Visual acuities and scotomas after 3 weeks' levodopa administration in adult amblyopia

Background: Previous studies have shown that both a single dose of levodopa and a 1-week administration of levodopa improve visual functions in adult amblyopic patients. In the present study, we investigated the effect of increased dosage and duration of levodopa on amblyopes' visual functions. Methods: Visual acuity and visual fields were examined before and after 3 weeks of daily administration of levodopa/carbidopa as well as 1 month and 2 months after completion of drug therapy in a double masked-design. Results: A significant increase in visual acuities and a decrease in fixation point scotomas were found. Changes were of comparable dimension to those found after 1 week of levodopa administration. Improvement of visual functions persisted 2 months after the levodopa/carbidopa administration was completed. Conclusion: The present study confirms previous findings of improvement in visual function in amblyopia after levodopa/carbidopa administration. However, increasing the dosage and the duration of levodopa did not enhance the effect in adults.Affiliated with the First University Eye Clinic, Vienna, Austria     

Amblyopia in unilateral congenital ptosis: early detection by sweep visual evoked potential

Background: Fixation preference assessment is a clinical tool widely used to determine amblyopia in young infants and children. It is our clinical experience that this tool underestimates amblyopia. The purpose of this study was to compare the results of sweep visual evoked potentials to fixation preference assessment in cases of unilateral ptosis. Methods: Sweep visual evoked potentials were performed in 17 children with unilateral ptosis thought to have equal acuity by fixation preference asessment. Binocular and monocular sweep visual evoked potentials were recorded to square-wave gratings of 80% contrast counterphase modulated at 6 Hz. A range of spatial frequencies from 1 to 30 cycles per degree were presented over a 10-s period. Resolution acuity was determined as the zero-microvolt intercept of linear regression analysis on the visual evoked potential amplitude versus spatial frequency. Results: Nine of the 17 children had interocular resolution acuity differences ranging from 0.8 to 2 octaves by sweep visual evoked potential testing. This correlates to a Snellen equivalent interocular difference of 2 to 7 lines and clinical amblyopia. Conclusion: This study confirms our clinical impression that children who are unable to preform recognition acuity tasks and are thought to have equal vision by fixation preference assessment often have 2 or more lines of Snellen acuity difference (amblyopia) when they are finally old enough to be tested by Snellen methods. It also implies that amblyopia precedes refractive errors and strabismus in unilateral ptosis cases. Clinical methods to determine amblyopia other than fixation preference assessment need to be explored with a view to earlier detection, better definition and treatment of amblyopia.     

Unusual retinal pigment epitheliopathy and choroidopathy in carcinomatosis: A rare case of cancer-associated retinopathy

Background: Cancer-associated retinopathy is a syndrome causing ocular symptoms. It is a rare entity and only a few cases have been reported. Methods: A 67-year-old woman with small-cell endometrial carcinoma suffering from deterioration of visual acuity is presented. Results: The patient presented with extensive mottled changes of the retinal pigment epithelium, accompanied by diffuse subretinal fluid in the posterior pole and exudative retinal detachments inferior in both eyes. Conclusion: This patient suffered from a rare variety of cancer-associated retinopathy.     

How often do patients need visual field tests?

Background: This study was undertaken to determine whether the interval between visual field tests affects the ability to detect progres sive glaucomatous field loss. Methods: One hundred and nineteen retinal locations which were deteriorating significantly by 1 dB/year (untreated normal tension glaucoma patients: 6 eyes) were studied. Analysis was repeated using thinned visual field tests: one test per year instead of the complete three per year over a period of 4 years. Results: The thinned tests identified only 45.4% of the deteriorating points over the 4-year period. Furthermore, there was a mean delay of 1.10 years in detection (P<0.01). Conclusions: Less frequent visual field testing detects fewer progressing locations and detects them later.Presented in part at the Association for Research in Vision and Ophthalmology Annual Meeting, May 1995 and at the American Academy of Ophthalmology Meeting, October 1995.The authors have no proprietary interest in any of the materials used in this study.     

