Reduction In Retinal Sensitivity Research Articles

Retinitis pigmentosa and nanophthalmos in a patient with attenuated Hunter's syndrome.

To describe a case of retinitis pigmentosa and nanophthalmos in a patient with attenuated Hunter's syndrome. Fundus photography, total field electroretinogram, ultrasound, computerized visual field examination, biochemical examination and genetic testing were obtained. The fundus exam showed diffuse arteriolar attenuation, optic disc with regular contours, and pigment agglomerates like "bone spicules" in the middle periphery. Ultrasound examination revealed scleral thickening and short axial diameter in both eyes. The total field electroretinogram exam showed a subnormal result with greater impairment of the scotopic phase of the exam. Computerized visual field examination demonstrated a diffuse reduction in retinal sensitivity in the periphery. Biochemical examination showed increased urine glycosaminoglycan excretion and iduronate-2-sulphatase activity (IDS) deficiency in leukocytes, confirming the type II mucopolysaccharidosis. Molecular analysis revealed a novel missense mutation (p.A77D) in the IDS gene. The case report is about a patient presented an attenuated form of the syndrome, with no cognitive impairment. Ophthalmologic follow-up is still an important part of multidisciplinary treatment for Hunter's syndrome.

Visual deterioration in patients with photoreceptor loss after retinal reattachment surgery

PurposeAssess the relationship between photoreceptor degeneration and visual function after retinal reattachment surgery (RRS) in a prospective cohort.MethodsPatients with rhegmatogenous retinal detachment (RRD) were reviewed before and 6 months after vitreoretinal surgery. Optical coherence tomographical thickness of the outer nuclear layer (ONL), outer retinal segment (ORS), retinal pigmented epithelium to ellipsoid zone (RPE-EZ) and external limiting membrane to EZ (ELM-EZ) were recorded 6 months post-operatively. These were compared to best corrected visual acuity (BCVA) and retinal sensitivity (Humphrey visual field).ResultsThirteen macula-off and 8 macula-on RRD patients were included. The mean ONL thickness was higher after macula-on RRD compared to macula-off RRD (97.70 ± 3.62 μm vs. 73.10 ± 4.98 μm). In all RRD eyes, every 1 μm decrease in ONL thickness correlated with a 0.052 dB decrease and in retinal sensitivity and every 1 μm decrease in ORS thickness was associated with a 0.062 dB reduction in retinal sensitivity. ORS, ELM-EZ and RPE-EZ thickness did not correlate with BCVA post-RRS.ConclusionThere was greater ONL and ORS thinning following macula-off compared to macula-on RRD. Correlations between ONL and ORS thinning with decreased retinal sensitivity may be explained by RRD-induced photoreceptor death.

Retinal Sensitivity and Structural Changes after Focal Photocoagulation for Diabetic Macular Edema: A Multisectorial Comparison

Introduction: The hindrance of a macular laser treatment for diabetic macular edema (DME) remains unclear. Our purpose was to evaluate macular functional and structural changes after focal macular photocoagulation for DME. Methods: This is a prospective cohort study that included patients with mild diabetic retinopathy, submitted to focal macular laser treatment as monotherapy for DME. Patients underwent optical coherence tomography and microperimetry after the necessary number of treatment sessions for complete resolution of DME. Eyes were compared in each macular sector (superior, temporal, and inferior 1- to 3-mm parafoveal ring) according to the presence of laser spots. Relative sensitivity was calculated as sectorial sensitivity divided by general sensitivity. Results: Sixty-four eyes were included. In sectors submitted to focal photocoagulation, we observed a significant reduction in absolute sensitivity (−1.0 to −0.4 dB, depending on the sector analyzed) and relative sensitivity (−2.1 to −0.6%) together with a reduction in the outer nuclear layer (ONL) thickness (−8 to −3 μm). The number of laser spots correlated with both functional and structural changes. Conclusion: In macular sectors that underwent photocoagulation, we found a small reduction in retinal sensitivity together with a reduction in the corresponding ONL thickness.

