Antarctica eye study: a prospective study of the effects of overwintering on ocular parameters and visual function.

BACKGROUND: In 2013 five polar explorers attempted to complete the first Trans-Antarctic Winter Traverse (TAWT). This study presents the ophthalmological findings for this group, who overwintered in Antarctica as part of the White Mars Human Science Protocol. Antarctic crews are exposed to extreme cold, chronic hypoxia and altered day-night cycles. Previous studies of Antarctic explorers have focused on the prolonged effect of ultraviolet radiation including the development of ultraviolet keratitis and accelerated cataract formation. This is the first study of its kind to investigate the effect of overwintering in Antarctica on the human eye. METHODS: Pre and post-expedition clinical observations were made including visual acuity, contrast sensitivity, colour vision, auto-refraction, subjective refraction, retinal examination, retinal autofluoresence and retinal thickness, which were graded for comparison. During the expedition additional observations were made on a monthly basis including LogMAR visual acuity, autorefraction and intraocular pressure. RESULTS: No significant differences between pre and post-expedition observations were found, including visual acuity, contrast sensitivity, colour vision, refraction, visual fields, intraocular pressure and retinal examination. There was a small but statistically significant decrease in retinal thickness across all regions of the retina, except for the macular and fovea, in all explorers. Intra-expedition observations remained within normal limits. CONCLUSION: Reassuringly, the human eye remains largely unchanged by exposure to the extreme conditions encountered during the Antarctic winter, however, further research is needed to investigate changes in retinal thickness. This may have implications for scientists who spend prolonged periods of time in the polar regions, as well as those who have prolonged exposure to the extreme cold or chronic hypoxia in other settings.

The effect of blue-light blocking spectacle lenses on visual performance, macular health and the sleep-wake cycle: a systematic review of the literature.

PURPOSE: Blue-blocking (BB) spectacle lenses, which attenuate short-wavelength light, are being marketed to alleviate eyestrain and discomfort when using digital devices, improve sleep quality and potentially confer protection from retinal phototoxicity. The aim of this review was to investigate the relative benefits and potential harms of these lenses. METHODS: We included randomised controlled trials (RCTs), recruiting adults from the general population, which investigated the effect of BB spectacle lenses on visual performance, symptoms of eyestrain or eye fatigue, changes to macular integrity and subjective sleep quality. We searched MEDLINE, EMBASE, the Cochrane Library and clinical trial registers, until 30 April 2017. Risk of bias was assessed using the Cochrane tool. RESULTS: Three studies (with 136 participants) met our inclusion criteria; these had limitations in study design and/or implementation. One study compared the effect of BB lenses with clear lenses on contrast sensitivity (CS) and colour vision (CV) using a pseudo-RCT crossover design; there was no observed difference between lens types (log CS; Mean Difference (MD) = -0.01 [-0.03, 0.01], CV total error score on 100-hue; MD = 1.30 [-7.84, 10.44]). Another study measured critical fusion frequency (CFF), as a proxy for eye fatigue, on wearers of low and high BB lenses, pre- and post- a two-hour computer task. There was no observed difference between low BB and standard lens groups, but there was a less negative change in CFF between the high and low BB groups (MD = 1.81 [0.57, 3.05]). Both studies compared eyestrain symptoms with Likert scales. There was no evidence of inter-group differences for either low BB (MD = 0.00 [-0.22, 0.22]) or high BB lenses (MD = -0.05 [-0.31, 0.21]), nor evidence of a difference in the proportion of participants showing an improvement in symptoms of eyestrain or eye fatigue. One study reported a small improvement in sleep quality in people with self-reported insomnia after wearing high compared to low-BB lenses (MD = 0.80 [0.17, 1.43]) using a 10-point Likert scale. A study involving normal participants found no observed difference in sleep quality. We found no studies investigating effects on macular structure or function. CONCLUSIONS: We find a lack of high quality evidence to support using BB spectacle lenses for the general population to improve visual performance or sleep quality, alleviate eye fatigue or conserve macular health.

