Scotopic thresholds on dark-adapted chromatic perimetry in healthy aging and age-related macular degeneration.

To evaluate the effect of aging, intra- and intersession repeatability and regional scotopic sensitivities in healthy and age-related macular degeneration (AMD) eyes. Intra- and intersession agreement and effect of age was measured in healthy individuals. The mean sensitivity (MS) and pointwise retinal sensitivities (PWS) within the central 24° with 505 nm (cyan) and 625 nm (red) stimuli were evaluated in 50 individuals (11 healthy and 39 AMD eyes). The overall intra- and intersession had excellent reliability (intraclass correlation coefficient, ICC > 0.90) and tests were highly correlated (Spearman rs = 0.75-0.86). Eyes with subretinal drusenoid deposit (SDD) had reduced PWS centrally, particularly at inferior and nasal retinal locations compared with controls and intermediate AMD (iAMD) without SDD. There was no difference in MS or PWS at any retinal location between iAMD without SDD and healthy individuals nor between iAMD with SDD and non-foveal atrophic AMD groups. Eyes with SDD have reduced rod function compared to iAMD without SDD and healthy eyes, but similar to eyes with non-foveal atrophy. Our results highlight rod dysfunction is not directly correlated with drusen load and SDD location.

Using an open-source tablet perimeter (Eyecatcher) as a rapid triage measure for glaucoma clinic waiting areas.

BACKGROUND: Glaucoma services are under unprecedented strain. The UK Healthcare Safety Investigation Branch recently called for new ways to identify glaucoma patients most at risk of developing sight loss, and of filtering-out false-positive referrals. Here, we evaluate the feasibility of one such technology, Eyecatcher: a free, tablet-based 'triage' perimeter, designed to be used unsupervised in clinic waiting areas. Eyecatcher does not require a button or headrest: patients are simply required to look at fixed-luminance dots as they appear. METHODS: Seventy-seven people were tested twice using Eyecatcher (one eye only) while waiting for a routine appointment in a UK glaucoma clinic. The sample included individuals with an established diagnosis of glaucoma, and false-positive new referrals (no visual field or optic nerve abnormalities). No attempts were made to control the testing environment. Patients wore their own glasses and received minimal task instruction. RESULTS: Eyecatcher was fast (median: 2.5 min), produced results in good agreement with standard automated perimetry (SAP), and was rated as more enjoyable, less tiring and easier to perform than SAP (all p<0.001). It exhibited good separation (area under receiver operating characteristic=0.97) between eyes with advanced field loss (mean deviation (MD) < -6 dB) and those within normal limits (MD > -2 dB). And it was able to flag two thirds of false-positive referrals as functionally normal. However, eight people (10%) failed to complete the test twice, and reasons for this limitation are discussed. CONCLUSIONS: Tablet-based eye-movement perimetry could potentially provide a pragmatic way of triaging busy glaucoma clinics (ie, flagging high-risk patients and possible false-positive referrals).

Association of Optical Coherence Tomography With Longitudinal Neurodegeneration in Veterans With Chronic Mild Traumatic Brain Injury.

Importance: Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. Objective: To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. Design, Setting, and Participants: This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could affect retinal thickness were excluded. Data analysis was performed from July 2019 to February 2020. Exposures: The presence and severity of mild TBI were determined through consensus review of self-report responses during the Minnesota Blast Exposure Screening Tool semistructured interview. Main Outcomes and Measures: Change over time of retinal nerve fiber layer (RNFL) thickness. Results: A total of 139 veterans (117 men [84%]; mean [SD] age, 49.9 [11.1] years) were included in the study, 69 in the TBI group and 70 in the control group. Veterans with mild TBI showed significantly greater RNFL thinning compared with controls (mean [SE] RNFL slope, -1.47 [0.24] µm/y vs -0.31 [0.32] µm/y; F1,122 = 8.42; P = .004; Cohen d = 0.52). Functionally, veterans with mild TBI showed greater declines in visual field mean deviation (mean [SE] slope, -0.09 [0.14] dB/y vs 0.46 [0.23] dB/y; F1,122 = 4.08; P = .046; Cohen d = 0.36) and pattern standard deviation (mean [SE] slope, 0.09 [0.06] dB/y vs -0.10 [0.07] dB/y; F1,122 = 4.78; P = .03; Cohen d = 0.39) and high spatial frequency (12 cycles/degree) contrast sensitivity compared with controls. Cognitively, there was a significantly greater decrease in the number of errors over time during the Groton Maze Learning Test (GMLT) in controls compared with veterans with mild TBI (mean [SE] slope, -9.30 [1.48] errors/y vs -5.23 [1.24] errors/y; F1,127 = 4.43; P = .04; Cohen d = 0.37). RNFL tissue loss was significantly correlated with both worsening performance on the GMLT over time (Spearman ρ = -0.20; P = .03) and mild TBI severity (Spearman ρ = -0.25; P = .006). The more severe the mild TBI (larger Minnesota Blast Exposure Screening Tool severity score), the faster the reduction in RNFL thickness (ie, the more negative the slope) across time. Conclusions and Relevance: This cohort study found longitudinal evidence for significant, progressive neural degeneration over time in veterans with mild TBI, as indicated by greater RNFL tissue loss in patients with mild TBI vs controls, as well as measures of function. These results suggest that these longitudinal measures may be useful biomarkers of neurodegeneration. Changes in this biomarker may provide early detection of subsequent cognitive and functional deficits that may impact veterans' independence and need for care.

