In vivo retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after surgery for parachiasmal tumors

PURPOSE: Restoration of visual function after neurosurgery for parachiasmal tumors is variable and unpredictable. The current study was conducted to determine whether in vivo retinal nerve fiber layer (RNFL) thickness measurements predict the visual recovery of such patients. METHODS: Forty patients undergoing surgical resection of parachiasmal lesions were prospectively assessed before surgery with a neuro-ophthalmic examination, involving standard automated visual field (VF) testing and optical coherence tomography (OCT) measurements of RNFL thickness, which was the prespecified marker for axonal loss. Tests were repeated within 6 weeks after surgery. RESULTS: Thinner preoperative RNFL thickness was associated with worse visual acuity (VA) and VF mean deviation (MD). Patients with normal preoperative RNFL had significant improvement in mean VA after surgery, from 20/40 to 20/25 (P = 0.028), whereas patients with thin RNFL did not improve (20/80 to 20/60, P = 0.177). Eyes with normal RNFL showed improvement in MD (-7.0 dB before surgery, -3.5 dB after surgery, P = 0.0007) unlike eyes with thin RNFLs, which had no significant improvement after surgery (-15.3 dB before and -13.3 dB after surgery, P = 0.191). RNFL thickness increased by 1% after surgery among all eyes (P = 0.04). Eyes with severe VF defects (MD 相似文献   

Visual outcomes following optic nerve sheath fenestration via the medial transconjunctival approach

This article determines the safety of optic nerve sheath fenestration (ONSF) for the treatment of patients with intracranial hypertension in the immediate 6-month post-operative period and its efficacy in reducing optic disk edema. Retrospective, non-comparative interventional case series. 207 eyes in 104 patients undergoing ONSF between the years 2005 and 2014. Papilledema grade based on modified Frisen scale and mean deviation of Humphrey visual field. 207 eyes of 104 patients (102 IIH, 2 IH due to dural sinus thrombosis) were included in the study. The patients were 96.1% female (N = 100) and 3.9% male (N = 4). The average patient age was 28.8 years (SD ± 9.5 years) and had a mean opening pressure of 39.85 cmH₂O (SD ± 8.4 cmH₂O). Mean follow-up period was 6.0 months (SD ± 5.9 months). Papilledema resolved in 76.1% of eyes at 1 week (N = 102 eyes), 75% of eyes at 1 month (N = 90 eyes), and 71% of eyes at 6 months (N = 94 eyes). Visual field comparison had a mean of the paired differences in MD at 1 week, 1 month, and 6 months of 1.59dB (P = 0.006), 2.53dB (P < 0.001), and 1.30dB (P = 0.016), respectively. ONSF is effective in reducing optic disk edema and does not cause vision loss in the 6-month post-operative period regardless of severity of IIH (as judged by elevation of opening pressure measured at pre-operative assessment).     

Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions

BACKGROUND: To determine the efficacy and safety of optic nerve sheath fenestration, and to identify factors predicting visual field (VF) and visual acuity (VA) in patients with progressive pseudotumour cerebri syndrome. METHODS: This retrospective observational case series studied 51 eyes of 32 patients with pseudotumour cerebri syndrome, by chart review and comparison of preoperative and postoperative examinations. Main outcome measures included VF, VA and complications. RESULTS: Postoperative VF mean deviation scores improved (P = 0.03) within 6 months when compared with preoperative VF. Multiple regression analysis demonstrated that eyes with mean deviation > or = -20 dB were associated with improved or stabilized VA at 6 months, odds ratio 7.5 and confidence interval (1.2, 46.1), P = 0.03. Eyes with VF defects outside 10 degrees of fixation were associated with improved or stabilized VF at 6 months odds ratio 9.7, 95% confidence interval 1.1, 85.9, P = 0.04. Five patients developed self-limiting complications from surgery. CONCLUSIONS: Optic nerve sheath fenestration is safe and effective in stabilizing or improving VF and VA in the short to medium term. Patients with mild VF loss improved following surgery, and patients with severe VF loss stabilized following surgery.     

Macular thickness measurements with frequency domain-OCT for quantification of axonal loss in chronic papilledema from pseudotumor cerebri syndrome

Purpose

To evaluate the ability of frequency domain-optical coherence tomography (FD-OCT)-measured macular thickness parameters to differentiate between eyes with resolved chronic papilledema and healthy eyes and to evaluate the correlation between FD-OCT measures and visual field (VF) loss on standard automated perimetry (SAP).