A Critical Analysis of Non-Complicated Macula-Off Rhegmatogenous Retinal Detachment with and Without Internal Limiting Membrane Peeling

Background: There is abundant and even confusing information in the available literature concerning the role of Internal Limiting Membrane (ILM) removal in macular conditions secondary to non-complicated macula-off Rhegmatogenous Retinal Detachment (RRD) repair. This retrospective, multicenter, long-term study aimed to analyze the incidence of Epiretinal Membrane (ERM) proliferation and other surgical complications and to compare the postoperative microstructural and multimodal imaging findings and correlate them with the final postoperative Best-Corrected Visual Acuity (BCVA) in selected eyes. Methods: This long-term retrospective study included 230 eyes divided into three groups according to the surgical management performed for uncomplicated macula-off RRD: 125 eyes in the buckle group underwent scleral buckle techniques; 55 eyes in the non-peeling group underwent primary vitrectomy with no ILM peeling; 50 eyes in the peeling group with primary preoperative or secondary postoperative presence of significant ERM proliferations underwent the ERM-ILM en-bloc complex removal or double-staining removal techniques. Results: The postoperative incidence of ERM was 23.2% (29 eyes) in the buckle group, 23.6% (13 eyes) in the non-peeling group, and 2.0% (one eye) in the peeling group (p<0.05; Student’s t-test). The mean postoperative BCVA difference among the buckle group, peeling group, and non-peeling group was significant (logarithm of the minimum angle of resolution, 0.40 ± 0.33 vs. 0.47 ± 0.16 vs. 0.28 ± 0.19, respectively). Postoperative multimodal imaging tests yielded abnormal retinal thickness in the three groups, with a diffuse optic nerve fibre layer and ellipsoid band disruptions predominantly in the peeling group, and a normal foveal profile in the buckle and non-peeling groups. Conclusion: Multiple structural alterations in spectral-domain optical coherence tomography biomarkers and a significant reduction in retinal sensitivity were observed in the peeling group. Eyes that developed secondary ERM proliferations in the buckle group and in the non-peeling group showed statistically significant upgrading in BCVA once the ERM proliferation and ILM were removed. Ultimately, our study contributes findings pertaining to severe consequences in macular structure and function. We can conclusively state that ILM removal with the main objective of avoiding macular ERM proliferation is not justified because of the high rate of potential macular complications and poor visual results.

Short wavelength automated perimetry and standard automated perimetry in central serous chorioretinopathy

Short wavelength automated perimetry (SWAP) is known for detecting the early reduction of retinal sensitivity (RS) in glaucoma. It’s application in retinal diseases have also been discussed previously. We investigated the difference in RS measured between standard white-on-white automated perimetry (WW) and blue-on-yellow SWAP in central serous chorioretinopathy (CSC). The overall RS (W-RS, S-RS) as well as the RS inside and outside of the serous retinal detachment (SRD) region were investigated in 26 eyes of 26 CSC patients using WW and SWAP. The central retinal thickness, central choroidal thickness, SRD area (SRDa), and SRD height at the fovea were measured using optic coherence tomography. RS inside the SRD region was lower than that of outside for both perimetries (both p < 0.001). The difference between RS inside and outside of the SRD region was greater in SWAP compared to WW (p < 0.001). Univariate analysis revealed significant correlations between SRDa and both W-RS and S-RS (both p < 0.001); moreover, multivariate analysis indicated that only S-RS was selected as the optimal model for SRDa. Our study demonstrated that SWAP was detected the decrease in RS more accurately than WW in CSC. These results may suggest the usefulness of SWAP for detecting change of retinal function in CSC.

Presymptomatic Retinal Sensitivity Changes in Intermediate Age-Related Macular Degeneration Associated With New Retinal Fluid.

