Unilateral Optic Nerve Hypoplasia with Contralateral Optic Pathway Hypoplasia: A Case Report.

Optic nerve hypoplasia is diagnosed by the ophthalmoscopic appearance of the fundus of the eye and by standard magnetic resonance imaging of the brain. The ability to study eyes with optic nerve hypoplasia by magnetic resonance diffusion tensor imaging has improved the evaluation of the optic pathways. The authors report a case of unilateral optic nerve hypoplasia with hypoplasia of the contralateral optic pathway. The entire visual pathway of this patient was examined by magnetic resonance and magnetic resonance diffusion tensor imaging. The images show a decrease of the volume of the optic radiation contralateral to the optic nerve abnormality and also pre- and post-chiasmal abnormalities.

Multifocal electroretinograms in age-related macular degeneration before and after photodynamic therapy.

PURPOSE: To evaluate multifocal electroretinograms (mfERG) and macular retinal thickness before and after photodynamic therapy (PDT) for predominantly classic choroidal neovascularization (CNV) (classic type) and occult with no classic CNV (occult type). METHODS: Recording of mfERG and measurement of macular retinal thickness were performed before and after PDT in 19 patients (19 eyes) with the classic type and 24 (26 eyes) with the occult type. The evaluation items were the amplitude of the first negative wave (N1), the amplitude from the peak of the negative wave to that of the following positive wave (P1), and the peak latencies of the negative and positive waves. RESULTS: Compared with mfERG before PDT, that after PDT showed a significant decrease in the P1 latency in the central area (31.1 ± 1.9 ms before and 29.6 ± 1.6 ms after PDT) for the classic type and significant decreases in both the central (32.0 ± 2.0 ms before and 30.5 ± 2.4 ms after PDT) and peripheral (30.2 ± 2.0 ms before and 29.5 ± 2.0 ms after PDT) areas for the occult type. Optical coherence tomography showed significant decreases in macular retinal thickness in both groups (464 and 314 µm before and after PDT, respectively, for the classic type and 516 and 340 µm for the occult type). CONCLUSIONS: After PDT, retinal function evaluated by mfERG improved for both the classic and occult types, and the recovery of P1 latency may be due to improvement in retinal edema.

Retinal nerve fiber layer thickness changes following optic neuritis caused by multiple sclerosis.

PURPOSE: To evaluate the peripapillary retinal nerve fiber layer (RNFL) thickness with scanning laser polarimetry in patients with optic neuritis (ON) caused by multiple sclerosis. METHODS: Peripapillary RNFL thickness was measured with a GDx VCC in 14 eyes of 13 patients with ON (nonrecurrent group), in 18 eyes of 11 patients with recurrent ON (recurrent group), and in 48 eyes of 48 healthy subjects (healthy group). The temporal, superior, nasal, inferior thickness (TSNIT) average, superior average, and inferior average of GDx VCC measurements were compared across the three groups. We calculated correlation coefficients between each of the three GDx VCC parameters and both the mean deviation (MD) of the Humphrey 30-2 full threshold visual field and the visual acuity (VA). RESULTS: The three parameters showed statistically significant differences across the three groups. There was no correlation between any of the three GDx VCC parameters and MD or VA in the nonrecurrent group, but there was significant correlation between each of the three GDx VCC parameters and MD in the recurrent group. CONCLUSIONS: ON caused morphological changes in the peripapillary RNFL, and recurrent ON aggravated the deterioration and caused diffuse rather than regional damage to the peripapillary RNFL.

Effects of astigmatism on the Humphrey Matrix perimeter.

PURPOSE: To evaluate the influence of astigmatism in terms of its amount and direction on the results of Humphrey Matrix perimetry. METHODS: A total of 31 healthy volunteers from hospital staff were consecutively recruited to undergo repeat testing with Humphrey Matrix 24-2 full threshold program with various induced simple myopic astigmatism. All subjects had previous experience (at least twice) with Matrix testing. To produce simple myopic astigmatism, a 0 diopter (D), +1 D, or +2 D cylindrical lens was added and inserted in the 180 degrees direction and in the 90 degrees direction after complete correction of distance vision. The influences of astigmatism were evaluated in terms of the mean deviation (MD), pattern standard deviation (PSD), and test duration (TD). RESULTS: A significant difference was observed only in the MD from five sessions. The MD in cases of 2 D inverse astigmatism was significantly lower than that in the absence of astigmatism. CONCLUSIONS: In patients with inverse myopic astigmatism of > or =2 D, the influences of astigmatism on the visual field should be taken into consideration when the results of Humphrey Matrix perimetry are evaluated.

