Konventionelle Perimetrie

Despite its relatively long history conventional perimetry has preserved its role in (glaucoma) diagnostics by the continuous advancement of technical equipment, examination strategies and new methods for analysis and visualization of progression. A high standardization in execution and evaluation of visual field examination can now be obtained by the increasing use of computer technology. Standardized protocols become increasingly more useful especially in cases of chronic diseases, such as glaucoma where several suitable diagnostic methods must be applied over a long time period. For the assessment of functional deterioration several (numeric) perimetric indices are available in addition to clinical evaluation. The use of fast threshold estimating strategies and locally condensed grids are promising tools for early detection of the functional manifestation or progression of (glaucomatous) loss of visual field. In cases of advanced (glaucomatous) visual field loss, perimetry with (computer generated) moving stimuli (semi-automated kinetic perimetry) allows an efficient, standardized and patient-friendly edge detection of scotoma borders. This method is also very well suited for expert opinions and ability testing. The assessment by morphological or morphometric, hydrodynamic and other functional parameters serve as complementary diagnostic aids or as elementary tools for plausibility control.     

Makulopathie mit areolären RPE-Defekten

Maculopathy with areolar or annular defects in the retinal pigment epithelium (RPE) can have manifold differential diagnoses. If such alterations occur in adolescence or early adulthood with good visual acuity, precise diagnostics and confirmation of the diagnosis are of special importance with respect to the prognosis of the disease. We report the case of a 36-year-old female patient with bilateral perifoveolar, areolar retinal pigment epithelium defects. The patient suffered from metamorphopsia with good visual acuity. Visual disturbances had initially begun 8 years previously. Perifoveolar RPE defects can be visualized with autofluorescence photography and optical coherence tomography (OCT) and result in functional defects in perimetry, microperimetry and multifocal electroretinography. The symptoms and course are in accordance with fenestrated sheen macular dystrophy. A therapy does not exist. This rare autosomal-dominant inherited macular dystrophy is often asymptomatic and has a good prognosis for visual acuity.     

Myopic CNV

Choroidal neovascularisation secondary to pathological myopia is the most common cause of severe visual impairment in myopic patients younger than 50 years old. The typical features of myopic CNV in contrast to age-related macular degeneration as well as the anatomic characteristics have an impact on the parameters of the baseline and follow-up examinations. As the usually small fibrovascular lesions show a rapid progression in the spontaneous course of the disease and lead to irreversible damage to the photoreceptors, prompt initiation of treatment is mandatory. The superior functional results of anti-VEGF drugs provide the reason for the first-line status of this treatment modality. Increasing safety data and consistent results of prospective pilot trials have proved photodynamic therapy to be inferior. There are signs that PRN-based treatment algorithms may allow for less frequent dosing than in other retinal diseases.