Optic disc hemorrhage in nonglaucomatous eyes: A cross-sectional study with average 8-year follow-up.

PURPOSE: To characterize changes in the retinal nerve fiber layer (RNFL) and peripapillary vessel density (VD) at the site of disc hemorrhage (DH) in nonglaucomatous eyes. MATERIALS AND METHODS: This retrospective cross-sectional study included nonglaucomatous eyes diagnosed with unilateral DH. The change of DH was recorded using disc photography. Both anatomical data and functional visual field (VF) data were collected using optical coherence tomography angiography and Humphrey VF examination. RESULTS: Sixteen patients were included with average follow-up duration of 95 months. Almost half of DH episodes was initially presented at the inferotemporal area of the optic disc. Pigment formation at the previous DH site after resolution was noted in 12.5% of eyes. Sectoral radial peripapillary VD at the DH site was significantly lower in DH eyes than in the control group; however, the sectoral RNFL thickness at the DH site was not significantly decreased. Progression of the VF defect corresponding to the DH site was found in 81.3% of eyes despite regular use of antiglaucoma agents. The mean change in the VF mean deviation was -0.64 dB/year in DH eyes. CONCLUSION: During long follow-up periods, decreased peripapillary VD at the DH site and progression of the VF defect corresponding to the DH site were detected in nonglaucomatous eyes. Retinal pigmentation with an RNFL defect is a clue for DH, although RNFL showed no significant change. Antiglaucoma treatment may not prevent the deterioration of visual function.

The usefulness of the Deep Learning method of variational autoencoder to reduce measurement noise in glaucomatous visual fields.

The aim of the study was to investigate the usefulness of processing visual field (VF) using a variational autoencoder (VAE). The training data consisted of 82,433 VFs from 16,836 eyes. Testing dataset 1 consisted of test-retest VFs from 104 eyes with open angle glaucoma. Testing dataset 2 was series of 10 VFs from 638 eyes with open angle glaucoma. A VAE model to reconstruct VF was developed using the training dataset. VFs in the testing dataset 1 were then reconstructed using the trained VAE and the mean total deviation (mTD) was calculated (mTDVAE). In testing dataset 2, the mTD value of the tenth VF was predicted using shorter series of VFs. A similar calculation was carried out using a weighted linear regression where the weights were equal to the absolute difference between mTD and mTDVAE. In testing dataset 1, there was a significant relationship between the difference between mTD and mTDVAE from the first VF and the difference between mTD in the first and second VFs. In testing dataset 2, mean squared prediction errors with the weighted mTD trend analysis were significantly smaller than those form the unweighted mTD trend analysis.

Validating the efficacy of the binomial pointwise linear regression method to detect glaucoma progression with multicentral database.

