Vessel Evaluation in Patients with Primary Open-Angle Glaucoma, Normal Tension Glaucoma and Healthy Controls.

PURPOSE: To compare changes in central retinal arterial equivalent (CRAE), central retinal vein equivalent (CRVE), arteriovenous ratio (AVR), tortuosity and fractal dimension in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and in a control group (CG) on fundus photographs. Further, to provide further evidence of vascular change in glaucoma patients using a novel method of tortuosity. PATIENTS AND METHODS: The primary endpoint was the change in CRAE, CRVE, AVR, fractal dimension and tortuosity of the retinal vasculature from baseline, retrospectively analyzed from 2011 to 2017 at the University Eye Hospital Tuebingen. Fundus photos of POAG (N = 49), NTG (N = 38) and CG (N = 18) were computer evaluated and analyzed in the quantities mentioned above. RESULTS: CRAE in NTG and POAG and CRVE in NTG significantly decreased (P = 0.02, P = 0.01; P = 0.03) whereas CRVE in POAG increased insignificantly (P = 0.72). In NTG, AVR decreased significantly (P = 0.05), but to a lesser extent than in POAG (P < 0.001). In CG, CRAE decreased insignificantly (P = 0.10), CRVE decreased significantly (P = 0.03) and AVR increased insignificantly (P = 0.77). In POAG tortuosity calculated using standard methods as well as our novel method, increased significantly (P = 0.015-0.04), whereas it did not occur in NTG (P = 0.18-0.57) and CG (P = 0.11-0.21). Fractal dimensions in POAG decreased significantly (P = 0.001-0.002), whereas in NTG and CG changes were insignificant (P = 0.33-0.92). CONCLUSION: Based on a retrospective analysis of fundus photographs, specific retinal vasculature features of the retinal vasculature display significant alterations associated with NTG and POAG. The assessment of tortuosity using our novel method was consistent with previously established methods for analyzing tortuosity.

Objective Monitoring of Spectacle Wearing Times in Adult Subjects Using the Theramon® Thermosensor.

PURPOSE: To find a reliable method to determine the wearing times of glasses in adults objectively on the basis of temperature measurements of the small-sized theramon® thermosensor device (TM) from orthodontics. Furthermore, the reliability of the determined wearing times during well and poor position of spectacles was explored. To address the previously reported lack of accuracy during higher outside temperatures, this study was conducted in midsummer and autumn. PATIENTS AND METHODS: Twenty adults wore their spectacles with three TMs attached to both inner sides and the right outer side in a period of three consecutive days. They were asked to report wearing and non-wearing times, indoor and outdoor activities and subjective perception of spectacle position as accurately as possible. To find the most reliable way to determine spectacle wearing times compared to protocolled wearing times, we applied and evaluated temperature categorizing methods and visual analysis of time logged temperatures. Percent error and percent accuracy of each method were calculated. The methods mentioned were applied and evaluated to determine poor spectacle position. RESULTS: Median percent errors of the most reliable determination methods were <10% with an accuracy between 90% and 96%. Comparing the most reliable methods, determinations on the basis of midsummer measurements (median percent error 0% to 2%, median percent accuracy 96%) were more accurate than on the basis of autumn measurements (median percent error -5% to -20%, median percent accuracy 90%). Poor spectacle position could be determined with a median percent error of 0% and a median percent accuracy of 100% by analysing the temperature measurements of TM's visually. CONCLUSION: A reliable and objective determination of spectacle wearing times is possible on the basis of TM temperature measurements in a standard clinical setting. Measurements of one inner TM seem to be sufficient to determine the wearing times and are more appealing. Poor spectacle position can be determined reliably by analysing visually the time logged temperatures. The findings of this study require further studies on larger groups of affected, amblyopic patients and children, to analyse the real impact of spectacle wearing times and poor spectacle position on visual development.

Posterior Uveal Effusion after Cataract Surgery.

We report a case of posterior uveal effusion (UE) with a long-term follow-up that has occurred following cataract surgery. A 64-year-old woman presented with diminished vision of the right eye (RE) 3 weeks after an uneventful phacoemulsification and intraocular lens implantation. Complete ophthalmic examination including fluorescein angiography (FA), indocyanine green angiography (ICGA), echography and optical coherence tomography (OCT) were performed. Best corrected visual acuity (BCVA) of the RE was 20/50. Anterior segment and intraocular pressure were unremarkable. OCT revealed prominent folds of the choroid and retina, subretinal fluid and darkening of the choroid with reduced visibility of the choroidal vessels and the scleral border. The left eye (LE) was unremarkable. BCVA of the LE was: 20/20. After topical anti-inflammatory and systemic corticosteroid therapy for 5 months, no morphological change of the macula was seen. The patient was observed without any treatment. Forty-three months after the cataract surgery and 38 months after cessation of the corticosteroid therapy, OCT revealed a normal macular morphology and the BCVA improved to 20/25. Even though rare, UE at the posterior pole may occur after modern cataract surgery. OCT examination is a reliable tool in monitoring the macular morphology. Since morphological and functional improvement can be seen in long-term, observation may be considered for some cases of posterior UE with resistance to the therapy.

