Perimetry Research Articles

Comparison of retinal nerve fiber layer thickness and Bruch’s membrane opening minimum rim width thinning rate in open-angle glaucoma

This study aimed to compare the rate of thinning between retinal nerve fiber layer thickness (RNFLT) and Bruch’s membrane opening minimum rim width (BMO-MRW) in open-angle glaucoma (OAG) according to glaucoma severity. We retrospectively reviewed subjects with a total of 111 eyes with OAG that had undergone optical coherence tomography more than four times during more than 3 years of follow-up. The subjects were divided into three groups based on the mean deviation (MD) of the baseline visual field test: high MD (MD > − 2 dB), medium MD (− 2 dB ≥ MD > − 6 dB), and low MD (− 6 dB ≥ MD > − 12 dB) groups. A linear mixed model was employed to compare the rate of thinning between RNFLT and BMO-MRW among the three groups. The rate of RNFLT thinning was fastest in the inferotemporal sector in all three groups. The rate of BMO-MRW thinning was fastest in the inferotemporal sector of the high MD group and the superotemporal sector of the other two groups. Among the three groups, the rate of RNFLT thinning was not significantly different in the global sector and all sectors except the nasal sector. The rate of BMO-MRW thinning in the inferotemporal sector showed no significant difference, but that in the superotemporal sector was faster in the medium MD and low MD groups than in the high MD group. The fastest rate of RNFLT thinning was consistently observed in the inferotemporal sector, but BMO-MRW showed a change in the fastest thinning sector from inferotemporal to superotemporal, with increasing severity in early to moderate OAG. The difference in the changes in the two parameters may help understand the pathogenesis of glaucoma and predict its progression.

Corneal endothelium, retinal nerve fiber layer, ganglion cell complex, and perimetry measurements in normal eyes and those with primary open-angle glaucoma.

Corneal endothelial cell (CEC) loss in glaucoma can be attributed to the direct compressive effect of elevated intraocular pressure. Herein, we aimed to evaluate specular microscopic changes in CEC count and morphology in correlation to retinal nerve fiber layer (RNFL) changes detected by spectral-domain optical coherence tomography (SD-OCT) in early and advanced primary open-angle glaucoma (POAG). This descriptive-analytical study involved patients with medically controlled POAG versus non-glaucomatous patients of the same age group. Specular microscopy, visual field testing, and SD-OCT of the RNFL and macular ganglion cell complex (GCC) were performed. Eyes with POAG were further subcategorized into early and advanced stages. The study included 130 eyes of 130 participants; 70 were eyes with POAG (40 eyes with early-stage POAG, 30 eyes with advanced-stage POAG), and 60 were healthy eyes. The groups were comparable regarding mean age and sex. No significant difference was found in corneal parameters between healthy eyes, eyes with early POAG, and eyes with advanced POAG (all P > 0.05). In eyes with early-stage POAG, a significant negative correlation was found between the coefficient of variation (CV) and superior RNFL thickness (r = - 0.5; P = 0.018), and between the percentage of hexagonal cells (hexagonality) and vertical cup-to-disc ratio (r = - 0.43; P = 0.035). A significant positive correlation was found between hexagonality and superior as well as inferior RNFL thickness (r = + 0.53; P = 0.008 and r = + 0.50; P = 0.015, respectively). However, in the advanced glaucomatous eyes, no significant correlation was found between RNFL thickness and CEC parameters. CEC parameters were not affected in eyes with early or advanced POAG compared with healthy eyes, despite a significant thinning of RNFL and macular GCC. In eyes with early-stage POAG, a significant correlation was found between morphological characteristics of CECs, such as CV and hexagonality, with superior and inferior RNFL thickness in the optic nerve head on SD-OCT images. Future longitudinal studies with larger sample sizes are needed to verify our results.

Association of macular vessel density and ganglion cell complex thickness with central visual field progression in glaucoma

Background/aimsTo evaluate the association of macular vessel density (VD) and ganglion cell complex (GCC) thickness with 10–2 central visual field (CVF) progression in glaucoma.MethodsIn this retrospective cohort study, patients with...

Application and Validation of LUXIE: A Newly Developed Virtual Reality Perimetry Software.

