Visual Field Mean Deviation Index Research Articles

Retinal function after intravitreal injection of autologous bone marrow-derived mesenchymal stromal cells in advanced glaucoma

To report electroretinographic (ERG) findings in advanced glaucoma treated with a single intravitreal injection of bone marrow-derived mesenchymal stem cells (MSCs). Intravitreal injection of autologous MSCs (1 × 106 cells) was performed in 2 eyes from 2 patients with open-angle glaucoma in advanced stage of optic neuropathy (ClinicalTrials.gov, NCT02330978, 01.05.2015): cup/disk ratio worse than 0.9, visual field mean deviation index lower than -15dB, visual acuity of light perception, but controlled intraocular pressure. ERG tests were recorded at baseline and week 1, 4 and 48 after injection, using DTL electrodes following the ISCEV standard: After dark adaptation, ERG was elicited using white flashes of 0.01cd.s/m2 and 3.0cd.s/m2, followed by 10-min light adaptation (30cd/m2) and stimuli of 3.0cd.s/m2 and 30Hz flicker. Patients did not show improvement on visual acuity or visual field after treatment. At baseline, ERG responses showed typical findings for advanced glaucoma, with a- and b-wave amplitude and latency within normative range, but reduced photopic negative responses. No noteworthy changes were observed on ERG responses for both cases up to 1week after treatment, but at day 15, one patient showed retinal detachment with proliferative vitreoretinopathy and was removed from the trial. The other patient kept ERG responses stable throughout study period. Although no ERG response changes were observed after MSCs injection in one case, the complication observed on the second one, along with the lack of visual function improvement, warrants further studies involving modified MSCs to treat ocular disorders, including glaucoma. ClinicalTrials.gov, NCT02330978- missed in pdf.

Exercise-Induced Changes in Ocular Blood Flow Parameters in Primary Open-Angle Glaucoma Patients

Purpose: To evaluate exercise-induced changes in ocular blood flow (OBF) parameters in primary open-angle glaucoma (POAG) patients. Methods: A prospective observational study was carried out, in which medically treated patients with POAG were enrolled. Following inclusion, all patients performed a 40-min cycloergometry in a standardized fashion. The following parameters were measured and compared immediately before and 1 and 30 min after the exercise: intraocular pressure (IOP; Goldman applanation tonometry), mean arterial pressure (MAP), ocular pulse amplitude (OPA; assessed by dynamic contour tonometry), and ocular perfusion pressure (OPP; 2/3 MAP – IOP). In addition, we investigated possible factors associated with OBF parameter changes immediately after exercise. Results: A total of 30 eyes (30 patients; mean age was 62.9 ± 1.7 years) were included. Most patients were women (53%), and median visual field mean deviation index was –3.5 dB. Both MAP (mean change, 21%) and IOP (mean change, 17.3%) increased significantly immediately after the workout (p < 0.01), persisting higher than baseline following 30 min (p < 0.01%). Regarding OBF parameters, both OPA (mean change, 58.8%) and OPP (mean change, 21.7%) increased significantly immediately after the workout and persisted higher than baseline 30 min after the workout (p < 0.01). Regression analysis revealed that only age was significantly associated with OPA variation (R² 0.14; p < 0.05). No significant associations were found for OPP (p ≥ 0.19). Conclusion: Aerobic exercise leads to a significant short-time increase in OBF parameters in patients with POAG. Even though IOP seems to present a modest elevation, it is accompanied by a significant increase in MAP, leading to higher OBF measurements. Exercise-induced short-term changes and its possible implications for glaucoma prognosis deserve further investigation.

Definition and diagnosis of advanced glaucoma

AbstractAccording to Hodapp’s criteria for visual field (VF) scoring, advanced glaucoma can be defined as having a VF mean deviation index (MD) &lt; ‐12 dB. Advanced glaucoma can also be defined on the basis of the patient’s skills to perform daily activities. Functional tests are usually more useful than structural parameters to follow‐up patients with advanced glaucoma. An overview of the available investigative techniques in advanced glaucoma will be provided.

Definition and investigative techniques in advanced glaucoma

AbstractAccording to Hodapp’s criteria for visual field (VF) scoring, advanced glaucoma can be defined as having a VF mean deviation index (MD) &lt; ‐12 dB. With those VF defects, the optic disc cupping is usually very distinct. Advanced glaucoma can also be defined on the basis of patient’s skills to perform daily activities. Functional tests are usually more useful than structural parameters to follow‐up patients with advanced glaucoma. An overview of the available investigative techniques in advanced glaucoma will be provided.

Short Duration Transient Visual Evoked Potentials in Glaucomatous Eyes

To investigate the correlation between structural and functional damage in patients with asymmetric glaucoma using a newly developed short duration transient visual evoked potential (SD-tVEP) device. Twenty-five patients with visual acuity ≥20/30 and asymmetric visual field (VF) loss [inter-eye difference in mean deviation index (MD) of at least 3 dB] were enrolled. Patients underwent optical coherence tomography (OCT) for macular thickness measurement, scanning laser polarimetry with variable corneal compensation for retinal nerve fiber layer measurement, and SD-tVEP (10% and 85% Michelson contrast, acquisition time of 20 s) in both eyes within 2 months. We correlated VF MD and structural test results with SD-tVEP P100 latency and Delta Amplitude (N75-P100). Using 10% contrast, there was a significant difference in SD-tVEP latency and amplitude between eyes with better and worse VF MD (P<0.001). MD correlated significantly with both SD-tVEP parameters (r>0.33, P≤0.01). When using 85% contrast, SD-tVEP amplitude differed between eyes (P=0.01) and MD values correlated significantly with amplitude results (r=0.32, P=0.01), but not with latency (P=0.46). In eyes with more advanced VF loss, there was a positive and significant correlation between SD-tVEP amplitude (85% contrast) and macular thickness on OCT (r=0.47, P=0.01), but not with retinal nerve fiber layer measured with polarimetry (P=0.26). In cases of asymmetric glaucoma, SD-tVEP results correlate significantly with the level of VF damage as measured by MD. In the eyes with more advanced VF loss, reduced SD-tVEP amplitude was associated with decreased macular thickness on OCT. These findings suggest that SD-tVEP may be a fast and objective method to assess or screen for functional damage in glaucomatous eyes.