BACKGROUND/AIM: We previously reported the benefit of applying binomial pointwise linear regression (PLR: binomial PLR) to detect 10-2 glaucomatous visual field (VF) progression. The purpose of the current study was to validate the usefulness of the binomial PLR to detect glaucomatous VF progression in the central 24°. METHODS: Series of 15 VFs (Humphrey Field Analyzer 24-2 SITA-standard) from 341 eyes of 233 patients, obtained over 7.9±2.1 years (mean±SD), were investigated. PLR was performed by regressing the total deviation of all test points. VF progression was determined from the VF test points analyses using the binomial test (one side, p<0.025). The time needed to detect VF progression was compared across the binomial PLR, permutation analysis of PLR (PoPLR) and mean total deviation (mTD) trend analysis. RESULTS: The binomial PLR was comparable with PoPLR and mTD trend analyses in the positive predictive value (0.18-0.87), the negative predictive value (0.89-0.95) and the false positive rate (0.057-0.35) to evaluate glaucomatous VF progression. The time to classify progression with binomial PLR (5.8±2.8 years) was significantly shorter than those with mTD trend analysis (6.7±2.8 years) and PoPLR (6.6±2.7 years). CONCLUSIONS: The binomial PLR method, which detected glaucomatous VF progression in the central 24° significantly earlier than PoPLR and mTD trend analyses, shows promise for improving our ability to detect visual field progression for clinical management of glaucoma and in clinical trials of new glaucoma therapies.

Visual Field Prediction using Recurrent Neural Network.

Artificial intelligence capabilities have, recently, greatly improved. In the past few years, one of the deep learning algorithms, the recurrent neural network (RNN), has shown an outstanding ability in sequence labeling and prediction tasks for sequential data. We built a reliable visual field prediction algorithm using RNN and evaluated its performance in comparison with the conventional pointwise ordinary linear regression (OLR) method. A total of 1,408 eyes were used as a training dataset and another dataset, comprising 281 eyes, was used as a test dataset. Five consecutive visual field tests were provided to the constructed RNN as input and a 6th visual field test was compared with the output of the RNN. The performance of the RNN was compared with that of OLR by predicting the 6th visual field in the test dataset. The overall prediction performance of RNN was significantly better than OLR. The pointwise prediction error of the RNN was significantly smaller than that of the OLR in most areas known to be vulnerable to glaucomatous damage. The RNN was also more robust and reliable regarding worsening in the visual field examination. In clinical practice, the RNN model can therefore assist in decision-making for further treatment of glaucoma.

Forecasting future Humphrey Visual Fields using deep learning.

PURPOSE: To determine if deep learning networks could be trained to forecast future 24-2 Humphrey Visual Fields (HVFs). METHODS: All data points from consecutive 24-2 HVFs from 1998 to 2018 were extracted from a university database. Ten-fold cross validation with a held out test set was used to develop the three main phases of model development: model architecture selection, dataset combination selection, and time-interval model training with transfer learning, to train a deep learning artificial neural network capable of generating a point-wise visual field prediction. The point-wise mean absolute error (PMAE) and difference in Mean Deviation (MD) between predicted and actual future HVF were calculated. RESULTS: More than 1.7 million perimetry points were extracted to the hundredth decibel from 32,443 24-2 HVFs. The best performing model with 20 million trainable parameters, CascadeNet-5, was selected. The overall point-wise PMAE for the test set was 2.47 dB (95% CI: 2.45 dB to 2.48 dB), and deep learning showed a statistically significant improvement over linear models. The 100 fully trained models successfully predicted future HVFs in glaucomatous eyes up to 5.5 years in the future with a correlation of 0.92 between the MD of predicted and actual future HVF and an average difference of 0.41 dB. CONCLUSIONS: Using unfiltered real-world datasets, deep learning networks show the ability to not only learn spatio-temporal HVF changes but also to generate predictions for future HVFs up to 5.5 years, given only a single HVF.

Current screening practice in patients under long-term hydroxychloroquine medication in Taiwan: A nationwide population-based cohort study.