Methods

Fifty-two eyes from 29 patients suffering from pseudotumor cerebri syndrome (PTC) and 62 eyes from 31 normal controls underwent FD-OCT scanning and ophthalmic evaluation including VF with SAP. All patients had previously been submitted to treatment of PTC and had clinically resolved papilledema and stable VF for at least 6 months before the study. Macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements were determined for both groups. Comparisons were made using Generalized Estimated Equations. Correlations between FD-OCT and VF measurements were verified.

Results

In eyes with resolved papilledema, the macular thickness parameters corresponding to the inner and outer superior, temporal, inferior and nasal segments, average macular thickness and most RNFL thickness measurements were significantly reduced when compared with controls. The discrimination ability was similar for macular thickness measurements and RNFL thickness measurements. Both sets of OCT measurements correlated well with VF sensitivity loss.

Conclusions

Eyes with resolved chronic papilledema show a significant reduction in macular thickness, which is well correlated with the severity of VF loss. Macular thickness measurements can potentially be used to estimate and monitor the amount of ganglion cell loss in eyes with papilledema from patients with PTC.     

Sub‐clinical atrophy of the retinal nerve fibre layer in multiple sclerosis

Acta Ophthalmol. 2010: 88: 748–752

Abstract.

Purpose: This study aimed to evaluate the presence of abnormalities in the retinal nerve fibre layer (RNFL) in multiple sclerosis (MS) patients with normal ophthalmic examination, and to compare the ability of optical coherence tomography (OCT) and scanning laser polarimetry (GDx) to detect axonal loss. Methods: Patients with MS and disease‐free controls were invited to enrol in the study from 1 February 2007 to 30 June 2008. Ophthalmic examination, including evaluation of visual acuity (VA) and visual field (VF), showed normal results in all subjects. Retinal nerve fibre layer properties were measured by means of OCT and GDx. Visual evoked potentials (VEPs) were also recorded. Results: Forty eyes of 40 MS patients and 20 eyes of age‐ and sex‐matched controls were included in the study. Despite normal VA and VF results, significant differences between the two groups were observed in VF mean deviation (MD), most of the RNFL measurements provided by OCT and GDx, and VEP P100 latency and amplitude. There was a significant correlation between OCT and GDx parameters, and between these parameters and VEP results. Nineteen MS eyes (35.7%) showed RNFL abnormalities detected either by OCT or GDx. Discussion: Sub‐clinical ganglion cell loss can be detected in MS patients with normal visual function. Both OCT and GDx are useful complementary tools with which to identify this damage.     

Trabeculectomy for advanced glaucoma

The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5 dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3 years (13–80 years). The mean follow-up time was 41.1 months (3–120 months). Preoperatively the mean IOP was 28.4 ± 13.1 mmHg, and the mean postoperative IOP was 14.8 ± 5.0 mmHg (P = 0.001). Preoperatively the mean VA was 0.87 ± 80, and the mean value of the MD was −24.5 ± 6.7 dB. At the latest follow-up there was no significant difference in VA (0.89 ± 79, P = 0.699) and MD (−23.9 ± 6.7, P = 0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.     

Optic Nerve Sheath Fenestration: A Five Year Audit

Idiopathic intracranial hypertension (IIH), also known as benign intracranial hypertension (BIH) and pseudotumor cerebri, is a syndrome characterised by raised intracranial pressure (ICP) in the absence of an intracranial mass or ventricular abnormality and normal cerebrospinal fluid (CSF). Optic nerve sheath fenestration (ONSF) is advocated as a treatment for patients on maximal medical therapy with progressive visual field loss. We present the visual results of 13 patients undergoing ONSF on 27 eyes (primary, secondary and tertiary procedures) over a 5 year period. Overall 4 eyes (14.8%) had improved visual acuity after surgery, whilst 23 eyes (85.2%) were unchanged. Visual fields were improved in 18 eyes (66.7%), 2 (7.4%) were unchanged and 4 (14.8%) deteriorated despite surgery. Colour vision improved in 12 (44.4%), was unchanged in 3 (11.1%) and deteriorated in 7 (25.9%) eyes. 5 (18.5%) eyes had normal colour vision before and after surgery. 10 (77%) subjects were able to stop medical treatment after ONSF.     

