Significant Visual Field Defects Research Articles

Predictors of long-term visual field outcome after an episode of acute primary angle closure.

To investigate the long-term visual field (VF) outcome and baseline factors associated with functional sequelae in patients who experienced an episode of acute primary angle closure (APAC) and underwent subsequent lens extraction. Fifty patients (50 eyes) who experienced an APAC episode and underwent subsequent lens extraction at Chonnam National University Hospital were enrolled in this retrospective study. Patients underwent VF examinations after 1 year of an acute episode. They were classified into two groups based on whether they had significant VF defects or not. Demographic data were recorded, and baseline anterior-segment OCT (AS-OCT) images were analysed. Multivariate logistic regression analysis was performed to assess baseline risk factors for presence of VF defects. Twenty-five (50%) eyes were found to have varied degree of VF defects after 1 year of an acute episode. Longer duration between the symptom onset and IOP lowering (p=0.005), a higher presenting IOP (p=0.014), and flat iris curvature (p=0.037) at baseline AS-OCT measurement were significant predictors of VF loss. The area under the receiver operating characteristic curve (AUC) revealed that combination of these three potential baseline factors could predict the long-term VF outcome (AUC=0.921). Patients exhibiting a long duration between symptom onset and IOP lowering, a high presenting IOP, and flat iris curvature were at a higher risk of visual impairment after an episode of APAC. The eyes with such features may require more careful follow-up after an episode of APAC.

The presenting visual symptoms of optic chiasmal disease.

Recognising optic chiasmal disease early is important in order to avoid irreversible visual loss and the potential risk of mortality for patients. Yet, there is frequently a delay in the initial diagnosis. Whilst the signs of optic chiasmal disease, particularly the perimetric findings, are well documented in the recent literature, the symptoms have been less well reported. Whilst some patients with optic chiasmal disease will be asymptomatic, many will complain of visual symptoms including symptomatic field defects, problems with central vision, difficulty with near tasks, binocular visual disturbances, colour vision disturbances, photophobia, phosphenes, glare, and rarely, oscillopsia and visual hallucinations. Others may have headache or the severe and sudden visual symptoms associated with pituitary apoplexy. The visual symptoms may be vague or non-specific, even when there are significant bitemporal visual field defects. We aim in this review to describe the presenting visual symptoms of optic chiasmal disease, and to illustrate these with selected qualitative descriptions from the literature. Our hope is that this will aid clinicians in eliciting a careful history of the sometimes subtle symptoms that may be present.

Perceptual Grouping During Binocular Rivalry in Mild Glaucoma.

PurposeThis study tested perceptual grouping during binocular rivalry to probe the strength of neural connectivity of the visual cortex involved in early visual processing in patients with mild glaucoma.MethodsSeventeen patients with mild glaucoma with no significant visual field defects and 14 healthy controls participated. Rivalry stimuli were 1.8°-diameter discs, containing horizontal or vertical sine-wave gratings, viewed dichoptically. To test the grouping, two spatially separated identical stimuli were presented eccentrically to the same or different eyes and to the same or different hemifields. The outcome measures were the time of exclusive dominance of the grouped percept (i.e., percept with synchronized orientations), the rivalry rate, and the epochs of exclusive dominance.ResultsFor both groups, the grouping occurred primarily for the matching orientations in the same eye/same hemifield (MO SE/SH) and for the matching orientations in the same eye/different hemifield (MO SE/DH) conditions. Time dominance of the grouped percept of the glaucoma group was similar to that of the control group in all conditions. The rivalry rates in the MO SE/SH and MO SE/DH conditions were significantly larger in the control group than in the glaucoma group. The epochs of exclusive dominance of the grouped percept in the MO SE/SH condition were a median of 48-ms longer for the control group, but a median of 116-ms shorter for the glaucoma group when compared to those in the MO SE/DH condition.ConclusionPatients with mild glaucoma show clear impairments in binocular rivalry while evidence for deficits in perceptual grouping could be inferred only indirectly. If these deficits truly exist, they may have implications for higher levels of visual processing, such as object recognition and scene segmentation, but these predictions remain to be tested in future studies.