Hydroxychloroquine (HCQ), an analog of chloroquine, is widely used in various rheumatologic and dermatologic disorders. However, it may cause severe retinopathy with long-term use. The guidelines proposed by the American Academy of Ophthalmology suggested a baseline fundus examination and an annual screening after 5 years by using automated visual fields (VF) plus spectral-domain optical coherence tomography (SD-OCT). Both multifocal electroretinogram (mfERG) and fundus autofluorescence (FAF) can also be used to improve the accuracy of diagnosis. The purpose of this study was to examine if the current HCQ screening practice in Taiwan was sufficient according to the guidelines to prevent severe macular complications.This study could remind every doctor to explain visual side effects thoroughly to every patient using HCQ, and refer patients for the ophthalmologic survey to eliminate potential visual impairment caused by this medicine.This nationwide population-based cohort study included all patients who started taking HCQ (n = 5826) from January 1, 1997, to December 31, 2007, in the Longitudinal Health Insurance Database 2000. The ICD codes used for HCQ retinopathy were 362.10, 362.55, 362.89, and 362.9. Patients previously diagnosed these retinal disorders were excluded. Demographic data including sex, age, diagnostic tools used, and the date of the initial diagnosis of the subsequent HCQ-related retinal disorder were collected. Patients were divided into 2 groups. The patients taking HCQ <5 years were defined as group 1, and >5 years as group 2. The risk of developing retinal diseases between these 2 groups was compared with a 2-sample t-test for continuous variables, and Fisher's exact test for discrete variables. Multiple logistic regressions were used for odds ratio calculation.The baseline examination ratio of the automated VF, SD-OCT scans, and multifocal electroretinograms (mfERGs) in the first 3 months were only 0.2% in both groups. The screening ratio of the 3 examination tools after 5 years were 1.1% in group 1 and 1.2% in group 2. 2.5% and 3.9% of patients developed a retinal disorder after HCQ use in group 1 and 2, respectively. The risk of developing retinal disorder was significantly higher in group 2 (relative risk = 1.53, P = .006). The odds ratio (OR) was also significantly higher in group 2 (1.67 with 95% cumulative incidence 1.20-2.30)The examination ratio according to the guidelines was very low in Taiwan. Thus, it is very important for doctors who prescribe HCQ to schedule both baseline and annual ophthalmology screening tests and inform patients of possible severe ocular complications, even in the patient taking HCQ <5 years. It is also important for ophthalmologists to review medical history carefully to find out the causes of retinotoxicity. Medications should be stopped, if possible when toxicity is recognized or strongly suspected.

Overuse and Underuse of Visual Field Testing Over 15 Years.

PRéCIS:: A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performance for nonglaucoma indications. Adherence to glaucoma management guidelines was suboptimal. Guidelines for referral to VF assessments should be established. PURPOSE: The purpose of this study was to identify trends in VF assessments over 15 years among patients with and without suspected or confirmed glaucoma, in a large healthcare maintenance organization. METHODS: This was a population-based retrospective cohort study, conducted by means of electronic medical database analyses. STUDY POPULATION: Maccabi Healthcare Services is an healthcare maintenance organization that insures 2 million members constituting 25% of the population. All members who underwent at least 1 VF test between January 2000 and December 2014 were included. In addition, all members with glaucoma or suspected glaucoma diagnosis or who were prescribed with antiglaucoma medications were evaluated. MAIN OUTCOME MEASURES: VF performance rates. RESULTS: A total of 93,617 Maccabi Healthcare Services members underwent 198,843 VF tests; of whom 47.9% involved patients without any glaucoma-related conditions. There was a growing trend over time toward more of those members to undergo VF tests and, by 2014, non-glaucoma-related members comprised 74.0% of new VF assessments. In contrast, 32.3% of glaucoma-related patients did not perform even 1 VF test throughout the entire study period. Although over 2 years (25.95±6.33 mo) passed between the first glaucoma-related diagnosis and first VF test, once a patient underwent the first VF test, an average once-a-year VF follow-up (0.95±0.37 annual tests) began. CONCLUSION: There is a growing trend for VF tests being apparently overused for indications other than glaucoma. Concurrently, adherence to glaucoma management guidelines on VF tests is suboptimal, leading to discernible underuse. Guidelines for VF assessments in nonglaucoma patients should be established. Adherence to existing glaucoma management guidelines should be improved.

