Perimetry Research Articles

Comparison of Visual Field Fluctuation Between Myopic and Emmetropic Glaucoma Patients

Background: Conflicting epidemiologic studies suggest that myopia may both increase and decrease the risk of glaucomatous visual field loss. To provide appropriate treatment to glaucoma patients, it is important to detect meaningful changes in the visual field, which requires distinguishing between visual field fluctuation and progression. Visual field fluctuation is defined as the variability between two visual field tests performed on separate days or months on the same eye that cannot be attributed to a pathologic change. We hypothesize that glaucoma patients with myopia will demonstrate more visual field fluctuation compared to emmetropic patients.
 Methods: Four or more 24-2 or 30-2 Humphrey visual field tests over several visits will be analyzed per patient. Data including the VFI plot, mean deviation, and threshold sensitivity on the glaucoma progression analysis will be collected to measure fluctuation. The sample is divided into two groups: 1. emmetropic glaucoma patients with a spherical equivalent refraction between +2 to -2 diopters and 2. high myopic glaucoma patients with a spherical equivalent refraction over -5 diopters. Bland-Altman plots, Mann-Whitney U tests, Root Mean Square Error (RMSE), intraclass correlation coefficients, and generalized estimating equation models for ordinal data will be used to analyze the collected data.
 Results: Thus far, 2,979 charts have been reviewed with data collected from 27 emmetropes and myopes who met the inclusion criteria. The recruitment goal is 78 per group and 156 total. Preliminary results for RMSE found a statistically significant p-value for mean deviation (0.0320), and no statistically significant difference for threshold sensitivity (0.5179) and VFI (0.0904).
 Conclusion and Potential Impact: This ongoing study will help establish if glaucoma patients with high myopia demonstrate greater visual field fluctuation. It is important for clinicians to have this information so that these patients can be examined carefully to prevent misdiagnoses or delayed glaucoma treatment.

The TsiogkaSpaeth grid for detection of neurological visual field defects: a validation study

BackgroundThe TsiogkaSpaeth (TS) grid is a new, low-cost, and easy to access portable test for visual field (VF) screening which could be used by clinicians in everyday clinical practice. Our study aimed to determine the validity of an innovative screening grid test for identifying neurological disease-associated VF defects.MethodsWe enrolled two groups of participants: We assessed the one eye of ten consecutive adult patients with different types of neurological disease associated VF defects and ten eyes of controls in each group. The TS grid test was performed in each group. Sensitivity, specificity, and positive and negative predictive values of the TS grid scotoma area were assessed using the 24–2 VF Humphrey field analyzer (HFA) as the reference standard.ResultsSensitivity and specificity of the TS grid test were 100% and 90.91%, respectively. The area under curve was 0.9545 with 95% CI 0.87–1.00. There was a significant correlation between the number of missed locations on the TS grid test and the visual field index of the HFA 24–2 (r = 0.9436, P < .0001).ConclusionThe sensitivity and specificity of the TS grid test were high in detecting VF defects in neurological disease. The TS grid test appears to be a reliable, low-cost, and easily accessed alternative to traditional VF tests in diagnosing typical neurological patterns of visual field defects. It would be useful in screening subjects for neurologically derived ocular morbidity in everyday clinical practice and in remote areas deprived of specialized health care services.

Glaucoma Agreement in New Zealand (GAINZ)