Ocular findings in Japanese women with nevus of Ota

Background: Nevus of Ota is common in Japanese women, but most patients are not examined ophthalmologically. Methods: We performed ophthalmologic examinations on 16 Japanese women who had had bluish pigmentation in the periorbital region, sclera, and conjunctiva since birth. Results: Fifteen patients had unilateral involvement, and one had bilateral lesions. The visual acuities were good, and the intraocular pressures were within normal range. All patients had a negative family history. Three patients had light pigmentation in the optic disc in the affected eye. Conclusion: We believe that optic disc pigmentation associated with nevus of Ota, as found in these three patients, may be common but have been rarely described.     

Clinical heterogeneity of dominant optic atrophy: the contribution of visual function investigations to diagnosis

Background: The variability of the visual function impairment in dominant optic atrophy (DOA) makes it difficult to diagnose the disease within genealogies. Physiologic investigations were conducted on a family with DOA to evaluate methods of detecting clinical and subclinical signs in obligate heterozygotes, in order to identify affected subjects within the genealogy and to formulate the individual and reproductive risks Methods: Investigations included tests for color vision, contrast sensitivity function (CSF), kinetic and static computerized perimetry, transient pattern reversal visual evoked potentials (VEPs) and steady-state flash VEPs Results: Eight subjects from the pedigree were diagnosed as having DOA. Two of them were unaware of their affection, and six showed wide clinical variability. CSF paralleled the central visual impairment, but was also slightly impaired in the two unaware subjects. Static computerized perimetry disclosed mild sensitivity defects in the central visual fields in these two patients. VEPs showed heteregeneous results as well, ranging from normal findings to severely altered tracings Conclusions: This investigation suggests that combined clinical and functional evaluation is necessary to diagnose DOA. Particularly, the combined use of computerized perimetry, CSF, and VEPs allowed the identification of cases at a subclinical stage.     

The use of tissue plasminogen activator in post-traumatic total hyphaema

Background: We wanted to evaluate whether intracameral injection of tissue plasminogen activator (tPA) is useful in managing traumatic hyphaema. Methods: Two eyes with total hyphaema after a severe penetrating injury were treated with a single intracameral injection of 25 g of tPA 5 and 14 days after the injury, respectively. Results: Most of the blood coagulum dissolved within 24 h, and in one of the two eyes the intraocular pressure decreased from 45 to 8 mmHg. The other eye was hypotonic. No re-bleeding or complications related to the use of tPA were noticed. Conclusion: The results in these two cases suggest that tPA is a useful adjunct in managing total hyphaema.     

The effect of nasolacrimal occlusion on drug-induced mydriasis

Background: Nasolacrimal occlusion has been shown to improve the efficacy of some topically applied ocular drugs. The aim of this study was to investigate the effect of nasolacrimal occlusion on tropicamide-induced mydriasis. Methods: We compared pupillary dilatation by 0.125% tropicamide with and without nasolacrimal occlusion in 40 healthy volunteers. Results: Analysis of variance with repeated measures failed to show any advantage due to nasolacrimal occlusion in drug-induced mydriasis. Conclusion: Nasolacrimal occlusion did not increase the mydriasis obtained with 0.125% tropicamide.     

HLA antigens in a Japanese family with Behçet's disease

Background: Familial Behçet's disease is rare. Methods: HLA antigens in a Japanese family with Behçet's disease were examined. Results: The affected patients had HLA B51, and unaffected family members also had the same antigen. Conclusion: It is likely that not only HLA B51 but also other factors may be involved in the pathogenesis of Behçet's disease in Japanese patients.     

Early detection of P-VEP and PERG changes in opthalmic Graves' disease

Background: In Graves' disease the optic neuropathy (ON) is due to direct compression of the nerve and/or of its blood supply. The aim of the present study was to detect early changes in the visual functions of patients affected by ophthalmic Graves' disease (OGD) by using electrophysiological tests (P-VEP and PERG). Methods: We studied 50 OGD patients who were in a range between class 2 and class 5 according to the Donaldson-American Thyroid Association classification, i.e. had no evident ON and normal visual acuity. We recorded transient reversal PERG and P-VEP in response to the stimulation of one eye at three spatial frequencies (2.2, 1.1 and 0.5 c/d). Results: Our results showed a statistically significant reduction in PERG amplitude in class 5, while the P-VEP amplitude was already reduced in class 2. Conclusion: The electrofunctional tests were useful to detect small changes in the visual function of patients affected by initial stages of OGD. Therefore, P-VEP and PERG recordings appear to be a useful tool for early diagnosis of the optic nerve involvement in Graves' disease.