A case of bilateral, acquired, and acute dysfunction of short-wavelength-sensitive cone systems.

To report a case of bilateral, acquired, and acute dysfunction of short-wavelength-sensitive (SWS) cone systems. The case was a healthy 39-year-old man. He noticed sudden onset of bilateral abnormal color vision. Ophthalmic examinations revealed normal fundi in both eyes. Farnsworth panel D-15 test and Farnsworth-Munsell 100-hue test showed tritanopia. White-on-white static perimetry showed no abnormality; however, blue-on-yellow static perimetry detected remarkably reduced sensitivity at the lower visual field in both eyes. ISCEV-standard full-field electroretinograms (ERGs) were normal; however, blue-on-yellow ERGs showed reduced amplitude of b-wave that was derived from SWS cone systems in both eyes. He was observed for 1 year, and no improvement in color vision was found during the observation. This is a unique case which showed bilateral, acquired, and acute dysfunction of SWS cone systems. The cause of the acquired tritanopia remains to be known.

Test Conditions in Macular Visual Field Testing in Glaucoma.

PURPOSE: The purpose of this study is to evaluate the suitable visual field (VF) test conditions (target size, test type, and eccentricity) for the macular region, we investigated the correlations between the ganglion cell layer (GCL) thickness and 6 VF test results. METHODS: We tested 32 eyes of patients (61.1±9.2 y) with preperimetric (6), early-stage (16), and moderate-stage (10) glaucoma. The VF tests included 3 SAP (the 10-2 HFA using SITA with target size III [HFA SITA (III)], full threshold with size III [HFA FULL (III)] and size I [HFA FULL (I)]) and 3 visual function-specific perimetry tests (the 10-2 SWAP, 10-2 flicker, and 10-2 Humphrey Matrix). The GCL and inner plexiform layer (GCL+IPL) thickness was measured by Spectral Domain Optical Coherence Tomography (SD-OCT) with a macular 7×7 mm cube scan (3D OCT-2000, Topcon). The coefficient of determination (r) for the correlation between visual sensitivity and the GCL+IPL thickness was calculated for each test at eccentricities 0 to 5 degrees, 5 to 7 degrees, and 7 to 10 degrees using linear and quadratic regressions. RESULTS: All 6 tests showed the strongest correlation with the GCL+IPL thickness at 5 to 7 degrees. The respective r (linear) and R (quadratic) for HFA SITA (III), HFA FULL (III), HFA FULL (I), SWAP, Flicker, and Matrix were (0.40, 0.50), (0.43, 0.53), (0.44, 0.46), (0.51, 0.51), (0.33, 0.34), and (0.52, 0.52). CONCLUSIONS: As compared with the frequently-used SAP with a size III, SAP with size I and the function-specific perimetry tests (especially the Matrix) could be more suitable for testing the macular region.

Visual Field Testing with Head-Mounted Perimeter 'imo'.

PURPOSE: We developed a new portable head-mounted perimeter, "imo", which performs visual field (VF) testing under flexible conditions without a dark room. Besides the monocular eye test, imo can present a test target randomly to either eye without occlusion (a binocular random single eye test). The performance of imo was evaluated. METHODS: Using full HD transmissive LCD and high intensity LED backlights, imo can display a test target under the same test conditions as the Humphrey Field Analyzer (HFA). The monocular and binocular random single eye tests by imo and the HFA test were performed on 40 eyes of 20 subjects with glaucoma. VF sensitivity results by the monocular and binocular random single eye tests were compared, and these test results were further compared to those by the HFA. The subjects were asked whether they noticed which eye was being tested during the test. RESULTS: The mean sensitivity (MS) obtained with the HFA highly correlated with the MS by the imo monocular test (R: r = 0.96, L: r = 0.94, P < 0.001) and the binocular random single eye test (R: r = 0.97, L: r = 0.98, P < 0.001). The MS values by the monocular and binocular random single eye tests also highly correlated (R: r = 0.96, L: r = 0.95, P < 0.001). No subject could detect which eye was being tested during the examination. CONCLUSIONS: The perimeter imo can obtain VF sensitivity highly compatible to that by the standard automated perimeter. The binocular random single eye test provides a non-occlusion test condition without the examinee being aware of the tested eye.