[Long-term study of nipradilol ophthalmic solution in patients with normal-tension glaucoma].

PURPOSE: We investigated the long-term clinical effects of a nipradilol ophthalmic solution on normal-tension glaucoma. METHODS: Among normal tension glaucoma patients who consulted the Nara Medical University Hospital or 2 affiliated hospitals between November 2001 and August 2002, we prospectively examined intraocular pressure-decreasing effects, the deterioration of visual field defects, and the appearance of side effects in 46 patients who underwent single therapy with a nipradilol ophthalmic solution. We evaluated intraocular pressure at 6-month intervals. The deterioration of visual field defects was assessed based on a 3-dB or more decrease in the mean deviation measured using the Humphrey Field Analyzer 30-2 program. RESULTS: The 60 months intraocular pressure value after administration of nipradilol ophthalmic solution was significantly lower than the pretreatment value. The deterioration of visual field defects was examined using the Kaplan-Meier life table. The survival rate after 60 months was 82.4%. In 4 of the 46 patients, administration of the nipradilol ophthalmic solution was discontinued due to side effects. CONCLUSION: Long-term therapy with a nipradilol ophthalmic solution may be useful for treating normal-tension glaucoma.

Objective visual field evaluation using multifocal visual evoked potentials in patients with intracranial disease complicated by mental disorders.

OBJECTIVES: We investigated whether visual field defects can be objectively evaluated using multifocal visual evoked potentials (mfVEPs) in patients with intracranial disease complicated by mental disorders. PATIENTS AND METHODS: First, to determine the normal pattern of mfVEPs, recordings were performed using a VERIS Junior Science recording apparatus (Mayo, Aichi, Japan) in 40 healthy subjects. Responses from 8 sites in each subject were divided into 4 quadrants (superior and inferior temporal quadrants and superior and inferior nasal quadrants). In each quadrant, two response waves were grouped and averaged, and the peak latency and amplitude were used for assessment. mfVEP recordings were also performed in 3 patients with intracranial disease complicated by mental disorders, in whom dynamic or static perimetry was impossible, or in whom reliable data could not be obtained, and quadrants showing abnormalities were compared with the sites of intracranial lesions observed by imaging techniques. RESULTS: In the 40 normal subjects, no significant differences were observed in the peak latency among the 4 quadrants, but the amplitude was significantly higher in the inferior than in the superior semi-field. mfVEPs in the 3 patients revealed abnormal waves, which corresponded to the lesions observed by imaging techniques. CONCLUSION: The objective evaluation of visual field defects using mfVEPs may be useful in patients with intracranial disease complicated by mental disorders, in whom kinetic/static perimetry as a subjective examination is difficult.

Usefulness of multifocal VEP in a child requiring perimetry.

We examined the reliability of multifocal visual evoked potentials for evaluating visual-field defects in a child with epilepsy and an arachnoid cyst. Multifocal visual evoked potentials were measured both when perimetry was difficult and several years later, when kinetic perimetry became possible in a child with epilepsy and homonymous hemianopia, as suggested by computed tomography of the brain. The peak latency and amplitude of response waves were used for assessment. The recordings of multifocal visual evoked potentials at both times revealed marked decreases in amplitude in the left visual hemifield. This area of decreased amplitude corresponded to the location of the lesion observed with imaging techniques, and was consistent with the left homonymous hemianopia observed via kinetic perimetry. The objective evaluation of visual-field defects through multifocal visual evoked potentials may be useful in children in whom conventional perimetry is difficult.

Frequency doubling technology perimetry after clear and yellow intraocular lens implantation.

PURPOSE: To evaluate the effect of intraocular lens (IOL) color on frequency doubling technology (FDT). DESIGN: Randomized clinical trial. METHODS: For 26 eyes of 26 patients, FDT perimetry (24-2-threshold test) was measured three months after cataract surgery. An acrylic IOL was randomly selected from clear (VA60BB, HOYA) and yellow-tinted lenses (YA60BB, HOYA), which only differed by color. As a control, a further 14 cataractous eyes with visual acuity > or =20/30 were examined. We analyzed mean deviation (MD) and pattern standard deviation (PSD) among the three groups. RESULTS: After cataract surgery, MD significantly improved (Fisher protected least significant difference (PLSD): P < .05), but PSD did not change (analysis of variance (ANOVA): P = .94) compared with control values. There was no significant difference between the two IOLs for either MD (Mann-Whitney test; P = .15) or PSD (Mann-Whitney test; P = .84). CONCLUSIONS: When interpreting the results of FDT, the effect of cataract should be considered but that of IOL color does not need consideration.

