Visual Field Exam Research Articles

Effects of trabeculectomy on the postoperative central visual field as revealed by refraction values.

To evaluate the effects of trabeculectomy on the rate of deterioration of the central visual field (VF) in patients with normal-tension glaucoma (NTG), as revealed by refraction values. Retrospective case series. We retrospectively analyzed 28 eyes, including 12 high myopic (spherical equivalent [SE] < - 6 diopters without pathological myopia) and 16 non-high myopic (SE ≥ - 6 diopters) eyes. The rate of VF deterioration (dB/year) was determined using linear regression analysis of 30 -2 and 10 -2 VF tests. The Wilcoxon signed-rank test was used to compare deterioration rates between groups. To assess the influence of initial post-surgery effects, statistical analyses were conducted with and without data from the initial postoperative VF exam. Trabeculectomy significantly reduced intraocular pressure (IOP) in myopic (14.1 to 9.0 mmHg, P ≤ 0.01) and non-myopic (13.4 to 9.5 mmHg, P ≤ 0.01) eyes. Postoperatively, the 10-2 VF deterioration rate significantly decreased in myopic (- 1.31 to - 0.55 dB/year, P = 0.01) and non-myopic (- 0.80 to - 0.30 dB/year, P = 0.03) eyes. Excluding the first postoperative VF exam, the deterioration rates were - 0.51 ± 0.24 dB/year and - 0.54 ± 0.89 dB/year, respectively, indicating a minor impact on progression assessment. Trabeculectomy may mitigate central VF deterioration in myopic NTG patients, emphasizing the potential benefits of timely surgical intervention. Further studies are needed to determine the optimal timing for surgery.

Novel Approaches for the Early Detection of Glaucoma Using Artificial Intelligence

Background: If left untreated, glaucoma—the second most common cause of blindness worldwide—causes irreversible visual loss due to a gradual neurodegeneration of the retinal ganglion cells. Conventional techniques for identifying glaucoma, like optical coherence tomography (OCT) and visual field exams, are frequently laborious and dependent on subjective interpretation. Through the fast and accurate analysis of massive amounts of imaging data, artificial intelligence (AI), in particular machine learning (ML) and deep learning (DL), has emerged as a promising method to improve the early detection and management of glaucoma. Aims: The purpose of this study is to examine the current uses of AI in the early diagnosis, treatment, and detection of glaucoma while highlighting the advantages and drawbacks of different AI models and algorithms. In addition, it aims to determine how AI technologies might transform glaucoma treatment and suggest future lines of inquiry for this area of study. Methods: A thorough search of databases, including Web of Science, PubMed, and Scopus, was carried out to find pertinent papers released until August 2024. The inclusion criteria were limited to research published in English in peer-reviewed publications that used AI, ML, or DL to diagnose or treat glaucoma in human subjects. Articles were chosen and vetted according to their quality, contribution to the field, and relevancy. Results: Convolutional neural networks (CNNs) and other deep learning algorithms are among the AI models included in this paper that have been shown to have excellent sensitivity and specificity in identifying glaucomatous alterations in fundus photos, OCT scans, and visual field tests. By automating standard screening procedures, these models have demonstrated promise in distinguishing between glaucomatous and healthy eyes, forecasting the course of the disease, and possibly lessening the workload of physicians. Nonetheless, several significant obstacles remain, such as the requirement for various training datasets, outside validation, decision-making transparency, and handling moral and legal issues. Conclusions: Artificial intelligence (AI) holds great promise for improving the diagnosis and treatment of glaucoma by facilitating prompt and precise interpretation of imaging data and assisting in clinical decision making. To guarantee wider accessibility and better patient results, future research should create strong generalizable AI models validated in various populations, address ethical and legal matters, and incorporate AI into clinical practice.

