Severe Visual Field Defects Research Articles

First Year Results of Suprachoroidal Adipose Tissue Derived Mesenchymal Stem Cell Implantation in Degenerative Macular Diseases.

Background and ObjectivesThis study shows the clinical data of 1-year follow-up of 8 patients with degenerative macular diseases who received suprachoroidal adipose tissue derived mesenchymal stem cell (ADMSC) implantation.Methods and ResultsThis prospective, single-center, phase 1/2 study enrolled 8 eyes of 8 patients with degenerative macular diseases of various reasons who underwent suprachoroidal implantation of ADMSCs. All patients had severe visual field defects and severe visual loss. All patients had defective multifocal electroretinography (mf ERG). The worse eye of the patient was selected for the operation. Patients were evaluated on the first day, first month, sixth month and at 1 year postoperatively. Best corrected visual acuity (BCVA), anterior segment and fundus examination, color photography, optical coherence tomography (OCT) and visual field (VF) examination were carried out at each visit. Fundus fluorescein angiography (FFA) and mfERG recordings were performed at the end of the sixth months. All 8 patients completed the 1 year follow-up. None of them had any systemic or ocular complications. Seven of the patients experienced visual acuity improvement, visual field improvement and improvement in the mfERG recordings. We found choroidal thickening in OCT of the four treated eyes.ConclusionsEven though the sample size is small, stem cell treatment with suprachoroidal implantation of ADMSCs seems to be safe and the improvements were encouraging. To optimize the cell delivery technique and to evaluate the effects of this therapy on visual acuity and the quality of life of these patients, future studies with larger number of cases will be necessary.

The Consequences of Glaucoma on Mobility and Balance Control in the Older Adults: A Cross-Sectional Study.

The aim of the study was to explore the functional impairments and related factors in older adults with moderate to advanced stages of glaucoma. Nineteen patients with glaucoma and 19 participants with no ocular disease performed step test and balance control tasks with analysis of overall stability index and fall risk index. Monocular and binocular Humphrey Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to measure physical activity level. Patients with glaucoma showed poorer values for most of the mobility and balance control parameters with medium and large effect sizes (0.3-0.5). Mobility scores in patients were partly associated with their monocular visual field defect (rs = .507, p < .05). Low physical activity was identified as a risk factor for falls (rs = -.453, p < .05) and postural instability (rs = -.457, p < .05). Functional declines in dynamic tasks were not related to glaucoma severity. Older adults with glaucoma display impairment with mobility and balance control compared to controls, associated with the degree of monocular visual field loss and lower daily physical activity.

Characterization of a novel mutation in the MYOC gene in a Chinese family with primary open‑angle glaucoma.

Although primary open-angle glaucoma (POAG)-related mutations in the myocilin (MYOC) gene have been reported, the underlying associations remain poorly understood. In the present study, the relationship between a MYOC mutation and POAG was investigated using ophthalmic examination and total exon gene sequencing in a Chinese family comprised of 5 individuals with POAG and 15 unaffected individuals. Pathogenic mutations underlying POAG were identified by whole-exome sequencing and subsequently validated by Sanger sequencing. Of the family members, nine (45%) harbored heterozygous p.D208Y mutations; among these, five had POAG and four were unaffected. The mean age at diagnosis was 26.2±4.12 years and the mean intraocular pressure (IOP) was 39.7±16.58 mmHg; all affected members complained of vision loss, headaches and eye swelling. Among the five cases of POAG, two presented with blindness. Among 10 members of the family who underwent comprehensive ophthalmologic examination, 3 individuals exhibited severe visual field defects. The mean age at the time of operation was 27.2±3.54 years. In the present study, a novel MYOC mutation (c.G622T: p.D208Y) was identified that was associated with severe visual impairment, high IOP and the need for frequent surgical interventions. Some carriers of the mutation were young and did not show signs of glaucoma. These individuals should be followed-up to firmly establish whether the mutated gene is pathogenic for POAG.