Purpose: To report the application of LUXIE and validate its reliability by comparing the test results with those of Humphrey Field Analyzer 3 (HFA3). Methods: In this pilot study, we prospectively recruited participants who had received HFA3 SITA standard 30-2 perimetry and tested them with LUXIE on the same day. LUXIE is a software designed for visual field testing cooperating with HTC Vive Pro Eye, a head-mounted virtual reality device with an eye-tracking system. The test stimuli were synchronized with eye movements captured by the eye-tracking system to eliminate fixation loss. The global, hemifields, quadrants, glaucoma hemifield test (GHT) sectors, and point-by-point retinal sensitivities were compared between LUXIE and HFA3. All participants were asked to fill out a post-test user survey. Results: Thirty-eight participants with 65 eyes were enrolled. LUXIE demonstrated good correlations with HFA3 in global (r = 0.81), superior hemifield (r = 0.77), superonasal, superotemporal, and inferonasal quadrants (r = 0.80, 0.78, 0.80). The user survey showed that participants were more satisfied with LUXIE in operating difficulty, comfortability, time perception, concentration, and overall satisfaction. Conclusions: LUXIE demonstrated good correlations with HFA3. Fixation loss could be eliminated in LUXIE with the eye-tracking system. The application of virtual reality devices such as the HTC Vive Pro Eye makes telemedicine and even home-based self-screening visual field tests possible. Key Messages: 1. Virtual reality perimetry is a developing technology that has the potential in telemedicine, and home self-screening visual field tests. 2. LUXIE demonstrated good correlations with Humphrey Field Analyzer 3 in visual field retinal sensitivities.

Prevalence of Reduced Vision among UK Elderly Drivers: The Bridlington Eye Assessment Project (BEAP)-A Cross-Sectional Study.

Self-assessment of driving fitness is mandatory in the United Kingdom. A paucity of data on visual function among drivers exists. We report prevalence of elderly drivers below legal visual acuity (VA) standard from a population study (The Bridlington Eye Assessment Project (BEAP)) conducted from 2002 to 2006. All residents aged ≥65 years were invited, 3459 undergoing structured interviews/ophthalmic examinations. Driving status was recorded, VA measured, and visual field (VF) testing performed. Outcomes were prevalence and characteristics of drivers below VA legal standard and prevalence of bilateral VF defects. Conditions causing reduced VA were explored and those with treatable conditions allowing visual improvement identified. Duration since last optometry review was recorded. Associations were explored using unpaired t-tests for continuous and chi-squared for discrete variables. Logistic regression was used for multivariate analysis and to determine odd ratios in the final adjusted model. Statistical analysis was performed using Stata 14.0 (Stata Corp, Tx). Within this sample, 7.1% (95% CI 6.0–8.3) of drivers fell below the VA legal driving standard (6/12) in their better eye, with 20% not having seen an optometrist for 2 years, including 8.2% who had not attended for over 5 years. The percentage of drivers falling below the VA minimum increases with age reaching 22.8% (95% CI 13.7–35.3) among those aged 85–89 years. 7.2% (95% CI 6.2–8.6) of drivers had bilateral visual field defects. 93% of drivers with reduced VA below legal standard had a cataract, refractive error or both in at least one eye. Significant numbers of elderly drive with VA below legal standard, most having easily correctable causes. Poor attendance with optometrists appears commonplace. Public education raised awareness of legal driving standards and encouraged compliance are required. Regular eye tests, appropriate refractive correction, and cataract surgery when needed should be encouraged.

Case Report: Retinal nerve fiber layer and ganglion cell thinning on spectral domain optical coherence tomography following multiple strokes

A 62-year-old Caucasian male presented for a routine exam with a history of a significant stroke suffered 5 years prior resulting in temporary aphasia and persistent visual field loss. At presentation, best correctable acuities were 20/20+ OU through mild hyperopic astigmatic correction. Visual field testing with frequency doubling technology revealed an incongruous left superior quandrantanopia. Anterior segments demonstrated mild bilateral mixed blepharitis but were otherwise unremarkable. Dilated fundus examination with spectral domain optical coherence tomography revealed moderate disc cupping and marked, symmetric inferior and temporal RNFL thinning, as well as diffuse bilateral ganglion cell thinning. This case demonstrates how OCT can be used as an objective test to detect retrograde neve fiber and ganglion cell loss secondary to post-chiasmal pathology.

Performance of a Glaucoma Screening Program Compared With Opportunistic Detection in China.