Analysis of the impact of a rhinologist-assisted endoscopic approach on a single neurosurgeon’s outcomes in transsphenoidal resection of pituitary adenomas

ObjectivesDetermine the improvements in outcomes of transsphenoidal pituitary adenoma resection following addition of a skull base rhinologist to the neurosurgical team. DesignAll patients that underwent transsphenoidal resection of pituitary adenoma were identified. Demographic data, Otolaryngology (ENT) involvement, initial adenoma size, extent of resection, hormonal secretion status, visual field exam, post-operative DI, CSF leak, recurrence, need for nasoseptal flap (NSF), re-operation rate were all collected. A linear-regression model adjusteds for confounders. SettingA single academic institution Participants271 patients who underwent transsphenoidal surgery between 2015 and 2020.Main Outcome MeasuresThe main outcome measures were Extent of Resection and Endocrinologic remission. ResultsOf the 271 patients identified, 228 (84 %) patients had macroadenomas, one-third of patients presented with bitemporal hemianopsia, and 27 % (72) were hormonally active. For these and demographics there were no statistically significant differences between the microscopic or endoscopic approach (EEA) groups. For patients with cavernous sinus invasion of >50 %, EEA was more likely to achieve gross total resection (GTR) (OR 2.6; p<0.001). For patients who had prior sellar surgery, EEA was 2.5x more likely to get a GTR (p=0.05). The EEA approach resulted in an extra hospital day (1–2 vs 2–3 p<0.05) and surgery lasted an additional hour (1.17 vs 2.5, p<0.05), but did not require fat grafts or lumbar drains on a routine basis. ConclusionsWhile the operating time and LOS were longer, the EEA approach performed by two specialized co-surgeons demonstrates superior value for adenomas that have had a prior surgical attempt or with significant cavernous sinus invasion.

Assessing chiasm perfusion and postoperative visual function with superior hypophyseal artery indocyanine green angiograms during endoscopic endonasal surgery.

To date, there are no validated intraoperative tools to predict postoperative visual function following endoscopic endonasal surgery (EES). Assessment of post-surgical vision during surgery can help in postoperative planning and disposition and inform surgical decisions in real-time. The objective of this study was to evaluate the capability of intraoperative endoscopic indocyanine green (ICG) angiography to measure optic chiasm perfusion and determine its relationship with postoperative visual function. A retrospective review was performed on patients undergoing EES for sellar andsuprasellar lesions. ICG was injected prior to surgical closure at a time when the optic chiasm and anterior circulation were visible. Luminescence of the superior hypophyseal artery (SHA) branches enveloping the optic chiasm was registered 10seconds after ICG penetration into the anterior cerebral arteries (ACAs). Pre and post-operative visual acuity and field exams were used to assess visual function. Patients with and without new deficits were compared to examine statistical association with intraoperative ICG findings. Twenty patients were included (mean age 49years, 55% female). Eighteen patients displayed stable or improved vision after resectionand demonstrated luminescence of all chiasmatic branches within 10s of ACA fluorescence. Two patients experienced new postoperative visual deficits. Upon review, their ICG administrations showed no fluorescence of the SHA branches enveloping the chiasm. A lack of chiasm fluorescence within ten seconds of ACA fluorescence was associated with new postoperative vision deficits (p = 0.005). This study shows that the lack of ICG fluorescence of SHA branches at the chiasm correlates with ischemic changes and new post-operative bitemporal hemianopsia. Lack of chiasm fluorescence after 10seconds of observation reflects compromised chiasm perfusion and likely new post-surgical visual deficits.