Effect of static visual acuity on dynamic visual acuity: a pilot study.

The aim of this pilot study was to evaluate whether dynamic visual acuity changes with or without refractive correction. 42 healthy enrolled subjects with normal vision were divided into two age-matched groups. In Group A, dynamic visual acuity was measured first with the refractive error fully corrected and then without. In Group B, dynamic visual acuity measurements were taken in the reverse order of that performed by Group A. The measurements were binocularly performed five times using free-head viewing after dynamic visual acuity values were stable. Significant changes in dynamic visual acuity (static visual acuity 20/20 vs 12/20) were observed in both Group A (171.6 +/- 36.0 deg./sec. vs 151.8 +/- 39.6 deg./sec., Wilcoxon test, p < .001) and Group B (169.8 +/- 30.0 deg./sec. vs 151.2 +/- 36.0 deg./sec., Wilcoxon test, p < .001). The interaction was significant (F1.20 = 8.12, p = .009). These results indicated that refractive correction affected dynamic visual acuity.

[Objective evaluation of the visual field defects in a patient with cerebral infarction using multifocal VEPs].

PURPOSE: We investigated whether visual field defects can be objectively evaluated using multifocal visual evoked potentials (mVEP) in a patient with cerebral infarction in whom it is difficult to measure the visual field. METHODS: To determine normal waves in mVEP recording was performed using a VERIS Junior Science (Mayo, Aichi, Japan) in 20 healthy subjects (20 eyes), peak latency and amplitude were used for assessment. In a patient with cerebral infarction, mVEP were recorded, and compared with the lesion observed by computed tomography. RESULTS: In 20 healthy subjects, the waveforms in the nasal and temporal quadrants were very similar but the waveforms in the superior and inferior quadrants were mirror images. The mVEP in patient with cerebral infarction showed abnormal waves, corresponding to the visual field defects in the lesion observed by computed tomography. CONCLUSIONS: Objective evaluation of visual field defects using mVEP may be useful in patients with cerebral infarction in whom kinetic/static perimetry as a subjective examination is difficult.

Use of multifocal visual evoked potential tests in the objective evaluation of the visual field in pediatric epilepsy surgery.

OBJECT: To evaluate objectively the visual fields of patients with pediatric epilepsy who are uncooperative with perimetry and in whom postoperative visual field deficits are expected, the authors investigated the usefulness of the multifocal visual evoked potential (VEP) method. METHODS: Normal waves in multifocal VEP were determined in 21 healthy children (21 eyes) 6 to 15 years of age (mean 11.4 years). Responses from eight sites in each child were divided into four quadrants (superior and inferior temporal and superior and inferior nasal). In each quadrant, two response waves were grouped and averaged. The peak latency and amplitude at approximately 100 msec were used for assessment. In three cases involving patients with epilepsy, multifocal VEP measurements were also recorded and compared with the peak latency and amplitude in the healthy children. In these children, no significant differences were observed in the peak latency of amplitude among four quadrants using one-way analysis of variance. In each patient, multifocal VEP tests showed abnormal waves in the quadrant corresponding to the lesion demonstrated in neuroradiological images. This result was useful in the treatment of choice and the postoperative evaluation. CONCLUSIONS: Multifocal VEP tests can be useful in evaluating the visual field of children objectively. They can also be valuable in assessing preoperative visual field defects and revealing changes in the visual field after treatment.

[Clinical application of multifocal visual evoked potentials in children with epilepsy caused by intracranial disease].

PURPOSE: We investigated whether visual field defects could be objectively evaluated using multifocal visual evoked potential(m-VEP) in two children with epilepsy caused by intracranial disease in whom it was difficult to measure the visual field. METHODS: To determine normal waves in m-VEP, recording was performed using a visual evoked response imaging system(VERIS)Junior Science program (Mayo, Aichi, Japan) in 20 healthy children (20 eyes); peak latency and amplitude were used for assessment. In the two children with epilepsy, m-VEPs were recorded, and compared with the results of static perimetry or the lesions observed by Magnetic Resonance Imaging (MRI). RESULTS: In the 20 healthy children, there was no significant difference in the peak latency or amplitude among 4 quadrants by one-way analysis of variance. m-VEP in the children with epilepsy showed abnormal waves, corresponding to the visual field defects in the static perimetry or the lesions observed by MRI. CONCLUSIONS: Objective evaluation of visual field defects using m-VEP may be useful in children with epilepsy caused by intracranial disease in whom kinetic/static perimetry as a subjective examination is difficult.