To Evaluate Optic Nerve Head Changes In Patients With Primary Open Angle Glaucoma

The early discovery of optic nerve head changes via careful assessment prompts initial finding and the board of essential open point glaucoma. The current examination was attempted to break down to the optic nerve head in patients of open point glaucoma regarding visual field defects.110 eyes of 60 patients were concentrated in this cross-sectional investigation. The mean age of the patients was 58.26±10.44 years, with 30 males and 30 females. 15% of the patients were suffering from hypertension. The mean IOP among the eyes was 18.63 ±4.17 mm of Hg. The mean vertical C/D ratio was 0.61 ±0.12. 89.09% of patients had a medium disc size. The R/D ratio among patients showed that majority of eyes having RD ratio of 0.01-0.1 (30.91%). HPA grades showed that 32.72% had severe visual field defects. 97.30% of eyes had a contiguous visual loss as compared to noncontiguous (2.70%). The nasal field was mostly affected by 51.35%. DDLS has a stronger correlation with Mean Defect than Vertical C/D ratio and with HPA classification than the Vertical C/D ratio. DDLS to be a simple, brisk, modest and precise strategy to record ONH harm. It seems, by all accounts, to be better than the C/D proportion for optic plate assessment.

Juvenile-onset Open-Angle Glaucoma at the University Teaching Hospitals - Eye Hospital, Lusaka Zambia

Purpose: To demonstrate the socioeconomic, demographic and clinical characteristics associated with patients of juvenile-onset open-angle glaucoma (JOAG) at the University Teaching Hospitals Eye Hospital (UTHs - EH).&#x0D; Methods: This was a cross-sectional survey for Juvenile Open Angle Glaucoma (JOAG) conducted at the UTHs - EH in, Lusaka, Zambia from January to December 2013. All participants aged between 18 and 39 years had a full ocular examination after capturing demographic and socioeconomic information. The ocular examination includedvisual acuity, intraocular pressure (IOP) and cup disc ratio (CDR) and tests performed were central corneal thickness (CCT) and visual fields. Severity was graded based visual field (VF) in the worse eye using the advanced glaucoma intervention study score. Univariate and multivariate logistic regression, stratified by age group and gender, wasused to determine the association between demographic factors and JOAG and between clinical factors and JOAG.Results: Of the 1625 patients recruited for the study, 309 were POAG patients. Of the 309 POAG patients, 140 aged 20 to 39 years old had bilateral JOAG. The distribution of the 140 participants was 98 (70.9%) females and 42 (29.4%) males. Thirteen (9.3 %) were aged 20 – 24 years, 29 (20.7%) 25 – 29 years, 44 (31.4%) 30 – 34 years, and 54 (38.6%) 35 –39 years. The mean age of the patients was 25.1 ± SD 8.7 years. The prevalence of JOAG was 8.6% (140/1625) distributed as 2.6% (95% CI 1.3, 3.9) males and 6.0% (95% CI 4.7, 9.2) females. There was a female preponderance of (71.2% vs. 28.8%; OR 2.98, 95% CI 2.3, 6.7, p=0.021). Eighty-five (60.7%) had complained of poor vision and 24 (17.1%) of eye pain. However, 24 (17.1%) presented with no definite symptoms. Patients with a positive family history presented 3.7 years earlier (P = 0.034, CI; 1.37-7.9) compared to those without a family history. Lower socioeconomic status (Odds ratio [OR] 3.5, P = 0.013, CI: 1.2-17.2), and higher IOP (OR 6.7, P = 0.002, CI: 2.6-21.8) were associated with severe glaucomatous visual field defects. High myopia (-6.47 ± 5.00 Diopters) was present in 70.9% of patients. The patients with myopia also had a severe elevation of IOP of (35.8 ±18.5 mmHg).&#x0D; Conclusions: The study found a high prevalence of JOAG at 8.6%. The patients with JOAG presented late with advanced disease and high IOP. Clinical, socioeconomic, and demographic factors are contributory to the severity of JOAG among JOAG patients.&#x0D; Recommendation: Early detection of cases during eye health care outreach programmes such as school and community screening of children and adults could be of great benefit in creating awareness, d ema n d , e a r l y d e t e c t i o n a n d p r omp t commencement of treatment. Glaucoma should no longer be considered a condition of the people aged 40 years and above.