6566 Concurrent Papillary Craniopharyngioma and Growth Hormone-Secreting Pituitary Adenoma: A Rare Collision Tumor

Abstract Disclosure: A.J. Mancini: None. R. Mathew: None. J. Oentoro: None. A.M. Devine: None. C. Maxwell: None. I. Kravets: None. Introduction: Collision tumors, which consist of two or more histologically distinct tumors in the same anatomic location, are rare; when occurring in the sella, they more commonly consist of a pituitary adenoma and Rathke cleft cyst. Here, we present a case of a collision tumor consisting of a papillary craniopharyngioma and GH-secreting pituitary adenoma. Clinical Case: A 49-year-old man presented with two months of headaches and blurry vision. Physical exam showed frontal bossing, enlarged jaw and hands, and macroglossia. A visual field exam revealed bitemporal hemianopsia. Initial labs included PRL 105.2 ng/mL (4.0-15.2), TSH 0.399 uIU/mL (0.27-4.2), free T4 0.95 ng/dL (0.93-1.70), FSH 0.8 mIU/mL (1.5-12.4), LH 0.3 mIU/mL (1.7-8.6), total testosterone 10 ng/dL (300-890) drawn at 6:00 a.m., cortisol 8.5 ug/dL (6.0-18.4) and ACTH 32.1 pg/mL (7.2-63.3) drawn at 10:30 a.m.; an IGF-1 was not initially sent. Pituitary MRI showed a 4.1 cm mixed solid and cystic sellar/suprasellar mass with mass effect on the optic chiasm. The patient underwent a craniotomy with tumor resection on hospital day (HD) 5 with pathology showing a papillary craniopharyngioma. The next week, an elevated IGF-1 level of 517 ng/mL (68-225) prompted a GH suppression test. GH levels 1 and 2 hours after oral glucose load were 19.3 ng/mL (0.05-3.00) and 17.8 ng/mL respectively, confirming the diagnosis of acromegaly. On HD 20, repeat MRI showed an interval increase in the mass size with increased mass effect on the optic chiasm. A second craniotomy with an endoscopic resection of the mass was performed, with pathology again showing a papillary craniopharyngioma. Post-operative MRI showed a residual mass with mild mass effect on the optic chiasm for which the patient began radiation therapy. Interval MRI demonstrating a further increase in the tumor size plus a rising IGF-1 level of 700 ng/mL and ongoing lack of GH suppression with an oral glucose load prompted a transsphenoidal resection of the tumor on HD 54. The pathology showed a growing residual papillary craniopharyngioma and a component of a PIT1 lineage adenoma, the majority of which expressed GH. The patient developed numerous complications during his hospitalization and ultimately passed away on HD 64. Conclusion: There are 22 reported cases of collision tumors of pituitary adenomas and craniopharyngiomas, and only five secreted GH. Moreover, four of the five cases described collision tumors with an adamantinomatous craniopharyngioma; the fifth case did not include data on the type of craniopharyngioma (1). Therefore, to the best of our knowledge, our case represents the first collision tumor of a GH-secreting pituitary adenoma and papillary craniopharyngioma. Reference: (1) Hasegawa H, Jentoft ME, Young WF, et al. Collision of Craniopharyngioma and Pituitary Adenoma: Comprehensive Review of an Extremely Rare Sellar Condition. World Neurosurg. 2021;149:e51-e62. Presentation: 6/3/2024

Prediction of visual field progression with serial optic disc photographs using deep learning

AimWe tested the hypothesis that visual field (VF) progression can be predicted with a deep learning model based on longitudinal pairs of optic disc photographs (ODP) acquired at earlier time...

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

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

Ocular manifestations and outcomes of OPMD- a report from the national IsrOPMD registry.

This study aims to describe the ocular manifestations, treatment, and prognosis of OPMD patients registered in the national Israel OPMD(IsrOPMD) registry. Data was prospectively collected from patients referred to the IsrOPMD registry from January 2022 to March 2023. This included patient demographics, medical and ocular history, eye exams, eyelid evaluations, visual field exams, and orthoptic evaluations. 30 patients (15 males, mean age 53 years) were treated in the ocular OPMD clinic, predominantly of Bukhari descent (86.6%). The mean visual acuity was 0.06 logMAR. Twenty-one patients (70%) had eye movement problem, mostly in horizontal gaze. 6(20%) patients' complaint about diplopia. Ptosis surgery was performed in 21(70%) patients, with 17(56.7%) patients underwent frontalis sling surgery and 4(13.3%) patients undergoing levator advancement. The mean Margin reflex distance (MRD1) improved post-surgery (2.28 mm vs. 1.58 mm), but 11(36.6%) patients required more than one ptosis surgery. The study contributes valuable insights into the ocular aspects of OPMD. It reveals that OPMD patients often experience a range of ocular symptoms, such as ptosis, abnormalities in eye movements, strabismus, and potentially diplopia, which can significantly impact their quality of life. The findings underscore the importance of regular ophthalmological follow-up for these patients to address these symptoms effectively. The study is significant in contributing to the limited but growing knowledge about the ocular manifestations of OPMD and the management of these symptoms to improve the quality of life for patients suffering from this condition.