Health examination center-based screening provide a good supplement to clinic-based glaucoma care by detecting early-stage glaucoma, especially those with normal intraocular pressure (IOP) and less visual impairment. Opportunistic glaucoma screening for early case identification is of great value in the prevention of severe visual impairment, however, novel, low-cost models are needed. We aimed to determine whether health examination center-based glaucoma screening identifies diseases earlier than outpatient cases in China. In this case-control study, 76 patients with primary glaucoma identified from a health examination center-based glaucoma screening program and 272 consecutive outpatient cases at the same hospital were enrolled from March 21 to September 30, 2016. Demographic characteristics, best-corrected visual acuity, IOP, mean deviation (MD), and pattern standard deviation (PSD) on Humphrey visual field testing in the better-seeing eye were compared between groups. Screening-detected glaucoma patients had significantly lower IOP (18.3±4.2mmHg) than out-patient cases (26.7±12.6mmHg, P <0.001). Most (71.1%) of the screening-detected patients had IOP<21mmHg compared with 37.1% in the clinic group ( P <0.001). Seventy-five patients (98.7%) in the screening group were diagnosed as primary open angle glaucoma, compared with 44.1% in the clinic group ( P <0.001). Screening-detected patients had significantly less visual impairment than the clinic group (6.6% vs. 38.6%, P <0.05). Mean MD (-4.4±5.0dB) and PSD (4.4±3.6dB) for the screening group were superior to the clinic group (MD: -16.5±10.5dB, P <0.001; PSD: 6.5±3.7dB, P <0.001). The glaucoma screening program was effective at detecting early disease, especially normal tension glaucoma and supplemented opportunistic detection of glaucoma.

Diagnostic accuracy of an iPad application for detection of visual field defects.

Tablet-based perimetry could be used to test for glaucomatous visual field defects in settings without easy access to perimeters, although few studies have assessed diagnostic accuracy of tablet-based tests. The goal of this study was to determine the diagnostic accuracy of iPad perimetry using the visualFields Easy application. This was a prospective, cross-sectional study of patients undergoing their first Humphrey Field Analyser (HFA) visualfield test at a glaucoma clinic in India. Participants underwent 24-2 SITA Standard HFA testing and iPad-based perimetry with the visualFields Easy application. Reference standards for both visualfield loss and suspected glaucoma were determined by ophthalmologist review of HFA results and optic disc photographs. Receiver operating characteristic curves were constructed to assess diagnostic accuracy at various test thresholds. 203 eyes from 115 participants were included, with 82 eyes classified as moderate or worse glaucoma. iPad perimetry had an area under the receiver operating characteristic (AUROC) curve of 0.64 (95% CI 0.57 to 0.71) for detection of any visualfield defect relative to HFA and an AUROC of 0.68 (0.59 to 0.76) for detection of moderate or worse glaucoma relative to ophthalmologist examination. At a set specificity of 90%, the sensitivity of iPad perimetry for detection of moderate or worse glaucoma was 35% (22-48%). iPad perimetry using the visualFields Easy application had inadequate diagnostic accuracy to be used as a screening tool for glaucoma in this South Indian population.

Ocular pulse amplitude and visual field changes in patients diagnosed with aortic regurgitation.

To examine whether there is a relationship between ocular pulse amplitude (OPA), intraocular pressure (IOP), and visual field (VF) deterioration among the patients diagnosed with aortic regurgitation (AR). Twenty-nine patients (average age of 62.06 ± 13.27years) with AR diagnosis without glaucoma history as AR group and 32 healthy participants (average age 63.81 ± 6.42years) as control group were included in the study. Routine ophthalmologic examination including VF test [mean deviation (MD), pattern standard deviation (PSD) and VF index (VFI) values were recorded], diurnal IOP and OPA measurements with Pascal dynamic contour tonometry (DCT) was conducted on the patients. VF deficits were classified by Glaucoma Staging System 2 (GSS 2) score. Sixteen (50.0%) of 32 healthy subjects and 14 (48.3%) of 29 AR patients were female (p = 1.000). The measurement conducted at 15:30 among the diurnal IOP measurements performed with the Pascal DCT was found to be statistically significantly higher in the AR group (p = 0.009). While the MD and PSD values of the group diagnosed with AR were determined to be statistically significantly high, the VFI value was found to be significantly low. When the healthy cases and the patients diagnosed with AR were compared, it was observed that there was a statistically significant positive correlation in terms of the significant GSS 2 stage (p < 0.001). Although there was no significant increase in IOP, VF deficits were detected in patients with AR. These VF pathologies may be due to the ocular perfusion disorder in AR. However, additional comprehensive studies that also examine perfusion are needed to further confirm this.