Predicting Lifetime Transition Risk of Severe Visual Field Defects Using Monte Carlo Simulation in Japanese Patients with Primary Open-Angle Glaucoma.

PurposeTo maintain visual fields and quality of life over a lifetime, medical practice must be conducted taking into consideration not only visual field progression but also future visual field changes that occur over the patients’ expected lifespan. The purpose of this study is to investigate the feasibility of establishing a model that predicts prognosis, estimating the proportion of glaucoma patients with severe visual field defects.Patients and MethodsThe data of 191 patients with primary open-angle glaucoma, with a predominance of normal-tension glaucoma, were used for this study. The model was developed based on patients’ backgrounds and risk factors, using Monte Carlo simulation. A “severe visual field defect” was defined as ≤-20 dB. The mean deviation (MD) value for 10,000 virtual patients in each simulation pattern (144 patterns) was calculated using a predictive formula to estimate the MD slope, and the effects of risk factors and intraocular pressure (IOP) reduction on the proportion of patients with severe visual field defects were evaluated.ResultsYounger age, later-stage disease, more severe glaucomatous structural abnormalities and the presence of disc hemorrhage were associated with an increase in the progression rate of patients with severe visual field defects. Conversely, lower IOP was associated with a decrease in this rate.ConclusionCombining regression analysis with Monte Carlo simulation could be a useful method for developing predictive models of prognosis in glaucoma patients.

Evaluation of Mehta's modification of the Crawford technique for Frontalis Sling Surgery with Silicon rod in Severe Ptosis

Background: Ptosis is the drooping of the upper lid margin below its normal anatomic position due to the levator complex dysfunction. In this condition, the aesthetic and functional abnormality is obvious and is accompanied by severe visual field defect. Ptosis surgery is one of the most common oculoplastic procedures with different surgical procedures. The decision for an appropriate surgical procedure and the material used to minimize the incidence of complication depends on proper evaluation of the patient. Aims of study: To evaluate Mehta's Modification of the Crawford technique for frontalis sling surgery with silicon rod in sever ptosis. Patients and Methods: We considered 10 patients (12 lids) who were treated between February 2017 and June 2018. There were seven males and three females; two patients were bilateral and three patients had negative Bell's phenomenon, which was surgically treated with Mehta's modification of the Crawford technique for frontalis sling surgery with silicon rod. The patients’ age ranged from 4 to 30 years; they all had severe eyelid ptosis (&gt;4mm) with poor levator function (≤4 mm). Results: Our patients' postoperative results were good, functional, and aesthetic, showing a clear visual field, with smooth and regular eyelid margin and no notching. Nine out of 10 patients achieved good results according to the above-mentioned criteria, and in addition to that, both patient and parents' satisfaction were taken into consideration. Only one patient had developed recurrence (1- month postop.) Conclusions: Mehta's modification of the Crawford technique for frontalis sling surgery with silicon rod in sever ptosis used for the treatment of severe ptosis with poor levator excursion is an easy and simple procedure that promises good postoperative results. Keywords: Eyelid ptosis, Silicon rod, Mehta's Modification of Crawford technique.

Severity of visual field defects in primary congenital glaucoma and their risk factors.