PurposeTo determine whether change in retinal sensitivity in areas with subretinal or intraretinal fluid secondary to age-related macular degeneration (AMD) precedes visual symptoms. If confirmed, retinal sensitivity testing could be used for home monitoring in AMD.MethodsIndividuals with intermediate AMD enrolled in a longitudinal study were seen every 6 months and underwent best-corrected visual acuity testing (BCVA), spectral domain–optical coherence tomography (SD-OCT), and microperimetry. Asymptomatic individuals who developed incidental, reading center–determined retinal fluid detected on SD-OCT were identified. The point-wise sensitivity (PWS) at the time of fluid detection was compared with 6 and 12 months prior.ResultsFourteen of 161 individuals developed fluid without symptoms. PWS over fluid areas at detection was reduced compared with 6 (difference −2.04 dB, P < 0.001) and 12 months (−2.27 dB, P < 0.001) prior. PWS over fluid areas was reduced compared with perifluid areas (difference −1.02 dB, P = 0.03), peripheral areas (−1.51 dB, P < 0.001), nonprogressed fellow eyes (−1.49 dB, P = 0.006), and nonprogressed age-matched intermediate AMD eyes (−2.29 dB, P = 0.001). No difference in BCVA was observed in eyes developing fluid compared to eyes that do not develop fluid (P = 0.76).ConclusionsRetinal areas with fluid on SD-OCT had a corresponding reduction in retinal sensitivity at the time of fluid detection compared with 6 and 12 months prior, in asymptomatic intermediate AMD without change in BCVA.Translational RelevanceDevelopment of self-monitoring tools to detect changes in retinal sensitivity may be helpful for early detection of retinal fluid suggestive of progression to neovascular AMD before acuity is affected.

Structure-Function Correlation Using OCT Angiography And Microperimetry In Diabetic Retinopathy.

PurposeTo evaluate macular vasculature in diabetic retinopathy (DR) with optical coherence tomography angiography (OCTA) and to correlate vessel density (VD) with retinal sensitivity (RS) as a way to assess structural and functional findings in DR.DesignProspective observational cross-sectional study.MethodsDiabetic patients with DR but no clinically significant diabetic macular edema (DME) and healthy subjects were included in this study. All of them underwent comprehensive ophthalmic examination, best corrected visual acuity (BCVA), OCTA with RS-3000 Advance AngioScan (Nidek, Gamagori, Japan) and microperimetry with MP-3 (Nidek, Gamagori, Japan). Retinal vascular density measured by OCT angiography in 9 areas was correlated with RS in the same 9 areas by Spearman correlation.ResultsIn this study, 50 subjects were enrolled: 25 eyes of diabetic patients with DR and 25 eyes of non-diabetic subjects. Diabetic patients mean age was 51.88±13.62 years; non-diabetic subjects were 43.48±13.42 years. The BCVA was 20/25 in the diabetic group and 20/20 in the non-diabetic group. Mean RS was decreased in the DR group (27.68±2.71 dB) compared to the non-diabetic group (31.68±1.46 dB) (p<0.05) and in the 9 studied areas (p<0.05). Mean VD was decreased in the DR group compared to non-diabetics (p<0.05) and in 7 of the 9 areas (except temporal superior and inferior squares) (p<0.05). Correlations by areas between VD and RS were assessed, we found moderate correlation in the area temporal to the fovea (r=0.501, p=0.01) in the DR group but not in the non-diabetic subjects. There were no other statistical significant correlations with this pattern.ConclusionDR without DME results in a retinal VD decreased that might be the cause of a reduction of RS in one of the studied areas. Microangiopathic changes are correlated with microperimetry sensitivity drop in the temporal to the fovea grid but not in the other studied grids.

Retinal Sensitivity Using Microperimetry in Age-Related Macular Degeneration in an Amish Population.