LBODP076 Hypophysitis Misdiagnosed As Pituitary Macroadenoma During Pregnancy

Abstract Introduction Surgical treatment of nonfunctioning symptomatic pituitary macroadenoma may be associated with significant morbidity and the need for long-term medications. In late pregnancy and the postpartum periods, lymphocytic hypophysitis can present as a pituitary macroadenoma. We present a rare case of a pregnant patient who underwent pituitary surgery for lymphocytic hypophysitis. Case presentation A 37-year-old woman was evaluated for headaches and double vision during the third trimester of her pregnancy. A visual field exam showed bitemporal hemianopsia. Brain magnetic resonance imaging (MRI) showed a 2 cm intrasellar tumor with suprasellar extension, interpreted as a pituitary macroadenoma. The patient underwent a cesarean section. Labs after delivery showed IGF-1: 153 ng/ml (79-259), LH: &amp;lt; 0.2 mIU/ml (1.9-12.8), FSH: 6.4 mIU/ ml (2.3-12.6), Prolactin: 4.3 ng/ml (2.2-30.3), and a low morning cortisol: 2.4 ug/dl (4.2- 22.4). Pituitary MRI with intravenous contrast found a stable pituitary macroadenoma with suprasellar extension compressing the optic chiasm and prechiasmatic optic nerves without evidence of apoplexy. She underwent image-guided endoscopic transsphenoidal resection of the pituitary mass. Postoperatively, she developed diabetes insipidus that was treated with desmopressin. She was treated with steroids for secondary adrenal insufficiency and levothyroxine for central hypothyroidism. The pathology report showed hypophysitis; a lymphoplasmacytic infiltrate identified within the specimen with increased IgG4 expression. Differential diagnoses included IgG4-related hypophysitis and lymphocytic hypophysitis with an IgG4-expressing plasma cell component. Serum IGG 4 was 62 mg/dl (normal: 2 - 96 mg/dl); however, patient was already on steroids. She has been requiring hydrocortisone, levothyroxine, and desmopressin. Discussion Lymphocytic hypophysitis often occurs in late pregnancy or the postpartum period. MRI usually shows a pituitary mass, mimicking an adenoma. However, differences between lymphocytic hypophysitis and pituitary adenoma, using different imaging techniques, have been described. Lymphocytic hypophysitis should be considered in the differential diagnosis of women presenting with pituitary enlargement in the peripartum period. These patients may benefit from conservative treatment with glucocorticoids based on clinical suspicion. Presentation: No date and time listed

Pointwise Visual Field Estimation From Optical Coherence Tomography in Glaucoma Using Deep Learning.

PurposeStandard automated perimetry is the gold standard to monitor visual field (VF) loss in glaucoma management, but it is prone to intrasubject variability. We trained and validated a customized deep learning (DL) regression model with Xception backbone that estimates pointwise and overall VF sensitivity from unsegmented optical coherence tomography (OCT) scans.MethodsDL regression models have been trained with four imaging modalities (circumpapillary OCT at 3.5 mm, 4.1 mm, and 4.7 mm diameter) and scanning laser ophthalmoscopy en face images to estimate mean deviation (MD) and 52 threshold values. This retrospective study used data from patients who underwent a complete glaucoma examination, including a reliable Humphrey Field Analyzer (HFA) 24-2 SITA Standard (SS) VF exam and a SPECTRALIS OCT.ResultsFor MD estimation, weighted prediction averaging of all four individuals yielded a mean absolute error (MAE) of 2.89 dB (2.50–3.30) on 186 test images, reducing the baseline by 54% (MAEdecr%). For 52 VF threshold values’ estimation, the weighted ensemble model resulted in an MAE of 4.82 dB (4.45–5.22), representing an MAEdecr% of 38% from baseline when predicting the pointwise mean value. DL managed to explain 75% and 58% of the variance (R2) in MD and pointwise sensitivity estimation, respectively.ConclusionsDeep learning can estimate global and pointwise VF sensitivities that fall almost entirely within the 90% test–retest confidence intervals of the 24-2 SS test.Translational RelevanceFast and consistent VF prediction from unsegmented OCT scans could become a solution for visual function estimation in patients unable to perform reliable VF exams.

