness to placebo treatment. Fifty-one patients (24 males and 27 females) between 35 and 61 years (average 46 years ± 3.8 SD) affected by POAG were enrolled in this study. Patients were divided in two groups: group A included 28 subjects that received an oral P-Ser treatment for 12 months; and group B included 23 subjects that received an oral placebo treatment for 12 months. Complete ophthalmological examination, standard automated perimetric examination, analysis of ON fibers via scanning laser polarimetry and glaucoma staging was performed in all patients at enrolment and 1, 3, 6, and 12 months after. Statistical analysis was performed using STATA 14.0 (Collage Station, TX, USA). Mean deviation (MD) and pattern standard deviation (PSD) analysis by means of 30-2 full threshold of the visual fields (VFs), retinal nerve fiber layer (RNFL) thickness by means of GDx, and IOP were considered to evaluate P-Ser therapy effectiveness in both groups. A statistically significant improvement (p<0.05) in VF, RNFL thickness and IOP compared to pre-treatment was found in patients in group A. Our study shows a significant improvement in several variables in patients with glaucoma treated with P-Ser compared to placebo and suggests a potential neuroprotective effect of P-Ser in treating glaucoma patients in association with the traditional hypotonic topical therapy.

Pseudoduplication of the optic disc initially resembling a bifurcated optic nerve in a strabismus child: a case report

BackgroundPseudoduplication of the optic disc is a rare clinical condition that is characterized by a circumscribed, disc-like lesion with radiating vessels but only one normal optic nerve. We report a rare case that initially resembled a bifurcated optic nerve in a strabismus child.Case presentationA 6-year-old female child was initially referred to our hospital due to perceptual exotropia of 15 degrees with poor fixation of the left eye. The visual acuity of the left eye was 3/100 with a refraction of + 1.75/− 1.25 × 175. Fundus images of her left eye revealed a circumscribed and disc-like lesion located one disc diameter (DD) below the true optic disc that showed profound central cupping resembling a second optic disc with a vascular supply. B scan ultrasonography showed an optic nerve with a bifurcated weak-echo region, suggesting that two strands originated from the optic nerve. Optic coherence tomography (OCT) demonstrated a large crater-like depression of the lesion, indicating a colobomatous defect covered by a mysterious membranous structure, a disturbed nerve fibre layer and the absence of regular outer retinal layers. A perimetric examination revealed a relatively superior defect. Magnetic resonance imaging (MRI) revealed the left eye globe showed an abnormal morphology and that the optic nerve was abnormally shaped and shifted nasally in the left eye. Fundus fluorescein angiography (FFA) of the left eye revealed the absence of independent vascular vessels in the disc-like lesion. Hyperfluorescence with patchy fluorescence was evident in the inferotemporal area of the disc. Vascular loops surrounding the temporal region were evident in both eyes. Her right eye was normal except for the vascular loop. We proposed that this represented a case of pseudoduplication of the optic disc. The patient did not undergo any treatment, and her visual acuity remained stable during the follow-up period.ConclusionsOur patient presented with a deep and ectatic coloboma below the optic disc that communicated with the true optic nerve and was originally thought to indicate a bifurcated optic nerve. This case suggests that atypical ectatic colobomas should be considered before diagnosing malformations related to the optic nerve in double optic disc cases.

Efficacy and safety of neuroprotection in patients with primary open-angle glaucoma

To study the effect of 'Cytoflavin' drug on the stabilization of glaucomatous optic neuropathy in patients with POAG. The study included 103 patients with initial or developed POAG. Patients were randomized into two groups using random numbers: the control group patients (n=50) receiving standard conservative treatment, and the main group (n=53), where patients received the combined drug with metabolic action 'Cytoflavin'. In addition to standard ophthalmological studies, all patients underwent biological, electrophysiological, perimetric, structural topographic, laboratory and sociological examinations before and after the treatment. By the end of the 3rd month of the treatment, the patients of the main group showed positive dynamics of the amplitude and phase characteristics of bioelectric activity of the retina, improvement in the total sensitivity of the retina for central field of view. Cytoflavin contributed to reducing the rate of progression of glaucoma according to optical coherence tomography: stabilization of the thickness of the nerve fiber layer, reduction of the rate of global and focal loss of retinal ganglion cells. In patients of the main group, by the end of the 3rd month, the severity of oxidative stress has significantly reduced and the antioxidant defense improved. On the background of stabilized glaucomatous process, a subjective improvement in general and psycho-emotional health, increased confidence in the success of the therapy and thus the improved the quality of life was observed in comorbid patients of the main group. Cytoflavin acts on the mechanisms that enhance the protection of the retina against the effects of reperfusion injury and oxidative stress, contributes to the metabolic adaptation of neurons and leads to a more favorable variant of POAG.