Does hemispheric vascular regulation differ significantly in glaucoma patients with altitudinal visual field asymmetry? A single-center, prospective study

PurposeVascular risk factors and ocular perfusion are heatedly discussed in the pathogenesis of glaucoma. The retinal vessel analyzer (RVA, IMEDOS Systems, Germany) allows noninvasive measurement of retinal vessel regulation. Significant differences especially in the veins between healthy subjects and patients suffering from glaucoma were previously reported. In this pilot-study we investigated if localized vascular regulation is altered in glaucoma patients with altitudinal visual field defect asymmetry.Methods15 eyes of 12 glaucoma patients with advanced altitudinal visual field defect asymmetry were included. The mean defect was calculated for each hemisphere separately (−20.99 ± 10.49 profound hemispheric visual field defect vs −7.36 ± 3.97 dB less profound hemisphere). After pupil dilation, RVA measurements of retinal arteries and veins were conducted using the standard protocol. The superior and inferior retinal vessel reactivity were measured consecutively in each eye.ResultsSignificant differences were recorded in venous vessel constriction after flicker light stimulation and overall amplitude of the reaction (p < 0.04 and p < 0.02 respectively) in-between the hemispheres. Vessel reaction was higher in the hemisphere corresponding to the more advanced visual field defect. Arterial diameters reacted similarly, failing to reach statistical significance.ConclusionLocalized retinal vessel regulation is significantly altered in glaucoma patients with asymmetric altitudinal visual field defects. Veins supplying the hemisphere concordant to a less profound visual field defect show diminished diameter changes. Vascular dysregulation might be particularly important in early glaucoma stages prior to a significant visual field defect.

Homonymous hemi-macular atrophy of the ganglion cell-inner plexiform layer with preserved visual function

Homonymous hemimacular thinning of the retinal ganglion cell-inner plexiform layer (GCIPL) on optical coherence tomography (OCT) in the absence of significant visual field defects may be identified in the workup of patients with visual complaints, but the causes of this finding remain unknown. We retrospectively reviewed 1425 consecutive patients referred for neuro-ophthalmic assessment who had high quality OCT scans and reliable Humphrey 24–2 SITA-Fast testing. A total of 7 patients, 3 females and 4 males, with a mean age of 39.4 ± 10.5 years that had homonymous thinning of the OCT macular-GCIPL without significant visual field defects were included in the study. Four patients had demyelinating disease and 3 patients had traumatic brain injury. Three patients with demyelinating disease had a documented prior homonymous visual field defect that resolved. The differential diagnosis of homonymous hemimacular thinning of the GCIPL without obvious visual field defects includes previous retrochiasmal demyelination and traumatic brain injury. OCT GCIPL provides a permanent objective way of documenting previous retrochiasmal disease including demyelination and may be helpful in establishing dissemination in time and space in patients being evaluated for multiple sclerosis.

Papillomacular retinoschisis associated with glaucoma

Peripapillary and macular retinoschisis is one of the rare manifestations of advanced glaucoma of different types. The article presents a case report and a mini-review. Peripapillary and macular retinoschisis with visual deterioration was diagnosed in a patient with advanced decompensated open-angle glaucoma and pseudoexfoliation syndrome. Surgical treatment of glaucoma led to intraocular pressure normalization, gradual regress of retinoschisis and improvement of visual functions. The retinal structure fully restored 1.5 years after the operation. The observation period was 3 years, retinoschisis did not recur. The article discusses the pathogenesis and potential algorithm for the treatment of the disease. Risk factors for the development of retinoschisis include high intraocular pressure, significant visual field defects and a wide range of diurnal intraocular pressure fluctuations. The source of the intra-retinal fluid is the vitreous body. Management of the patient consists of medical, laser and surgical normalization of intraocular pressure and regular monitoring. In case of persisting retinoschisis, patient undergoes vitreoretinal surgery or barrier laser coagulation. Retinal structure recovers gradually after the intervention and takes on average 1 year.