Visual Field Parameters and Pupil Size Measured through and Compared between Colored Contact Lenses and Clear Contact Lenses: A Prospective Comparative Pilot Study in Asian Population

Objective: To compare visual field (VF) parameters and pupil size as measured through colored and clear contact lenses (CL) in Asian population.Materials and Methods: Demographic data and CL prescription data were recorded during the baseline visit. Visual acuity and autorefraction were evaluated while patients wore clear CL, followed by slit-lamp examination and intraocular pressure measurements after CL removal. During the second visit, subjects were given dark browncolored CL with their same prescription. Visual acuity and autorefraction were measured. Pupil size and VF tests were measured twice with the clear CL and the colored CL. Measurements through colored and clear CL were compared.Results: Twenty-one volunteers (mean age: 31 years) were recruited. Refractive error varied from 0.00 to -7.00 diopters. Mean horizontal meridian measured through clear and colored CL was 134.8±7.8° and 133.3±4.7°, respectively. Mean vertical meridian measured through clear and colored CL was 100.1±3.8° and 100.4±2.5°. Mean total VF area measured through clear and colored contact lenses was 9,890.9±822.8° and 9,882.7±528.1°. There was no significant difference between clear and colored CL groups for horizontal meridian, vertical meridian, total VF area, or pupil size.Conclusion: There was no significant difference in any evaluated parameters between clear and colored CL.

Clear Lensectomy with Hydrus Stent in Black and Afro-Latino Patients: A 1-Year Retrospective Study.

Purpose To determine the efficacy and safety of phacoemulsification, clear lensectomy, and the Hydrus microstent (Ivantis, Inc.) in Black and Afro-Latino glaucoma patients. Method This is a retrospective nonrandomized study of 134 Black and Afro-Latino patients who underwent clear lensectomy with Hydrus stent implant for the treatment of glaucoma. For comprehensive analysis, patients were divided into mild, moderate, and advanced glaucoma. The evaluated parameters were reductions in the number of medications, intraocular pressure (IOP), mean deviation on visual field test, and visual acuity. Results A total of 134 patients with 1-year follow-up were evaluated. At 1 year, the average number of medications significantly decreased from 2.5 ± 1.4 preoperatively to 0.43 ± 1.04 (p < 0.001) and IOP decreased from 14.4 ± 3.9 to 13.8 ± 3.10 (p=0.16). 110 (82.1%) patients were medication-free at 1 year (n = 57, 83.8% mild glaucoma; n = 37, 92.5% moderate glaucoma; n = 16, 61.5% advanced glaucoma). There was stabilization of mean deviation on the visual field test (baseline, −8.28; 1 year, −8.28; p=1). The most reported adverse effects were transient IOP spike and hyphema (n = 7, 5.2%; n = 3, 2.2%, respectively); both events were self-resolving. No decline in vision or sight-threatening complications were reported at 1 year, and no additional surgeries were required. Conclusion This 1-year retrospective study demonstrated the efficacy and safety of clear lensectomy and Hydrus stent implantation in decreasing medication burden while maintaining lower IOP in Black and Afro-Latino glaucoma patients.

Two-year Outcomes of XEN Implantation with Minimal Bleb Needling.