ABSTRACT Clinical Relevance With an ageing population, ophthalmologists are becoming burdened with glaucoma management, and patient care can be delayed. Therefore, the use of optometrists in glaucoma management can help alleviate the burden. Background The ageing population and subsequent rise of glaucoma prevalence are putting a strain on the public health system in New Zealand. Glaucoma collaborative care between optometrists and ophthalmologists has been gaining support with the aim to reduce this burden on ophthalmologists. There has been little investigation of the agreement in care and management of mild-to-moderate severity glaucoma patients by optometrists and ophthalmologists. Methods One hundred and three glaucomatous eyes were used in a survey where clinical history and examination, intraocular pressures (IOPs), visual field testing and optical coherence tomography (OCT) imaging were evaluated for glaucoma progression and decision-making regarding subsequent management by four participants. Two participants were glaucoma-credentialled optometrists (Group 1), and the other two were glaucoma specialists (Group 2). Results With respect to glaucoma progression, Spearman coefficients identified strong agreement between the two groups for IOP, visual fields and overall status and moderate agreement for OCT imaging. A confusion matrix was used to analyse management and found 80% ± 10% agreement between the two groups. Review periods gave an agreement of 55% ± 20% between the two groups. Conclusion There was strong agreement in the assessment of glaucoma progression between the two groups. The 80% level of agreement for subsequent management between the two groups is comparable to other published reports. These results provide some reassurance that a collaborative care system can perform safely and as intended.

Progressive Changes in the Neuroretinal Rim and Retinal Nerve Fiber Layer in Glaucoma: Impact of Baseline Values and Floor Effects

ObjectiveTo determine whether more severe baseline damage impedes measurement of minimum rim width (MRW) and peripapillary retinal nerve fibre thickness (RNFLT) change in glaucoma patients because of a floor effect. DesignProspective longitudinal cohort study in a hospital-based setting. SubjectsThe study included patients with open-angle glaucoma and healthy control subjects. Participants had at least 5 years of follow-up with optical coherence tomography every 6 months. MethodsBaseline global and sectorial MRW and RNFLT values were classified as within normal limits, borderline, or outside normal limits based on reference normative values. Regression analysis was used to determine the magnitude and significance of MRW and RNFLT change. Additionally, the follow-up period for each participant was divided into two equal halves (1st and 2nd periods) to determine whether there was attenuation of MRW and RNFLT change with follow-up time. Main Outcomes MeasuresRates of global and sectoral MRW and RNFLT changes (slopes). ResultsA total of 97 patients with glaucoma (median age, 70.3 years) and 42 healthy subjects (median age, 64.8 years) were followed for a median of 6.9 years and 7.0 years, respectively. The median mean deviation of visual field test for glaucoma patients was -4.30 dB (interquartile range: -7.81 to -2.06 dB, range: -20.68 to 1.37 dB). Statistically significant changes in global and sectoral MRW and RNFLT were detected across all baseline classifications, however, there was tendency for less change with increasing baseline damage. In glaucoma patients, RNFLT slopes, but not MRW slopes, were significantly more positive (less change) in the 2nd period compared to the 1st. There were also no differences in either MRW or RNFLT slopes in the 1st and 2nd periods in healthy subjects. Conclusions and RelevanceSignificant MRW and RNFLT changes were detected at all levels of baseline damage. However, an attenuation in the rate of RNFLT change compared to MRW indicate an earlier floor effect in RNFLT measurements globally and in equivalent sectors. Because the axonal component of these measurements should be equivalent, our results suggest important differences in tissue remodelling at the level of the optic nerve head and peripapillary retina.

Archetypal analysis for dominant optic atrophy visual field loss

Aims/Purpose: Identification of the characteristic visual field loss patterns of dominant optic atrophy (DOA) employing the Archetypal Analysis (AA) machine learning algorithm and further relation with patient‐specific parameters.Methods: For 64 patients affected by molecularly confirmed DOA with OPA1 heterozygous mutation, binocular visual field (VF) tests performed by SITA standard 30–2 or 24–2 Humphrey VF analyser (Carl Zeiss Meditec, Dublin, CA, USA) were collected. For patients that had multiple VF tests, several VFs were collected to enlarge the dataset. Resorting to Python 3.8 (Anaconda) an AA model was developed to determine and quantify the DOA underlying patterns of visual loss. After a careful analysis involving different linear and non‐linear machine Learning models and algorithms, the different archetypes (AT) were related to parameters such as age and visual acuity.Results: Considering 229 VF test, employing the AA, twelve archetypes were detected for the characterization and quantification of visual loss in DOA. Central, ceco‐central, and para‐central ATs revealed to be the most significant ones, matching the common characteristic scotomas for DOA patients, followed by quadrantanopia, altitudinal, and nasal step ATs.Younger patients were related to less severe visual loss representative ATs, while patients with lower visual acuity were related to more severe visual loss representative ATs.Conclusions: Archetypal analysis shows to be a potential powerful tool to support clinicians in the identification of DOA patients by identifying and quantifying visual loss patterns characteristic of this disease. Relation with other patient‐specific parameters might strengthen the differential DOA diagnosis.