Hipertensión intracraneal idiopática: casuística y revisión de la bibliografía / Idiopathic intracranial hypertension: epidemiology and current literature review

Introducción: se analizan las características de la hipertensión intracraneal idiopática; clínica al inicio, pruebas realizadas, tratamiento y evolución que presentaron. Material y métodos: estudio descriptivo retrospectivo de los pacientes diagnosticados de hipertensión intracraneal idiopática en los últimos siete años (2011-2017) en un hospital de tercer nivel. Resultados: se estudiaron 40 pacientes (55% mujeres) con una edad media de 9,6 años. Como factores asociados, el 5% seguían tratamiento con hormona del crecimiento. Solo el 25% presentaban sobrepeso u obesidad. El síntoma principal fue cefalea opresiva, asociando vómitos (27,5%) o alteraciones visuales (22%). Tres pacientes presentaron hallazgo casual de papiledema bilateral. La exploración física fue anodina (65%), se observó estrabismo por parálisis del VI par craneal (35%). Presentaron papiledema el 62,5%. La campimetría solo se realizó en el 55% de los pacientes y estaba alterada en el 50% de estos. El tiempo hasta el diagnóstico fue 44,8 días. Obtuvimos una presión de apertura media 29,7 cm H2O (± 8,2). Se realizó tomografía computarizada al 85% de los pacientes y fue normal en el 88,2% de estos. Se hizo resonancia magnética craneal al 7,5%, y fue normal en el 70% de estos. Se practico angio-RM al 5%, y fue normal en todos los casos. Se solicitó analítica, con función renal y hepática (62,5%, todos normal), hormonal (65%), estudio de trombofilias y autoinmunidad (10% y 20% respectivamente, anodinas). Se inició tratamiento con acetazolamida (95%), y hubo que añadir corticoterapia por falta de respuesta en el 24% de los casos. En el 5% se autolimitó espontáneamente. Como último escalón, el 7,5% requirió válvula de derivación lumboperitoneal. Evolucionaron favorablemente el 95%, con recidivas en el 15% de los casos. El tiempo medio hasta la resolución fue de 3,9 meses. Conclusión: el diagnóstico y tratamiento precoz de la hipertensión intracraneal idiopática es importante para evitar posibles secuelas irreversibles. El estudio oftalmológico, especialmente la campimetría, es esencial para el diagnóstico, seguimiento y determinación de la agresividad del tratamiento

Introduction: the characteristics of idiopathic intracranial hypertension are analyzed; epidemiology, clinic at the beginning, tests performed, treatment and evolution that presented the analyzed cases. Material and methods: a retrospective descriptive study was conducted on patients with idiopathic intracra­nial hypertension in the last seven years (2011-2017), in a third level hospital. Results: forty patients (55% women) were studied, with a mean age of 9.6 years. As associated factors, 5% had a treatment with growth hormone. It is important to note that only 25% were overweight or obese. The main symptom was oppressive headache, without predominance hours, associating vomiting (27.5%), or visual alterations (22%). Three asymptomatic patients presented a chance finding of bilateral papilledema. The physical examination was anodyne (65%), showing strabismus due to cranial nerve palsy VI (35%). 62,5% presented papilledema, and the campimetry was only performed in 55% of the patients, altered in 50% of them. The time to diagnosis was 44.8 days. We obtained an average opening pressure of 29.7 cm H2O (± 8.2). CT was performed (85%), being normal (88.2%). MRI of the skull (7.5%), normal (70%). Angio-NMR (5%), all normal. Analytical was requested, with renal and hepatic function (62.5%, all normal), hormonal (65%), thrombophilic study and autoimmunity (10% and 20% respectively, anodyne). Treatment was started with acetazolamide (95%), requiring the addition of corticotherapy due to lack of response 24%. In 5%, it spontaneously self-limited. As a last step, 7.5% required a lumboperitoneal bypass valve. They evolved favora­bly 95%, relapsing 15%. Redialing the average time to resolution was 3.9 months. Conclusion: idiopathic intracranial hypertension is rare, but its diagnosis and early treatment is essential to avoid possible irreversible sequelae. The ophthalmological study, by fundus and especially campimetry, is es­sential for the diagnosis, monitoring and determination of the aggressiveness of the treatment

Effects of head tilt on visual field testing with a head-mounted perimeter imo.