Retinal contraction and metamorphopsia scores in eyes with idiopathic epiretinal membrane.

PURPOSE: Using M-CHARTS (Inami Co., Tokyo, Japan), which were developed by the authors to measure metamorphopsia, and image-analysis software, which was developed to quantify retinal contraction, the authors investigated the relationship between the degree of retinal contraction and the degree of metamorphopsia in eyes with idiopathic epiretinal membrane (ERM). METHODS: This study was conducted in 29 eyes with ERM (29 patients, 20 women; mean age, 62.1 +/- 8.6 years) observed for at least 3 years (mean, 3.55 +/- 0.6 years) after diagnosis. Horizontal (MH) and vertical (MV) metamorphopsia scores were obtained with the M-CHARTS. Horizontal and vertical retinal contraction due to ERM was measured by using image-analysis software developed by the authors to calculate horizontal and vertical components of changes in the locations of retinal vessels on sequential fundus images. RESULTS: There was a significant (P < 0.01) positive correlation between the degree of retinal contraction and metamorphopsia score. In addition, there were significant positive correlations between horizontal contraction of the retina and the MV score (P < 0.01) and between vertical contraction of the retina and the MH score (P < 0.05). No significant correlations were found between change in the metamorphopsia score and change in visual acuity or mean defect. CONCLUSIONS: Metamorphopsia scores correlate well with measurements of retinal contraction due to idiopathic ERM. Using M-CHARTS is a simple and useful method for quantitatively monitoring metamorphopsia in patients with ERM.

Development of a new fully automated kinetic algorithm (program k) for detection of glaucomatous visual field loss.

PURPOSE: In Program K, a new automated kinetic algorithm that we developed, the frequency distributions of the number of patients' response points were obtained for external angles to distinguish normal and abnormal isopters. We also assessed the agreement between the results of Program K and Goldmann manual kinetic perimetry (MKP). METHODS: Program K detected abnormalities in isopters by using the external angles of patients' response points. In experiment 1, a normal external angle range and endpoint for the algorithm were determined by using visual field (VF) results of 100 data sets. In experiment 2, the results of Program K and Goldmann MKP were compared in 63 virtual patients. Visual field loss was assessed by using stimuli of V/4e, III/4e, I/4e, I/3e, I/2e, and I/1e at a speed of 3 deg/s. The isopters by Program K and Goldmann MKP were overlapped and the area of intersection was expressed as a percentage of the union area. The intersection percentages and test durations were evaluated. RESULTS: A normal external angle range between 150° and 240° and phase 3 as the appropriate endpoint for the algorithm were determined. The intersection percentages for the six isopters were 84% (V/4e), 83% (III/4e), 78% (I/4e), 71% (I/3e), 60% (I/2e), and 50% (I/1e) (average, 71%). The average examination duration for Program K was 16.0 ± 3.2 minutes. The results of Program K and Goldmann MKP were comparable. CONCLUSIONS: Program K is clinically efficient and useful for detection and evaluation of abnormalities in a kinetic VF.

CLOCK CHART(®): a novel multi-stimulus self-check visual field screener.

PURPOSE: CLOCK CHART(®) is a multi-stimulus-type self-check visual field screening sheet developed by our group. The test chart is rotated during the examination, and the visual field abnormalities are pointed out by the patients themselves. In this study, we evaluated the clinical usefulness of this chart in patients with glaucoma. METHODS: We studied 114 eyes of 114 glaucoma patients (average age 60.0 ± 11.1 years) and 45 eyes of 45 normal individuals (average age 45.0 ± 16.4 years) using CLOCK CHART(®). The static visual fields were obtained using the Octopus 101 G2 program and classified using the Aulhorn classification as modified by Greve (stages 0-I to IV) and by mean defect (MD; early <6 dB; moderate 6 ≤ MD ≤12 dB; severe >12 dB).The sensitivity and specificity of CLOCK CHART(®) for detecting visual field abnormalities were evaluated within the entire 25° field and at the 5°, 10°, 15°, 20°, and 25° eccentricity zones. The visual field agreement between the results of CLOCK CHART(®) and the static visual fields were also evaluated. RESULTS: In glaucomatous eyes, the sensitivity of CLOCK CHART(®) was 85, 93, and 100 % for Greve stages I, II and III-VI, respectively, and 87, 93, and 97 % for the MD value in early, moderate, and severe eyes, respectively. The agreement of the visual field defect area in CLOCK CHART(®) with the static fields was 85 and 100 % with Greve stages 0-I to I and II-VI, respectively, and 91, 96, and 96 % in early, moderate and severe glaucomatous eyes according to MD, respectively. The specificity of CLOCK CHART(®) was 89 %. CONCLUSION: CLOCK CHART(®) is a simple and reliable self-check screening chart for detecting visual field abnormalities in patients with glaucoma.