Assessing the effects of dynamic luminance contrast noise masking on a color discrimination task.

The aim of this work was to assess the influence of dynamic luminance contrast noise masking (LCNM) on color discrimination for color normal and anomalous trichromats. The stimulus was a colored target on a background presented on a calibrated CRT display. In the static LCNM condition, the background and target consisted of packed circles with variable size and static random luminance. In the dynamic LCNM condition, a 10 Hz square luminance signal was added to each circle. The phase of this signal was randomized across circles. Discrimination thresholds were estimated along 20 hue directions concurrent at the color of the background. Six observers with normal color vision, six deuteranomalous observers, and three protanomalous observers performed the test in both conditions. With dynamic LCNM, thresholds were significantly lower for anomalous observers but not for normal observers, suggesting a facilitation effect of the masking for anomalous trichromats.

Maximum likelihood conjoint measurement of lightness and chroma.

Color varies along dimensions of lightness, hue, and chroma. We used maximum likelihood conjoint measurement to investigate how lightness and chroma influence color judgments. Observers judged lightness and chroma of stimuli that varied in both dimensions in a paired-comparison task. We modeled how changes in one dimension influenced judgment of the other. An additive model best fit the data in all conditions except for judgment of red chroma where there was a small but significant interaction. Lightness negatively contributed to perception of chroma for red, blue, and green hues but not for yellow. The method permits quantification of lightness and chroma contributions to color appearance.

Perifoveal L- and M-cone-driven temporal contrast sensitivities at different retinal illuminances.

We established a protocol using a well-established LED stimulator to measure temporal contrast sensitivities driven by sine-wave modulation of L- and M-cones in the perifovea using triple silent substitution. The stimulus was presented in an annular field (2° inner diameter, 13° outer diameter). We validated this technique by studying the contrast sensitivity of three color normal observers at 10 different temporal frequencies (between 1 and 28 Hz) over a large range of retinal illuminances (between 0.07 and 587 phot Td), spanning the complete mesopic range. In one subject, sensitivities to counterphase modulation of L- and M-cones and in-phase modulation of L, M, and S-cones were additionally measured, which putatively reflected the parvo- and magnocellular retinogeniculate pathways, respectively. Furthermore, we performed measurements of temporal contrast sensitivities as a function of frequency at 294 phot Td in two protanopes, in two deuteranopes, and in one subject with S-cone monochromacy. Quality of isolation was satisfactory and we were able to reproduce known physiological patterns of temporal vision, such as the typical temporal contrast sensitivity functions of the L- and M-cone, the parvo- and magnocellular retinogeniculate pathways, as well as the light adaptation curves. These results will help determine optimal stimulus conditions in future studies. Results from the dichromats and the S-cone monochromat also support the quality of isolation of our protocol and underpin its potential clinical value.

An analytical model of the influence of cone sensitivity and numerosity on the Rayleigh match.