The primary objective of the study was to assess the frequency and severity of visual field defects (VFD) in primary congenital glaucoma (PCG). The secondary objective was to ascertain any associated risk factors. An ambispective review of patients with PCG on follow-up with a 'target' intraocular pressure (IOP) of ≤ 15mmHg. Age, sex, laterality, duration of follow-up, baseline IOP, baseline cup-disc ratio (CDR), central corneal thickness (CCT), age during filtering surgery, second surgery if any, yearly IOP, glaucoma medications and best corrected visual acuity from 2013 (year 1) to the final review and final CDR were noted down. Children ≥ 5years of age with best corrected visual acuity ≥ 6/60 were subjected to manual kinetic Goldmann perimetry, and visual field defects (VFD) were identified. Seventy-one of 90 eyes completed a reliable kinetic perimetry. The mean age of children was 12.34 ± 4.86years, and the mean follow-up duration was 10.77 ± 4.69years. Baseline IOP and CDR were 29.07 ± 8.83mmHg and 0.66 ± 0.22, respectively. 86.67% of eyes underwent a trabeculotomy + trabeculectomy with mitomycin-C. Thirty-one eyes (34.44%) required a second surgery, 25 of which were bleb revisions and 3 trabeculectomies. Mean IOP and CDR during last visit were 10.23 ± 2.76mmHg and 0.52 ± 0.25, p < 0.001 as compared with baseline. On Goldmann perimetry, 19 eyes, 26.76%, had defects, arcuate scotoma being most frequent. On the Fisher exact test, a baseline/final CDR > 0.8, undergoing just a trabeculectomy with MMC, needing ≥ 2 glaucoma medications on review or a repeat trabeculectomy was associated with greater severity of VFD. On univariate logistic regression, eyes that needed a bleb revision [OR, 95% CI 9.75 (2.66-35.67), p = 0.001], a repeat trabeculectomy with mitomycin-C [OR (CI) 18 (1.31-245.58), p = 0.03] and final CDR of > 0.8 [OR (CI) 23.1 (3.7-144.21), p = 0.001] were associated with VFD. On multivariable regression analysis, female sex [OR (CI) 18 (2.01-161.04), p = 0.01] was identified as the single most important risk factor for development of a VFD. At a 'target' IOP of ≤ 15mmHg, 26.76% of PCG eyes manifested a VFD over 10years. Baseline and/or final CDR > 0.8, necessity for ≥2 medications or a repeat glaucoma surgery, and female sex were identified as risk factors for development and greater severity of glaucomatous VFD.

Trends in the Retinal Nerve Fiber Layer Thickness Changes with Different Degrees of Visual Field Defects.

Purpose To explore the disease progression of primary open-angle glaucoma (POAG) in individuals with different degrees of VF defects by analyzing the trends in retinal nerve fiber layer (RNFL) changes at each stage. Methods A total of 39 patients (77 eyes) were divided into three groups based on the severity of glaucomatous visual field (VF) loss: the first group included patients with mild baseline VF defects (mild group; n = 21 eyes). The second group included patients with moderate VF defects (moderate group; n = 18 eyes). The third group included patients with severe baseline VF defects (severe group; n = 38 eyes). For all patients, slit-lamp biomicroscopy of the anterior and posterior segments and detailed fundus and optic disc inspections were performed, the intraocular pressure (IOP) was measured by Goldman tonometry, best-corrected visual acuity (BCVA) was measured, the RNFL thickness was measured by OCT, and the VF was assessed by the Octopus perimeter. All the groups were followed up postoperatively for 18 months. Results The mean RNFL thickness was recorded for all the visits. Using simple linear regression analysis, we found that the R2 values of the three groups were 0.988, 0.982, and 0.814, respectively, and the slopes of mean RNFL thickness changes for mild, moderate, and severe baseline VF defects were −0.088, −0.082, and −0.015, respectively. Moreover, we used simple linear regression analysis to explore whether and how the speed of RNFL thinning differs across groups. The R2 values of the three groups were 0.982, 0.978, and 0.805, respectively, and the slopes for mild, moderate, and severe baseline VF defects were 0.089, 0.085, and 0.017, respectively. Conclusion The rate of RNFL thinning is linear; RNFL thinning is the fastest in individuals with mild baseline VF defects, followed by those with moderate baseline VF defects. In individuals with severe VF defects, changes in the RNFL thickness do not appropriately reflect the progression of the disease. The clinical trial is registered with ChiCTR2000028975.