Traumatic optic neuropathy caused by blunt injury to the inferior orbital rim.

A 48-year-old woman was struck on the right inferior orbital rim by a gardening device and immediately developed complete visual loss in the right eye. Clinical and imaging evaluations failed to disclose any damage to the globe or optic nerve or to their nearby soft tissues and bones. Within months, ipsilateral optic disc pallor, a nerve fiber bundle visual field defect, and a persistently subnormal visual acuity developed. We attribute the visual loss to indirect optic nerve injury. To our knowledge, blunt injury to the inferior orbital rim has not been reported as a cause of this phenomenon.

Pattern-reversal visual evoked potentials in patients with human T-lymphotropic virus type 1 uveitis.

PURPOSE: The purpose of this study was to evaluate the possible injury in the optic pathway by measuring P100 peak latency of pattern-reversal visual evoked potentials (PVEPs) in patients with human T-lymphotropic virus type 1 uveitis (HU). METHODS: The P100 peak latency of PVEP was measured during the period without macular abnormalities observed by fluorescein angiography in 23 patients (46 eyes) with HU and 24 patients (48 eyes) with Vogt-Koyanagi-Harada disease (VKH) with a corrected visual acuity of 20/25 or more. To determine the normal upper limit of P100 peak latency, PVEPs were measured in 31 normal subjects (31 eyes). In addition, in the HU patients, the serum anti-HTLV-1 antibody titer was measured by particle agglutination assay within 3 months of PVEP recording, and the period of HU was retrospectively surveyed. RESULTS: Delayed latency was observed in 4 (7 eyes) of the 23 patients (46 eyes) with HU but none of the 24 patients (48 eyes) with VKH. All four patients with delayed latency showed a serum anti-HTLV-1 antibody titer of more than x4000. The HU period in the HU patients was 0.2-14.0 years, and the HU periods in the four patients with delayed latency were 0.8, 2.7, 4.2, and 14.0 years, respectively. CONCLUSIONS: We measured pattern-reversal visual evoked potentials and observed delayed P100 peak latency in 7 of the 46 eyes in 4 (17.4%) of the 23 HU patients. This suggests injury in the optic pathway including the optic nerve by HTLV-1 in some patients with HU. In the future, consideration should also be given to the possible development of optic neuropathy due to HTLV-1.

Change in dynamic visual acuity (DVA) by pupil dilation.

OBJECTIVE: This study was conducted to assess dynamic visual acuity (DVA) under pupil dilation. BACKGROUND: Pupil dilation may negatively affect driving performance. METHODS: Thirty healthy young adults (mean age 29.4 years) with pupil dilation participated in this study as the Mydrin P group. In addition to them, 15 healthy young adults (mean age 28.5 years) without pupil dilation were enrolled as the control group. DVA was measured binocularly with free-head viewing at 0, 30, 60, 120, and 360 min after mydriatic drop instillation in both eyes. Pupil size was measured at each time. RESULTS: In the Mydrin P group, DVA significantly improved at 30, 60, and 120 min (ANOVA; p < .01) but returned to the predilation level at 360 min (ANOVA; p = .61). Pupil size changed from 4.1 to 7.8 mm (ANOVA; p < .01) at 30 min after the instillation, and this level was maintained up to 120 min but returned to normal within 360 min. In the control group, DVA did not significantly change at all measured times (ANOVA; p > .9). DVA was significantly (p < .05) correlated with the pupil size at all measured times. CONCLUSION: The improvement in DVA was related to the enlargement of the pupil. This study suggests that the pupil size is one factor that may affect DVA. APPLICATION: Potential applications of this study include useful information to assess the effect of pupil dilation on driving performance.

Effect of tilt of 2 acrylic intraocular lenses on high-order aberrations.