The Study of Effectiveness in a Modified Rib Oblique Projection View Using a Chest Phantom

This study is filmed by applying the axial angle variation of the X-ray tube instead of the patient’s position change during the perimetric examination of the ribs. A Reference image with the rib oblique examination using a chest phantom and experimental images applied with a six-phase variation in the axial angle by increasing 5° tube angle each from 5°~30° from the vertical incident direction of the chest phantom to the right horizontal axis were obtained. For the quantitative comparative evaluation of the images, SNR and CNR were calculated for regions of interest in the experimental images based on the reference image. Also, the left-right rib ratio in the reference image and the left-right rib ratio in the experimental images are measured and compared. As a result of the study, the experimental images with a tube angle of 25° were best shown in the measurements of the SNR, CNR and left-right rib ratio compared to the reference image with a standard examination method. The modified rib examinations will consider useful, if it is difficult to maintain the patient’s examination position.

Stage of visual field loss and age at diagnosis in 1988 patients with different glaucomas: implications for glaucoma screening and driving ability

To compare stage of visual field loss (VFL) and age at diagnosis between patients with different types of glaucoma with regard to glaucoma screening and driving ability. In a cross-sectional study of 1988 consecutive patients with different types of glaucoma VFL at diagnosis and age at diagnosis were assessed. Patients with binocular advanced or severe VFL were classified unable, patients with no VFL in one eye and VFL I-V (Aulhorn classification) in the other eye able, all other constellations questionably able to drive. There were significant differences in age at diagnosis between different glaucomas and between patients with different stages of VFL at diagnosis. Age-related assessment of VFL at diagnosis in normal tension glaucoma (NTG) compared to primary open-angle glaucoma (POAG) showed that NTG is not a disease of the elderly but a disease with late diagnosis at severe VFL. In POAG a solely age-related glaucoma screening, e.g. from the age of 50years, does not sufficiently lead to diagnosis at an early stage of the disease. In POAG solely based on binocular VFL 11.5% of patients were judged unable, 29.2% questionably able to drive, in NTG 19.6%/43.1%, pigmentary glaucoma 16%/22%, pseudoexfoliation glaucoma 9.1%/16.7%, and in primary angle-closure glaucoma 14.6%/30%. Depending on type of glaucoma more than 50% of patients require counselling regarding safe driving as part of clinical care. A disease-specific, age-related perimetric examination considering additional risk factors like family history of glaucoma is essential for early detection of glaucoma and road safety.

Evaluation of the progression of visual field damage in patients suffering from early manifest glaucoma.

BackgroundThis retrospective study aimed to determine how often a perimetric examination should be carried out in order to identify visual field (VF) changes in patients with relatively early manifestation glaucoma.Materials and methodsPatients included had a relatively recent manifestation of primary open-angle glaucoma. Patients with a minimum follow-up of 5 years and a minimum of seven VF tests were included. Statistical analysis was performed to verify the trend of variations in mean defect (MD) over time (PeriData). The results were subjected to a t-test for a comparative analysis of progression of VF changes over time. The annual rate of progression provided by PeriData considering all the VFs analyzed was compared with that obtained on half of the VF examinations during the same follow-up period. An analysis of the MD trend over time was also carried out in relationship to the number of VF tests done and by dividing the sample into a high-frequency group (more than eight VFs) and a low-frequency group (fewer than eight VFs) in the follow-up period.ResultsA total of 96 eyes of 96 patients were included, and overall 846 VFs were examined. The paired t-test performed comparing the MD index of all the VFs against half of them did not show statistical significance (P=0.537). The high-frequency group comprised 39 eyes (average VF 11.05±1.91, average time interval 0.76 years) while the low-frequency group comprised 57 eyes (average VF 6.95±0.6, average time interval 1.21 years). The analysis of the MD trend in the high-frequency patients showed significance (P=0.017); the low-frequency group did not show statistical significance (P=0.08).ConclusionThe number of VFs in a determined time interval was not significant. However, a greater frequency of tests provides a predictive evaluation of the rate of progression of early manifestation open-angle glaucoma.

Challenges of glaucoma care – high volume, high quality, low cost

Challenges of glaucoma care – high volume, high quality, low cost

A case of pituitary macro-adenoma with acromegaly and visual field defects

A 45-year-old female visited our medical out-patient department with a history of gradual increase in the thickness of her skin and prominence of lower jaw and forehead in the past 10 years. Hormonal assay revealed unsuppressed growth hormone levels (7.86 ng/ml) with oral glucose load at 1 hour. Magnetic resonance imaging (MRI) of brain showed pituitary macroadenoma. Perimetric examination revealed visual field defects. Clinical, hormonal, imaging, and perimetric studies together confirmed the diagnosis of pituitary macroadenoma with acromegaly and pressure effects.