Choroidal osteoma clinical manifestation

The patient is a 38-year-old female, with no known past medical or ocular history, who presented to the office with a complaint of a progressive decrease in vision of her left eye over the past several months. Uncorrected visual acuity was 20/20 OD and 20/400 OS. Pupils were equal with no afferent pupillary defect. The external ocular movement was intact, and no gross visual field defect was found on the confrontational visual field exam. Intraocular pressure was 11 OD and 14 OS. Slit-lamp exam of the ocular surface, anterior chamber, lens, and vitreous were not remarkable

The Impact of Covid-19 in the Follow-Up of Glaucoma Patients in a Tertiary Center: A Comparison Between Pre-Pandemic and Pandemic Periods.

PurposeTo evaluate the impact of Covid-19 on the treatment and follow-up of glaucoma patients in a tertiary center.Materials and MethodsWe compared the total number of outpatient clinical visits, visual field exams, surgical procedures and medications released in the pre-pandemic period (March 2019–February 2020) and pandemic period (March 2020–February 2021). We also performed a paired analysis, which included patients who were examined in both periods, comparing the number of visits and medications.ResultsThe total number of outpatients clinical visits, visual field exams, surgical procedures and medications released decreased 92.52% (7117 vs 532), 93.84% (1525 vs 94), 72.74% (682 vs 145) and 19.63% (23,259 vs 18,692), respectively, when the pre-pandemic and pandemic periods were compared. The mean number of annual clinical visits per patient (1.8 ± 0.79 vs 1.04 ± 0.18, p<0.0001) and surgical procedures per patient (1.46 ± 0.92 vs 1.13 ± 0.41, p<0.0001) decreased significantly, whereas the mean number of medications released per patient did not change significantly (28.62 ± 19.11 vs 30.34 ± 20.15, p=0.97). In the paired analysis, the mean number of visits (n=423 patients) decreased from 1.86 ± 0.76 to 1.04 ± 0.19 (p<0.0001) and the mean number of medications (n=561 patients) decreased from 33.44 ± 18.61 to 31.97 ± 19.86 in the pre-pandemic and pandemic periods, respectively (p=0.393).ConclusionThe Covid-19 pandemic dramatically decreased the number of outpatient visits and surgical procedures, impacting the follow-up of glaucoma patients in our service. We encourage other health care units to verify the impact of the pandemic in their own population to better prepare for a possible overload of uncontrolled glaucoma patients in the future.

Investigation of progression pattern and associated risk factors in glaucoma patients with initial paracentral scotomas using Humphrey 10-2

Central visual field (VF) progression could directly threaten patientss visual function compared to glaucomatous damage. This study was designed to investigate visual field (VF) progression pattern and associated risk factors including optical coherence topography angiographic (OCT-A) findings in glaucoma patients with initial paracentral scotoma. This prospective, observational study included 122 eyes presenting as initial paracentral scotomas with serial 24-2 and 10-2 VF tests at the glaucoma clinic of Seoul St Mary's Hospital between November 2017 and August 2020. The participants underwent at least 5 serial VF exams and OCT-A at baseline. Numerical values of the initial and final 10-2 VF tests were averaged for each VF test point using the total deviation map. Innermost 10-2 VF progression was defined as three or more new contiguous points at the central 12 points on 10-2 VF. Other clinical characteristics were collected including history of disc hemorrhage and vessel density (VD) was measured from OCT-A images. Linear regression analysis was performed to obtain the change of mean deviation and a cut-off for progression was defined for both 24-2 and 10-2 VFs. The average total deviation maps of the initial 10-2 VF tests shows initial paracentral scotoma located in the superior region in an arcuate pattern that was deep in the 4°–6° region above fixation. This arcuate pattern was more broadly located in the 4°–10° region in the primary open-angle glaucoma (POAG) group, while it was closer to fixation in 0°–4° region in the normal-tension glaucoma (NTG) group. The final average map shows deepening of scotomas in the 4°–10° region in POAG, which deepened closer to the region of fixation in NTG. The diagnosis of NTG (β 1.892; 95% CI 1.225–2.516; P = 0.035) and lower choroidal VD in the peripapillary atrophy (PPA) region (β 0.985; 95% CI 0.975 to 0.995; P = 0.022) were significantly related to innermost 10-2 VF progression. Initial paracentral scotomas in NTG tended to progress closer to the region of fixation, which should be monitored closely. Important progression risk factors related to paracentral scotoma near the fixation were the diagnosis of NTG and reduced choroidal VD in the β-zone PPA region using OCT-A. We should consider vascular risk factors in NTG patients presenting with initial paracentral scotoma to avoid vision threatening progression of glaucoma.