PD38-05 PROSPECTIVE EVALUATION OF EFFECT ON INTRAOCULAR PRESSURE AND VISUAL FUNCTION IN PATIENTS WITHOUT AND WITH OPHTHALMIC DISEASES AFTER ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2018PD38-05 PROSPECTIVE EVALUATION OF EFFECT ON INTRAOCULAR PRESSURE AND VISUAL FUNCTION IN PATIENTS WITHOUT AND WITH OPHTHALMIC DISEASES AFTER ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY SHIGENORI KAKUTANI, HIROSHI FUKUHARA, FUMIYUKI ARAKI, MASAAKI ASAMOTO, NOBUKO ITO, MAKOTO AIHARA, and HARUKI KUME SHIGENORI KAKUTANISHIGENORI KAKUTANI More articles by this author , HIROSHI FUKUHARAHIROSHI FUKUHARA More articles by this author , FUMIYUKI ARAKIFUMIYUKI ARAKI More articles by this author , MASAAKI ASAMOTOMASAAKI ASAMOTO More articles by this author , NOBUKO ITONOBUKO ITO More articles by this author , MAKOTO AIHARAMAKOTO AIHARA More articles by this author , and HARUKI KUMEHARUKI KUME More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1752AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although the fact is well-known that Trendelenburg position increases intraocular pressure (IOP) during robotic surgery and might cause postoperative visual loss (POVL), very few papers have reported on effect in patients with ophthalmic diseases after robotic surgery. Taketani Y et al reported that transient but significant unilateral visual field defects were found in 28% subjects after robotic assisted laparoscopic prostatectomy (RALP). We prospectively evaluated the effect on IOP and visual function in patients undergoing RALP. METHODS In this clinical study, the enrolled patients were performed RALP uneventfully under general anesthesia from December in 2015 to March in 2017 in our single institution, The University of Tokyo Hospital. We measured IOP of both eyes before, during and 7days after RALP and performed visual field tests using Humphrey visual field analyzer (HFA) before, 7days after, and 1-3 months after RALP. RESULTS A total of 99 patients were analyzed; mean IOP before and during RALP were 11.5±4.2 mmHg and 22.4±3.6 mmHg, respectively. IOP was significantly increased during RALP with P value < 0.01 as previously reported. POVL in 7 days after RALP was detected in 21 eyes of 16 subjects but all of them recovered to normal in 1 month after RALP. Among of them, 4 eyes of 3 subjects were diagnosed as ophthalmic diseases before RALP; 2 eyes of 1 subject as normal tension glaucoma, 1 eye of 1 subject as epiretinal membrane and 1 eye of 1 subject as scleritis. Before RALP, 24 eyes of 15 subjects were diagnosed as glaucoma; 22 eyes of 14 subjects as normal tension glaucoma and 2 eyes of 1 subject as closed angle glaucoma, in whom laser iridectomy was performed before RALP and no POVL was detected after RALP. CONCLUSIONS In our study, although transient POVL was detected in 16% of subjects after RALP, no severe visual defects were detected in 1-3 months after RALP both in patients without and in patients with ophthalmic diseases. Our data suggests that RALP does not affect visual function in the long term after surgery even in patients with normal tension glaucoma. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e737-e738 Advertisement Copyright & Permissions© 2018MetricsAuthor Information SHIGENORI KAKUTANI More articles by this author HIROSHI FUKUHARA More articles by this author FUMIYUKI ARAKI More articles by this author MASAAKI ASAMOTO More articles by this author NOBUKO ITO More articles by this author MAKOTO AIHARA More articles by this author HARUKI KUME More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms

BackgroundFlow-diverter stents (FDSs) are an upgrade in the treatment of intracranial aneurysms. However, complications concerning covered branches have been reported, especially the ophthalmic artery (OA). The purpose of our study...