The future of visual fields

Perimetry forms an essential component of the assessment of visual function, particularly for glaucoma and neurological conditions affecting vision. Conventional automated perimetry though has limitations, including that it is disliked by patients, takes considerable time, particularly in those with poor vision, and is subject to visit‐to‐visit variability meaning a large number of tests are often needed to confidently detect change over time. Regrettably visual field testing is often performed less frequently than it should. Though imaging techniques such as optical coherence tomography (OCT) provide objective information about the structure of the retina and optic nerve head, imaging is not a substitute for assessment of visual field, and perimetry remains a measure more directly relevant to vision‐related quality of life.Several new perimetry devices are under development and evaluation including devices for home perimetry using virtual reality headsets or tablet computers, and devices which detect response to stimuli using eye tracking rather than relying on the patient pressing a button. Such technologies may allow a greater number of visual field assessments, potentially improving ability to detect change. Progress is also being made to optimize visual field test strategies and to combine information from tests of structure and function.

Overview of biomarkers in vitreoretinal conditions

Biomarkers are measurable indicators that can be used to diagnose diseases or monitor their progression. In vitreoretinal conditions, biomarkers can be found in various structures of the eye, including the retina, vitreous, and choroid.One of the most commonly used biomarkers in vitreoretinal conditions is visual acuity, which is a measure of how well a person can see. Other biomarkers include imaging techniques, such as optical coherence tomography (OCT) and fundus photography, which can provide detailed images of the retina and vitreous.In addition to structural biomarkers, there are also functional biomarkers that can be used to evaluate visual function, such as contrast sensitivity and visual field testing. These measures are often used to monitor the progression of diseases such as macular degeneration and diabetic retinopathy.Recent advances in biomarker research have led to the discovery of new markers for vitreoretinal conditions, including genetic markers, inflammatory markers, and metabolic markers. These markers may provide new insights into the underlying mechanisms of disease and may help to identify new therapeutic targets.Overall, biomarkers are an important tool in vitreoretinal conditions for the diagnosis, monitoring, and management of a wide range of ocular diseases. They may also help to improve our understanding of these conditions and facilitate the development of new therapies.

Biomarkers in diabetic retinopathy

Diabetic retinopathy (DR) is a leading cause of blindness in working‐age adults worldwide, affecting up to 80% of patients who have had diabetes for more than 10 years. Biomarkers are measurable indicators that can be used to diagnose diseases or monitor their progression. In DR, biomarkers can be found in various structures of the eye, including the retina, vitreous, and aqueous humour.One of the most commonly used biomarkers in DR is glycated haemoglobin (HbA1c), which reflects long‐term blood glucose control. Elevated HbA1c levels are associated with an increased risk of developing DR, and strict glycemic control can help to prevent or delay its onset.Other biomarkers in DR include imaging techniques such as optical coherence tomography (OCT) and fundus photography, which can provide detailed images of the retina and allow for the detection of microaneurysms, haemorrhages, and exudates. OCT angiography (OCTA) can also visualize changes in retinal blood flow, which may be indicative of early DR.In addition to structural biomarkers, there are also functional biomarkers that can be used to evaluate visual function, such as contrast sensitivity and visual field testing. These measures are often used to monitor the progression of DR and assess the efficacy of treatment.Recent advances in biomarker research have led to the discovery of new markers for DR, including genetic markers, inflammatory markers, and metabolic markers. Genetic markers, such as single nucleotide polymorphisms (SNPs), have been associated with an increased risk of developing DR. Inflammatory markers, such as cytokines and chemokines, are elevated in the aqueous humour and vitreous of patients with DR and may contribute to the development and progression of the disease. Metabolic markers, such as advanced glycation end‐products (AGEs), are elevated in patients with DR and may play a role in the pathogenesis of the disease.Overall, biomarkers are an important tool in the diagnosis, monitoring, and management of DR. They may also help to improve our understanding of the disease and facilitate the development of new therapies. By identifying patients at high risk of developing DR, biomarkers may enable earlier interventions to prevent or delay the onset of vision loss.