Deep Relation Transformer for Diagnosing Glaucoma With Optical Coherence Tomography and Visual Field Function

Glaucoma is the leading reason for irreversible blindness. Early detection and timely treatment of glaucoma are essential for preventing visual field loss or even blindness. In clinical practice, Optical Coherence Tomography (OCT) and Visual Field (VF) exams are two widely-used and complementary techniques for diagnosing glaucoma. OCT provides quantitative measurements of the optic nerve head (ONH) structure, while VF test is the functional assessment of peripheral vision. In this paper, we propose a Deep Relation Transformer (DRT) to perform glaucoma diagnosis with OCT and VF information combined. A novel deep reasoning mechanism is proposed to explore implicit pairwise relations between OCT and VF information in global and regional manners. With the pairwise relations, a carefully-designed deep transformer mechanism is developed to enhance the representation with complementary information for each modal. Based on reasoning and transformer mechanisms, three successive modules are designed to extract and collect valuable information for glaucoma diagnosis, the global relation module, the guided regional relation module, and the interaction transformer module, namely. Moreover, we build a large dataset, namely ZOC-OCT&VF dataset, which includes 1395 OCT-VF pairs for developing and evaluating our DRT. We conduct extensive experiments to validate the effectiveness of the proposed method. Experimental results show that our method achieves 88.3% accuracy and outperforms the existing single-modal approaches with a large margin. The codes and dataset will be publicly available in the future.

Reduced Visual Field Activity Due to Covid-19 in a Patient With a Pituitary Macroadenoma

Background: Vision changes can be the presenting symptom of pituitary macroadenomas. The first-line therapy is transsphenoidal resection except for macroprolactinomas where medical therapy with dopamine agonist (DA) is the initial treatment of choice. Surgical resection is reserved if treatment with DA did not result in decreased serum prolactin (PRL), size of adenoma and/or alleviation of symptoms. With the Covid-19 pandemic, there have been a variety of symptoms reported including ophthalmic manifestations (1). We will present how an acute decrease in vision from Covid-19 nearly led to surgical intervention of macroprolactinoma. Clinical Case: A 61-year-old woman presented to the emergency room (ER) with complaints of headache in 6/2020. MRI Brain showed a 4.0 x 4.0 x 4.5 cm pituitary macroadenoma with suprasellar extension and invasion of the cavernous sinuses. The mass engulfed the adjacent circle of Willis, the MCAs bilaterally, the PCAs and the superior aspect of the vertebrobasilar system. Initial PRL was 7441 ng/mL (5.2-26.25 ng/mL). She was discharged on Cabergoline 0.25 mg twice weekly. Visual field exam showed mild nonspecific field defects in the right eye and larger diffuse field defects in the left eye slightly more temporal. One month later, Cabergoline dose was increased to 0.5 mg twice weekly with PRL drop to 1161.7 ng/mL. In 8/2020, she started to complain of worsening vision. Ophthalmological exam showed worsening visual fields in both eyes and the optic discs showed temporal pallor. She was referred to ER where she tested positive for Covid-19 and was admitted. CT Head showed stable partially calcified enhancing sellar and suprasellar mass. Repeat PRL was 635.6 ng/mL. Despite reduction in PRL, transsphenoidal resection was considered but was deferred to 9/2020 due to Covid-19. Follow up appointment with Neuro-ophthalmology in 9/2020 prior to scheduled surgery, showed visual field improvement with just mild nonspecific defects and surgery was canceled. PRL in 10/2020 decreased to 239.1 ng/mL. Patient’s visual fields continued to improve after recovery from Covid-19 and with reduction in PRL. It was determined that the patient’s reduction in visual fields was due to Covid-19 and not her macroadenoma. Conclusion: There have not been many reported cases of decreased visual fields due to Covid-19 (1). Proposed mechanisms include expression of ACE-2 receptors in the aqueous humor, which is the main receptor for Covid-19, and thromboembolic disease (1). More studies and data are needed to conclude the mechanism of decreased visual fields. This will avoid unnecessary surgical interventions for patients with macroprolactinomas.