Prognostic Factors for Progression of Visual Field Damage in Patients with Normal-Tension Glaucoma

Purpose

To evaluate the rate of progression and the prognostic factors of visual field damage in patients with normal-tension glaucoma (NTG).

Methods

Ninety-two NTG patients (92 eyes) were followed up for more than 2 years with topical antiglaucoma medications. All subjects were classified as having early damaged eyes with an initial mean deviation (MD) of ?6?dB or better, moderately damaged eyes with MD between ?6?dB and ?12?dB, and severely damaged eyes with MD of ?12?dB or worse, and survival data were analyzed using regression analysis based on the Cox proportional hazards model.

Results

The probability of visual field stability was significantly higher in patients with moderate damage than in those with severe damage (P = 0.035). The patients with early damage showed no difference in the probability of visual field stability compared with patients with moderate or severe damage. The progression of visual field damage was significantly associated with mean intraocular pressure (IOP) (P = 0.000) or IOP fluctuation (P = 0.002) during follow-up regardless of the severity of the initial visual field damage.

Conclusions

The rate of progression of visual field damage differed according to the severity of the initial visual field damage. IOP reductive medication may be effective in preventing glaucomatous visual field progression in patients with NTG. Jpn J Ophthalmol 2006;50:38–43 © Japanese Ophthalmological Society 2006     

Prevalence and causes of visual impairment in craniosynostotic syndromes

BACKGROUND: To assess the prevalence and causes of visual impairment in patients with craniosynostotic syndromes of Apert, Crouzon, Pfeiffer, Saethre-Chotzen and craniofrontonasal dysplasia. METHODS: The medical records of patients who attended the Craniofacial Clinic at two large paediatric hospitals in Sydney, Australia between 1983 and 2004 were retrospectively reviewed. Presenting visual acuity (VA) was assessed using tests appropriate to age and cognition: 'fix and follow' in infants (<18 months old), Teller card acuity in preverbal children (18 months to less than 3 years old), Kay picture test or Sheridan-Gardiner test in children aged between 3 and less than 6 years and Snellen chart in those aged 6 years or older. Visual impairment was defined as the inability to fix and follow or presenting VA < 6/12 in the better eye. Amblyopia was defined as a two-line difference in VA between both eyes in the absence of an organic eye disease. RESULTS: Sixty-three patients with craniosynostotic syndromes were identified, of whom 55 had VA assessed at the first visit. Of these 55, 19 (35.5%) had bilateral visual impairment and 5 (9.1%) had unilateral visual impairment. Causes of visual impairment include amblyopia (16.7%), ametropia (25%), optic atrophy (16.7%) and exposure keratopathy (4.2%). Risk factors for amblyopia include strabismus (43.3%), astigmatism (> or =1.5 dioptres) (39.5%), hypermetropia (18.4%) and anisometropia (> or =1.5 dioptre difference between both eyes) (15.8%). Six of the 63 patients (9.5%) had papilloedema; those who were followed up showed gradual resolution of papilloedema following timely decompressive surgery. CONCLUSIONS: A high prevalence of visual impairment in patients with craniosynostotic syndromes was found, almost half of them due to potentially correctable causes, including amblyopia and ametropia. Optic atrophy remains an important cause of visual impairment. Further studies are needed to assess the timing and efficacy of intervention for modifiable causes of visual loss in craniosynostotic syndromes.     

Parapapillary Choroidal Microvasculature Dropout in Branched Retinal Vein Occlusion and Glaucoma

PurposeTo investigate parapapillary choroidal microvasculature dropout (MvD) in branch retinal vein occlusion (BRVO) patients and compare them with open-angle glaucoma (OAG) patients using optical coherence tomography angiography (OCT-A).MethodsIn total, 85 eyes of BRVO patients and 85 eyes of OAG patients, matched by age, spherical equivalent, and baseline mean deviation (MD) of the visual field (VF), were assessed. MvD was defined as complete loss of microvasculature within the choroidal layer on OCT-A. Linear regression analysis was used to obtain the slope of the MD change of the VF.ResultsThe presence of MvD on OCT-A was significantly more frequent in OAG eyes (63.1%) compared to BRVO eyes (31.8%). BRVO eyes with MvD showed worse baseline MD of the VF than BRVO eyes without MvD (−10.19 ± 8.50 and −7.77 ± 6.46 dB, respectively; P = 0.045). The presence of MvD was the only factor significantly associated with MD change of the VF in OAG eyes. Lower baseline average RNFL thickness, greater MvD angle, and lower macular superficial vessel density were significantly associated with MD change of the VF in BRVO eyes.ConclusionsOCT-A of the parapapillary area showed choroidal microvasculature impairment in both BRVO and OAG patients. However, the frequency was higher in glaucoma patients with similar degrees of VF damage, which suggests that the glaucomatous process contributes to MvD development. The effect of MvD on VF change was different between BRVO and OAG, suggesting that the underlying pathogenesis may also be different.     

