A Consensus Statement on the Terminology for Automated Visual Field Abnormalities.

BACKGROUND: A multitude of terms have been used to describe automated visual field abnormalities. To date, there is no universally accepted system of definitions or guidelines. Variability among clinicians creates the risk of miscommunication and the compromise of patient care. The purposes of this study were to 1) assess the degree of consistency among a group of neuro-ophthalmologists in the description of visual field abnormalities and 2) to create a consensus statement with standardized terminology and definitions. METHODS: In phase one of the study, all neuro-ophthalmologists in Israel were asked to complete a survey in which they described the abnormalities in 10 selected automated visual field tests. In phase 2 of the study, the authors created a national consensus statement on the terminology and definitions for visual field abnormalities using a modified Delphi method. In phase 3, the neuro-ophthalmologists were asked to repeat the initial survey of the 10 visual fields using the consensus statement to formulate their answers. RESULTS: Twenty-six neuro-ophthalmologists participated in the initial survey. On average, there were 7.5 unique descriptions for each of the visual fields (SD 3.17), a description of only the location in 24.6% (SD 0.19), and an undecided response in 6.15% (SD 4.13). Twenty-two neuro-ophthalmologists participated in the creation of a consensus statement which included 24 types of abnormalities with specific definitions. Twenty-three neuro-ophthalmologists repeated the survey using the consensus statement. On average, in the repeated survey, there were 5.9 unique descriptions for each of the visual fields (SD 1.79), a description of only the location in 0.004% (SD 0.01), and an undecided response in 3.07% (SD 2.11%). Relative to the first survey, there was a significant improvement in the use of specific and decisive terminology. CONCLUSIONS: The study confirmed a great degree of variability in the use of terminology to describe automated visual field abnormalities. The creation of a consensus statement was associated with improved use of specific terminology. Future efforts may be warranted to further standardize terminology and definitions.

Randomized Controlled Phase 2a Study of RPh201 in Previous Nonarteritic Anterior Ischemic Optic Neuropathy.

BACKGROUND: No proven treatment exists for nonarteritic anterior ischemic optic neuropathy (NAION), either in the acute or late phase. OBJECTIVE: To assess safety and changes in visual function and structure after RPh201/placebo treatment in participants with previous NAION. DESIGN AND SETTING: Phase 2a, single-site, prospective, randomized, placebo-controlled, double-masked trial (registration NCT02045212). MAIN OUTCOMES MEASURES: Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), visual fields, retinal nerve fiber layer, and visual evoked potential at weeks 13, 26, and after a 13-week wash-out ("off-drug") period; and safety. STUDY POPULATION: Twenty-two participants aged 18 years or older with previous NAION. INTERVENTION(S): RPh201 (20 mg) or placebo (cottonseed oil vehicle) administered subcutaneously twice weekly at the study site. RESULTS: Thirteen men and 9 women were randomized, of which 20 completed all visits. The mean (±SD) age was 61.0 ± 7.6 years. In a post hoc analysis, after 26 weeks of treatment, BCVA improved by ≥15 letters in 4/11 (36.4%) eyes with RPh201, compared to 1/8 (12.5%) eyes with placebo (P = 0.24). Overall, 7/11 (63.6%) of participants on RPh201 showed some improvement in BCVA, compared with 3/8 (37.5%) on placebo (P = 0.26). Improvement in BCVA from a calculated baseline was 14.8 ± 15.8 letters for RPh201 and 6.6 ± 15.3 for placebo (P = 0.27). Of the 154 adverse effects (AEs), 52 were considered related to the study procedures/treatment. Across the study and 1,017 injections, the most frequently reported AE was injection site pain (23 events in 5 participants). There were no clinically significant changes in vital signs or laboratory values. CONCLUSIONS: This Phase 2a was designed to assess safety, feasibility, and explore potential efficacy signals in treating previous NAION with RPh201. No safety concerns were raised. The results support a larger trial in patients with previous NAION.

[COEXISTENCE OF ORBITAL VARICOSE VEIN AND THYROID ORBITOPATHY].