Idiopathic intracranial hypertension in Omani adults: A tertiary center experience.

To evaluate the clinical profile, risk factors, and ophthalmic diagnostic and monitoring tools in Omani patients with idiopathic intracranial hypertension (IIH) using optical coherence tomography (OCT). A retrospective single institutional cohort study on Omani patients with a fulfilled diagnosis of IIH from January 1, 2014, to January 1, 2020, was conducted. The data obtained from the neuro-ophthalmic clinic contained age of onset of the disease, gender of patients, body mass index (BMI), presence of other associated conditions, and medication use. Our study group comprised 21 patients with IIH with an annual incidence rate of 2.8 per 100,000 population. Female-to-male ratio was 9.5:1 with a mean age of 27.24 ± 7.1. Headaches appeared to be the most prevalent symptom in 21 (100%) patients, followed by transient obscuration of vision in 9 (42.9%) patients and diplopia in 3 (14.3%) patients, and the least common symptom was pulsatile tinnitus in 2 (9.5%) patients. Increased BMI was seen in 19 (90.5%) patients and noted to be the most prevalent predisposing factor among our study group. The use of oral contraceptive pills was documented in 4 (19%) patients and 1 (4.8%) patient was noted to have polycystic ovary syndrome. All patients (100%) had a best-corrected visual acuity of 1.0 in both eyes pre- and postrecovery and 7 (33.3%) patients had an enlarged blind spot on visual field testing. All patients had papilledema on presentation and an average of 14.1 months to resolve to normal clinically and on OCT monitoring. All patients were treated with medications and only 1 (4.8%) continued to have intractable headaches that did not respond to maximum medical therapy and required surgery. The incidence of IIH in the Omani population was found to be less than neighboring countries but comparable worldwide. OCT is considered a useful tool to confirm and document papilledema and more importantly monitor recovery.

Clinical, phenotypic and genetic characteristics of macula‐sparing stargardt disease

Aims/Purpose: Fundus flavimaculatus and Stargardt's disease are monogenic but heterogeneous disease entities leading to loss of central vision in adolescence, caused by more than 490 mutations in the ABCA4 gene. We herein report the clinical, phenotypic and genetic characteristics of adult onset fovea sparing Stargardt's disease.Methods: Two Caucasian males in their 40s presenting with complaints of paracentral scotomata underwent complete ophthalmic exam, visual field testing, optical coherence tomography (OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), electroretinography (ERG) and genetic testing.Results: Visual acuity was 20/20 in both patients with normal IOP. Anterior segments were unremarkable. Posterior segment examination revealed pigment mottling in the macula with ring‐shaped perifoveal chorioretinal atrophy and numerous white deposits in the mid‐periphery. Visual fields confirmed the paracentral ring scotomata. OCT demonstrated concentric perifoveal loss of outer retinal layers with foveal sparing simulating oedema. Extensive hyperautofluorescence in the area of chorioretinal atrophy was revealed by FAF. Full‐field ERG confirmed incomplete loss of cone bioelectrical activity with preserved morphology of the foveal peak and normal rod function. Genetic testing discovered several pathogenic mutations in both patients with shared ABCA4 c.5603A&gt;T, p.(Asn1868Ile), a risk factor mutation. None of the mutations of our patients were previously reported in foveal sparing Stargardt's disease.Conclusions: The variant ABCA4 c.5603A&gt;T, p.(Asn1868Ile) might be associated with foveal sparing Stargardt's disease. Further population studies are need to confirm this association.

Glaucoma or not glaucoma? ‐ How to navigate problematic cases?