AimOur study aims to report the 2 years outcomes of the XEN implant in a single unit, single surgeon setting with minimal bleb needling.MethodsA retrospective cohort study was conducted. Inclusion criteria were patients who underwent implantation with a XEN device between May 2016 and December 2017. This included patients who underwent both combined phacoemulsification and intraocular lens implantation alongside XEN implantation and those who underwent XEN implantation alone. Data gathered included basic demographic data, best-corrected visual acuity (LogMAR), intraocular pressure (IOP) in mm Hg, mean deviation from their visual field test, and the number of IOP-lowering medications they were on. This information was recorded for their preoperative visit, and then at 6, 12, 18 and 24 months postoperatively. The primary outcome assessed was a complete success when the patient was without glaucoma medications and had an IOP of 18 mm Hg or less, but more importantly, this also had to equate to a 20% reduction in IOP compared to baseline. Qualified success was defined as the same change in IOP but with medications. Surgical failure is defined as those who required additional glaucoma surgery or those who did not obtain an IOP of 18 mm Hg alongside a 20% reduction in IOP compared to baseline.ResultsAt 24 months follow-up 82.5% of patients were surgical successes. Complete surgical success was achieved in 27% of patients. Qualified surgical success was achieved in 55.6% of patients. Subgroup analysis of those undergoing XEN implantation on its own and those combined with phacoemulsification + IOL were similar. The rate of bleb needling was low at 4.5%. Complication rates were acceptable at 9.5%.ConclusionIt is possible to get good IOP control with minimal postoperative bleb needling in patients who have undergone XEN implantation. Similar success rates are found in those undergoing combined procedures.Clinical SignificanceBleb needling carries its own risks. Minimizing the number of bleb needling allows procedures to be reserved at a later date. Furthermore, our study shows that success rates are not affected by doing a combined procedure with phacoemulsification.How to cite this articleAli ZC, Moshin N, Hakim MT, et al. Two-year Outcomes of XEN Implantation with Minimal Bleb Needling. J Curr Glaucoma Pract 2022;16(2):79-83.

Glaucoma and Driving License: How to Identify Patients at Risk of Revocation

AimTo identify clinical criteria that are easily achievable with follow-up tests and can identify subjects not suitable for driving.Patients and methodsWe recruited 194 subjects with a clear diagnosis of glaucoma, with no other conditions that could affect the visual field (VF), and who performed a reliable VF examination. All patients underwent a full ophthalmologic evaluation and a questionnaire considering driving habits. An integrated visual field (IVF) was built using both monocular VF charts; the number of missed points (NoMP) within the central 20°, the average sensitivity (AS), and the better eye mean deviation (BEMD) were evaluated.ResultsA total of 128 subjects showed a valid driving license (DL); 61.7% of drivers did not show missed points within the central 20° of the IVF, 27.4% presented one to three missed points, and 10.9% had four or more missed points. Best corrected visual acuity (BCVA) was highly above the legal criteria.Stratifying drivers by their BEMD (−7, −10, and −14 dB), we confirmed that the BEMD decrease corresponds to an increased NoMP and a decreased AS.ConclusionBetter eye mean deviation can be useful in clinical practice to identify patients at increased risk of being unsuitable for driving. Nevertheless, it is important to set specific cut-offs based on on-road driving performance. IVF evaluation may also be implemented in perimeter analysis software so that the composition of IVF, the BEMD, and the AS could directly describe the patient's binocular VF, excluding recourse to the Esterman visual field test (EVFT).Clinical significanceThis new methodology will allow every physician—not just ophthalmologists—even if not an expert in evaluating a VF test, in assessing the ability to drive of glaucomatous patients.How to cite this articleLandini L, Donati S, Digiuni M, et al. Glaucoma and Driving License: How to Identify Patients at Risk of Revocation. J Curr Glaucoma Pract 2022;16(2):117-123.

Visual field examinations using different strategies in Asian patients taking hydroxychloroquine

In this study, we investigated the patterns of visual field (VF) defects and the diagnostic abilities of VF tests using different strategies in Asian patients with hydroxychloroquine retinopathy. Patients screened for hydroxychloroquine retinopathy using optical coherence tomography, fundus autofluorescence, VF, and/or multifocal electroretinography were included. The VF was performed using the Humphrey 30-2 and/or 10-2 strategy, and 2,107 eyes of 1,078 patients with reliable results, including 136 eyes of 68 patients with hydroxychloroquine retinopathy, were analyzed. The characteristics of VF findings were evaluated and the sensitivity and specificity were compared between the 30-2 and 10-2 tests in subgroups of retinopathy severity and pattern. The most common VF defect pattern was partial- or full-ring scotoma in both the 10-2 and 30-2 tests. Among the eyes with hydroxychloroquine retinopathy that underwent both tests, 14.2% showed a disparity between the two tests, almost all at the early stage. In overall and early pericentral retinopathy, the sensitivity of the 30-2 test was significantly higher than that of the 10-2 test (95.7% vs. 77.1% and 90.6% vs. 53.1%, respectively; P < 0.05). However, the specificity of the 10-2 test was significantly higher than that of the 30-2 test (89.6% vs. 84.8%, P < 0.001). Therefore, the pattern of retinopathy should be carefully considered when choosing a VF strategy for better detection of hydroxychloroquine retinopathy.