PURPOSE: To describe a thyroid orbitopathy patient who had asymmetric progression of exophthalmos due to orbital varicose vein. PATIENT: A 55-year-old patient with thyroid orbitopathy had asymmetric progression of exophthalmos without complaints over 4 years of follow-up. RESULTS: In repeated computerized tomography (CT) of the orbit, a dilation of the superior ophthalmic vein was noted on the more proptotic eye, in addition to bilateral excessive orbital fat. This finding was also confirmed on color Doppler imaging in valsalva manoeuver. CONCLUSIONS: In patients with thyroid orbitopathy who have atypical progression course of their exophthalmos, repeated orbital CT scan is advocated to rule out other concurrent orbital disorders such as varicose veins.

Comparison of optic nerve head topography findings in eyes with non-arteritic anterior ischemic optic neuropathy and eyes with glaucoma.

BACKGROUND: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness in eyes affected by non-arteritic ischemic optic neuropathy (NAION) or glaucoma as determined by optical coherence tomography (OCT). METHODS: This cross-sectional institutional study included 18 eyes with NAION (at least 6 months since the acute event) and 29 eyes with glaucoma, both having localized visual field (VF) defects confined to one hemifield. Twenty-nine normal subjects served as controls. The fast RNFL thickness protocol (3.4) of the Stratus OCT (Carl Zeiss Meditec, Dublin, CA, USA) was used. The RNFL thickness and inferior maximum/temporal average (Imax/Tavg) and superior maximum/temporal average (Smax/Tavg) data corresponding to the hemifield with and without visual sensitivity loss were compared between NAION and glaucomatous eyes and with corresponding quadrants in normal eyes. The area under the receiver operating characteristic curve (AUC), sensitivities, and specificities were used to determine the OCT parameters that differ most in the two groups. RESULTS: The mean RNFL thickness in the quadrants corresponding to the affected hemifield in the NAION and glaucomatous eyes was not significantly different (P > 0.9), but the values for both were decreased compared to the control eyes (P < 0.0001). The mean RNFL thickness in the quadrant corresponding to the unaffected hemifield was significantly lower in the glaucomatous eyes (73.8 +/- 20.04 micro) than in the NAION eyes (96.6 +/- 23.32 micro, P = 0.023), and in both study groups compared to the controls (117.2 +/- 13.44 micro, P < 0.0001 for glaucomatous vs control eyes, and P < 0.025 for NAION vs control eyes). Smax/Tavg and Imax/Tavg of the quadrant corresponding to the unaffected hemifield had the strongest power to differentiate the two diseases (an AUC of 0.92). CONCLUSIONS: Stratus OCT detected significant quantitative differences in RNFL thickness between glaucomatous and NAION eyes, both conditions with hemifield defects. These differences might hold a clue in understanding the processes involved in optic nerve injury.

The prevalence of glaucoma in patients with sleep apnea syndrome: same as in the general population.

PURPOSE: An association of glaucoma and sleep apnea syndrome (SAS) has been widely reported. We investigated the largest group of patients with SAS thus far to determine the prevalence of glaucoma among these patients. DESIGN: Cross-sectional study. METHODS: An institutional study. STUDY POPULATION: A total of 228 patients with SAS. OBSERVATION PROCEDURES: Sleep studies determined the respiratory disturbance index (RDI) during night sleep. Ocular examination included intraocular pressure (IOP) measurement, optic disk evaluation, and Humphrey visual field examination. MAIN OUTCOME MEASURES: The SAS was diagnosed as an RDI > 10. The RDI was graded to determine the severity of SAS: mild (RDI, 10-19), moderate (RDI, 20-39), and severe (RDI > 40). Open-angle glaucoma was diagnosed when a glaucomatous visual field defect matched the optic disk changes, irrespective of IOP levels. RESULTS: Nineteen participants had mild SAS (mean +/- standard deviation, RDI = 15 +/- 3), 129 had moderate SAS (RDI = 28 +/- 5), and 80 had severe SAS (RDI = 54 +/- 11). Open-angle glaucoma was found in five SAS subjects, a prevalence of 2% (95% confidence interval, 0.7% to 5%). There was no correlation between RDI and the presence of glaucoma (chi-square = 1.18; degrees of freedom = 2; P =.6) or between the RDI and the IOP (r = -0.067; P =.316). CONCLUSION: The prevalence of glaucoma in SAS patients was similar to that in the general Caucasian population.

Central retinal artery occlusion after peribulbar anesthesia.

We describe the development of central retinal artery occlusion (CRAO) in 2 patients after peribulbar (periconal) anesthesia during uneventful phacoemulsification. Although peribulbar anesthesia avoids direct optic-nerve injury, indirect injury presenting as CRAO may occur from vasospasm in response to the injection.