A 15-year review of secondary and tertiary optic nerve sheath fenestration for idiopathic intracranial hypertension

Purpose: Optic nerve sheath fenestration (ONSF) is a common surgical option for patients with idiopathic intracranial hypertension (IIH) with vision loss refractory to medical management. Little is known about the visual benefit of repeated ONSF. The authors aimed to assess the efficacy of secondary and tertiary ONSF in patients with IIH.

Methods: A retrospective chart review was performed on all patients with repeat ONSF for IIH at Emory University from 1999 to 2016. Primary outcome measures included visual acuity, optic nerve head findings, and visual field results.

Results: A total of nine eyes in seven patients (five females and two males) with repeat ONSF were identified. Two of the seven patients had repeat ONSF in both eyes, while the remaining five patients had only one eye repeated. Five of seven patients (five eyes) improved or remained stable after the secondary ONSF. Two patients (three eyes) continued to worsen despite the secondary fenestration surgery and underwent tertiary ONSF at an average of 13.2 months (SD 5.5 months) after the failed secondary ONSF. Both patients that underwent the tertiary fenestration showed improvement. Six of the patients had either improvement or stability in their clinical findings at their last documented follow-up, but one continued to worsen despite intervention.

Conclusions: This study suggests that secondary and tertiary nerve sheath fenestration is a viable management option for patients with progressive vision loss from IIH. Repeat ONSFs do not appear to have increased complication or failure rates compared to prior documented studies regarding primary fenestrations.     

Evaluation of relationship between retinal nerve fiber layer thickness progression and visual field progression in patients with glaucoma

Purpose

To evaluate the capability of optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, and visual field (VF) measurements in glaucoma progression detection.

Methods

The study examined 62 eyes of 37 glaucoma patients observed over a 3-year period. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least 3 years. VF testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer (HFA) on the same day as the RNFL imaging. Both serial RNFL thicknesses and VF progression were assessed by the guided progression analysis (GPA) software program. RNFL thickness progression was evaluated by event analysis. Total deviation (TD) in the superior or inferior hemifield was also examined.

Results

A total of 295 OCT scans and 295 VFs were analyzed. Five eyes exhibited progression by OCT only and 8 eyes exhibited progression by VF GPA only. When the analysis was based on the combined measurement findings, progression was noted in 6 eyes. The average of the progressive hemifield TD at baseline for combined RNFL and VF progression was ?3.21 ± 1.38 dB, while it was ?2.17 ± 1.14 dB for RNFL progression and ?9.12 ± 3.75 dB for VF progression. The average of the progressive hemifield TD indicated a significant advancement of VF progression as compared to RNFL progression (P = 0.002).

Conclusions

When a mild VF defect is present, OCT RNFL thickness measurements are important in helping discern glaucoma progression.     

Validation of point-wise exponential regression to measure the decay rates of glaucomatous visual fields

Purpose. This study was conducted to validate a recently described technique for measuring the rates of visual field (VF) decay in glaucoma. Methods. A pointwise exponential regression (PER) model was used to calculate average rates of faster and slower deteriorating VF components, and that of the entire VF. Rapid progressors had a faster component rate of >25%/year. Mean deviation (MD) and visual field index (VFI) forecasts were calculated by (1) extrapolation of linear regression of MD and VFI, and (2) calculation de novo from the PER-predicted final thresholds. Results. The mean (± SD) years of follow-up and number of VFs were 9.2 (± 2.7) and 13.7 (± 5.8), respectively. The median rates of the decay were -0.1 and 3.6 (%/year) for the slower and the faster components, respectively. The "rapid progressors" (32% of eyes) had a mean decay rate of 52.2%/year. In comparison with actual values, the average absolute difference and the mean squared error for MD forecasts with linear extrapolation of indices were 3.58 dB and 31.91 dB(2), and with the de novo recalculation from PER predictions were 2.95 dB and 17.49 dB(2), respectively. Similar results were obtained for VFI forecasts. Comparisons of the prediction errors for both the MD and VFI favored the PER forecasts (P < 0.001). Conclusions. PER for measuring rates of VF decay is a robust indicator of rates across a wide range of disease severity and can predict future global indices accurately. The identification of "rapid progressors" identifies high-risk patients for appropriate treatment.     

Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by optical coherence tomography

PURPOSE: To evaluate the strength and pattern of the relationship between visual field (VF) sensitivity and retinal nerve fiber layer (RNFL) thickness as measured by StratusOCT (Carl Zeiss Meditec, Inc., Dublin, CA). METHODS: Three hundred eleven subjects--45 normal, 102 with preperimetric glaucoma (PPG), and 164 with primary open-angle glaucoma (POAG)--were enrolled in this cross-sectional study. The relationship between RNFL thickness and VF sensitivity, expressed as mean deviation (MD) and mean sensitivity (MS), were evaluated with linear and nonlinear regression models, and the coefficient of determination (R(2)) was calculated. The association between RNFL/VF was described by bivariate Pearson correlation coefficients. RESULTS: The correlation of RNFL and the VF parameters MS and MD in normal and PPG eyes was not significant. In POAG eyes, RNFL and both MS (r = 0.733) and MD (r = 0.718) correlated significantly. Linear regression plots of MS or MD against RNFL thickness demonstrated a negligible degree of determination in normal (R(2) = 0.0378 and 0.0121, respectively) and PPG groups (R(2) = 0.0215 and 0.0151, respectively), whereas their relationship fit a curvilinear regression model (R(2) = 0.6947 and 0.723) in the POAG group. Receiver operating characteristic (ROC) curves describing the VF parameters and average RNFL thickness (AVG) were evaluated to differentiate PPG from POAG eyes. Repeated analysis with the best-performing test parameter, pattern standard deviation (PSD) (AUROC = 0.937) with a cutoff of 1.9 dB, showed that regression profiles in the POAG group with PSD >1.9 dB maintained a strong curvilinear RNFL/VF relationship, whereas those with PSD <1.9 dB exhibited a relationship almost indistinguishable from the PPG group. CONCLUSIONS: Evaluation of the structure-function relationship in normal subjects and those with PPG or POAG showed strong curvilinear regression in POAG eyes with PSD >1.9 dB and RNFL AVG thickness below 70 microm, whereas no correlation was detectable above these values.     

Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids

Background

To evaluate the visual and anatomic outcomes after systemic steroid treatment in non-arteritic anterior ischemic optic neuropathy (NAION).

Methods

Ten eyes from ten patients diagnosed with NAION and treated during the acute phase with 80 mg daily, tapering-down dose of corticosteroids were compared with a non-contemporary cohort of 27 patients that received no treatment. The visual outcomes of treated and untreated group were compared. Patients underwent complete ophthalmic examination including determination of Snellen visual acuity (VA), visual fields (VFs) (standard automated perimetry, Swedish Interactive Testing Algorithm 24–2 strategy), and optical coherence tomography (OCT) scanning of the optic nerve head at diagnosis, 6–8 weeks and 6 months after presentation.

Results

No statistical differences were found between steroid-treated and untreated NAION for the median change in VA (Mann–Whitney P?=?0.28), median change in VF mean deviation (MD) and median change in VF pattern standard deviation (PSD) (Mann–Whitney P?=?0.213 and P?=?0.07 respectively). Statistical analysis showed no differences when comparing average RNFL loss (P?=?0.871) and RNFL loss for superior, nasal, inferior and temporal optic disc quadrants between both groups. Complications occurred in three of the ten treated patients (30%); in one of them, steroid therapy had to be discontinued. Another two patients developed a NAION in their fellow eye after 2 and 3 months while on low-dose prednisone. No complications developed in the control group. The study was interrupted early due to a significantly higher rate of complications observed in the treated group (P?=?0.002)

Conclusion

High-dose systemic steroid treatment did not show any beneficial effect in visual and anatomic outcomes when given during the acute phase of NAION. Furthermore, it caused serious complications in a third of the patients treated.     

Areas of the visual field important during reading in patients with glaucoma

Purpose

To determine the areas of the binocular visual field (VF) associated with reading speed in glaucomatous patients with preserved visual acuity (VA).