Quantification of metamorphopsia in patients with epiretinal membranes.

PURPOSE: To quantify the degree of metamorphopsia in patients with idiopathic epiretinal membranes (ERMs), by use of a new metamorphopsia chart (M-CHARTS) developed by the authors. METHODS: These M-CHARTS had 19 dotted lines with dot intervals of between 0.2 degrees (fine) and 2.0 degrees (coarse) visual angles. As the dot intervals were changed from fine to coarse, a decrease in the severity of metamorphopsia was noted. In this study, the minimum visual angle of the dotted lines needed to cause the metamorphopsia to disappear was measured in 51 eyes of 51 patients with ERM. The metamorphopsia scores were compared with the stages of ERM classified by scanning laser ophthalmoscope (SLO) images. RESULTS: In patients with ERM, the metamorphopsia score increased depending on the severity of membrane proliferation classified by SLO images. The scores obtained from the horizontal dotted lines were larger than those of the vertical lines in advanced stages of ERM. CONCLUSIONS: M-CHARTS provide a very simple and useful method for evaluating the severity of metamorphopsia in patients with ERM.

Correlations between M-CHARTS and PHP findings and subjective perception of metamorphopsia in patients with macular diseases.

PURPOSE: To assess the correlations between a patient's subjective perception of metamorphopsia and the clinical measurements of metamorphopsia by M-CHARTS and PreView PHP (PHP). METHODS: The authors designed a 10-item questionnaire focusing on the symptoms of metamorphopsia and verified its validity with a Rasch analysis. M-CHARTS measured the minimum visual angle of a dotted line needed to detect metamorphopsia, and PHP used the hyperacuity function for detection. Subjects were 39 patients with idiopathic epiretinal membrane (ERM), 22 patients with idiopathic macular hole (M-hole), 19 patients with age-related macular degeneration (AMD), and 51 healthy controls. RESULTS: Rasch analysis suggested the elimination of one question. The nine-item questionnaire score significantly correlated to the M-CHARTS score in ERM (r = 0.59; P = 0.0004) but not in M-hole and to the PHP result in AMD (r = -0.29; P = 0.04) but not in ERM. Eighty percent of ERM patients with greater horizontal M-CHARTS score subjectively perceived horizontal metamorphopsia more often. M-CHARTS showed better sensitivities than PHP in both ERM (89% vs. 42%) and AMD (74% vs. 68%) and better specificity (100% vs. 71%) in healthy controls. Rasch analysis indicated that the present form of the questionnaire is better suited for moderate to severe cases of metamorphopsia than for mild cases. CONCLUSIONS: The questionnaire appears to be a valid assessment of patient subjective perception of metamorphopsia and can be used to supplement the clinical measurements of metamorphopsia by M-CHARTS and PHP in patients with macular diseases.

Detectability of glaucomatous changes using SAP, FDT, flicker perimetry, and OCT.