The Rayleigh match is defined by the range of mixtures of red and green lights that appear the same as an intensity-adjustable monochromatic yellow light. The perceptual match indicates that the red-green mixture and the yellow light have evoked the same respective cone absorptions in the L- and M-cone pathways. Going beyond the existing models, the Poisson noise in cone absorptions is proposed to make the matching proportion of red-green mixtures span a finite range because any mixture in that range evokes cone absorptions that do not differ from those by a yellow light by more than the variations in the absorption noise. We derive a mathematical formula linking the match midpoint or match range with the sensitivities and numerosities of the two cones. The noise-free, exact, matching point, close to the midpoint of the matching range, depends only on the L- and M-cone sensitivities to each of the red, green, and yellow lights [these sensitivities, in turn, depend on the preferred wavelengths (λmax) and optical densities of the cone pigments and the properties of prereceptoral light filtering]. Meanwhile, the matching range depends on both these cone sensitivities and the relative numerosity of the L and M cones. The model predicts that, in normal trichromats, all other things being equal, the match range is smallest when the ratio r between L and M cone densities is r=R(-1/2) with R as the ratio between the sensitivities of the L and M cones to the yellow light, i.e., when L and M cones are similarly abundant in typical cases, and, as r departs from R(-1/2), the match range increases. For example, when one cone type is 10 times more numerous, the match range increases two- to threefold, depending on the sensitivities of the cones. Testing these model predictions requires either a large data set to identify the effect of one factor (e.g., cone numerosity) while averaging out the effects of the other factors (e.g., cone sensitivities) or for all factors to be known. A corollary of this prediction is that, because they are more likely than usual to have L:M cone ratios skewed, the matching ranges of normal female trichromats who are carriers of dichromacy (but not anomalous trichromacy) are likely to have a larger matching range than usual, particularly for the deutan carriers. In addition, the model predicts that, in strong tetrachromats (whose four dimensions of color are preserved post-receptorally), either the Rayleigh matching is impossible or the matching range is typically smaller than usual.

Understanding disability glare: light scatter and retinal illuminance as predictors of sensitivity to contrast.

The presence of a bright light in the visual field has two main effects on the retinal image: reduced contrast and increased retinal illuminance because of scattered light; the latter can, under some conditions, lead to an improvement in retinal sensitivity. The combined effect remains poorly understood, particularly at low light levels. A psychophysical flicker-cancellation test was used to measure the amount and angular distribution of scattered light in the eye for 40 observers. Contrast thresholds were measured using a functional contrast sensitivity test. Pupil-plane glare-source illuminances (i.e., 0, 1.35, and 19.21 lm/m2), eccentricities (5°, 10°, and 15°), and background luminances (1, 2.6, and 26 cd/m2) were investigated. Visual performance was better than predicted, based on a loss of retinal image contrast caused by scattered light, particularly in the mesopic range. Prediction accuracy improved significantly when the expected increase in retinal sensitivity in the presence of scattered light was also incorporated in the model.

Photoresponse diversity among the five types of intrinsically photosensitive retinal ganglion cells.

Intrinsically photosensitive retinal ganglion cells (ipRGCs) mediate non-image-forming visual responses, including pupillary constriction, circadian photoentrainment and suppression of pineal melatonin secretion. Five morphological types of ipRGCs, M1-M5, have been identified in mice. In order to understand their functions better, we studied the photoresponses of all five cell types, by whole-cell recording from fluorescently labelled ipRGCs visualized using multiphoton microscopy. All ipRGC types generated melanopsin-based ('intrinsic') as well as synaptically driven ('extrinsic') light responses. The intrinsic photoresponses of M1 cells were lower threshold, higher amplitude and faster than those of M2-M5. The peak amplitudes of extrinsic light responses differed among the ipRGC types; however, the responses of all cell types had comparable thresholds, kinetics and waveforms, and all cells received rod input. While all five types exhibited inhibitory amacrine-cell and excitatory bipolar-cell inputs from the 'on' channel, M1 and M3 received additional 'off'-channel inhibition, possibly through their 'off'-sublamina dendrites. The M2-M5 ipRGCs had centre-surround-organized receptive fields, implicating a capacity to detect spatial contrast. In contrast, the receptive fields of M1 cells lacked surround antagonism, which might be caused by the surround of the inhibitory input nullifying the surround of the excitatory input. All ipRGCs responded robustly to a wide range of motion speeds, and M1-M4 cells appeared tuned to different speeds, suggesting that they might analyse the speed of motion. Retrograde labelling revealed that M1-M4 cells project to the superior colliculus, suggesting that the contrast and motion information signalled by these cells could be used by this sensorimotor area to detect novel objects and motion in the visual field.

Ultraviolet sensitivity and colour vision in raptor foraging.