Defective angles of localized retinal nerve fiber layer reflect the severity of visual field defect- a cross-sectional analysis

BackgroundIn order to detect glaucomatous optic nerve damages early on and evaluate the severity of glaucoma, a previously developed analytic method based on photographic retinal nerve fiber layer (RNFL) angle defect was proposed. However, the correlation between these defective angles and the severity of visual field defect has not been verified. This study aimed to confirm the correlation described above.MethodsWe reviewed a total of 227 glaucomatous eyes (38 enrolled, 189 excluded) during an interval of 5 years. The angles of all eyes were measured on RNFL photograph, of which angle α is the angular width between the macula center and the proximity of RNFL defect, and angle β (+c) is the sum of angular width(s) of localized RNFL defect. The severity of visual field defect was determined by mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). Correlation analysis was performed on angle α and angle β (+c) with the presence of central scotoma and visual field defect parameters, respectively.ResultsAngle β (+c) showed significant correlation with MD (P = 0.007), PSD (P = 0.02), VFI (P = 0.03), and average RNFL thickness (P = 0.03). No correlation was found between angle α and the presence of central scotoma.ConclusionsIn conclusion, measuring the angular width of localized RNFL defect is a viable method for determining the severity of visual field defect.

Glaucomatous visual field loss in eyes undergoing first trabeculectomy in Iceland

Glaucoma is a degenerative disease in the optic nerve with associated visual field defects (VFD). Trabeculectomy is the most common glaucoma surgery. Surgery is indicated if glaucomatous optic neuropathy progresses despite tolerated medical treatment or in patients with severe VFD. The purpose of this paper is to describe the severity of visual field damage in patients undergoing their first trabeculectomy in Iceland. A retrospective review of medical records of all patients with open angle glaucoma that underwent first trabeculectomy at Landspítali University Hospital, from June 2013 to March 2016. Visual fields were examined by Octopus automated perimetry and the severity of glaucoma damage was staged according to the mean defect (MD). 86 eyes were included in the study, mean age 75 ± 11 years, 57% men. Patients used on average three IOP lowering medications. Mean MD at referral to surgery was 13.4 ± 7.7dB (min 0.8dB, max 26.2 dB), 21% had early glaucomatous damage (MD <6dB), 23% moderate (MD 6-12 dB) and 56% severe (MD > 12). VFD at referral to surgery varied from mild VFD to severe damage. Like clinical guidelines recommend, treatment seems to be individualized and the most common indication for surgery was increased VFD despite medical treatment. Mean MD at referral to surgery was high compared to other studies. Eyes with severe VFD had on average lower IOP and thinner cornea. This might indicate that great emphasis is placed on high IOP and perhaps too little emphasis on VFD and cornea thickness.

Vision-related quality of life in patients with occipital stroke.

The aim of this study was to detect visual field defects (VFDs) after occipital infarction, investigate the rate of recovery and the impact of VFD upon vision-related quality of life (QoL). Multicenter, prospective study including patients with MRI verified acute occipital infarction (NOR-OCCIP project). Ophthalmological examination including perimetry was performed within 2weeks and after 6months. Vision-related QoL was assessed by the National Eye Institute Visual Function Questionnaire 25 (VFQ-25) at one and 6months post-stroke. We included 76 patients, reliable perimetry results were obtained in 66 patients (87%) at a median of 8days after admittance and VFD were found in 52 cases (79%). Evaluation of VFD after 6months revealed improvement in 52%. Patients with VFD had significantly lower composite score in VFQ-25 at both test points (77 vs 96, P=.001 and 87 vs 97, P=.009), in nine out of eleven subscales of VFQ-25 at 1month and seven subscales after 6months, including mental health, dependency, near and distance activities. Milder VFD had better results on VFQ-25 modified composite score (95 vs 74, P=.002).VFD improvement was related to improved VFQ-25 modified composite score (9.6 vs 0.8, P=.018). About 10% of patients with VFD reported driving 1month post-stroke and 38% after 6months. VFD substantially reduces multiple aspects of vision-related QoL. Severity of VFD is related to QoL and VFD improvement results in better QoL. Neglecting visual impairment after stroke may result in deterioration of rehabilitation efforts. Driving post-stroke deserves particular attention.