PURPOSE: A newly developed head-mounted perimeter termed "imo" enables visual field (VF) testing without a fixed head position. Because the positional relationship between the subject's head and the imo is fixed, the effects of head position changes on the test results are small compared with those obtained using a stationary perimeter. However, only ocular counter-roll (OCR) induced by head tilt might affect VF testing. To quantitatively reveal the effects of head tilt and OCR on the VF test results, we investigated the associations among the head-tilt angle, OCR amplitude and VF testing results. SUBJECTS AND METHODS: For 20 healthy subjects, we binocularly recorded static OCR (s-OCR) while tilting the subject's head at an arbitrary angle ranging from 0° to 60° rightward or leftward in 10° increments. By monitoring iris patterns, we evaluated the s-OCR amplitude. We also performed blind spot detection while tilting the subject's head by an arbitrary angle ranging from 0° to 50° rightward or leftward in 10° increments to calculate the angle by which the blind spot rotates because of head tilt. RESULTS: The association between s-OCR amplitude and head-tilt angle showed a sinusoidal relationship. In blind spot detection, the blind spot rotated to the opposite direction of the head tilt, and the association between the rotation angle of the blind spot and the head-tilt angle also showed a sinusoidal relationship. The rotation angle of the blind spot was strongly correlated with the s-OCR amplitude (R2≥0.94, p<0.0001). A head tilt greater than 20° with imo causes interference between adjacent test areas. CONCLUSIONS: Both the s-OCR amplitude and the rotation angle of the blind spot were correlated with the head-tilt angle by sinusoidal regression. The rotated VF was correlated with the s-OCR amplitude. During perimetry using imo, the change in the subject's head tilt should be limited to 20°.

Frequency of Testing to Detect Visual Field Progression Derived Using a Longitudinal Cohort of Glaucoma Patients.

PURPOSE: To determine the time required to detect statistically significant progression for different rates of visual field loss using standard automated perimetry (SAP) when considering different frequencies of testing using a follow-up scheme that resembles clinical practice. DESIGN: Observational cohort study. PARTICIPANTS: One thousand seventy-two eyes of 665 patients with glaucoma followed up over an average of 4.3±0.9 years. METHODS: Participants with 5 or more visual field tests over a 2- to 5-year period were included to derive the longitudinal measurement variability of SAP mean deviation (MD) using linear regressions. Estimates of variability then were used to reconstruct real-world visual field data by computer simulation to evaluate the time required to detect progression for various rates of visual field loss and different frequencies of testing. The evaluation was performed using a follow-up scheme that resembled clinical practice by requiring a set of 2 baseline tests and a confirmatory test to identify progression. MAIN OUTCOME MEASURES: Time (in years) required to detect progression. RESULTS: The time required to detect a statistically significant negative MD slope decreased as the frequency of testing increased, albeit not proportionally. For example, 80% of eyes with an MD loss of -2 dB/year would be detected after 3.3, 2.4, and 2.1 years when testing is performed once, twice, and thrice per year, respectively. For eyes with an MD loss of -0.5 dB/year, progression can be detected with 80% power after 7.3, 5.7, and 5.0 years, respectively. CONCLUSIONS: This study provides information on the time required to detect progression using MD trend analysis in glaucoma eyes when different testing frequencies are used. The smaller gains in the time to detect progression when testing is increased from twice to thrice per year suggests that obtaining 2 reliable tests at baseline followed by semiannual testing and confirmation of progression through repeat testing in the initial years of follow-up may provide a good compromise for detecting progression, while minimizing the burden on health care resources in clinical practice.

Escala NEI VFQ-25 como instrumento de medición de la calidad de vida relativa a la visión / NEI VFG-25 scale as a measuring instrument of the vision-related quality of life

La salud es un elemento decisivo de la calidad de vida. El concepto de calidad de vida es cada vez más utilizado como medida del bienestar y depende de elementos objetivos y de la valoración subjetiva que el paciente hace de diferentes aspectos de su vida. Las pruebas de calidad de vida son adaptables al campo de la Oftalmología y aplicables a cualquier paciente, además de las pruebas de función visual. El NEI VFQ-25 mide las dimensiones del estado de salud orientado a la visión. El uso de estos estudios permite conocer la respuesta clínica y el grado de satisfacción del paciente, lo que conlleva una mejor calidad de vida. Con la presente investigación se pretende mostrar una de las pruebas más utilizadas para describir los resultados de la calidad visual(AU)

The health is a decisive element of the life quality. The quality of life concept is more and more utilized, it depends on objective elements, and subjective opinion of the patient makes of different aspects of its life. The quality of life test is adaptive to the ophthalmology patient, beside the tests of visual function. The NEI VFQ-25, measures the dimensions from the health to the vision. The use of these studies allows knowing the clinical response and the patient satisfaction, what means a better life quality(AU)

Applying "Lasso" Regression to Predict Future Glaucomatous Visual Field Progression in the Central 10 Degrees.