Raptors have excellent vision, yet it is unclear how they use colour information. It has been suggested that raptors use ultraviolet (UV) reflections from vole urine to find good hunting grounds. In contrast, UV plumage colours in songbirds such as blue tits are assumed to be 'hidden' communication signals, inconspicuous to raptors. This ambiguity results from a lack of knowledge about raptor ocular media transmittance, which sets the limit for UV sensitivity. We measured ocular media transmittance in common buzzards (Buteo buteo), sparrowhawks (Accipiter nisus), red kites (Milvus milvus) and kestrels (Falco tinnunculus) so that, for the first time, raptor UV sensitivity can be fully described. With this information, and new measurements of vole urine reflectance, we show that (i) vole urine is unlikely to provide a reliable visual signal to hunting raptors and (ii) blue tit plumage colours are more contrasting to blue tits than to sparrowhawks because of UV reflectance. However, as the difference between blue tit and sparrowhawk vision is subtle, we suggest that behavioural data are needed to fully resolve this issue. UV cues are of little or no importance to raptors in both vole and songbird interactions and the role of colour vision in raptor foraging remains unclear.

Edge detection depends on achromatic channel in Drosophila melanogaster.

Edges represent important information in object recognition, and thus edge detection is crucial for animal survival. Various types of edges result from visual contrast, such as luminance contrast and color contrast. So far, the molecular and neural mechanisms underlying edge detection and the relationship between different edge information-processing pathways have been largely undemonstrated. In the present study, using a color light-emitting-diode-based Buridan's paradigm, we demonstrated that a blue/green demarcation is able to generate edge-orientation behavior in the adult fly. There is a blue/green intensity ratio, the so-called point of equal luminance, at which wild-type flies did not show obvious orientation behavior towards edges. This suggests that orientation behavior towards edges is dependent on luminance contrast in Drosophila. The results of mutants ninaE(17) and sev(LY3);rh5(2);rh6(1) demonstrated that achromatic R1-R6 photoreceptor cells, but not chromatic R7/R8 photoreceptor cells, were necessary for orientation behavior towards edges. Moreover, ectopic expression of rhodopsin 4 (Rh4), Rh5 or Rh6 could efficiently restore the edge-orientation defect in the ninaE(17) mutant. Altogether, our results show that R1-R6 photoreceptor cells are both necessary and sufficient for orientation behavior towards edges in Drosophila.

Oblique color vision in an open-habitat bird: spectral sensitivity, photoreceptor distribution and behavioral implications.

Color vision is not uniform across the retina because of differences in photoreceptor density and distribution. Retinal areas with a high density of cone photoreceptors may overlap with those with a high density of ganglion cells, increasing hue discrimination. However, there are some exceptions to this cell distribution pattern, particularly in species with horizontal visual streaks (bands of high ganglion cell density across the retina) that live in open habitats. We studied the spectral sensitivity and distribution of cone photoreceptors involved in chromatic and achromatic vision in the Canada goose (Branta canadiensis), which possesses an oblique rather than horizontal visual streak at the ganglion cell layer. Using microspectrophotometry, we found that the Canada goose has a violet-sensitive visual system with four visual pigments with absorbance peaks at 409, 458, 509 and 580 nm. The density of most cones involved in chromatic and achromatic vision peaked along a band across the retina that matched the oblique orientation of the visual streak. With the information on visual sensitivity, we calculated chromatic and achromatic contrasts of different goose plumage regions. The regions with the highest visual saliency (cheek, crown, neck and upper tail coverts) were the ones involved in visual displays to maintain flock cohesion. The Canada goose oblique visual streak is the retinal center for chromatic and achromatic vision, allowing individuals to sample the sky and the ground simultaneously or the horizon depending on head position. Overall, our results show that the Canada goose visual system has features that make it rather different from that of other vertebrates living in open habitats.

