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2.
Medicine (Baltimore) ; 98(45): e17924, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702674

RESUMO

Bilateral asymmetry has been used in optical coherence tomography tests to find early damage to the optic nerve. However, limited studies have quantitatively evaluated bilateral asymmetry in electrophysiological disorders in patients with glaucoma. The aim of the study was to evaluate bilateral asymmetry in pattern visual evoked potentials (PVEPs) and conventional clinical markers as well as its potential use in detecting glaucomatous impairment. After investigating 60 glaucomatous patients (120 eyes) and 65 age and sex-matched normal control subjects (130 eyes) using uni- and multivariable analysis, we found that vision-related quality of life (VRQOL) impairment was significantly associated with larger bilateral asymmetry index (BAI) of clinical markers. Rasch-calibrated National Eye Institute Visual Function Questionnaire-25 scores were significantly associated with the BAI in PVEPs latency in 15 minutes check size (ß = -0.478, 95% confidence interval [CI], -0.708 to -0.248, P < .001) and the BAI in visual field mean deviation (ß = -0.249, 95% CI, -0.454 to -0.044, P = .018) according to multivariable analysis. Bilateral asymmetry in objective and subjective functional measurements was quantitatively associated with glaucomatous VRQOL impairment. This finding may help bridge the gap in understanding between patients and clinicians, and increase awareness of how glaucomatous neuropathic progression may interfere with patients' daily life.


Assuntos
Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Qualidade de Vida , Campos Visuais/fisiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Glaucoma de Ângulo Fechado/psicologia , Glaucoma de Ângulo Aberto/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Testes de Campo Visual/métodos
3.
Invest Ophthalmol Vis Sci ; 60(14): 4548-4555, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675072

RESUMO

Purpose: To determine the association of statins, five classes of antihypertensive medications, and proton pump inhibitors with (1) primary open-angle glaucoma (POAG) progression and (2) conversion of POAG suspects to POAG. Methods: We retrospectively investigated the records of a cohort with POAG cases and suspects from the Groningen Longitudinal Glaucoma Study. To quantify visual field (VF) deterioration in cases, we used the rate of progression of the mean deviation (MD). Suspects were considered to have converted at the time point after which two consecutive VF tests for at least one eye were abnormal (glaucoma hemifield test outside normal limits). Progression and conversion were analyzed with quantile and logistic regression, respectively, with the systemic medications as predictors, controlling for age, sex, body mass index, pretreatment IOP, corneal thickness, and baseline MD. The multivariable models were built with and without IOP intervention. Results: No systemic medications were associated with POAG progression in the final IOP/treatment-adjusted or unadjusted model. However, angiotensin II receptor blockers (ARBs) appeared to slow progression in older patients (b = 0.014, P = 0.0001). Angiotensin-converting enzyme inhibitors (ACEIs) were significantly associated with a decrease in POAG suspect conversion in both the IOP/treatment-adjusted and -unadjusted model (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.79, P = 0.012; OR=0.24, 95% CI 0.07-0.78, P = 0.021, respectively), as were ARBs (OR 0.12, 95% CI 0.01-0.98, P = 0.014; OR 0.11, 95% CI 0.01-0.87, P = 0.005, respectively). Conclusions: No overall association of VF progression with systemic medication was found; ARBs delayed progression in older patients. ACEIs and ARBs were associated with lower risk of suspect conversion. The pathophysiology of this relationship is to be disentangled.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glaucoma de Ângulo Aberto/diagnóstico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , Anti-Hipertensivos/efeitos adversos , Progressão da Doença , Feminino , Alemanha , Glaucoma de Ângulo Aberto/induzido quimicamente , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Pressão Intraocular/efeitos dos fármacos , Pressão Intraocular/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nível de Efeito Adverso não Observado , Hipertensão Ocular/induzido quimicamente , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Transtornos da Visão/induzido quimicamente , Transtornos da Visão/diagnóstico , Testes de Campo Visual , Campos Visuais/efeitos dos fármacos , Campos Visuais/fisiologia
4.
Invest Ophthalmol Vis Sci ; 60(14): 4711-4716, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725170