PURPOSE OF THE STUDY: We recently reported that it is beneficial to apply least absolute shrinkage and selection operator (Lasso) regression to predict future 24-2 visual field (VF) progression. The purpose of the current study was to investigate the usefulness of Lasso regression to predict VF progression in the central 10 degrees (10-2) in glaucoma patients. METHODS: Series of 10 VFs (Humphrey Field Analyzer 10-2 SITA-standard) from each of 149 eyes in 110 open angle glaucoma patients, obtained over 5.7±1.4 years (mean±SD) were investigated. Mean deviation values of the 10th VF were predicted using varying numbers of VFs (ranging from the first to third VFs to the first to ninth VFs), applying ordinary least square regression (OLSLR) and Lasso regression. Absolute prediction errors were then compared. RESULTS: With OLSLR, prediction error varied between 5.4±5.0 (using first to third VFs) and 1.1±1.6 dB (using first to ninth VFs). Significantly smaller prediction errors were obtained with Lasso regression, in particular with small numbers of VFs (from 2.1±2.8: first to third VFs, to 1.0±1.6 dB: first to ninth VFs). A large λ value, which is an index showing the degree of penalty in Lasso regression, was observed when a small number of VFs were used for prediction. CONCLUSION: Mean deviation prediction using OLSLR with a small number of VFs resulted in large prediction errors. It was useful to apply Lasso regression when predicting future progression of the central 10 degrees, compared to OLSLR.

The Frequency of Optical Coherence Tomography Testing in Glaucoma at a Single Academic Medical Center.

PURPOSE: To determine the frequency of optical coherence tomography (OCT) examinations compared with clinical examinations and visual field (VF) tests in patients with 5 types of glaucoma. PATIENTS AND METHODS: A retrospective, longitudinal cohort study was conducted of 5154 patients treated between 2003 and 2010 at a single academic medical center. Patients were classified using billing records as having primary open-angle glaucoma, low-tension open-angle glaucoma (NTG), pigmentary open-angle glaucoma, chronic angle-closure glaucoma, or pseudoexfoliation glaucoma. Analysis of variance, χ test, and exact χ test were performed to identify associations between glaucoma type and test frequency. RESULTS: Pigmentary open-angle glaucoma and NTG patients had a higher rate of undergoing at least 2 VFs (94.4%, 94.9%), and chronic angle-closure glaucoma patients had a lower rate of undergoing at least 2 OCTs (25.3%) than all other glaucoma types. NTG patients also had the highest rate of undergoing at least 2 OCTs and at least 2 VFs (36.6%). Overall, the rate of clinical examinations (2.68 examinations/y) exceeded the rates of OCTs (1.39 examinations/y), which exceeded the rate of VF tests (1.24 tests/y). There were no differences in OCT frequency between glaucoma types (0.91 to 1.63 OCTs/y). Within each glaucoma diagnosis, patients had clinical examinations more frequently than OCTs and clinical examinations more frequently than VFs. Primary open-angle glaucoma and pseudoexfoliation glaucoma patients also had OCTs more frequently than VFs. More patients had at least 2 VF tests than at least 2 OCTs (4481 vs. 1679). CONCLUSION: The relative use of clinical examinations, VF testing, and OCT imaging varies among glaucoma diagnoses.

Geographic Variation in the Use of Diagnostic Testing of Patients with Newly Diagnosed Open-Angle Glaucoma.