PURPOSE: To compare the detectability between glaucomatous visual field changes using standard automated perimetry (SAP), frequency doubling technology (FDT), short-wavelength automated perimetry (SWAP), and flicker perimetry and structural changes using optical coherence tomography (OCT). PARTICIPANTS: Fifty-nine eyes of fifty-nine patients with open-angle glaucoma, 24 eyes of 24 glaucoma suspects (GSs), and 40 eyes of 40 healthy age-matched subjects. METHODS: All subjects underwent Humphrey visual field analyzer II 24-2 full threshold (SAP), Swedish interactive threshold algorithm-SWAP, FDT (30-1, 30-5, 24-2-1, 24-2-5), flicker perimetry on Octopus 311 (4-zone probability 38S), and Stratus OCT [fast retinal nerve fiber layer thickness (NFLT) and fast optic disc]. To evaluate the visual field, FDT and flicker used the number of abnormal points, whereas SAP used mean deviation (MD) and SWAP used both the number of abnormal points and MD. The areas under the receiver operating characteristic curves [area under the curve (AUCs)] and sensitivities at fixed specificities were used to assess the detectability of glaucoma. RESULTS: The AUC for FDT 30-1, 30-5, 24-2-1, 24-2-5, flicker perimetry, SWAP (MD), and SWAP (number of abnormal points) were 0.95, 0.94, 0.88, 0.89, 0.99, 0.88, and 0.88 in the early glaucoma group and 0.67, 0.69, 0.65, 0.70, 0.80, 0.64, and 0.66 in the GS group, respectively. In the early glaucoma and GS groups, all OCT parameters had an AUC >0.81 except the disc area parameter. Especially, average NFLT had the highest AUC of 0.94 in the OCT parameters. CONCLUSIONS: FDT, SWAP, flicker perimetry, and OCT are all useful methods for discriminating between healthy eyes and eyes with early glaucoma. Among all 10 OCT parameters, NFLT has the highest sensitivity for detecting early glaucomatous changes in GS patients.

Quantification of metamorphopsia in a macular hole patient using M-CHARTS.

PURPOSE: In cases of macular hole, metamorphopsia is one of the most important symptoms, along with decreased visual acuity and a central scotoma. We investigated the relationship between the degree of metamorphopsia and the morphological appearance of macular holes. METHODS: Using M-CHARTS developed by ourselves, we quantified the metamorphopsia scores in 35 eyes with an idiopathic macular hole in 35 patients. Metamorphopsia in eyes with macular hole was characterized by straight lines recognized by the subject as bending toward the central scotoma. We also evaluated best corrected visual acuity (VA) and the central 10 degrees of differential light sensitivity using the Octopus 101 program M2. The size of the macular hole and the fluid cuff were measured using a scanning laser ophthalmoscope. We also evaluated the improvement in metamorphopsia scores after surgical treatment for macular hole in 22 patients. RESULTS: A significant correlation was found between metamorphopsia score and fluid cuff size, but not diameter of the macular hole. After vitrectomy, VA improved in 14 of 22 patients and metamorphopsia scores improved in 19 of 22 patients. M-CHARTS is a simple and useful method for the quantification and follow-up of metamorphopsia in patients with macular hole.

Automated flicker perimetry in glaucoma using Octopus 311: a comparative study with the Humphrey Matrix.

PURPOSE: We evaluated the clinical usefulness of flicker perimetry in glaucoma and glaucoma suspect patients using the new Octopus 311 automated perimeter. METHODS: A total of 52 eyes of 52 glaucoma patients, 26 eyes of 26 glaucoma suspect patients and 61 eyes of 61 normal subjects were examined using standard automated perimetry (SAP), flicker perimetry and frequency doubling technology (FDT) perimetry. Flicker perimetry was performed using the Octopus 311 and its remote software package. Suprathreshold four-zone probability strategy was used to classify the critical fusion frequency probability level. The classified levels were set at 5% and 1% of probability of normality and 5 Hz. Frequency doubling technology perimetry was performed using 24-2-5, 24-2-1, N-30-5, N-30-1 screening programs using Humphrey Matrix perimetry. Standard automated perimetry was performed using the Humphrey field analyser program 24-2 full threshold. Optical coherence tomography using Stratus OCT was used for evaluating the retinal nerve fibre layer thickness in all glaucoma and glaucoma suspect patients. RESULTS: Receiver operating characteristic (ROC) curves were calculated. In the early stage of glaucoma, the areas under the ROC curve (AUCs) were 0.96 in flicker and 0.90 in Matrix perimetry. In the moderate and advanced stages of glaucoma, the AUCs were almost 1.0 in all tests. In glaucoma suspect patients, the AUC of the 5% probability level in flicker was significantly higher than in Matrix perimetry. CONCLUSION: The four-zone probability strategy using the Octopus 311 is a useful method for evaluating the flicker field in early glaucoma and glaucoma suspect patients.