RESUMO

Purpose: Neuroretinopathy is increasingly being recognized as an independent cause of vision loss in diabetes. Visual field loss, as detected by frequency doubling technology (FDT)-based visual perimetry, is a sign of neuroretinopathy and occurs in early stages of diabetic retinopathy (DR). Here, we hypothesized that FDT visual field testing could identify patients with diabetic neuroretinopathy in the absence of clinically detectable microvascular DR. Methods: All National Health and Nutrition Examination Survey (NHANES) 2005-2008 participants receiving fundus photography and visual field screening by FDT were included in this study. Participants with self-reported glaucoma, use of glaucoma medications, or determination of glaucoma based on disk features were excluded. Visual fields were screened using FDT protocol in which participants underwent a 19-subfield suprathreshold test. Results: Patients with diabetes but no DR were more likely to have ≥1 subfield defects at 5%, 2%, and 1% probability levels than patients without diabetes (41.3% vs. 28.6%; 27.4% vs. 17.5%; 15.9% vs. 9.4%; all P < 0.0008). Multivariable regression showed that each additional glycated hemoglobin % (HbA1c) was associated with 19% greater odds of having ≥1 visual subfield defects in those with diabetes without DR (odds ratio: 1.19, 95% confidence interval: 1.07-1.33; P = 0.0020). Conclusions: Patients with diabetes have visual field defects in the absence of clinically detectable DR, suggesting neuroretinopathy precedes classical microvascular disease. These defects become more frequent with the onset of visible retinopathy and worsen as the retinopathy becomes more severe. Longitudinal studies are required to understand the pathogenesis of diabetic neuroretinopathy in relation to classic DR.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Feminino , Hemoglobina A Glicada/metabolismo , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fotografação , Transtornos da Visão/fisiopatologia , Testes de Campo Visual
5.
Invest Ophthalmol Vis Sci ; 60(14): 4931-4942, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770433

RESUMO

Purpose: We studied the relationship between structure and function of the choriocapillaris (CC), retinal pigment epithelium (RPE), and photoreceptors in patients with choroideremia (CHM). Methods: Six CHM patients (12 eyes) and four normal subjects (six eyes) were studied with fundus-guided microperimetry, confocal and nonconfocal adaptive optics scanning laser ophthalmoscopy (AOSLO), near-infrared and color fundus photos, short wavelength fundus autofluorescence (SW-AF), and swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA) images. Cone spacing was represented using Z-scores (standard deviations from the mean at that eccentricity). CC flow voids were defined using a threshold of 1 SD below the normal mean. Results: Cone spacing Z-scores were not significantly correlated with distance from the borders of preserved RPE, determined using either the SS-OCT or SW-AF scans. Cone spacing Z-scores were significantly correlated with CC flow voids and retinal sensitivity. Flow voids were abnormal in regions of preserved RPE and increased progressively from within -2° of the preserved area to +2° beyond the border. Visual sensitivity decreased as CC flow voids increased approaching and beyond the border of preserved structure. Conclusions: In CHM, cone spacing Z-scores correlated with CC flow voids, and were negatively correlated with retinal sensitivity, suggesting cone degeneration accompanied reduced CC perfusion. Functional cones were found outside the presumed borders of preserved outer-retina/RPE as defined by SW-AF, but not outside the borders determined by SS-OCT. The use of SW-AF to identify the border of preserved structures may underestimate regions with cells that may be amenable to treatment.


Assuntos
Corioide/patologia , Coroideremia/patologia , Células Fotorreceptoras Retinianas Cones/patologia , Epitélio Pigmentado da Retina/patologia , Adolescente , Adulto , Idoso , Corioide/diagnóstico por imagem , Coroideremia/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Oftalmoscopia , Imagem Óptica , Ondas de Rádio , Tomografia de Coerência Óptica , Testes de Campo Visual , Campos Visuais/fisiologia , Adulto Jovem
6.
BMC Neurol ; 19(1): 302, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779601