Long-Term Follow-Up of Normal Tension Glaucoma Patients With TBK1 Gene Mutations in One Large Pedigree

To characterize features of glaucoma associated with a TANK binding kinase 1 (TBK1) gene duplication, which is among the most common molecularly defined causes of normal tension glaucoma (NTG). Retrospective observational case series. We conducted a retrospective case series, by reviewing medical records of 7 members of a pedigree with NTG caused by TBK1 gene duplications. Clinical features of these patients at diagnosis, throughout management, and at latest follow-up were identified, including age, intraocular pressure (IOP), central corneal thickness (CCT), optic nerve head appearance, and mean deviation (MD) assessed with Humphrey visual field (HVF) testing protocols. At initial diagnosis, the mean age was 35 ± 7 years, IOP was 16 ± 2.1mm Hg, cup-to-disc (C/D) ratio was 0.9 ± 0.08, and MD assessed via HVF 30-2 and/or 24-2 testing protocols was-9.0 ± 8.9 (range:-1.8 to-27) dB in the 14 study eyes. At initial diagnosis, 4 of 14 eyes (28%) had no visual field defect, 4 (28%) had early visual field defects, and 6 (43%) had severe visual field defects. Patients had a mean follow-up of 21.5 ± 9.0 years and experienced an average reduction of IOP by 28%. Four of 12 eyes (33%) had stable visual fields throughout follow-up, while 8 eyes (67%) had slow-to-moderate progression. The 30-2 and/or 24-2 HVF tests had an average change in MD of-0.53 ± 0.26 dB/year. No eyes had rapid progression with an MD >1.0 dB/year. At final follow-up, the mean IOP was 11.5 ± 2.9, and C/D ratio was 0.94 ± 0.4. At final follow-up, 3 of 14 eyes (21%) had early visual field defects, 4 (29%) had moderate visual field defects, and 7 (50%) had severe visual field defects. Six of 14 eyes (43%) met criteria for legal blindness. We provide the first report of the clinical features and long-term clinical course in a family of NTG patients with TBK1 gene duplications. TBK1-associated glaucoma exhibits classic features of NTG. Patients present with severe disease at a relatively early age and most (67%) have slow-to-moderate progression of their visual field defects. The rate of visual field change appears correlated with the magnitude of IOP, suggesting that it may be advantageous to set extremely low IOP targets for some patients with TBK1-associated glaucoma.

Sellar region extramedullary plasmacytoma – A rare skull base tumour

Plasma cell neoplasms can present either as multiple myeloma, or in <10% of cases, as solitary plasmacytoma. Extramedullary plasmacytoma, a subtype of solitary plasmacytoma, only accounts for <5% of all plasma cell neoplasms, and <1% of all head and neck tumours. Extramedullary plasmacytoma usually arises from aerodigestive tract, and infrequently, from skull base and calvarium. Sellar region extramedullary plasmacytoma is a relatively rare tumour in the sellar region. Sellar region extramedullary plasmacytoma is usually asymptomatic until the lesion is large enough to impinge on surrounding structures, most commonly the cranial nerves. Radiological findings for extramedullary plasmacytoma are rather non-specific, but MR pituitary provides essential information with regards to its origin and its content, which aid in ruling out other diagnoses. The tumour usually enhanced homogenously post-Gadolinium, without involvement of surrounding bones. Due to the rarity of sellar region extramedullary plasmacytoma, tumour histo-pathological examination is recommended to achieve an accurate tissue diagnosis. Apart from neuroimaging, evaluations for plasma cell neoplasms include total body skeletal survey, serum and urine electrophoresis, routine blood count, serum calcium level and bone marrow biopsy. Principally, the diagnosis of plasmacytoma is confirmed by ruling out the presence of multiple myeloma. As for management of extramedullary plasmacytoma, local irradiation is the treatment of choice. Nonetheless, surgery is required for tissue diagnosis and tumour debulking in patients with neurological deficit due to mass effect.A 48-year-old lady presented with 5 months history of progressive bilateral poor vision and worsening headache. Clinically, she had severe visual acuity and visual field defect, but no other neurological deficit. MR imaging showed a large lobulated sellar mass, homogenously enhanced with extension and invasion to surrounding structures. She had undergone bifrontal craniotomy and tumour debulking. Intraoperatively, the tumour was highly vascularised. Tumour histopathological result was reported as extramedullary plasmacytoma. Serial plasma and urine investigations showed negative results for multiple myeloma. Hence, the final diagnosis of skull base extramedullary plasmacytoma was established. She was then scheduled for adjuvant radiotherapy. Unfortunately, her vision impairment persists.