[Treatment monitoring and innovations in amblyopia treatment]. / Therapiemonitoring und Innovationen in der Amblyopietherapie.

Technical innovations, such as computer games and shutter glasses open up elegant treatment options for amblyopia. The lack of monitoring of compliance means that there is no scientific basis on which a comparative study between a new therapeutic approach and occlusion therapy as the standard of care could be designed. An easy to use microsensor for measurement of compliance could have a broad spectrum of applications in scientific studies as well as in routine clinical practice. This article gives a brief overview about emerging and innovative approaches.

Posttraumatic acute choroidopathy.

PURPOSE: To report a case of acute choroidopathy following a blunt ocular trauma. METHODS: Ocular examination included dilated fundus examination and optical coherence tomography enhanced depth imaging (OCT-EDI). PATIENTS: Single-patient case report. CASE REPORT: A 10-year-old boy was referred following a blunt trauma to the right eye. The visual acuity diminished to 20/200 and mild hemorrhage was found in the anterior chamber. The fundoscopy was unremarkable. An OCT-EDI revealed a choroidal thickening and detachment at the macula. Six month later, the choroidal morphology resolved and the visual acuity improved. CONCLUSIONS: This study reported a case of acute choroidopathy associated with temporary thickening of the choroid and separation of the Haller's layer from the sclera. OCT-EDI helped to detect and monitor the morphological changes in the apparently normal-looking macular choroid after ocular trauma. Further case reports with long term follow-up are needed to clarify the clinical impact of posttraumatic acute choroidopathy.

[The Use of a Microsensor in Therapy of Amblyopia]. / Der Einsatz eines Mikrosensors in der Amblyopietherapie.

Amblyopia is one of the most common visual disorders in children. Current therapy of amblyopia is an occlusion therapy of the stronger eye with an occlusion patch until the best corrected visual acuity is achieved. The success of occlusion therapy essentially depends on the compliance of the children and their parents. There is a commercially available 8 × 12 mm small TheraMon microsensor (TheraMon-Chip, MC Technology GmbH). This sensor allows a simple objective documentation of the therapy compliance of patches and glasses. It samples the surrounding temperature in regular intervals. Due to the specific temperatures, it is possible to detect the time of application and, therefore, the compliance. Therefore, TheraMon microsensor could be a study-related approach for monitoring the compliance and further leading to possible improvement of application time protocols in amblyopia therapy.

Correction to: Posttraumatic acute choroidopathy.

In the original publication, Figure 2 was published incorrectly. The correct version is given in this correction.

Limitations of the TheraMon® -microsensor in monitoring occlusion therapy.

PURPOSE: A proof of principle study showed that the TheraMon® -microsensor can reliably measure wearing times of glasses and occlusion patches while having no discomfort for the bearer. The goal of this study was to identify specific temperature profiles in a larger patient group wearing the microsensor with an occlusion patch on the eye, the forehead or in the trouser pocket. METHODS: Temperature measurements with microsensors were performed at the orbital rim of the eye, at the forehead and in a trousers pocket of 20 healthy adults. The temperature measurements were analysed comparing the three locations using a repeated-measures anova with a 0.050 two-sided significance level. RESULTS: There was no significant temperature difference in wearing the microsensors at the orbital rim compared to forehead (p = 0.507). A significant difference could be detected if the microsensors had been in trousers pockets as compared to being positioned at orbital rim/forehead (p = 0.001). The study participants reported easy handling and comfortable wearing. CONCLUSION: This study demonstrates for the first time that TheraMon® -microsensors are fully operational in monitoring occlusion therapy in a larger group of patients (20 adult study participants). Because of the microsensor's ease of handling further studies in a larger group of children is recommended.

Parkinson's disease with and without preceding essential tremor-similar phenotypes: a pilot study.

The aim of this pilot study was to compare clinical aspects of tremor-dominant Parkinson's disease (PD) patients with and without preceding essential tremor to identify characteristics of these two subgroups. Nineteen patients with diagnoses of both essential tremor (ET) and Parkinson's disease in comparison to 18 patients with tremor-dominant Parkinson's disease without preceding tremor were investigated. The profile of several motor and non-motor symptoms, including cognitive dysfunction, depression, sleep alterations, olfaction changes and some autonomic symptoms, as well as imaging aspects obtained by transcranial sonography were compared between groups. Parkinson's patients with essential tremor scored higher in kinetic and postural tremor items (p < 0.05) and displayed an enlarged third ventricle on transcranial sonography (p = 0.010), which was not found in tremor-dominant Parkinson's disease patients. All other motor and non-motor symptoms could not distinguish between either study group. Neither group showed a distinct clinical profile related to non-motor symptoms or symptoms other than tremor-specific motor aspects. The fact that non-motor symptoms were similar in ET-PD gives rise to the hypothesis that also the prodromal phase of PD is similar in ET patients later developing classical PD compared to individuals developing PD without preceding ET. This hypothesis needs to be followed in prospective studies to verify whether the establishment of an ET subgroup with prodromal markers for PD is feasible.