Diagnosis and treatment of anti-myelin oligodendrocyte glycoprotein antibody positive optic neuritis.

Anti-myelin-oligodendrocyte glycoprotein (MOG) antibody positive optic neuritis has been established as a new subset of optic neuropathy. Anti-MOG antibodies are usually measured by cell-based assay. Patients with anti-MOG antibody positive optic neuritis respond well to steroid therapy, and, while visual acuity outcomes are favorable, significant visual field defects remain. Furthermore, patients who are anti-MOG antibody positive have higher rates of recurrence compared to antibody negative patients. Based on these findings, anti-MOG antibody positive patients with optic neuritis have the characteristics of good visual outcomes, residual visual field defects, and high risk of recurrence. Tests for anti-MOG antibody are useful for the diagnosis and treatment of optic neuritis.

Transcranial Supraorbital Approach for Tumor Removal of Spheno-Orbital Meningioma with Favorable Clinical Outcomes

Background: To describe and evaluate the surgery results regarding resectability and clinical outcomes oftranscranial supraorbital approach for tumor removal of spheno-orbital meningiomaCase Illustration: A 58-year-old woman presented with proptosis of the right eye since 9 years prior.At initial examination, visual acuity was 6/15 with significant nasal visual field defect. There wereprominent proptosis and inferior globe displacement of the right eye with no palpable mass. A frontoparietalbone deformity was also observed. CT scan examination revealed hyperostosis of sphenoid,frontal, and temporal bone with extensive intraorbital mass with contrast enhancement suggestive ofmeningioma. Incisional biopsy was the performed and confirmed the histopathological diagnosis ofmeningothelial meningioma (WHO grade 1). Transcranial supraorbital in conjunction with lateralorbitotomy was performed in this patient as the definitive treatment for tumor removal of sphenoorbitalmeningioma. Craniotomy and opening of orbital roof were carried out by neurosurgeon toexpose intraorbital region. Total tumor removal was than completed.Conclusion: Transcranial supraorbital approach is an effective surgery for spheno-orbital meningiomaremoval as it offers excellent exposure. A radical resection through transcranial approach can be achievedwith low morbidity, providing a significantly improved clinical outcome in long term period. In thiscase, the spheno-orbital meningioma was grossly resected totally with excellent visual outcome andacceptable cosmetic appearance.Keywords: spheno-orbital meningioma, transcranial approach, tumor resection

GPS Usage in a Population of Low-Vision Drivers

ABSTRACTPurpose: We surveyed bioptic and non-bioptic low-vision drivers in Illinois, USA, to determine their usage of global positioning system (GPS) devices. Methods: Low-vision patients completed an IRB-approved phone survey regarding driving demographics and usage of GPS while driving. Participants were required to be active drivers with an Illinois driver’s license, and met one of the following criteria: best-corrected visual acuity (BCVA) less than or equal to 20/40, central or significant peripheral visual field defects, or a combination of both. Results: Of 27 low-vision drivers, 10 (37%) used GPS while driving. The average age for GPS users was 54.3 and for non-users was 77.6. All 10 drivers who used GPS while driving reported increased comfort or safety level. Conclusions: Since non-GPS users were significantly older than GPS users, it is likely that older participants would benefit from GPS technology training from their low-vision eye care professionals.

Patterns of Binocular Visual Field Loss Derived from Large-Scale Patient Data from Glaucoma Clinics