Optic neuropathies refer to a group of eye conditions that involve acute or chronic damage to the optic nerve, which is responsible for transmitting visual information from the eye to the brain. The optic nerve is made up of millions of nerve fibres that can be affected by a variety of primary or secondary insults, leading to progressive neurodegeneration of optic nerve axons, being projections of retinal ganglion cells. The most common optic neuropathies that we should consider in differential diagnosis represent glaucoma, ischemic, inflammatory, toxic, hereditary, traumatic, and compressive optic neuropathies.Although the visual field test is one of the most basic and oldest diagnostic method in ophthalmology, it represents a sophisticated test that allows to differentiate ongoing pathology, based on features of observed scotomas. The specific features include localization, steepness, relativity and symmetry of visual field defects. By combining those features with clinical anamnesis, imaging techniques and electrophysiological data, properly used visual fields can be a powerful tool to provide patients and other medical specialists with further direction of diagnostic process and treatment. This course aims to provide a series of cases‐based analysis of different visual field results, to establish certain universal rules and to provide useful tips, how to diagnose difficult glaucoma cases using perimetry and how to rule out non‐glaucomatous neuropathies, allowing to speed up and to properly direct the diagnostic process.

Comparative study of recording intraocular pressure in adults by three different tonometers Goldmann applanation tonometer, noncontact tonometer, and tonopen

Purpose To compare and correlate the intraocular pressure (IOP) measurement obtained by Goldmann applanation tonometer (GAT), noncontact tonometer (NCT), and tonopen in normal and glaucomatous patients. Patients and methods A cross-sectional, observational, and comparative study was carried out. Two hundred eyes of 100 patients were screened, detailed history was taken, and thorough ocular examination was done. IOP was recorded using NCT (Keeler Pulsair), Tonopen (Tonopen XL), and GAT. Gonioscopy, optic disc examination, central corneal thickness, and visual field testing were done. Results The mean age of the study group was 53.25 years. Mean IOP by NCT was 19.20 mmHg, by GAT was 22.44 mmHg, and by tonopen was 19.33 mmHg. There was statistically significant difference between mean IOP with respect to method used (P&lt;0.001). Forty-eight percent of eyes, 40% eyes, and 49% eyes had IOP less than 18 mmHg by NCT, GAT, and tonopen, respectively. In total, 35.5% eyes, 19.5% eyes, and 35.5% eyes had IOP ranging between 18 and 25 mmHg by NCT, GAT, and tonopen, respectively. In total, 16.5% eyes, 40.5% eyes, and 15.5% eyes had IOP more than 25 mmHg by NCT, GAT, and tonopen, respectively. Conclusion NCT and tonopen readings correlate well with GAT readings in physiologic IOP range up to 20 mmHg, but at higher IOP range they tend to underestimate IOP readings as compared with GAT. However, NCT and tonopen can be used for screening purpose as they are portable and easy to use.

External testing of an established glaucoma screening AI on a glaucoma clinic population from Finland

Purpose: To assess the external performance of an existing deep learning regression model for glaucoma detection (G‐RISK) in a glaucoma clinic population from Finland.Methods: Colour fundus images were retrospectively collected from the Tampere University Hospital (Tays), Finland. Eyes that had a visit in 2019 or 2020 were included based on the availability of ground truth labels. Ground truth labels for glaucoma were obtained through clinical evaluation of the optic nerve head (ONH) from colour fundus photos, clinical evaluation of retinal nerve fibre layer (RNFL) defects from fundus photos imaged with a cobalt filter, and clinical evaluation of the SITA Fast visual field (VF) test. Glaucoma diagnosis at Tays followed the ‘2 out of 3 rule’ recommended by the Finnish Evidence‐Based Guideline for Glaucoma, which requires at least 2 positive indications of glaucoma tests for referral [1]. Preprocessed colour fundus images were used as input to a previously trained deep learning model (G‐RISK) [2]. Performance was evaluated using the area under the receiver operating characteristic curve (AUC), accompanied by 95% confidence intervals. Patient aggregated results were obtained by comparing the maximum of both prediction and ground truth label.Results: Over 3000 patients had at least one ground truth available for a visit in 2019 or 2020. Clinical evaluation of structural features (ONH, RNFL) triggered more glaucomatous symptoms than the SITA Fast VF test. When thresholding the AI prediction against a single ground truth type, the best AUC was obtained on the ONH label (0.90 [0.89–0.91]), followed by RNFL (0.84 [0.83–0.86]) and VF (0.83 [0.81–0.84]). When implementing the 2 out of 3 rule, AUC reached 0.88 [0.82–0.90].Conclusion: The model performed best when using the ONH label and incorporating the ‘2 out of 3 rule’, reaching an AUC of 0.88. These findings suggest that the G‐RISK model could be a valuable tool for screening in clinical practice.