Spectral-domain optical coherence tomography for early glaucoma assessment: analysis of macular ganglion cell complex versus peripapillary retinal nerve fiber layer

Objective We sought to compare the glaucoma discrimination ability of macular inner retinal layer (MIRL) thickness with that of conventional peripapillary retinal nerve fiber layer (pRNFL) thickness as measured by spectral-domain optical coherence tomography (SD-OCT) in patients with early glaucoma. Design Cross-sectional study. Participants We studied 67 patients with early glaucoma (visual field mean deviation index ≥-6 dB), and 56 healthy subjects were prospectively enrolled. Methods All patients underwent MIRL thickness measurement (ganglion cell complex [GCC] scan) and pRNFL thickness measurement (3.45 mm scan) by SD-OCT. Whenever both eyes were eligible, one was randomly selected. Receiver operating characteristic curves and sensitivities at fixed specificities were generated for different parameters. The areas under the receiver operating characteristic curves (AUCs) of each parameter were compared. Results The average mean deviation for the glaucomatous eyes was −2.5 ± 1.6 dB. The AUCs for average (0.815); superior (0.807); and inferior (0.788) MIRL thicknesses were not significantly different ( p ≥ 0.18). The AUCs for average (0.735); superior (0.728); and inferior (0.697) pRNFL thicknesses were also similar ( p ≥ 0.15). Average MIRL thickness had a significantly larger AUC compared to average pRNFL thickness analysis (0.815 vs 0.735; p = 0.03). Sensitivities at 80% specificity for average MIRL and pRNFL thicknesses were 66.7% (cutoff, 89.9 μm) and 62.9% (cutoff, 111.8 μm), respectively. Conclusions The GCC scan showed a similar or even a slightly better ability to discriminate between healthy and early glaucomatous eyes compared to the pRNFL scan. Different from previous analyses considering total macular thickness, the GCC macular scan seems to be a useful tool for identification of early structural damage in patients with glaucoma.

Medical decision, persistence of initial treatment, and glaucoma progression in a Brazilian reference hospital

To evaluate the initial medical decision regarding primary open-angle glaucoma (POAG) treatment in a referral center, and to assess the relationship between the persistence of treatment and the disease progression in cases managed exclusively with medication. A retrospective chart review was performed for 65 patients with primary open-angle glaucoma referred to a tertiary hospital. The following clinical data were analyzed: initial medication, persistence of treatment, best corrected visual acuity, visual field mean deviation index, cup/disc ratio, and intraocular pressure. Patients were classified into four categories in order to verify the clinical evolution. The mean number of visits/ year was 4.4 +/- 3.5, and the follow-up period was 40.7 +/- 22.8 months. Mean persistence time was 12.9 +/- 13.9 months. By six and twelve months, respectively, 39.1% and 62.5% of patients had discontinued the initially prescribed regimen, mainly by adding to (42%) or changing (26%) the course of treatment. Thirteen patients (21%) were reclassified to a worse category of primary open-angle glaucoma, however, despite this trend, no significant correlation was found between shorter persistence and primary open-angle glaucoma worsening. Persistence rates with initial therapy schemes were low, as measured by medical decisions to change the course of treatment. Therefore, improvement in the initial medical decision is crucial in order to offer a more stable and effective treatment for primary open-angle glaucoma.

Changes in visual function after intraocular pressure reduction using antiglaucoma medications

To evaluate the change in visual function after starting glaucoma treatment and correlate this to a decrease in intraocular pressure (IOP) in primary open-angle glaucoma patients. A prospective, randomized clinical trial was carried out involving 54 glaucoma patients (54 eyes). After inclusion, patients randomly received timolol maleate 0.5%, brimonidine tartrate 0.2%, or travoprost 0.004% in one randomly selected eye. Patients underwent Goldmann applanation tonometry, visual acuity test, standard automated perimetry (SAP), visual quality perception test (visual analogue scale), and contrast sensitivity (CS) test, in a random order before and after the 4-week glaucoma treatment. There were statistically significant changes in IOP (mean change [standard deviation], 7.8 [3.6] mmHg, P<0.001), SAP mean deviation index (0.84 [2.45] dB, P=0.02), visual quality perception (0.56 [1.93], P=0.045), and CS at frequencies of 12 cycles/degree (0.10 [0.37], P=0.03) and 18 cycles/degree (0.18 [0.42], P=0.02) after the 4-week treatment when compared with baseline. No statistically significant differences were found between the treatment groups in visual function changes after treatment (P>0.40). No significant correlations between IOP reduction and changes in visual function were found (P>0.30). Visual quality perception, visual field mean deviation index, and CS at higher frequencies improve after starting glaucoma therapy. However, no correlation was found between IOP reduction and changes in visual function, and no differences were found in visual function when the three medications studied were compared.