Materials and methods

Fifty-four patients with glaucoma (mean age ± standard deviation 70 ± 8 years) and 38 visually healthy controls (mean age 66 ± 9 years) had silent reading speeds measured using non-scrolling text on a computer setup. Participants completed three cognitive tests and tests of visual function, including the Humphrey 24-2 threshold VF test in each eye; the results were combined to produce binocular integrated VFs (IVFs). Regression analyses using the control group to correct for cognitive test scores, age and VA were conducted to obtain the IVF mean deviation (MD) and total deviation (TD) value from each IVF test location. Concordance between reading speed and TD, assessed using R ² statistics, was ranked in order of importance to explore the parts of the IVF most likely to be linked with reading speed.

Results

No significant association between IVF MD value and reading speed was observed (p = 0.38). Ranking individual thresholds indicated that the inferior left section of the IVF was most likely to be associated with reading speed.

Conclusions

Certain regions of the binocular VF impairment may be associated with reading performance even in patients with preserved VA. The inferior left region of patient IVFs may be important for changing lines during reading.

     

Impact of cataract on the results of frequency-doubling technology perimetry

PURPOSE: To determine the effect of cataract on the results of frequency-doubling technology (FDT) perimetry. DESIGN: Consecutive cohort study. PARTICIPANTS: Forty-four patients with normal ophthalmic examinations, with the exception of cataract, scheduled to undergo phacoemulsification and posterior chamber lens implantation were prospectively identified and completed the study. METHODS: All subjects underwent FDT perimetry using the full-threshold C-20 strategy. Both eyes were tested within 1 month before cataract surgery and up to 3 months after surgery. The unoperated fellow eyes served as controls. MAIN OUTCOME MEASURES: Changes in visual acuity (VA), mean deviation (MD), and pattern standard deviation (PSD) were evaluated. For each subject, the change in MD and PSD in the eye that underwent cataract surgery was adjusted for change in the control eye that is thought to occur due to a learning effect. RESULTS: Among the eyes that underwent cataract surgery, the median preoperative VA was 20/60 (range, 20/30-20/800) and the mean preoperative MD was -4.00+/-3.72 decibels (dB). Postoperatively, the median VA improved to 20/30 (range, 20/20-20/70) and the mean postoperative MD was -0.26+/-3.09 dB (P<0.001). Among the control eyes, MDs were -1.74+/-3.71 dB preoperatively and -0.94+/-3.85 dB postoperatively (P = 0.019). The adjusted improvement in MD among eyes that underwent cataract surgery was 2.94+/-3.44 dB (P<0.001). There was no significant change in PSD. Preoperative VA correlated significantly with preoperative MD (r = 0.39, P = 0.01). The improvement in VA correlated significantly with the adjusted improvement in MD (r = 0.38, P = 0.01). CONCLUSIONS: Cataract has an adverse effect on the MD but not the PSD in FDT perimetry. Among eyes with visually significant cataract, the MD correlates significantly with VA. After cataract surgery, the change in VA correlates significantly with the adjusted change in MD.     

Ungewöhnliches Erscheinungsbild einer tamoxifenassoziierten Makulopathie

Background

In approximately 0.6-12% of patients systemic tamoxifen therapy is complicated by ocular toxicity. Classical findings include severe loss of visual acuity combined with crystalline retinal deposits in the macula and macular edema or crystalline deposits in the peripheral retina.

Methods

We report the case of a 55-year-old female patient with known breast cancer and osseous metastases who presented with bilateral visual loss lasting over 10 months (OD et OS cc 0.2). The patient had received a systemic therapy with tamoxifen (20 mg per day) 7 years ago.

Results

The biomicroscopic examination showed a cup-disc-ratio of 0.5 in both eyes due to primary open angle glaucoma. Optic coherence tomography (OCT) of the right eye revealed a cystoid foveal area with focal lamellar disruption of the photoreceptor layer without evidence of macular edema or thickening. The 30–2 Humphrey visual field of the right eye revealed a mean deviation (MD) of 6.2 dB and a glaucoma-specific absolute scotoma without connection to the blind spot. The visual field of the left eye was inconspicuous (MD 1.1 dB). The left eye showed a perifoveolar area of increased autofluorescence where there was a slight increase of staining in the early phase of fluorescein angiography. The full-field electroretinography was inconspicuous for both eyes.