To evaluate retinal sensitivity (RS) by mesopic and scotopic microperimetry (MP-1S) in an elderly Amish population with age-related macular degeneration (AMD). Mesopic and scotopic microperimetric testing was performed in 148 eyes of 77 elderly Amish subjects (age > 50 years) from Pennsylvania using a retinal function analyzer. Scotopic testing was performed using a 2.0 log unit neutral density filter following 30 minutes of dark adaptation. All subjects underwent complete ophthalmic examinations, including spectral-domain optical coherence tomography, fundus autofluorescence, infrared reflectance imaging, and flash color fundus photography. Certified graders at Doheny Image Reading Center identified subjects with evidence of AMD as defined by the Beckman classification and quantified drusen volume. RS in subjects with and without AMD was compared. Correlations between RS and drusen burden were analyzed. Ten eyes with incomplete MP-1S exams were excluded from the final analysis. Among the 138 eyes from 77 subjects included in the final analysis, 42 eyes from 29 subjects had evidence of early or intermediate AMD. The mean age of subjects with AMD was 69.65 years ± 13.81 years versus 63.04 years ± 12.69 years in those without AMD (P = .06). Mesopic RS was 18.8 dB ± 2.1 dB in subjects with AMD and 19.6 dB ± 1.4 dB in those without AMD (P = .07). Scotopic RS was significantly lower (P = .04) in subjects with AMD (15.9 dB ± 2.9 dB) compared with those without AMD (17.3 dB ± 2.4 dB). There was no relationship between mesopic RS and either drusen area (r = -0.06; P = .32) or drusen volume (r = -0.08; P = .30). There was a trend for an association between scotopic RS and both drusen area (r = -0.39; P = .24) and drusen volume (r = -0.36; P = .30). In an elderly Amish population, eyes with early or intermediate AMD show a greater reduction in scotopic RS than mesopic RS, suggesting that rod function is more severely affected than cone function. Drusen area and volume measurements better correlated with scotopic RS. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e236-e241.].

CHRONIC CENTRAL SEROUS CHORIORETINOPATHY: Early and Late Morphological and Functional Changes After Verteporfin Photodynamic Therapy.

To describe early and late morphological and functional changes in subjects receiving photodynamic therapy (PDT) for chronic central serous chorioretinopathy. Patients with chronic central serous chorioretinopathy were prospectively enrolled and received standard PDT. At the baseline examination, each subject underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) assessment, fluorescein angiography and indocyanine green angiography, spectral domain optical coherence tomography, and microperimetry. Spectral domain optical coherence tomography, microperimetry, and BCVA assessment were repeated in multiple sections over 7 days after PDT and at 1-, 3-, and 12-month intervals. Main outcome measures were: identification of early changes (1-week examination) in BCVA, retinal sensitivity, and spectral domain optical coherence tomography parameters and their influence on outcomes at the 1-year follow-up. Three main patterns of early response to PDT were identified during the 1-week examination. The neurosensory retinal detachment most frequently decreased rapidly (12/19 pts), with complete resolution in 50% of cases. An increase in neurosensory retinal detachment height was registered in 16% (3/19) of cases, whereas in 21% (4/19), a large fluctuation in neurosensory retinal detachment was encountered. Best-corrected visual acuity declined significantly in 5/12 patients in the first group and was stable or improved in the remaining cases. Overall, retinal sensitivity diminished in 16/19 subjects, with a mean worsening of 2.56 dB (P = 0.0002). At the 12-month examination, final mean BCVA improved by 14.4 letters (P = 0.001) and a similar progressive recovery in the retinal sensitivity was observed (+2.69 dB, P = 0.0039). The neurosensory retinal detachment completely resolved in 18/19 (95%) cases, with a parallel significant reduction in central foveal choroidal thickness (P < 0.0001). Three patterns of early response to standard PDT can be identified. Although an early and abrupt reduction in BCVA and retinal sensitivity after treatment is possible, this does not compromise a final improvement in visual functions.

