RESPONSE OF INFLAMMATORY CYSTOID MACULAR EDEMA TO TREATMENT USING ORAL ACETAZOLAMIDE.

PURPOSE: To determine the treatment effect of oral acetazolamide on refractory inflammatory macular edema. METHODS: A retrospective review of identified patients with uveitic or pseudophakic macular edema treated using acetazolamide between 2007 and 2014. Visual acuity and central macular subfield thickness was determined at baseline and at first follow-up. Baseline optical coherence tomography features were analyzed as predictors of acetazolamide response. RESULTS: Sixteen patients (19 eyes) of 61 screened met all criteria. Mean age was 57.9 years (19.7-81.1). The most common diagnosis was idiopathic uveitis (n = 6, 31.6%). Mean uveitis duration was 4.4 years (0.2-27.5). Average central macular subfield thickness decreased significantly (from 471.8 ± 110.6 µm to 358.3 ± 50.4 µm) (P < 0.0001). Average visual acuity (logarithm of the minimum angle of resolution) improved significantly from 20/54 (0.43 ± 0.25) to 20/37 (0.27 ± 0.16) (P = 0.003). Pretreatment optical coherence tomographies demonstrated intraretinal fluid (n = 19, 100%), subretinal fluid (n = 8, 42.1%), epiretinal membrane (n = 13, 68.3%), and vitreomacular traction (n = 1, 5.2%). No optical coherence tomography characteristic was predictive of a response to therapy. CONCLUSION: There is a significant benefit to vision and central macular subfield thickness after acetazolamide treatment in patients with inflammatory macular edema. In patients with refractory inflammatory macular edema, treatment using acetazolamide can provide anatomical and visual benefit without corticosteroid-related adverse effects.

The effect of induced monocular blur on measures of stereoacuity.

PURPOSE: To determine the effect of induced monocular blur on stereoacuity measured with real depth and random dot tests. METHODS: Monocular visual acuity deficits (range, 20/15 to 20/1600) were induced with 7 different Bangerter filters (<0.1, 0.1, 0.2, 0.3, 0.4, 0.8, and 1.0) in 15 visually normal adults. Stereoacuity was measured with Frisby and Frisby Davis Distance (FD2) real depth tests and Preschool Randot (PSR) and Distance Randot (DR) random dot tests. Stereoacuity results were grouped as either "fine" (60 and 200 arcsec to nil) stereo. RESULTS: Across visual acuity deficits, stereoacuity was more severely degraded with random dot (PSR, DR) than with real depth (Frisby, FD2) tests. Degradation to worse-than-fine stereoacuity consistently occurred at 0.7 logMAR (20/100) or worse for Frisby, 0.1 logMAR (20/25) or worse for PSR, and 0.1 logMAR (20/25) or worse for FD2. There was no meaningful threshold for the DR because worse-than-fine stereoacuity was associated with -0.1 logMAR (20/15). Course/nil stereoacuity was consistently associated with 1.2 logMAR (20/320) or worse for Frisby, 0.8 logMAR (20/125) or worse for PSR, 1.1 logMAR (20/250) or worse for FD2, and 0.5 logMAR (20/63) or worse for DR. CONCLUSIONS: Stereoacuity thresholds are more easily degraded by reduced monocular visual acuity with the use of random dot tests (PSR and DR) than real depth tests (Frisby and FD2). We have defined levels of monocular visual acuity degradation associated with fine and nil stereoacuity. These findings have important implications for testing stereoacuity in clinical populations.

The effect of Bangerter filters on optotype acuity, Vernier acuity, and contrast sensitivity.

PURPOSE: Bangerter filters are designed to cause progressive degradation of distance optotype acuity to predicted levels (density label indicating expected decimal acuity) and are used to treat amblyopia and diplopia. Few authors have reported data regarding induced acuity deficits. We investigated the effect of Bangerter filters on distance and near optotype acuity, vernier acuity, and contrast sensitivity. METHODS: Fifteen subjects with best-corrected optotype acuity of at least 20/25 in each eye were blurred sequentially in one eye with 7 Bangerter filters (densities <0.1, 0.1, 0.2, 0.3, 0.4, 0.8, and 1.0). At each filter level, distance and near optotype acuity (LogMAR), vernier acuity, and contrast sensitivity were assessed. Mean log acuities were compared using generalized estimating equation methods. RESULTS: The 1.0, 0.8, and 0.4 filters degraded distance optotype acuity to a similar degree (mean 0.22, 0.23, and 0.28 logMAR). Subsequent filters progressively degraded acuity: 0.44, 0.57, 0.93, and 1.69 logMAR. Near optotype acuity was reduced in a similar pattern. Vernier acuity was minimally degraded by 1.0, 0.8, and 0.4 filters (18, 19, and 20 arcsec), followed by progressive degradation with subsequent filters (31, 35, 113, and 387 arcsec). Contrast sensitivity was minimally reduced with filters 1.0 through 0.2 and then precipitously degraded with 0.1 and <0.1 filters. CONCLUSIONS: The 1.0, 0.8, and 0.4 filters cause similar, minimal degradation of distance and near optotype and vernier acuity, whereas subsequent filters cause progressive degradation. Contrast sensitivity is not markedly reduced until the 0.1 filter. These results have important implications for the use of Bangerter filters therapeutically.