To estimate prevalence of visual field (VF) loss in superior and inferior hemifields in binocular VFs in a large sample of patients with bilateral glaucoma. Retrospective cohort study. Glaucoma patients and suspects attending 4 regionally different secondary-care eye clinics in the United Kingdom. Binocular integrated visual fields (IVFs) using a best location method were constructed for 16 642 patients with bilateral VF loss. A significant VF defect was defined as 3 or more VF locations less than a certain sensitivity threshold, such as 20 dB. Patients were classified as having a VF defect in the inferior hemifield, superior hemifield, both hemifields, or neither hemifield. The criteria for number of locations and sensitivity threshold (in decibels) were varied across a large range of values. In addition, factor analysis was applied to the sensitivity values (in decibels) of the IVFs to determine common defect patterns in an automated fashion. Ratio of patients with binocular VF defects in the superior compared with the inferior areas of the IVF. Estimates of the ratio of patients having binocular VF defects in the superior compared with the inferior region of the IVF ranged from 2.1 (95% confidence interval, 2.1-2.4) to as high as 5.1 (95% confidence interval, 4.7-5.5), depending on the defect criteria used. Fewer than 10% of those patients exhibiting relatively early binocular VF loss had a defect confined to the inferior region only. Common patterns of binocular VF loss were dominated chiefly by superior hemifield defects. In a clinical population of patients with measurable VF loss in both eyes, superior-only binocular VF loss is more common than inferior-only loss. These estimates, derived from large collections of electronic medical records, are useful for interpreting findings about location of binocular VF loss impacting everyday activities and examining visual disability in glaucoma.

Usage of Accessibility Options for the iPhone and iPad in a Visually Impaired Population

ABSTRACTPurpose: The iPad and iPhone have a number of low-vision accessibility features including Siri Voice Assistant, Large Text, Zoom Magnification, Invert Colors, Voice Over, and Speech Selection. We studied their usage within a low-vision population. Methods: Patients were recruited to participate in an IRB-approved survey regarding their usage of the iPad and/or iPhone. Participants met one of the following criteria: best corrected visual acuity (BCVA) of 20/60 or worse, or significant peripheral visual field defects. Results: Thirty-three low-vision patients agreed to participate (mean age 54.3 years). There were 18 different diagnoses represented and the average visual acuity of respondents was 20/119 in the right eye and 20/133 in the left eye. The most commonly used vision accessibility features were Zoom Magnification and Large Text. Conclusions: Although many patients are using the low-vision accessibility features, few are receiving training or recommendations from their eye care specialist.

Transient but Significant Visual Field Defects after Robot-Assisted Laparoscopic Radical Prostatectomy in Deep Trendelenburg Position

BackgroundRobot-assisted laparoscopic radical prostatectomy (RALP) is a minimally invasive surgical procedure for prostate cancer. During RALP, the patient must be in a steep Trendelenburg (head-down) position, which leads to a significant increase in intraocular pressure (IOP). The association of RALP with visual field sensitivity, however, has not been prospectively studied. The purpose of this study was to evaluate prospectively the visual field, retinal nerve fiber layer (RNFL) thickness, and optic disc morphology in 50 normal eyes of 25 male patients that underwent RALP.MethodsThe subjects were 25 males among 33 consecutive patients who underwent uneventful RALP under general anesthesia in our hospital. Visual field tests using the Humphrey visual field analyzer 30-2 SITA-standard program were performed before, 7 days after, and 1-3 months after RALP. IOP was measured before, during, and after RALP; and ophthalmologic examinations, including slit-lamp, fundus examination, and optical coherence tomography (OCT), were scheduled before and 7 days after surgery.ResultsIOP was significantly increased during RALP up to 29.4 mmHg (P<0.01). Postoperative local visual field defects were detected in 7 eyes of 7 subjects dominantly in the lower hemifield without abnormal findings in the optic nerve head or retina, and the visual field recovered to normal within 3 months after surgery. General factors associated with RALP, IOP, RNFL thickness, or optic disc parameters did not differ significantly between eyes with and without postoperative visual field defects, and parameters of OCT measurements were not altered after surgery.ConclusionTransient but significant unilateral visual field defects were found in 28% of the subjects examined. The probable cause are the increased IOP and altered perfusion during surgery and ophthalmologic examinations are therefore suggested before and after RALP.