Eye-Hand Coordination Impairment in Glaucoma Patients.

This study examined whether patients with glaucoma exhibit differences in eye–hand coordination tasks compared to age-matched normal-sighted control subjects. Twenty-eight patients with moderate-to-advanced stages of glaucoma and 28 subjects with no ocular disease participated in the study. The Motor Performance Series (MLS) of the Vienna Test System including aiming, linear tracking, tremor, and tapping tests were used to assess eye–hand coordination. Monocular Humphrey Visual Field and binocular Humphrey Esterman Visual Field tests were used to estimate visual field (VF) defect severity. Correlation between MLS scores and VF defects, visual acuity, and patient age were assessed. Glaucoma patients performed slower aiming at targets, committed more errors, and took longer to complete linear tracking and tremor tasks compared to the normal-sighted control group. Furthermore, tapping test scores indicated reduced hand movements at maximum frequency. The presence of asymmetrical monocular VF defects were associated with longer error durations in linear tracking tasks. Furthermore, MLS scores decline with advancing age and reduced visual acuity. Glaucoma patients had lower values for most MLS parameters compared to controls. However, monocular and binocular VF defects cannot fully explain the impartments in eye–hand coordination associated with glaucoma.

Obstructive Sleep Apnea in Patients With Primary-open Angle Glaucoma: No Role for a Screening Program.

It has been proposed that OSA might be a contributing factor in the development of POAG and by extension that there could be a role for screening people with POAG for OSA. To assess whether the prevalence of OSA among patients with POAG is different from that in people without glaucoma and to examine for associations between apnea-hypopnea index (AHI) and markers of functional and structural changes in POAG. Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed. Data from 395 participants, 235 POAG patients, and 160 controls were analyzed. The prevalence of OSA was 58% [95% confidence interval (CI), 52-65] in POAG patients and 54% (95% CI, 47-62) in controls, with 22% (95% CI, 16-27) of POAG patients and 16% (95% CI, 11-22) of controls diagnosed with moderate or severe OSA. A total of 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (P=0.91 for AHI≥5 and P=0.66 for AHI≥15). The AHI was not associated with the severity of visual field defect or retinal nerve fiber layer thinning after adjustment for confounders. This study confirms a high prevalence of OSA among patients with POAG which is, however, not higher than in people without glaucoma matched for known OSA risk factors. Our results do not support screening for OSA in patients with POAG.

Sectoral Differences in the Association of Optic Nerve Head Blood Flow and Glaucomatous Visual Field Defect Severity and Progression.

To investigate sectoral differences in the relationship between optic nerve head tissue blood flow, anatomically corresponding visual field defect severity, and future progression. This retrospective longitudinal medical chart review comprised 508 eyes of 319 open-angle glaucoma patients (mean deviation: -9.2 ± 7.0 dB), followed for an average of 4.7 ± 1.1 years; an average 11.7 ± 3.7 visual field tests were performed. Average total deviation (TD) was calculated in the superior, central, and inferior sectors of the Humphrey 24-2 program. The optic nerve head was divided to obtain inferior, temporal, and superior tissue-area mean blur rate (MT), derived from laser speckle flowgraphy. At baseline, the correlation between MT and TD was compared in anatomically corresponding sectors. We performed a multivariate analysis to determine the contribution of baseline MT to corresponding TD slope and to determine background factors influencing superior to temporal MT. We used a linear-mixed effect model for the statistical analysis. At baseline, the highest β coefficients were found between MT-superior and TD-inferior, MT-temporal and TD-central, and between MT-inferior and TD-superior, in that order (β = 0.38, β = 0.27, β = 0.26, respectively). MT-superior and MT-temporal independently contributed to corresponding TD slope (P < 0.05). Male sex, high body mass index, and the prevalence of sleep apnea syndrome were contributing factors to lower superior to temporal MT (P < 0.05). Review of medical history, measurements of systemic variables, and laser speckle flowgraphy parameters might help clinicians to predict visual field defect severity and progression.