Visual properties of human retinal ganglion cells.

The retinal output is the sole source of visual information for the brain. Studies in non-primate mammals estimate that this information is carried by several dozens of retinal ganglion cell types, each informing the brain about different aspects of a visual scene. Even though morphological studies of primate retina suggest a similar diversity of ganglion cell types, research has focused on the function of only a few cell types. In human retina, recordings from individual cells are anecdotal or focus on a small subset of identified types. Here, we present the first systematic ex-vivo recording of light responses from 342 ganglion cells in human retinas obtained from donors. We find a great variety in the human retinal output in terms of preferences for positive or negative contrast, spatio-temporal frequency encoding, contrast sensitivity, and speed tuning. Some human ganglion cells showed similar response behavior as known cell types in other primate retinas, while we also recorded light responses that have not been described previously. This first extensive description of the human retinal output should facilitate interpretation of primate data and comparison to other mammalian species, and it lays the basis for the use of ex-vivo human retina for in-vitro analysis of novel treatment approaches.

The effect of blue light filtering lenses on speed perception.

Blue-light filtering lenses (BFLs) are marketed to protect the eyes from blue light that may be hazardous to the visual system. Because BFLs attenuate light, they reduce object contrast, which may impact visual behaviours such as the perception of object speed which reduces with contrast. In the present study, we investigated whether speed perception is affected by BFLs. Using a two-interval forced-choice procedure in conjunction with Method of Constant Stimuli, participants (n = 20) judged whether the perceived speed of a moving test stimulus (1.5-4.5°/s) viewed through a BFL was faster than a reference stimulus (2.75°/s) viewed through a clear lens. This procedure was repeated for 3 different BFL brands and chromatic and achromatic stimuli. Psychometric function fits provided an estimate of the speed at which both test and reference stimuli were matched. We find that the perceived speed of both chromatic and achromatic test stimuli was reduced by 6 to 20% when viewed through BFLs, and lenses that attenuated the most blue-light produced the largest reductions in perceived speed. Our findings indicate that BFLs whilst may reduce exposure to hazardous blue light, have unintended consequences to important visual behaviours such as motion perception.

Perceived luminance depends on temporal context.

Brightness--the perception of an object's luminance--arises from complex and poorly understood interactions at several levels of processing. It is well known that the brightness of an object depends on its spatial context, which can include perceptual organization, scene interpretation, three-dimensional interpretation, shadows, and other high-level percepts. Here we present a new class of illusion in which temporal relations with spatially neighbouring objects can modulate a target object's brightness. When compared with a nearby patch of constant luminance, a brief flash appears brighter with increasing onset asynchrony. Simultaneous contrast, retinal effects, masking, apparent motion and attentional effects cannot account for this illusory enhancement of brightness. This temporal context effect indicates that two parallel streams--one adapting and one non-adapting--encode brightness in the visual cortex.

Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuro-oncology program.

We evaluated the visual outcome of a cohort of children with neurofibromatosis type 1 (NF1) and optic pathway glioma (OPG) treated according to standardized therapeutic guidelines. The study population consisted of all consecutive patients with NF1 and OPG referred to a specialized pediatric neuro-oncology program between 1994 and 2004. Treatment was instituted only in cases of progressive disease or clinical deterioration. Treatment modalities were chemotherapy (based on vincristine/carboplatin) for children younger than 5 years and radiotherapy for all others. Ten boys and 10 girls (seven with a positive family history) entered the trial (median age at diagnosis of OPG, 29 months). At a median follow-up time of 78 months, seven patients had been treated with chemotherapy only, four with radiotherapy, and four with chemotherapy plus radiotherapy. Five patients were observed only. Currently, 18 are alive and two have died. Eight patients were treated for progressive visual loss in the face of stable disease, five for tumor volume increase without visual deterioration, and two for symptomatic tumor volume increase. At referral, six children had a visual acuity (VA) of < 30% in both eyes; eight children had 100% VA bilaterally. At referral, the visual field (VF) could be assessed in three children: One had VF loss in both eyes, one had VF loss in one eye, and one had normal VF. At last follow-up, eight children had VA < 20% in both eyes; only two children had 100% VA in both eyes. Among 11 children who had some visual function, three had VF loss in one eye and three in both eyes, and five had an intact VF. Contrast and color sensitivity were abnormal in seven and six patients, respectively. Thirteen children fell into the WHO hypovision category. In summary, among the 15 children treated, one had a definitive and two a mild improvement in VA. In conclusion, the visual outcome of this selected cohort of NF1 patients with OPG is unsatisfactory. A critical reappraisal of the therapeutic strategy adopted is needed.