Examining Visual Field Loss in Patients in Glaucoma Clinics During Their Predicted Remaining Lifetime

To evaluate the proportion of patients in glaucoma clinics progressing at rates that would result in visual disability within their expected lifetime. This retrospective study used visual field (VF) series of at least 3 years' duration from 3790 UK patients in glaucoma clinics calculating rates of loss for each eye using linear regression of mean deviation (MD) over time. Residual life expectancies derived from the UK Office of National Statistics actuarial tables for each patient were combined with these rates to estimate predicted MDs at end of expected lifetime. The proportion of patients projected to progress to visual impairment (MD: -14 dB or worse) or statutory blindness (MD: -22 dB or worse) in both eyes before end of expected lifetime was calculated. Only 3.0% (95% confidence interval [CI] 2.7%-3.4%) of patient eyes progressed at faster than -1.5 dB/year (n = 7149 eyes). Of those patients with both eyes followed, 5.2% (CI 4.5%-6.0%) were predicted to progress to statutory blindness, with a further 10.4% (CI 9.4%-11.4%) reaching visual impairment in their lifetime. More than 90% (CI 85.7%-94.3%) of patients predicted to progress to statutory blindness, had an MD worse than -6 dB in at least one eye at presentation. This modeling exercise indicates that most patients in glaucoma clinics are not at high risk of progressing to statutory blindness. The likelihood of patients suffering impairment in their lifetimes is linked to VF loss at presentation, which illuminates the importance of reliably detecting significant VF defects in primary care.

Effectivness of brimonidin and dorsolamid as additional therapy to beta‐blockers‐comparable analysis

AbstractPurpose The aim of this survey is comparison of brimonidin and dorsolamid effect as an additional therapy for primary open angle glaucoma patients already treated with beta‐blockers.Methods Primary open angle glaucoma patients treated with beta‐blockers and who had unregulated IOP were divided in two groups: the first one was additionally treated with 0,2% Brimonidin, and the second one with 2% Trusopt. The therapy was administered twice a day to all the patients. IOP and visual field changes and progression were followed up in next six months. Analysis and comparison of IOP and computerised visual field was done after 4, 12, 16 and 24 weeks from the treatment beginning.Results We have followed up 80 patients in total, 40 in the group treated with 0,2% Brimonidin and 40 in the group treated with 2% Trusopt. 48 patients or 60% were women. We didn’t noticed any significant differences in visual field defects progression during the six months period between these two groups, but middle IOP decrease was 4.2mmHg in the first and 3.0mmHg in the second; that presents high statistical significance. From 15.6% patients (13 in total; 6 in the 0.2% Brimonidin group and 7 in the 2% Trusopt group) with significant visual field defects at the end of study, 85% (11 patients) had those defects already in the first week, at the beginning of additional therapy.Conclusion There was no statistically significant difference between these two groups in the visual field defects prevention and progression during six months period of treatment. Middle IOP decrease in these two groups was significant. Key words: glaucoma, optic nerve, 0.2% Brimonidin, 2% Dorsolamid, beta‐blockers.

Stereotactic Fractionated Radiotherapy for Cavernous Venous Malformations (Hemangioma) of the Orbit

Purpose: Cavernous malformations (hemangioma) of the orbit, when symptomatic, can often be treated successfully with complete surgical excision. However, when they involve local structures in their capsule, are situated in the orbital apex, or extend through the superior orbital fissure, the risks of surgery increase significantly. In such cases, alternative treatment modalities can be explored. In this study, the authors report on the use of fractionated stereotactic radiotherapy (SFRT) for the treatment of surgically complicated cavernous malformations. Methods: In this retrospective cohort study, the authors reviewed the clinical and radiologic records of 5 patients treated with SFRT over the past 5 years. Results: Patients ranged in age from 30 to 65 years, and 3 out of 5 were female. Two cases involved the cavernous sinus, one involved the ophthalmic artery, one involved the posterior ciliary artery, and the last traversed the superior orbital fissure. Four had significant visual field defects. Each was treated with SFRT. A total dose of 4000 cGy divided into 20,200 cGy fractions was applied for 3 cases, while 2 other cases were treated with total doses of 4563 and 4959 cGy divided into 28 × 162 cGy and 29 × 171 cGy fractions, respectively. Rapid resolution of visual field defect was noted by 3 months, and overall tumor shrinkage was on average 60% (range: 32–79%). Follow-up was on average 23.4 months (range: 5–50 months). No complications of treatment were noted. Conclusions: For symptomatic cavernous malformations demonstrating anatomical position that may increase risk of surgical excision, SFRT is an effective and safe method to control lesion size and improve visual function.