COMPARING MICROPERIMETRIC AND STRUCTURAL FINDINGS IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION AND DIABETIC MACULAR EDEMA.

To compare retinal sensitivity and central retinal thickness in patients with focal diabetic macular edema (DME) and edema secondary to branch retinal vein occlusion (BRVO). In this consecutive, cross-sectional, observational study, patients with either DME or BRVO underwent measurements for best-corrected visual acuity, microperimetry, and spectral domain optical coherence tomography. Retinal thickness and sensitivity were measured using Optos Spectral optical coherence tomography/scanning laser ophthalmoscopy (Optos plc, Dunfermline, Scotland, United Kingdom). Areas defined as abnormal demonstrated edema with clearly defined cystic spaces. Abnormal and control areas were compared in mean retinal sensitivity and mean retinal thickness for both conditions. Twenty eyes with focal DME and nine eyes with BRVO were included. In DME, mean retinal thickness was 413.6 ± 84.5 μm and 291.7 ± 36.7 μm in abnormal and control areas, respectively. Mean retinal sensitivity was 10.22 ± 4.23 dB and 12.25 ± 3.57 dB, respectively. In BRVO, mean retinal thickness was 491.4 ± 102.9 μm and 315.9 ± 29.9 μm in abnormal and control areas, respectively. Mean retinal sensitivity was 6.36 ± 5.47 dB and 13.05 ± 2.28 dB. In DME, a decrease in retinal thickness of 0.341 μm correlated with 1 dB reduction of retinal sensitivity, although this was not statistically significant (P = 0.717). In BRVO, however, an increase in retinal thickness of 9.702 μm correlated with 1 dB reduction of retinal sensitivity (P = 0.001). In BRVO, an increase in retinal thickness corresponded with a significant reduction in retinal sensitivity; in DME, however, there was no significant correlation between retinal thickness and retinal sensitivity. Further study is required to assess why this is the case. The Optos Spectral optical coherence tomography/scanning laser ophthalmoscopy allows for a reliable point-to-point correlation, as microperimetry and spectral domain optical coherence tomography can be performed in the same device.

Morphological and Functional Changes Immediately After Half-Time Photodynamic Therapy in Patients With Central Serous Chorioretinopathy.

To evaluate early treatment outcomes of half-time photodynamic therapy (PDT) in patients with central serous chorioretinopathy (CSC). The anatomical and functional results were assessed for 24 eyes of 23 patients with CSC treated with half-time PDT in this prospective case series. Central foveal thickness (CFT) and subfoveal choroidal thickness (SCT) were evaluated by spectral-domain optical coherence tomography (SD-OCT), and mean retinal sensitivities and fixation characteristics were evaluated by MP-1 microperimetry at baseline and 1 day, 3 days, 1 week, 1 month, and 3 months after treatment. Observations 1 day after treatment revealed an increase in both SCT and CFT and a decrease in retinal sensitivity (P = .013; P = .02; and P = .02, respectively). The CFT significantly resolved 1 month after treatment (P = .002), and the SCT significantly resolved 7 days after treatment (P = .011). Although an immediate decrease in retinal sensitivity was observed at post-treatment day 1 (P = .02), the greatest reduction in retinal sensitivity was observed 3 days after treatment(P = .009), and then a tendency to increase was seen at subsequent visits. Despite early anatomical and functional impairments, such as an increase in CFT and SCT and a decrease in retinal sensitivity immediately after half-time PDT, best-corrected visual acuity and retinal sensitivity improved significantly 3 months after treatment. Half-time PDT is associated with early transient deterioration, but not with permanent adverse effect in patients with CSC. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:932-940.].

Longitudinal Changes in Retinotopic Rod Function in Intermediate Age-Related Macular Degeneration.