Predicting hypogonadotropic hypogonadism persistence in male macroprolactinoma.

To study the baseline characteristics predicting hypogonadotropic hypogonadism (HH) persistence in men with macroprolactinoma that achieved prolactin normalization. Retrospective cohort study. Male patients diagnosed with macroprolactinoma and HH that received cabergoline treatment with subsequent prolactin normalization were included: men that achieved eugonadism, and men that remained hypogonadal. Patient's demographic, clinical and biochemical parameters, sellar imaging, and visual fields tests were obtained. Univariate and multivariate models were used to identify predictors of HH persistence. Fifty-eight male patients (age 49.2 ± 12.6years) with a median baseline prolactin of 1154ng/mL (IQR 478-2763ng/mL) and adenoma (maximal) diameter of 25.9 ± 14.8mm were followed for a median of 5.6years (IQR 3.0-10.7). Twelve men (21%) suffered from HH persistence at the end of follow-up and 46 men achieved eugonadism. Forty-two out of 46 men (91%) accomplished eugonadism within the first year following prolactin normalization. In a multivariate logistic regression model, hypopituitarism (OR 10.1; 95% CI 1.10-101.94), visual field defect (OR 9.9; 95% CI 1.07-92.33), and low baseline testosterone levels (OR 0.5; 95% CI 0.29-0.93) were independent predictors of HH persistence. In our cohort of men with macroprolactinoma that reached prolactin normalization with cabergoline treatment, 21% had HH persistence. Pituitary hormone deficiency, visual field defects, and low baseline testosterone levels were independently associated with HH persistence. 91% of men achieved eugonadism within the first year following prolactin normalization. These findings may support informed clinical decision-making regarding the initiation of testosterone replacement in men with macroprolactinomas.

Measurement of Fixational Eye Movements With the Head-Mounted Perimeter Imo.

PurposeAlthough visual field testing is conducted with the subject gazing at a fixation target, constant minute eye movements, called fixational eye movements, do occur during fixation. We examined dynamic changes in fixational eye movements associated with stimulus presentation during visual field testing.MethodsWe used the head-mounted perimeter imo, which is capable of measurement under binocular conditions, with the frame rate of its fixation monitoring camera improved to 300 Hz, to assess fixational eye movements in 18 healthy individuals. We measured changes in fixational eye movements during testing under monocular and binocular conditions and analyzed these changes based on the bivariate contour ellipse area (BCEA). We also assessed the changes in the horizontal and vertical microsaccade rates separately.ResultsBoth the BCEA and horizontal microsaccade rates were higher at 400 to 600 msec after stimulus presentation than during stimulus presentation (P < 0.01). Additionally, the BCEA and vertical microsaccade rates were significantly lower in the binocular condition than in the monocular condition (P < 0.01 and P < 0.05, respectively). We did not observe a significant correlation between the test locations and microsaccade direction during visual field testing.ConclusionsFixational eye movements, especially vertical microsaccade rates, were lower in the binocular condition than in the monocular condition. Visual field testing under binocular conditions is a useful method for suppressing fixational eye movements and stabilizing the fixation during testing and may improve the reliability of the test results.Translational RelevanceVisual field testing under binocular conditions can make the fixation more stable during the testing compared with monocular conditions.

The ICD-10 Glaucoma Severity Score Underestimates the Extent of Glaucomatous Optic Nerve Damage

To evaluate the International Classification of Disease, Tenth Revision (ICD-10) codes used for glaucoma severity classification, which are based on the location of visual field (VF) defects; given the known poor sensitivity of the 24-2 visual field test to early disease and macular damage, we hypothesized that the ICD-10 codes would not accurately reflect the extent of glaucomatous damage. Retrospective validity and reliability analysis. We evaluated 80 eyes with glaucomatous optic neuropathy (GON). Masked reviewers assigned an ICD-10 severity grade based on 24-2 VF. Two additional masked examiners determined the presence of optical coherence tomography (OCT) structural damage in each hemifield and/or central 5 degrees to define an OCT-based equivalent ICD-10 classification. A total of 80 eyes with GON were classified as mild, moderate and advanced in 15, 23, and 42 cases, respectively, based on the 24-2 VF, and in 6, 7, and 67 cases, respectively, based on OCT. The OCT classifications were more severe in 29 of 80 cases (36%). In 33 cases (41.3%), macular damage detected by OCT was missed by the 24-2. In 4 of 80 cases (5%), the VF overestimated the severity, likely due to variability of the 24-2 test. The ICD-10 system relies solely on damage seen on the 24-2 and as provides a 24-2 functional score rather than a "glaucoma" severity score. OCT revealed wide variation of damage across grades, with a significant proportion of the eyes showing macular structural damage missed with the 24-2 VF. Adding OCT information to the ICD-10 system would help it to more accurately reflect the extent of glaucomatous damage.