Long-term Development of Significant Visual Field Defects in Highly Myopic Eyes

To identify the characteristics that are associated significantly with visual field (VF) defects in highly myopic eyes. Retrospective, observational series. The medical records of 492 eyes of 308 patients with high myopia (myopic refractive error > 8 diopters or axial length ≥ 26.5 mm) with a follow-up of 5 years or more were reviewed. The VFs were determined by Goldmann kinetic perimetry, and the VFs were quantified in 100 sectors within the V4 isopter. Eyes with loss of 10% or more of the sectors were classified as having significant VF defects, and a further loss of 10% or more during the follow-up period was classified as a significant progression. To avoid the influence of the posterior fundus changes resulting from the high myopia, eyes with any type of myopic macular or peripheral lesions that could cause visual field defects were excluded. Significant VF defects were newly developed in 13.2% of these selected highly myopic eyes during a mean follow-up ± standard deviation of 11.6 ± 5.5 years. The incidence of significant VF defects in myopic eyes was significantly higher in eyes with an oval optic disc than that in eyes with a round optic disc. An oval optic disc was present significantly more frequently in the myopic eyes with VF defects. Temporal and nasal VF defects were present in the same eye. Among the eyes with significant VF defect, the temporal VF defects were observed in 61.5% of the eyes with round discs, in 75.0% of the eyes with vertically oval discs, and in 68.2% of the eyes with obliquely oval discs. During a mean follow-up ± standard deviation of 10.2 ± 3.4 years, 73.8% of the eyes showed a significant progression of the VF defects. An abrupt change of the scleral curvature (types VII and IX staphyloma by Curtin) was the only factor significantly associated with a progression of the VF defects. Because the VF defects are progressive, we suggest that high myopia is a high risk factor for VF defects and that these eyes be examined at least once yearly. The combination of stretching and distortion of the optic nerve fibers resulting from an abrupt change of scleral curvature may be the factors that lead to the damage of the optic nerve fibers in highly myopic eyes.

Bilateral nonarteritic anterior ischemic neuropathy following acute angle-closure glaucoma in a patient with iridoschisis: case report

A 55-year-old woman was referred to our clinic because of a one-week history of visual loss and raised intraocular pressure in the left eye followed 4 days later by visual loss in the right eye. Slit-lamp examination showed bilateral conjunctival hyperemia, slight diffuse corneal edema, shallow anterior chamber and fixed and dilated pupil in both eyes. Splitting of the anterior layers of the iris with fibrillar degeneration extending for approximately one quadrant inferiorly was presented in each eye. Fundus examination showed optic disc edema with no vascular tortuosity and no cup in both eyes. The condition was treated as bilateral acute angle-closure glaucoma in a patient with irisdoschisis. After medical treatment and improvement of visual acuity, perimetry revealed a significant visual field defect especially in left eye; this case represents a rare concurrence of acute angle-closure glaucoma and bilateral nonarteritic ischemic optic neuropathy. Although most cases of elevated intraocular pressure, including acute angle-closure glaucoma, do not result in optic disc edema and irreversible vision loss, variations in the vascular supply of the nerve optic head along with others ocular systemic risk factors, may predispose certain individuals to nonarteritic ischemic optic neuropathy during periods of elevated intraocular pressure.

Clinical characteristics of hydroxychloroquine retinopathy

AimsTo assess the characteristics and outcomes of patients with hydroxychloroquine retinopathy and to review the current screening guidelines.MethodsRetrospective chart review of patients diagnosed as having hydroxychloroquine retinopathy at our institution...