Although impairment of rod function in the early stages of age-related macular degeneration (AMD) has been well recognized, data on longitudinal changes in rod function at multiple retinal locations remain limited. This study investigated the longitudinal changes in retinotopic rod function in eyes with intermediate AMD (iAMD). Complete ophthalmic examination, multimodal imaging, and scotopic perimetry were performed at baseline and at 12-month follow-up. Perimetric scotopic retinal sensitivities for the 505-nm stimulus were repeatedly measured for 20 minutes after exposing to a single photobleach (∼30%). The rod intercept time (RIT) and retinal sensitivity at seven retinal loci within the central 12° were ascertained. Using the 95% limit of measurement variability derived from the control eyes as a reference, the proportion of test points with a significant change in retinal sensitivity or RIT at follow-up was determined. Twenty iAMD and 6 control eyes were included. Decline in rod function was detected at 12-month follow-up in eyes with iAMD, but not in control eyes. Approximately 25% of test points in iAMD eyes showed a significant increase in RIT compared to 6% of test points with a decrease in RIT over the 12-month period (P < 0.001). Similarly, 40% of test points demonstrated a reduction in retinal sensitivity compared to the 7% of test points with an increase in retinal sensitivity at follow-up (P < 0.001). There are detectable retinotopic changes in rod function over 12 months in iAMD eyes, indicating an ongoing disease progression in rod impairment or loss with time.

Reduction of Retinal Sensitivity in Eyes With Reticular Pseudodrusen

To evaluate the effect of macular reticular pseudodrusen on retinal function using multiple imaging methods. Prospective cross-sectional study. Thirteen eyes with reticular pseudodrusen, but without any other macular abnormality or glaucoma, and 20 normal eyes were evaluated. All subjects underwent color fundus photography, infrared reflectance (IR), fundus autofluorescence (FAF), and microperimetry. The similarity in the number of reticular pseudodrusen was evaluated through inter-observer intraclass correlation coefficients, which ranged from 0.852-0.944. IR could detect reticular pseudodrusen within the center circle area in 12 eyes, whereas blue-channel fundus photography and FAF could only detect these lesions in 1 and 3 eyes, respectively. The number of reticular pseudodrusen correlated among the different imaging modalities (P < .001 for all) for all areas of the macula, except the center. The mean retinal sensitivity in eyes with reticular pseudodrusen was lower in all areas of the macula, compared with normal eyes (P < .001 for all). The number of reticular pseudodrusen correlated with retinal sensitivity in all areas by IR imaging (P=.003, P < .001, P= .003 for center, inner ring, outer ring, respectively), in the inner and outer rings by blue-channel fundus photography (P < .001 for both), and in the inner and outer rings by FAF (P < .001 and P= .001, respectively). Although multiple imaging modalities are capable of quantifying reticular pseudodrusen, IR appears to have the best ability to do so as compared to blue-channel photography and FAF. The distribution and number of reticular pseudodrusen lesions are closely associated with retinal sensitivity.

Erratum to: Recovery of visual function in patient with melanoma-associated retinopathy treated with surgical resection and interferon-beta

We report on a 33-year-old woman who was treated for a cutaneous malignant melanoma on a left finger by surgical resection and chemotherapy including local injections of interferon-beta in 2007. In March 2009, the melanoma had metastasized to her left hand, and she underwent metastasectomy and monthly local injections of interferon-beta. She developed shimmering vision, photopsia, blurred vision, and night blindness in her left eye in April 2009 and visited our clinic. At our initial examination, her best-corrected visual acuity was 1.5 OD and 1.2 OS, and ophthalmoscopy showed that the retina appeared normal in both eyes. However, there was a mild narrowing of retinal arteries in the left eye. Humphrey field analyzer (HFA) showed a reduction in retinal sensitivity within the central 30° of the left eye. The maximum combined response of the full-field electroretinogram (ERG) had a normal waveform in the right eye and a negative waveform in the left eye. Immunocytochemical tests showed antibodies against retinal bipolar cells, which confirmed the diagnosis of melanoma-associated retinopathy (MAR). The metastatic melanoma was successfully treated. Seventeen months after her first visit, her visual acuity was 1.5 OD and 1.2 OS, and HFA showed normal retinal sensitivity in both eyes. The full-field ERGs were also normal in both eyes. Although several therapeutic modalities have been proposed for MAR, surgical resection with local injections of interferon-beta should be considered as a treatment option for MAR patients.