The evidence informing the surgeon's selection of intraocular lens on the basis of light transmittance properties.

In recent years, manufacturers and distributors have promoted commercially available intraocular lenses (IOLs) with transmittance properties that filter visible short-wavelength (blue) light on the basis of a putative photoprotective effect. Systematic literature review. Out of 21 studies reporting on outcomes following implantation of blue-light-filtering IOLs (involving 8914 patients and 12 919 study eyes undergoing cataract surgery), the primary outcome was vision, sleep pattern, and photoprotection in 9 (42.9%), 9 (42.9%), and 3 (14.2%) respectively, and, of these, only 7 (33.3%) can be classed as high as level 2b (individual cohort study/low-quality randomized controlled trials), all other studies being classed as level 3b or lower. Of the level 2b studies, only one (14.3%) found in favor of blue-light-filtering IOLs vs ultraviolet (UV)-only filtering IOLs on the basis of an association between better post-operative contrast sensitivity (CS) at select frequencies with the former; however, that study did not measure or report CS preoperatively in either group, and the finding may simply reflect better preoperative CS in the eyes scheduled to be implanted with the blue-light-filtering IOL; moreover, that study failed to measure macular pigment, a natural preceptoral filter of blue-light, augmentation of which is now known to improve CS. In terms of photoprotection, there is no level 2b (or higher) evidence in support of blue filtering IOLs vs UV-only filtering IOLs. On the basis of currently available evidence, one cannot advocate for the use of blue-light-filtering IOLs over UV-only filtering IOLs.

Safety and acceptability of an organic light-emitting diode sleep mask as a potential therapy for retinal disease.

PurposeThe purpose of the study was to study the effect of an organic light-emitting diode sleep mask on daytime alertness, wellbeing, and retinal structure/function in healthy volunteers and in diabetic macular oedema (DMO).Patients and methodsHealthy volunteers in two groups, 18-30 yrs (A), 50-70 yrs (B) and people with DMO (C) wore masks (504 nm wavelength; 80 cd/m2 luminance; ≤8 h) nightly for 3 months followed by a 1-month recovery period. Changes from baseline were measured for (means): psychomotor vigilance task (PVT) (number of lapses (NL), response time (RT)), sleep, depression, psychological wellbeing (PW), visual acuity, contrast sensitivity, colour, electrophysiology, microperimetry, and retinal thickness on OCT.ResultsOf 60 participants, 16 (27%) withdrew, 8 (13%) before month 1, due to sleep disturbances and mask intolerance. About 36/55 (65%) who continued beyond month 1 reported ≥1 adverse event. At month 3 mean PVT worsened in Group A (RT (7.65%, P<0.001), NL (43.3%, P=0.005)) and mean PW worsened in all groups (A 28.0%, P=0.01, B 21.2%, P=0.03, C 12.8%, P<0.05). No other clinically significant safety signal was detected. Cysts reduced/resolved in the OCT subfield of maximal pathology in 67% Group C eyes. Thinning was greater at 3 and 4 months for greater baseline thickness (central subfield P<0.001, maximal P<0.05).ConclusionSleep masks showed no major safety signal apart from a small impairment of daytime alertness and a moderate effect on wellbeing. Masks were acceptable apart from in some healthy participants. Preliminary data suggest a beneficial effect on retinal thickness in DMO. This novel therapeutic approach is ready for large clinical trials.

