Migraine-Like Visual Auras Among Traumatized Cambodians with PTSD: Fear of Ghost Attack and Other Disasters.

This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1-44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees.

ß-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study.

Importance: ß-zone parapapillary atrophy (ßPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of ßPPA differs between individuals of African descent (AD) and European descent (ED). Objective: To test whether the association between the presence and progression of ßPPA vs visual field progression of glaucoma differs between these 2 ancestry groups. Design, Setting, and Participants: In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of ßPPA at baseline and ßPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. Exposures: Disc stereophotographs. Main Outcomes and Measures: Progression of ßPPA in AD and ED individuals. Results: In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between ßPPA at baseline and visual field progression was not significantly different between AD and ED eyes (ß = 0.071; 95% CI, -0.016 to 0.158; P = .11), nor was the association between ßPPA progression and visual field progression (ß = 0.020; 95% CI, -0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline ßPPA progressed faster than did AD eyes with baseline ßPPA (ß = -0.124; 95% CI, -0.241 to -0.007; P = .04), although the association between ßPPA progression and visual field progression did not differ significantly between race groups (ß = -0.101; 95% CI, -0.323 to 0.119; P = .37). Conclusions and Relevance: Race had a significant effect on the association between baseline ßPPA and rates of visual field progression in eyes with GON. Progression of ßPPA was not associated with faster visual field progression in either racial group.

A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities.

PURPOSE: To assess the impact on visual function of community glaucoma screening in an African American population using spectral-domain optical coherence tomography (SD-OCT). METHODS: Using a Monte Carlo microsimulation model with a 10-year time horizon, we analyzed the efficacy of SD-OCT screening on visual field outcomes in a population of African Americans who are not otherwise seeking office-based care. Outcomes included classification of visual field severity, quality-adjusted life years, and direct health care costs. RESULTS: Assuming a 60% follow-up rate, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%, and decreased the prevalence of severe visual field loss in patients with glaucoma from 29.1% to 23.9%. Conversely, screening increased the prevalence of mild visual field loss in patients with glaucoma from 9.2% to 18.7%. From initial screening through confirmatory eye examination, the screening program ("screen only") cost $98 per screened individual, and $2561 per new diagnosis of glaucoma. When considering the costs of initial screening though the resultant treatment, the screening program ("screen and treat") had an average annual cost of $79 and $2138, respectively, over a 10-year time period. The cost of one quality-adjusted life year (QALY) gained by screening, including management and treatment, in comparison with opportunistic case finding, ranged from $46,416 to $67,813. CONCLUSIONS: Our findings suggest that community SD-OCT screening in an African American population will minimize glaucoma-related visual morbidity. Ideally, strategies to maximize treatment efficacy through improved medication adherence and improved compliance with follow-up should be identified and implemented before instituting a screening program.

Clinical characteristics of optic neuritis in Koreans greater than 50 years of age.

PURPOSE: To report clinical characteristics of optic neuritis (ON) in Koreans >50 years of age. METHODS: A retrospective chart review was performed on patients with ON between January 2000 and December 2009. We obtained the best-corrected visual acuity (BCVA), Goldmann perimetry, relative afferent pupillary defect (RAPD), and color function tests as well as brain magnetic resonance imaging (MRI) findings in patients who were in the acute stage of the disorder. RESULTS: Nine eyes in eight patients were included. The mean age of patients at presentation was 60.5 years (range, 53 to 71 years). Six patients were female, and two were male. There was one patient with bilateral ON. The mean BCVA at presentation was 20 / 400 (no light perception-20 / 70). Eight eyes (89%) complained of pain with eye movement. Six eyes (66%) had disc edema. Central scotoma was the most common field defect. All eyes had color abnormalities. Five eyes in four patients showed abnormalities of the involved optic nerves on MRI. The patients were followed for a mean of 11.3 months (range, 2 to 34 months). All of the patients recovered to a BCVA of 20 / 40 or better within 2 months. On the last follow-up, the mean BCVA was 20 / 20 (20 / 40 to 20 / 16). Four eyes showed remnant central scotoma. One eye had remnant RAPD, and two eyes had mild color abnormalities. CONCLUSIONS: Although ON is uncommon in elderly patients, it can develop in patients >50 years of age, and clinical features of optic neuritis in elderly patients are similar to those of younger patients.

Clinical Characteristics of Optic Neuritis in Koreans Greater than 50 Years of Age

PURPOSE: To report clinical characteristics of optic neuritis (ON) in Koreans >50 years of age. METHODS: A retrospective chart review was performed on patients with ON between January 2000 and December 2009. We obtained the best-corrected visual acuity (BCVA), Goldmann perimetry, relative afferent pupillary defect (RAPD), and color function tests as well as brain magnetic resonance imaging (MRI) findings in patients who were in the acute stage of the disorder. RESULTS: Nine eyes in eight patients were included. The mean age of patients at presentation was 60.5 years (range, 53 to 71 years). Six patients were female, and two were male. There was one patient with bilateral ON. The mean BCVA at presentation was 20 / 400 (no light perception-20 / 70). Eight eyes (89%) complained of pain with eye movement. Six eyes (66%) had disc edema. Central scotoma was the most common field defect. All eyes had color abnormalities. Five eyes in four patients showed abnormalities of the involved optic nerves on MRI. The patients were followed for a mean of 11.3 months (range, 2 to 34 months). All of the patients recovered to a BCVA of 20 / 40 or better within 2 months. On the last follow-up, the mean BCVA was 20 / 20 (20 / 40 to 20 / 16). Four eyes showed remnant central scotoma. One eye had remnant RAPD, and two eyes had mild color abnormalities. CONCLUSIONS: Although ON is uncommon in elderly patients, it can develop in patients >50 years of age, and clinical features of optic neuritis in elderly patients are similar to those of younger patients.

Patterns of damage in chronic angle-closure glaucoma compared to primary open-angle glaucoma.

PURPOSE: To compare patterns of damage in chronic angle-closure glaucoma (CACG) to a control group of patients with primary open-angle glaucoma (POAG). DESIGN: Retrospective cross-sectional study. METHODS: setting: Academic tertiary-care glaucoma clinic. study population: Thirty-two eyes of 32 patients with CACG and good-quality Heidelberg Retina Tomograph (HRT) images (pixel standard deviation <50 µm) and stereoscopic disc photographs within 1 year of a visual field showing reproducible glaucomatous field loss (mean deviation ≥-15.0 dB) were enrolled. Control eyes with POAG meeting similar criteria and matched for severity of field loss (±1 dB) and race were selected. outcome measures: Presence of focal rim loss (≤1 clock hour), HRT stereometric parameters, and extent and location of field loss. RESULTS: The average mean deviation was -5.1 dB in both groups. Patients with CACG were more hyperopic (0.6 ± 0.4 vs -1.4 ± 0.5 D; P < .001) and had higher IOP at the time of imaging (15.8 ± 0.8 vs 13.9 ± 0.9 mm Hg; P = .015). Focal disc damage was not less frequent in PACG eyes (19% vs 24%; P = .545). Eyes with PACG had smaller cup area, cup volume, and mean cup depth and larger rim/disc area ratio (P < .05 for all), which persisted after adjusting for disc size, age, refractive error, and IOP. The average (±SD) number of abnormal test locations was similar in the 2 groups (P = .709), although CACG eyes were less likely to have paracentral points involved (47% vs 72%; P = .04). CONCLUSIONS: Patterns of glaucomatous damage seem to be different in CACG compared with POAG. This difference in patterns of damage may adversely affect detection of early disease or its progression in CACG.