PURPOSE: To determine the extent of geographic variation in the proportion of patients with newly diagnosed open-angle glaucoma (OAG) undergoing visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI) among patients residing in different US communities. DESIGN: Retrospective, longitudinal cohort study. PARTICIPANTS: All enrollees with newly diagnosed OAG enrolled in a managed care network between 2001 and 2014. METHODS: We identified all persons in the plan with incident OAG residing in 201 communities across the United States. All communities contributed ≥20 enrollees. The proportion of enrollees undergoing ≥1 VF test, FP, OOI, and no testing of any type in the 2 years after first OAG diagnosis was determined for each community, and comparisons were made to assess the extent of variation in use of diagnostic testing among patients residing in the different communities. MAIN OUTCOME MEASURES: Receipt of VF testing, FP, OOI, or none of these tests in the 2 years after initial OAG diagnosis. RESULTS: Of the 56675 enrollees with newly diagnosed OAG, the mean proportion of patients undergoing VF testing within 2 years of initial diagnosis was 74%±7%, ranging from as low as 51% in Rochester, Minnesota, to as high as 95% in Lancaster, Pennsylvania. The mean proportion undergoing OOI was 63%±10% and varied from 34% in Palm Springs/Rancho Mira, California, to 85% in Charleston, South Carolina. The mean proportion receiving FP was 26%±10% and ranged from as low as 3% in Fresno, California, to as high as 57% in Harlingen, Texas. The proportion undergoing no glaucoma testing ranged from 0% in Binghamton, New York, to as high as 35% in 2 other communities. CONCLUSIONS: In many US communities, a high proportion of patients are undergoing testing according to established practice guidelines. However, in several communities, less than 60% of patients with newly diagnosed OAG are undergoing VF testing in the 2 years after initial OAG diagnosis, and in a few communities >1 in 4 patients have no record of glaucoma diagnostic testing of any type. Additional research is needed to understand factors driving this variation in practice patterns and its impact on patient outcomes.

[Visual field defects after epilepsy surgery: implications for driving license tenure]. / Gesichtsfelddefekte nach epilepsiechirurgischen Eingriffen : Bedeutung für die Fahrerlaubnis.

BACKGROUND: Epilepsy surgery is an effective and established therapy in medically uncontrollable seizure disorders. In the course of such operations lesions of the visual pathway are often unavoidable. The resultant visual field defects can conflict with the legal requirements for a driving license. METHODS: In this single center trial Goldmann perimetric findings in 135 temporal lobe epilepsy surgery procedures were analyzed retrospectively. The data were reviewed with respect to current and former German legal requirements for a driving license. RESULTS: Of the surgical procedures 64 % resulted in visual field defects, 50% of the postoperative visual field findings did not comply with the legal requirements for a driving license and 56% did not comply with those for a heavy goods vehicle driving license. DISCUSSION: A considerable proportion of the epilepsy surgery procedures examined in this study resulted in visual field defects that did not comply with the German legal requirements for driving vehicles. In all cases defects in the center of the visual field proved pivotal.

Perimetry in children: survey of current practices in the United Kingdom and Ireland.

PURPOSE: Visual fields are key functional outcome measures in children with a variety of ophthalmologic disorders. However, reliably assessing fields in children is challenging. We report the findings of a survey of current practices of perimetry in children in the United Kingdom and Ireland. METHODS: An electronic questionnaire was sent to Orthoptic Service Heads in July 2008. Respondents were asked for comments regarding visual field testing in children as well as details of the volume and type of perimetry performed in their units, over a 1-year period. RESULTS: Of the 98 (62%) completed questionnaires, 16 departments reported not testing visual fields in children. In total 3675 subjects under 16 years of age were reported to have undergone perimetry in 1 year, most in units with a ≥ 50% pediatric caseload for orthoptics. A total of 42% of units used static perimetry alone, 11% kinetic, and 47% used a combination of both. CONCLUSION: High numbers of visual field tests are carried out in children in the UK and Ireland annually. Automated perimetry is used predominantly, despite the underlying algorithms having been developed for adult populations. Thus there is a clear need for more research, to ensure that evolving management practices are informed by understanding of the diagnostic accuracy and value of perimetry in children.

Microperimetry and optical coherence tomography in a case of traumatic macular hole and associated macular detachment with spontaneous resolution.

The association of macular detachment with posttraumatic macular hole is a known but rare occurrence. Spontaneously occurring resolution of the detachment and closure of the macular hole has been reported only once in the literature. We describe a similar rare event in a young male, the documentation of which was done serially by microperimetry (MP) and optical coherence tomography (OCT). A 17-year-old male presented with a decrease in vision following a closed globe injury to the left eye. A coexisting macular hole and macular detachment were detected in the affected eye. Serial follow-up with OCT and MP documented complete resolution of the macular hole and the macular detachment within 1 week of presentation. The case highlights that spontaneous resolution of traumatic macular hole and related macular detachment may occur and a waiting period is advisable before undertaking any corrective surgical procedure. The pathophysiologic mechanisms of causation and the resolution of posttraumatic macular hole-related retinal detachment are discussed.