Conclusion

Although tamoxifen-associated retinopathy is a rare complication of breast cancer therapy it is one of the primary differential diagnoses in a patient presenting with loss of visual acuity and a history of a long standing tamoxifen therapy. Because of the rareness of this disease there are classical examples of tamoxifen-associated ocular toxicity in the literature, but also transient forms which complicate the differential diagnosis. The differentiation from carcinoma-associated retinopathy is particularly important because of the different therapeutic options.     

Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by scanning laser polarimetry

PURPOSE: To evaluate the strength and pattern of the relationship between visual field (VF) sensitivity and retinal nerve fiber layer (RNFL) thickness measurements by scanning laser polarimetry (SLP). METHODS: Fifty-four eyes of 54 normal subjects (age, 42 +/- 15 years; VF mean deviation [MD], -0.69 +/- 1.01 dB) and 51 eyes of 51 glaucoma patients (age, 66 +/- 14 years; VF MD, -6.92 +/- 5.43 dB) were imaged with an SLP using fixed corneal compensation (FCC) and variable corneal compensation (VCC). VF sensitivity was recorded in the dB and the 1/L scales. Linear and logarithmic relationships were sought globally and in six VF sectors. Relationships of VF and RNFL thickness with age were sought in normal subjects. RESULTS: Both VF sensitivity and RNFL thickness declined with age (as determined by the regression slope): -0.13% (P = 0.0005) and -0.64% (P = 0.0001) per year for dB and 1/L VF sensitivity, respectively, and -0.25% (P = 0.003) per year for VCC RNFL thickness. FCC RNFL thickness was not statistically significantly related to age. The relationship of VF sensitivity to VCC global (R(2) = 0.49) and sectoral (R(2) = 0.00-0.47) RNFL thickness was greater than for FCC global (R(2) = 0.12) and sectoral (R(2) = 0.00-0.21) RNFL thickness. Relationships were curvilinear with the dB scale, with logarithmic regression of dB VF sensitivity against RNFL thickness being significantly better than linear regression. Logarithmic regression of 1/L VF sensitivity against RNFL thickness was no better than linear regression for all sectors. There was no relationship between VF sensitivity and RNFL thickness in the temporal peripapillary RNFL sector. CONCLUSIONS: The strength of the structure/function relationships compare well with previous reports in the literature. The relationships were curvilinear with the dB scale and linear with the 1/L scale, and were much stronger with VCC than with FCC RNFL thickness measurements.     

Association of Intereye Visual-Sensitivity Asymmetry With Progression of Primary Open-Angle Glaucoma

PurposeTo investigate the relationship between intereye visual field defect (VFD) asymmetry and subsequent VF progression in primary open-angle glaucoma (POAG).MethodsModerate-stage patients with POAG (226 eyes of 113 patients) with a single hemifield defect were followed for 8.7 years. Participants were categorized into three groups by initial VF pattern: (1) unilateral VFD, (2) bilateral VFD within same hemifield (superior–superior, inferior–inferior), (3) bilateral VFD within opposite hemifield (superior–inferior). The mean deviation (MD) difference between the intereye was defined as the intereye MD asymmetry index (iMAI). Intereye visual-sensitivity difference within the same hemifield was calculated as the intereye hemifield visual-sensitivity asymmetry index. Functional progression was detected by Glaucoma Progression Analysis. The overall rate of MD change and the association between new indices were evaluated by linear regression. A Kaplan-Meier survival analysis was performed and the factors associated with glaucoma progression were evaluated by Cox proportional hazard modeling.ResultsUnilateral VFD eyes and bilateral VFD eyes within opposite VF hemifield showed significant progression and faster rate of MD change compared with bilateral VFD eyes within same VF hemifield (71.1% vs. 45.9% vs. 21.1% [P = 0.001]; –1.27 dB/y vs. −0.64 dB/y vs. −0.32 dB/y [P = 0.001]). Unilateral VFD eyes showed the fastest time to VF progression compared with other groups (P = 0.002). A faster rate of MD change was associated with greater intereye MD asymmetry index (P = 0.001) and greater intereye hemifield visual-sensitivity asymmetric index (P = 0.031), which were significant risk factors for glaucoma progression (all P < 0.001).ConclusionsAmong POAG eyes with comparable hemifield VFDs, eyes without a corresponding hemifield defect in the fellow eye showed faster rates of progression compared with those with a corresponding hemifield defect.