Evaluation of the Correlation between Regional Retinal Ganglion Cell Damage and Visual Field Sensitivity in Patients with Advanced Glaucoma.

(1) Background: to investigate the correlation between structural (retinal ganglion cells and retinal nerve fibers) and functional alterations analyzed point-by-point in the central 10 degrees of the visual field of patients with advanced glaucoma using Humphrey 10-2 visual field tests. (2) Methods: Single-center prospective cohort study carried on from October 2018 to February 2019 at the Croix-Rousse hospital, Lyon, France. The primary outcome measure was the point-by-point correlation between retinal sensitivity (Humphrey 10-2) and retinal ganglion cell complex (GCC) thickness. (3) Results: 29 eyes of 27 patients were examined. Of these, 15 eyes had a mean deviation (MD) less than −20 dB. There were statistically significant linear relationships between GCC thickness and 10-2 visual field sensitivity for several points in the lower part of the visual field, with lower retinal sensitivity being associated with thicker GCC layers. There were no strong linear relationships or statistically significant correlations in the other regions of the visual field. For the patients with MD < −20 dB, there were statistically significant linear relationships between GCC thickness and 10-2 visual field sensitivity for several points in the superior nasal region. Retinal sensitivity was not correlated with retinal nerve fibre layer thickness. (4) Conclusions: In this study of patients with advanced glaucoma, GCC thickness was linearly associated with 10-2 visual field sensitivity in certain regions, negatively for patients with less-severe glaucoma. The initial thickening raises questions about the apoptosis mechanism, while the thinning observed in the most severe cases is consistent with the ganglion cell death identified on visual field tests.

Birdshot Chorioretinopathy: A Review.

Birdshot chorioretinopathy (BSCR) is a bilateral chronic inflammation of the eye with no extraocular manifestations. BSCR affects middle-aged individuals from European descent and is strongly associated with the human leucocyte antigen (HLA)-A29 allele. The immune mechanisms involved are not fully understood, but recent advances have shown the role of Endoplasmic Reticulum Aminopeptidase 2 (ERAP2) in disease pathogenesis. Multimodal imaging, including fluorescein angiography, indocyanine angiography, fundus autofluorescence, and optical coherence tomography, are useful in confirming the diagnosis and monitoring disease activity. Visual field testing is also important to assess the disease progression. To date, there is no consensus for optimal treatment regimen and duration. Local and systemic corticosteroids can be used for short periods, but immunosuppressive or biological therapies are usually needed for the long-term management of the disease. Here, we will review publications focused on birdshot chorioretinopathy to give an update on the pathophysiology, the multimodal imaging, and the treatment of the disease.

Intereye structure–function relationship using photopic negative response in patients with glaucoma or glaucoma suspect

We evaluated the intereye structure–function relationship in glaucoma patients using photopic negative response in electroretinogram analysis. Patients with confirmed glaucoma (36 eyes, 36 patients) or suspected glaucoma (19 eyes, 19 patients) were included in this study. Electroretinogram (RETI-scan) was performed with red stimulus on blue background. Intereye comparison for 55 patients was performed between better eyes and worse eyes, which were divided based on average retinal nerve fiber layer (RNFL) thickness measured using spectral-domain optical coherence tomography. In the intereye analysis, PhNR amplitude was lower in worse eyes than in better eyes (P < 0.001). The intereye difference in PhNR amplitude was significantly correlated with intereye difference in average RNFL, as well as average or minimum ganglion cell-inner plexiform layer (GCIPL) thickness (P = 0.006, 0.044, 0.001). In patients with mean deviation ≥ − 6 dB of worse eyes, the intereye difference in PhNR amplitude was significantly associated with intereye difference in average RNFL thickness or minimum GCIPL thickness (P = 0.037, 0.007), but significant correlation was not found between mean sensitivity of visual field tests and structural parameters. In conclusion, PhNR performed well with regard to intereye structure–function association in glaucoma patients, especially at the early stage.