Retinal function in patients with serpiginous choroiditis: a microperimetry study

To investigate fixation pattern and retinal sensitivity in patients with serpiginous choroiditis (SC). Twenty-eight eyes (14 patients) with SC were evaluated. Best-corrected visual acuity, color fundus photography, fundus autofluorescence, and fluorescein and indocyanine green angiography were performed. Microperimetry was used to assess fixation pattern and retinal sensitivity. Of 28 eyes, 16 (57%) had central, one (4%) poor central, and 11 (39%) eccentric fixation; and 18 (64%) had stable, four (14%) relatively unstable, and six (21%) unstable fixation. In patients with posterior pole symmetrically involved in both eyes, the better eye had stable and central fixation in all cases. Atrophic lesions were characterized by a dense scotoma in all cases, with a relative scotoma at their margins in ten eyes (38%). In two cases of active disease, a dense scotoma correlated to an active lesion could be detected. A relative scotoma was documented in areas not involved by the disease at the posterior pole in eight eyes (28%), and in the peripapillary area in 11 eyes (39%). Quantification of retinal sensitivity and fixation pattern by microperimetry offers new data about the impact of visual impairment in patients with SC. A reduction of retinal sensitivity in an apparently healthy area suggests a wider functional involvement of the retina, undetectable by morphologic evaluation alone.

The role of optical coherence tomography in the detection of pituitary adenoma

To analyse retinal nerve fibre layer (RNFL) thickness in eyes with compression of the optic chiasm by a pituitary adenoma. RNFL thickness was analysed with optical coherence tomography (OCT) and compared to visual field measurements using high-pass resolution perimetry (HRP). Sixteen eyes from eight patients with pituitary adenoma were studied. All had bitemporal visual field depression caused by compression of the optic chiasm. Patients were submitted to an ophthalmic examination more than 14 months after surgery (seven patients had undergone trans-sphenoidal and one trans-cranial adenomectomy). The examination included HRP, fundus photography and measurement of the peripapillar RNFL thickness using OCT. In spite of temporal visual field depression, not all eyes showed reduced RNFL thickness by OCT. This was also true for some eyes in which RNFL was judged to be reduced on fundus photographs. Contrary to our expectations, RNFL thickness in the nasal quadrant was normal in nine of the 16 eyes. Corresponding figures for the superior, inferior and temporal quadrants were eight, six and five, respectively. The overall RNFL thickness, as measured by OCT, did not correlate well with neural capacity, which is an index of remaining retino-cortical neural channels in HRP. RNFL thickness as measured with OCT was reduced in most, but not all, eyes with temporal field depression caused by chiasmal compression. The pattern of RNFL loss did not correlate well with the visual field defect. Sensitivity of RNFL thickness measurement in OCT was low. The method has limited value in the diagnosis of pituitary tumour compression.

Correlation between retinal nerve fibre layer thickness and retinal sensitivity

To evaluate the relationship between retinal nerve fibre layer (RNFL) thickness measured by optical coherence tomography (OCT) and light threshold values obtained with the Micro Perimeter 1 (MP1). Forty-nine normal subjects and 37 glaucoma patients were included. Thickness of the RNFL around the optic disc was measured with Stratus OCT scans, and static threshold perimetry was performed with the MP1 at the same visit. Total average and mean 12-clock-hour RNFL thickness were measured with Stratus OCT. An automated 4-2-1 staircase strategy with Goldmann III stimuli was used for MP1. The correspondence between Stratus OCT and MP1 RNFL measurements in each clock-hour was best fit by a second-order polynomial. Average RNFL thickness in the normal group was significantly higher than that in the glaucoma group in each clock hour. Comparing the normal and glaucomatous groups, retinal sensitivity differed significantly at 6, 7, 8 and 11 o'clock. In these regions, structure-function relationships were generally stronger than in other regions. Structure-function associations may be strong when loss of nerve fibres is severe. However, significant reduction in retinal sensitivity does not emerge until the atrophy of nerve fibres is severe.