Correlation of Visual Field With Peripapillary Vessel Density Through Optical Coherence Tomography Angiography in Normal-Tension Glaucoma.

PurposeTo investigate the retinal vessel density (VD) in healthy and normal-tension glaucoma (NTG) eyes through optical coherence tomography angiography (OCTA) and to determine the correlation between VD and the retinal nerve fiber layer (RNFL) thickness and functional visual field (VF) defects for different locations.MethodsA total of 74 NTG eyes and 24 healthy eyes were included. OCTA VD at 4.5 × 4.5 mm peripapillary region and 3.0 × 3.0 mm macula area, RNFL thickness, and VF pattern deviation results were individually analyzed on the basis of the Garway-Heath sectorization. Correlations between VD and VF/RNFL and VF were compared.ResultsIn the NTG group, peripapillary VD, superficial macula VD, RNFL thickness, and ganglion cell complex thickness were significantly lower. In the whole peripapillary area and inferotemporal sector, anatomic correlations between VD and VF pattern deviation values were significantly higher than those between the RNFL thickness and VF values. In the subgroup analysis, VD was anatomically correlated with VF in early-, moderate-, and severe-stage NTG eyes, whereas the RNFL thickness was correlated with VF in moderate- and severe-stage NTG eyes.ConclusionsWe observed VD reduction in the peripapillary retina and superficial macula area in NTG eyes. The microvascular dropout of VD in the peripapillary retina, especially in the inferotemporal sector, provided a more accurate anatomic correlation with functional VF defects than that of the RNFL thickness, especially in early-stage NTG eyes.Translational RelevanceIn patients who cannot comply VF exam, VD is a good tool for disease detection.

Visual Field Estimation by Probabilistic Classification.

The gold standard clinical tool for evaluating visual dysfunction in cases of glaucoma and other disorders of vision remains the visual field or threshold perimetry exam. Administration of this exam has evolved over the years into a sophisticated, standardized, automated algorithm that relies heavily on specifics of disease processes particular to common retinal disorders. The purpose of this study is to evaluate the utility of a novel general estimator applied to visual field testing. A multidimensional psychometric function estimation tool was applied to visual field estimation. This tool is built on semiparametric probabilistic classification rather than multiple logistic regression. It combines the flexibility of nonparametric estimators and the efficiency of parametric estimators. Simulated visual fields were generated from human patients with a variety of diagnoses, and the errors between simulated ground truth and estimated visual fields were quantified. Error rates of the estimates were low, typically within 2dB units of ground truth on average. The greatest threshold errors appeared to be confined to the portions of the threshold function with the highest spatial frequencies. This method can accurately estimate a variety of visual field profiles with continuous threshold estimates, potentially using a relatively small number of stimuli.

Prognosis Factors and Outcomes of Neuro-ophthalmologic Sarcoidosis

ABSTRACT Background: Neuro-ophthalmologic manifestations are uncommon in sarcoidosis. We aim to assess the prognostic factors and outcome of neuro-ophthalmic sarcoidosis. Methods: We conducted a multicenter retrospective study on patients with neuro-ophthalmic sarcoidosis. Response to therapy was based on visual acuity, visual field, and orbital MRI exam. Factors associated with remission and relapse were analyzed. Results: Thirty-five patients [median (IQR) age of 37 years (26.5–53), 63% of women] were included. The diagnosis of sarcoidosis was concomitant of neuro-ophthalmologic symptoms in 63% of cases. Optic neuritis was the most common manifestation. All patients received corticosteroids and 34% had immunosuppressants. At 6 months, 61% improved, 30% were stable, and 9% worsened. Twenty percent of patients had severe visual deficiency at the end of follow-up. Nonresponders patients had significantly worse visual acuity at baseline (p = 0.01). Relapses were less frequent in patients with retro-bulbar optic neuropathy (p = 0.03). Conclusion: Prognosis of neuro-ophthalmic sarcoidosis is poor.