Dampening Spontaneous Activity Improves the Light Sensitivity and Spatial Acuity of Optogenetic Retinal Prosthetic Responses.

Retinitis pigmentosa is a progressive retinal dystrophy that causes irreversible visual impairment and blindness. Retinal prostheses currently represent the only clinically available vision-restoring treatment, but the quality of vision returned remains poor. Recently, it has been suggested that the pathological spontaneous hyperactivity present in dystrophic retinas may contribute to the poor quality of vision returned by retinal prosthetics by reducing the signal-to-noise ratio of prosthetic responses. Here, we investigated to what extent blocking this hyperactivity can improve optogenetic retinal prosthetic responses. We recorded activity from channelrhodopsin-expressing retinal ganglion cells in retinal wholemounts in a mouse model of retinitis pigmentosa. Sophisticated stimuli, inspired by those used in clinical visual assessment, were used to assess light sensitivity, contrast sensitivity and spatial acuity of optogenetic responses; in all cases these were improved after blocking spontaneous hyperactivity using meclofenamic acid, a gap junction blocker. Our results suggest that this approach significantly improves the quality of vision returned by retinal prosthetics, paving the way to novel clinical applications. Moreover, the improvements in sensitivity achieved by blocking spontaneous hyperactivity may extend the dynamic range of optogenetic retinal prostheses, allowing them to be used at lower light intensities such as those encountered in everyday life.

Are recognition deficits following occipital lobe TMS explained by raised detection thresholds?

It is known that transcranial magnetic stimulation (TMS) administered over the occipital pole suppresses recognition of visual objects. Our aim was to ascertain whether this suppression can be interpreted as a change in visual contrast threshold. Four subjects detected the orientation of an U-shaped hook flashed for 21 ms. Under control conditions, mean contrast threshold was found at 0.88 log units Weber contrast. Thresholds were raised if TMS was applied 40-200 ms after the visual stimulus. Maximum elevation was 1.67 log units under TMS at 120 ms stimulus onset asynchrony. This phenomenon can be interpreted as a reduction in signal-to-noise ratio of the visual stimuli by TMS, which can be compensated for by increasing the contrast of the stimuli.

Evaluation of the effects of radiotherapy to the chiasm and optic nerve by visual psychophysical and electrophysiologic tests in nasopharyngeal carcinoma.

PURPOSE: To evaluate the effects of high-dose radiotherapy (RT) to the chiasm and optic nerves in locally advanced nasopharyngeal carcinoma patients by visual psychophysical and electrophysiologic tests. METHODS AND MATERIALS: A series of visual tests, including visual evoked potentials (VEPs), contrast sensitivity, and visual field and visual acuity tests, were administered to 27 patients with locally advanced (T4) nasopharyngeal carcinoma who had undergone RT to high doses 6 to 74 months previously. As a control group, the same tests were administered to 40 unirradiated patients who had been referred to the ophthalmology department for any reason. RESULTS: The median values of VEP latency, VEP amplitude, and contrast sensitivity and the rate of visual field defect were significantly worse in the RT group (p = 0.06, p <0.001, p <0.001, and p = 0.005, respectively). No dose-response relationship was found in any tests when 50 Gy was the cutoff value. However, a positive correlation between the interval after RT and VEP latency (r = 0.406, p = 0.003) and a negative correlation between the interval and contrast sensitivity (r = -0.499, p <0.001) was noted; no correlation could be established regarding VEP amplitude and the interval after RT. CONCLUSION: Radiation-induced injury to the anterior visual pathways could result in an increase in VEP latency and a decrease in VEP amplitude and contrast sensitivity. This injury seems to be a continuous process developing with time.