PURPOSE: To investigate the high-order aberrations (HoAs) in pseudophakia between 2 foldable acrylic intraocular lenses (IOL) with differences in the tilt of IOL. SETTING: Department of Ophthalmology, Nara Medical University, Nara, Japan. METHOD: Sixty-four eyes that had uncomplicated phacoemulsification and IOL implantation were assigned to 1 of 2 groups: Acryfold 60BB (HOYA [n=30 eyes]) and AcrySof MA60AC (Alcon [n=34 eyes]). All patients had best corrected visual acuity better than 20/25. High-order aberrations were measured using the Hartmann-Shack aberrometer at 4.0 mm and 6.0 mm wavefront aperture diameters, and the IOL tilt and decentration were measured using Scheimpflug videophotography. RESULTS: There was a significant difference in the IOL tilt (60BB=2.22 degrees +/- 1.44 (SD), 60AC=3.18 +/- 1.84 degrees; P=.041, Mann-Whitney U test), but no difference in IOL decentration (P>.05). In the cornea, there were no differences between the 2 groups in HoAs at 4.0 mm and 6.0 mm aperture diameters (P>.05, Mann-Whitney U test). In the whole eye, there was no difference between the 2 groups in spherical-like aberrations, coma-like aberrations, and total aberrations at the 4.0 mm and 6.0 mm aperture diameters (P>.05). The compensation of the internal optics with the 60BB group was better than with the 60AC group for coma-like (P=.037) and total aberrations (P=.010) at 6.0 mm aperture diameter. CONCLUSION: The smaller tilt of the IOL induced more compensation for the coma-like and total aberrations at the 6.0 mm aperture diameter. The IOL tilt should be small, especially in a large pupil, with regard to HoAs.

Influence of intraocular lens optical design on high-order aberrations.

PURPOSE: To compare differences in high-order aberrations (HOAs) between 2 intraocular lens (IOL) optical designs. SETTING: Department of Ophthalmology, Nara Medical University, Nara, Japan. METHOD: Sixty eyes that had uncomplicated phacoemulsification and IOL implantation were assigned to 1 of 2 groups based on the type of IOL optical design: more posteriorly curved biconvex shape (AcrySof MA30BA, Alcon) (n=30 eyes) or more anteriorly curved biconvex shape (AcrySof MA30AC) (n=30 eyes). All patients had best corrected visual acuity better than 20/25. High-order aberrations were measured using a Hartmann-Shack aberrometer at 4.0 mm and 6.0 mm wavefront aperture diameters. RESULTS: At 4.0 mm aperture diameters, there were no differences between the 2 groups in HOAs (P>.05, Mann-Whitney U test) in the cornea and the whole eye. At 6.0 mm aperture diameters, MA30AC eyes had a smaller amount of spherical-like aberrations (P=.043) than MA30BA eyes; however, there were no significant differences between the 2 groups in coma-like aberrations and total aberrations in the whole eye (P>.05). At 6.0 mm aperture diameters, there were no differences between the 2 groups HOAs in the cornea. (P>.05). CONCLUSION: The optical design of the spherical IOL influenced the spherical-like aberrations in the whole eye. This may reduce retinal image quality.

A child with epilepsy in whom multifocal VEPs facilitated the objective measurement of the visual field.

PURPOSE: We investigated whether visual field defects can be objectively evaluated by using multifocal visual evoked potential (multifocal VEP) in children with epilepsy in whom it is difficult to measure the visual field. METHODS: First, to determine normal waves in multifocal VEP, recording was performed by using a VERIS Junior Science (Mayo, Aichi, Japan) in 21 healthy children (21 eyes) consisting of 12 boys and nine girls aged 6 to 15 years (mean age, 11.4 years). Responses from eight sites in each subject were divided into four quadrants (superior and inferior temporal quadrants and superior and inferior nasal quadrants). In each quadrant, two response waves were grouped and averaged; peak latency and amplitude were used for assessment. In a child with epilepsy in whom kinetic or static perimetry was impossible, multifocal VEPs were recorded and compared with the peak latency and amplitude in the healthy subjects. RESULTS: In the 21 healthy children, no significant differences were observed in the peak latency or amplitude among four quadrants by one-way analysis of variance. Multifocal VEPs in the child with epilepsy showed abnormal waves in the right hemivisual field, which corresponded to the lesion observed with magnetic resonance imaging. CONCLUSIONS: The objective evaluation of visual field defects by using multifocal VEP may be useful in children with epilepsy in whom kinetic/static perimetry as a subjective examination is difficult.