Visual field loss patterns in dominant and recessive optic atrophy based on OPA1 archetypes

Aims/Purpose: Identification and quantification of visual field loss patterns of dominant optic atrophy forms (ACO2 and AFG3L2 mutations) and recessive optic atrophy form (WFS1 mutation, Wolfram Syndrome, WS) based on machine learning‐obtained archetypes for OPA1‐Dominant Optic Atrophy (DOA).Methods: Five patients affected by hereditary optic neuropathies carrying ACO2 gene mutations, 5 with AFG3L2 mutations, and 20 with WFS1 mutations were enrolled. Visual field (VF) tests performed by SITA standard 30–2 or 24–2 Humphrey VF analyzer (Carl Zeiss Meditec, Dublin, CA, USA) were collected for these patients. The VFs of these rare mutations (30% WFS1, 10% ACO2 and 3% AFG3L2 [1]) were decomposed and quantified according to the archetypes (AT) obtained in the unsupervised machine learning model developed for the OPA1 mutation.Results: The archetype analysis (AA)‐model developed for the DOA‐OPA1 mutation is composed of twelve ATs, with the central, the ceco‐central, and the para‐central as the most significant ones. For WS patients, the VF‐decomposition was mostly made up of ATs resembling more severe abnormalities, while for the ACO2 and AFG3L2‐affected patients the most important ATs were similar to the OPA1 cases.Conclusions: The developed AA‐model based on OPA1‐DOA affected patients enabled the decomposition of VFs of more rare optic atrophy mutations. The association of weights to the different ATs for patient‐specific VFs showed to be a possible option to identify and quantify the most important patterns of visual field loss in such particular cases of autosomal dominant or recessive optic neuropathies. A pattern‐specific visual field loss might strengthen the differential diagnosis between OPA1 and other mutations and support future clinical and therapeutic trials.

Deep learning models to predict primary open-angle glaucoma.

Glaucoma is a major cause of blindness and vision impairment worldwide, and visual field (VF) tests are essential for monitoring the conversion of glaucoma. While previous studies have primarily focused on using VF data at a single time point for glaucoma prediction, there has been limited exploration of longitudinal trajectories. Additionally, many deep learning techniques treat the time-to-glaucoma prediction as a binary classification problem (glaucoma Yes/No), resulting in the misclassification of some censored subjects into the nonglaucoma category and decreased power. To tackle these challenges, we propose and implement several deep-learning approaches that naturally incorporate temporal and spatial information from longitudinal VF data to predict time-to-glaucoma. When evaluated on the Ocular Hypertension Treatment Study (OHTS) dataset, our proposed convolutional neural network (CNN)-long short-term memory (LSTM) emerged as the top-performing model among all those examined. The implementation code can be found online (https://github.com/rivenzhou/VF_prediction).