Correlation of Functional Impairment and Morphological Alterations in Patients With Group 2A Idiopathic Juxtafoveal Retinal Telangiectasia

To correlate functional impairment with morphological alterations in patients with group 2A idiopathic juxtafoveal retinal telangiectasia. As part of the Macular Telangiectasia Project, a cohort of 10 patients underwent additional functional testing and imaging studies including photopic and scotopic fine matrix mapping, microperimetry, reflectance, and autofluorescence imaging with scanning laser ophthalmoscopy. From clinical stage 2 to 5, scotopic central function was reduced, which corresponded to depletion of macular pigment density. From clinical stage 3 onward, severe photopic and scotopic scotomata with up to 30 dB of loss were found next to fixation and were not totally confined to abnormalities seen with standard imaging modalities. The number of test points with loss of 10 dB or more was significantly greater for scotopic testing than for photopic testing (P = .007, Wilcoxon signed rank test). Rod function may be more severely affected than cone function in patients with group 2A idiopathic juxtafoveal retinal telangiectasia, and this may occur early in the disease progression. Severe reduction in retinal sensitivity is spatially confined to morphological alterations seen with scanning laser ophthalmoscopy imaging. The findings imply that idiopathic juxtafoveal retinal telangiectasia is not solely a vascular disease and that early neuronal involvement may be implicated in the pathogenesis of the disease.

Microperimetric Evaluation of Macula in Retinopathy of Membranoproliferative Glomerulonephritis Type II: A Case Report

To report on the microperimetric evaluation of the central visual field in a patient with retinopathy due to membranoproliferative glomerulonephritis. The central 20 degrees visual field was evaluated using fundus-related perimetry with (Nidek MP1) microperimeter in a patient with proven membranoproliferative glomerulonephritis type II, who had multiple drusen-like lesions involving the posterior pole of both eyes, with corresponding window defects on fundus fluorescein angiogram. Static threshold perimetry of the central 20 degrees using a 10 dB threshold, Goldmann size II stimulus, with (Nidek-MP1) microperimeter showed reduction in retinal sensitivity in the parafoveal and in the temporal paramacular areas in both the eyes that had drusen-like lesions. Early loss of function in retinopathy of membranoproliferative glomerulonephritis type II can probably be detected by fundus-related microperimetry.

Changes in retinal light sensitivity following blunt ocular trauma.

To prospectively examine changes in retinal light sensitivity following blunt ocular trauma in eyes with traumatic hyphaema with no evidence of retinal injuries 1 week, 1 month and 4 months after injury. Sixteen patients who sustained hyphaema after blunt ocular trauma without visible traumatic retinal lesions underwent visual field testing on the C 30-2 programme of the Humphrey field analyser as soon as visual acuity recovered to 0.7 or more with correction. Significant reduction in retinal sensitivity with MD (mean deviation) p values less than 5% was found in 50% (8 eyes) of our patients 1 week after injury. MD p values significantly improved 1 month after injury (p < 0.001) and even more so after 4 months (p < 0.00004). After 4 months only in one eye (6%) was a significant reduction in retinal sensitivity observed with a MD p value less than 5%. No correlations between improvement in retinal sensitivity and the extent of hyphaema or the extent of angle recession were observed. In 50% of eyes following blunt ocular trauma without evident traumatic posterior segment abnormalities significant transient reduction in retinal light sensitivity was observed with nearly complete recovery over time.