Variation in corneal hysteresis and central corneal thickness among black, hispanic and white subjects

To determine whether differences in corneal hysteresis (CH) and central corneal thickness (CCT) between black, Hispanic and white subjects exist independently of one another. Retrospective, cross-sectional data were reviewed for 807 eyes of 410 patients consecutively evaluated for glaucoma. Included patients had open angles, at least one reliable 24-2 perimetric examination and no evidence of nonglaucomatous vision loss. Patients underwent CH measurement with the ocular response analyzer followed by CCT measurement and full ocular examination. Patients were asked to self-classify their race or ethnicity. Statistical analyses were performed to identify characteristics that varied between black, Hispanic and white subjects and to explain this variation. Of the 270 patients (511 eyes) included, 84 were black, 96 Hispanic and 90 white. There were no significant differences in diagnosis, sex, age, intraocular pressure or glaucoma severity between races/ethnicities (p ≥ 0.16). Blacks were found to have lower CCT (529.3 μm) and CH (8.7 mmHg) compared to Hispanics (544.7 μm, p = 0.008; 9.4 mmHg, p = 0.007) and whites (549.9 μm, p < 0.001; 9.8 mmHg, p < 0.001). On multivariable analysis, inter-racial/ethnic differences in CCT were not found to exist independent of CH (p ≥ 0.10), whereas the significant intergroup variation in CH remained after adjustment for CCT and other covariates (p ≤ 0.005). Variation in CCT between races/ethnicities does not exist independent of CH. However, significant intergroup variation in CH is present independent of CCT. This finding suggests that CH may be a preferable measurement to evaluate intergroup differences in corneal properties and their relationship to open-angle glaucoma.

Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

Hemianopia can cause considerable disability. Only scarce data are available for ischemic stroke patients presenting with isolated homonymous hemianopia and being treated with intravenous thrombolysis. We analyzed outcome of such patients registered in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). The SITS-ISTR (n=45 079) was searched for patients who presented with isolated homonymous hemianopia. We identified 72 such patients. We report their baseline and demographic characteristics, radiological data, change in their National Institutes of Health Stroke Scale score within 7 days after thrombolysis, and their 3-month modified Rankin Scale (mRS) score. Univariate analysis of parameters associated with any improvement was performed. Hemianopia was assessed with perimetric examination. Of 72 patients, 40 (56%) improved within 7 days after thrombolysis; 19 (26%) had full recovery. Those who improved had significantly lower systolic blood pressure before thrombolysis and were less often administered antiplatelet agents before index stroke. Infarction was visible on 24-hour computed tomography scan in 65% of patients who improved compared with 81.2% of those without improvement (P=0.32). No symptomatic intracranial hemorrhage occurred in patients who improved compared with 1 (3.1%) patient in the nonimproved group (P=0.08). Seventy-one percent of all patients had 3-month mRS score 0 to 2, and 51% had mRS score 0 to 1. Those who improved within 7 days had a significantly better 3-month outcome (median mRS [interquartile range], 0 [0-1] vs 2 [1-2]). Relatively few ischemic stroke patients received thrombolysis because of isolated homonymous hemianopia. Thrombolysis seems to be safe in these patients. Of those treated, more than half improved and more than two-thirds had good outcome.

The times they are a‐changin’: time to change glaucoma management

The times they are a‐changin’: time to change glaucoma management

Chronic phototoxic maculopathy caused by welding arc in occupational welders

ObjectiveTo investigate whether occupationally-related phototoxicity can occur from welding. DesignCross-sectional study. ParticipantsForty welders from manufacturing enterprise and 40 age-matched nonwelder controls. MethodsParticipants underwent thorough ophthalmologic examination including fundus photography, automatic perimeter examination, and high definition optical coherence tomography (OCT) scan. The clinical history of all subjects was screened carefully before the study. ResultsThere was no significant difference for best corrected distance visual acuity when comparing welders with nonwelders. Anterior segment, red reflex, Amsler grid test, and perimetric examinations were unremarkable. Fundus photographs revealed a small, round, or oval, dark-yellow macular lesion with an obscure boundary in 19 welder eyes (23.8%). OCT revealed an interruption or defect in the inner segment/outer segment (IS/OS) layer and the inner portion retinal pigment epithelium (RPE) layer in varying degrees in 30 welder eyes (38.0%), revealing a higher prevalence of maculopathy. All control examinations were unremarkable. We have also discovered that OCT is more sensitive than fundus photography in identifying macular lesions. ConclusionsOccupational welders exposed to a welding arc environment have a higher risk of phototoxic maculopathy than nonwelders, as diagnosed most effectively using OCT.