What are the characteristics and progression of visual field defects in patients with Leber hereditary optic neuropathy: a prospective single-centre study in China

ObjectiveTo study the characteristics and progression of visual field defects in patients with Leber hereditary optic neuropathy.DesignProspective study.Setting3-A-class hospital in China; single-centre study.ParticipantsFrom 100 patients diagnosed with Leber hereditary optic...

Visual field defects and changes in central retinal artery occlusion.

ObjectivesTo investigate the characteristics and temporal changes in visual field defects (VFDs) in eyes with acute central retinal artery occlusion (CRAO).DesignRetrospective, observational case seriesMethodsA total of 119 patients diagnosed with acute non-arteritic CRAO through examination with Goldmann perimetry were included among the patients who visited Seoul National University Bundang Hospital between January 2009 and December 2016. They were treated with either conservative treatments or intra-arterial thrombolysis (IAT). The baseline features and temporal changes of visual field examination results and the association with clinical parameters including visual acuity, optical coherence tomography (OCT) findings, and the CRAO stages.ResultsAll of the 119 patients showed visual field defect and suffered unilateral acute CRAO. We observed five characteristic VFDs: peripheral constriction only (8%), paracentral scotoma (3%), central and cecocentral scotoma (19%), temporal island (59%), and no visual field (10%). Severe VFDs were associated with severe CRAO stages, poor baseline BCVA, delayed retinal arterial perfusion, and severe retinal morphologic changes on OCT. We found improvements in the visual field in 39% of all cases during the follow-up periods. Mild CRAO stages, good baseline BCVA, mild retinal morphologic changes, and mild initial VFDs were significantly associated with visual field improvement.ConclusionsThe five characteristic types of VFDs and their improvement in eyes with CRAO are associated with baseline features related to the severity of retinal ischemia. We suggest that the underlying mechanisms of VFDs involve the balance between the retinal arterial perfusion and the ischemic vulnerability of each retinal area.

Correlation of peripapillary nerve fiber layer thickness with visual outcomes after decompression surgery in subclinical and clinical thyroid-related compressive optic neuropathy

PurposeTo assess the correlation of peripapillary retinal nerve fiber layer (PRNFL) thickness with visual recovery in compressive optic neuropathy (CON) in patients with thyroid eye disease (TED). MethodsTwenty-three eyes of 13 consecutive patients with TED-related CON were prospectively recruited. Assessment of PRNFL by means of spectral domain optical coherence tomography (SD-OCT), visual field (VF) parameters, color vision, and visual acuity in logMAR were compared before and 6 months after decompression surgery in the operated eye for each patient, which in ten cases included both eyes. Decompression surgery was performed as medial and inferior wall decompression sparing the orbital strut by the same surgeon. ResultsThere was a significant correlation between the preoperative PRNFL average thickness and postoperative improvement in visual acuity among all patients (P = 0.048). This correlation was found to be significant in clinically non-edematous optic neuropathy cases (P = 0.023) but not in edematous optic neuropathy (P = 0.23). There was significant correlation between PRNFL thickness and improvement of postoperative mean deviation (MD) and pattern standard deviation (PSD) parameters in VF studies and in color vision scores (P = 0.005, P = 0.02, P = 0.01, respectively). Average PRNFL thickness and quadrantal PRNFL were all significantly reduced after decompression surgery in all of the cases (P = 0.024). ConclusionsPRNFL thickness measured by SD-OCT is correlated with visual recovery after decompression surgery in TED-related CON. In eyes with severe VF defect (MD worse than −10 dB), the ones with higher preoperative PRNFL thicknesses (>65 μm) had more improvement in MD compared with those with thin PRNFL measures (<60 μm).