Breaking the mould: An essential need in optic neuritis management

Aims/Purpose: To present a clinical case to highlight the importance of ophthalmological examination in the management of optic neuritis.Methods: Case report.Results: A 45‐year‐old woman with Sjögren's syndrome and a family history of MS presents to the emergency department. She complains of decreased vision OD for the past 4 days, with exacerbated‐by‐eye‐movements retroocular pain and migraine‐like headache. BCVA is amaurosis OD and 1 OI, with right RAPD and no colour vision impairment in OI. Except for optic disc oedema with splinter haemorrhages in OD the rest of the ophthalmological examination is normal. RNFL‐OCT reveals thickening in the OD (220 μm/110 μm). Brain CT and laboratory tests, including D‐dimers, are normal. A LP is performed to rule out infectious causes is normal. Neurofilament and ESR are also normal. Brain and spinal MRI show no abnormalities. Due to the severity, methylprednisolone therapy is initiated. One week later, her symptoms are stable, except for headache and retroocular pain improvement. Upon reassessment, despite preserved BCVA and Ishihara in OI, an increase in RNFL thickening is noted in OI (120 μm), with partial arcuate defect in visual field. Anti‐MOG, AQP4 and a panel of autoantibodies including anti‐Ro and anti‐La, are still pending. Considering the bilateral involvement, plasma exchange therapy is initiated. 14 days after, BCVA OU has improved to 1, and the visual field and Ishihara test have normalized. RNFL thickening is still observed OU (161/120 μm) and there is persistent optic disc edema OD. Anti‐MOG are positive, AQP4‐Ab are negative, and both negative in CSF.Conclusions: The coexistence of other autoimmune diseases, can lead to attributing the ON to that disease rather than considering the neuroinflammatory aetiology, leading to delayed diagnosis. The detection of subclinical bilateral involvement was crucial in escalating the therapeutic regimen. Seropositivity is the confirmatory diagnostic marker, but in many centres, it may be difficult to obtain reliable biomarker data.

Effect of correction of refractive error and threshold estimation in ocular headache patients in a tertiary eye care center

Purpose: Headache is one of the most common symptoms in patients with refractive error. Our study aimed to find the effect of refractive error correction and estimate the threshold of refractive error in patients with ocular headaches in a tertiary eye care center. Methods: We enrolled patients who came with complaints of headaches. It was a prospective, interventional study. All the patients underwent comprehensive ocular examination that included a detailed headache history, objective and subjective refraction, cycloplegic refraction, Humphrey visual fields test (30-2), cover test, and dilated fundus examination. We excluded uveitis, glaucoma, optic atrophy, papilledema, sinusitis, migraine, dental cavities, and neuropathy patients. We prescribed glasses after the post-mydriatic test. We surveyed via phone call regarding the compliance of spectacle wear and relief of headaches. Results: Out of the 98 enrolled patients, 67 were female and 31 were male in the age group of 16 to 35. The patients had simple astigmatism (57.14%), simple myopia (15.30%), simple myopic astigmatism (23.46%), and hyperopia (9.18%). The threshold value of dioptric power was −1.25 D, −1.00 D, −0.75 DS/−0.75 DC, and +1.00 D for simple astigmatism, simple myopia, simple myopic astigmatism, and hyperopia, respectively. 86.73% recovered with glasses. Simple astigmatism had the highest recovery rate. Headaches frequently occurred in the frontal (44.89%), followed by temporal (32.65%), parietal (16.32%), occipital, and parietal (11.22%). Conclusion: Lower degrees of refractive error caused the headache. We reported the threshold values of the refractive error that caused the ocular headache. Correcting the refractive error relieved the headache

Saccadic movements during an exploratory visual search task in patients with glaucomatous visual field loss.

To evaluate the saccadic movements of patients with visual field loss due to primary open-angle glaucoma. Thirteen patients with good visual acuity (0.2 logMAR or better) (seven patients with primary open-angle glaucoma 65 ± 13 years) and six controls (51 ± 6 years) yielded a comprehensive ophthalmological examination, including Humphrey Visual Field tests (SITA-Standard 24-2), and performed a monocular, exploratory digital visual search task that quantifies the duration for finding the number "4" on a random array of digits distributed on the screen. After individual adjustments of the angle and distance positioning, the screen was spatially matched with the 24-2 visual field, and divided into five areas for analysis. During the task, saccades were simultaneously recorded in the same eye with a video-based eye tracker. The patients with primary open-angle glaucoma showed a significantly higher number of saccades/screen (median ± interquartile range, 59.00 ± 29.00 vs. 32.50 ± 19.75 saccades (p=0.027) and visual search time per screen (38.50 ± 60.14 vs. 23.75 ± 8.90 seconds (p=0.035) than the controls did. Although the univariate analysis indicated a significant correlation with visual field mean deviation (coefficient=26.19 (p=0.02), only the visual search time/screen was significantly associated with the number of saccades/screen in the multivariate regression model (coefficient=0.55 (p<0.001). Overall, no significant correlation was observed between the sectorial number of saccades and the sensitivity of the five visual field areas. The patients with primary open-angle glaucoma show impaired search performance and showed a higher number of saccades needed to find stimuli when performing the exploratory visual task.