Pediatric Pseudotumor Cerebri: Epidemiological Features.

Objective: The purpose was to study the epidemiological and clinical features of Pediatric Pseudotumor Cerebri; we especially evaluated age, sex, sexual maturity, weight, symptoms, duration of the episode, visual acuity, correlation with systemic diseases or drugs. Methods: We investigated a population of 40 children (80 eyes), aged between 2 and 18 years, that referred to our Centre (Città della Salute e della Scienza di Torino - presidio Ospedale Regina Margherita) from 2000 to 2018. All the patients were monitored with visual field exam, fundus exam and Frisen classification, pupillary reflexes, best corrected visual acuity, orthoptic exam. Then, the demographic characteristics, BMI (body max index) and weight changes, the correlation with systemic diseases or drugs, the Relative Afferent Pupillary Defect (RAPD), the VI cranial nerve deficit, the time required for the diagnosis, the modality of onset, the correlation between diagnosis delay and best corrected visual acuity, the resolution time and the probability of recurrence were studied. Results: We observed 2 age peaks in our population, one consisting of adolescents (aged between 11 and 14 years) and one consisting of younger children aged between 4 and 7 years, with a statistically significant correlation between age and BMI. The deficit of the VI cranial nerve and the diplopia were resolved within the first month, despite the longer time of resolution of the papilledema. Headache was the main onset symptom, but after reclassifying onset symptoms per weight classes, in overweight children, we found an increased variability of symptoms (dizziness, postural instability, photophobia, nausea, vomit, strabism and diplopia, visual fogging, drowsiness, irritability). Moreover, we found only one totally asymptomatic case, during a routine visit, in a 6 years old overweight child with Down syndrome. Conclusion: The Pediatric Pseudotumor Cerebri is, even nowadays, a little known pathology. To provide a correct diagnostic assessment, it will be imperative to recollect the epidemiological features of this disease.

Efficacy and Safety of Primary Glaucoma Device Implantation Surgery in Exfoliative Glaucoma: A Retrospective Consecutive Case Series.

Purpose To evaluate the efficacy and safety of primary glaucoma drainage implant (GDI) surgery for exfoliation glaucoma (XFG). Methods This study was a retrospective, consecutive case series study including 36 eyes of 36 patients with XFG who underwent primary GDI surgery. Intraocular pressure (IOP), the mean deviation (MD) from the visual field exam, corneal endothelial cell density (ECD), and the number of topical antiglaucoma agents used during the preoperative and postoperative periods were retrospectively analyzed. Surgical success was defined by the following criteria: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% with 1 or no medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% with 1 or no medication; and (3) IOP ≤ 12 mmHg and an IOP reduction of 30% with 1 or no medication. The probability of success of GDI surgery was determined via Kaplan–Meier survival analysis. Results The preoperative IOP was 25.9 ± 4.7 mmHg, and the postoperative IOP at 24 months was decreased to 14.2 ± 3.6 mmHg (p value < 0.001). The postoperative MD and ECD were similar to baseline (MD p value = 0.155; ECD p value = 0.055). However, a significant reduction in the number of antiglaucoma agents was observed (p value < 0.001). The surgical success rates were 77.8%, 63.9%, and 55.6% at 24 months for criteria 1, 2, and 3, respectively. Early hypotony (4 patients, 11.1%) and persistent corneal edema (5 patients, 13.9%) were the most common early and late postoperative complications, respectively. Conclusions In XFG, primary GDI surgery reduced IOP by 45.2% and had a 77.8% success rate according to criteria 1 at 24 months postoperatively. However, considering that ECD reduction continues to decline over time, primary GDI surgery should be carefully considered in XFG.