Mutational Profile and Retinal Phenotypes of PCARE-Related Cone-Rod Dystrophies in a Mexican Cohort.

The aim of the study is to describe the genotype and phenotype of a Mexican cohort with PCARE-related retinal disease. The study included 14 patients from 11 unrelated pedigrees with retinal dystrophies who were demonstrated to carry biallelic pathogenic variants in PCARE. Visual assessment methods included best corrected visual acuity, color fundus photography, Goldmann visual field test, kinetic perimetry, dark/light adapted chromatic perimetry, full-field electroretinography, autofluorescence imaging, and spectral domain-optical coherence tomography imaging. Genetic screening was performed either by gene panel sequencing or by exome sequencing. According to the results of multimodal imaging and functional tests, all 14 patients were diagnosed with cone-rod dystrophy. Six different PCARE pathogenic alleles were identified in our cohort, including three novel mutations: c.3048_3049del (p.Tyr1016∗), c.3314_3315del (p.Ser1105∗), and c.551A > G (p.His184Arg). Notably, alleles p.His184Arg, p.Arg613∗, and p.Arg984∗ were present in 18 of the 22 (82%) PCARE alleles from probands in our cohort. Our work expands the PCARE mutational profile by identifying three novel pathogenic variants causing retinal dystrophy. While phenotypic variations occurred among patients, a cone-rod dystrophy pattern was observed in all affected individuals.

When atypical becomes urgent: Unleashing the ophthalmologist's role in managing unconventional macroadenomas

Aims/Purpose: To present an atypical macroadenoma case and its management, in which the visual monitoring was key to indicate surgical intervention.Methods: Case report.Results: A 55‐year‐old male who was admitted to our emergency department with a main complaint of bilateral central and painless visual loss of 2 days' duration. He had DM type II. BCVA OU was 0.2, with no RAPD, but bilateral dyschromatopsia (OD: 4/16 OS: 10/16). Computerized visual field testing revealed a central scotoma (OD) and temporal hemifield loss (OS). An urgent CT scan revealed the presence of a 24 × 15 × 3 mm sellar‐suprasellar mass, with a locoregional mass effect and possible extension to cavernous sinuses and optic chiasm compression. 12 h after admission, deterioration of BCVA was observed (OD: 0.05 and OS: 0.1), along with worsening of dyschromatopsia (OD: 2/16 and OS: 7/16) and campimetric deficit progression (left homonymous hemianopic pattern). The MRI revealed the presence of a 21 × 21 × 36 mm sellar mass, without signs of recent intratumoral bleeding, with solid suprasellar extension, posterior cystic degeneration, compressing optic nerve, right optic tract, optic chiasm, and invading right cavernous sinus. Due to the worsening visual function, a consensus decision was made to proceed with same‐day endoscopic transsphenoidal resection. 24 h post‐surgery, the patient showed improvement in BCVA (1.0 OU) and dyschromatopsia (OD: 10/16 and OS: 12/16).Conclusions: In our case, despite unclear compressive effect on neuroimaging, careful monitoring of visual function allowed to timely indicate surgery, as the positive outcomes reflect. Managing this pathology in tertiary hospitals goes beyond the required experience of the neurosurgical team. The time for surgery indication is a big challenge due to the lack of clear definitions to indicate surgical intervention: “impending vision loss” or “clinically significant increase in size near the visual pathway.”