RESUMO

BACKGROUND: Visual field defects caused by injury to Meyer's loop (ML) are common in patients undergoing anterior temporal lobectomy during epilepsy surgery. Evaluation of the anatomical shapes of the curving, fanning and sharp angles of ML to guide surgeries is important but still challenging for diffusion tensor imaging. We present an advanced diffusion data-based ML atlas and labeling protocol to reproduce anatomical features in individuals within a short time. METHODS: Thirty Massachusetts General Hospital-Human Connectome Project (MGH-HCP) diffusion datasets (ultra-high magnetic gradient & 512 directions) were warped to standard space. The resulting fibers were projected together to create an atlas. The anatomical features and the tractography correspondence rates were evaluated in 30 MGH-HCP individuals and local diffusion spectrum imaging data (eight healthy subjects and six hippocampal sclerosis patients). RESULTS: In the atlas, features of curves, sharp angles and fanning shapes were adequately reproduced. The distances from the anterior tip of the temporal lobe to the anterior ridge of Meyer's loop were 23.1 mm and 26.41 mm on the left and right sides, respectively. The upper and lower divisions of the ML were revealed to be twisting. Eighty-eight labeled sides were achieved, and the correspondence rates were 87.44% ± 6.92, 80.81 ± 10.62 and 72.83% ± 14.03% for MGH-HCP individuals, DSI-healthy individuals and DSI-patients, respectively. CONCLUSION: Atlas-labeled ML is comparable to high angular resolution tractography in healthy or hippocampal sclerosis patients. Therefore, rapid identification of the ML location with a single modality of T1 is practical. This protocol would facilitate functional studies and visual field protection during neurosurgery.


Assuntos
Lobectomia Temporal Anterior/métodos , Epilepsia do Lobo Temporal/cirurgia , Transtornos da Visão/etiologia , Campos Visuais , Adolescente , Adulto , Estudos de Casos e Controles , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Epilepsia do Lobo Temporal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Testes de Campo Visual , Adulto Jovem
7.
Vestn Oftalmol ; 135(5. Vyp. 2): 305-311, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31691677

RESUMO

Increased intraocular pressure is the main, and the only modifiable risk factor in the development of glaucoma. This review analyzes studies on differential diagnostics of ocular hypertension and risk factors of its conversion to glaucoma, and gives recommendations based on literature data for the most correct algorithm for management of patients with ocular hypertension.


Assuntos
Hipertensão Ocular , Humanos , Pressão Intraocular , Fatores de Risco , Testes de Campo Visual
8.
Invest Ophthalmol Vis Sci ; 60(13): 4462-4468, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31658354

RESUMO

Purpose: To investigate the serum changes of antioxidant/oxidant markers and the relationship between these factors and visual function in patients with retinitis pigmentosa (RP). Methods: Fifty-two RP patients <40 years old and 25 controls were included. Serum samples were analyzed for superoxide dismutase 3 (SOD3) activity, glutathione peroxidase (GPx), potential antioxidant (PAO), and hexanoyl-lysine (HEL). The relationships between these markers and visual parameters, including best-corrected visual acuity (BCVA), mean deviation (MD), and average retinal sensitivity of 4 or 12 central points on static perimetry tests (Humphrey Field Analyzer, the central 10-2 program) were examined in the RP patients. Results: Although there was no significant difference in the serum SOD3 activity between RP patients and controls, serum SOD3 activity in the severe degeneration group with macular involvement (16.3 ± 11.3 U/mL) was significantly lower compared with those in the mild degeneration group (those with midperipheral scotomas; 28.5 ± 16.6 U/mL, P = 0.0459). SOD3 was significantly related to visual acuity (r = -0.3701, P = 0.0069) and the average retinal sensitivity of four central points (r = 0.3463, P = 0.0137) in RP patients. The linear trends of these two parameters across SOD3 levels were also significant (P = 0.0264 and 0.0172, respectively). There was no consistent correlation between other serum antioxidant/oxidant markers and visual parameters. Conclusions: Lower serum SOD3 activity was associated with the severe retinal degeneration in RP patients. Our results suggest that serum SOD3 activity may be related to disease severity in RP.


Assuntos
Antioxidantes/metabolismo , Biomarcadores/sangue , Oxidantes/sangue , Retinite Pigmentosa/sangue , Acuidade Visual/fisiologia , Adulto , Feminino , Glutationa Peroxidase/sangue , Humanos , Lisina/sangue , Masculino , Oxirredutases atuantes sobre Doadores de Grupo CH-NH/sangue , Retinite Pigmentosa/fisiopatologia , Superóxido Dismutase/sangue , Testes de Campo Visual , Campos Visuais/fisiologia , Adulto Jovem
10.
Zhonghua Yan Ke Za Zhi ; 55(10): 777-784, 2019 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-31607067

RESUMO

Objective: To evaluate risk factors for visual field (VF) loss progression in primary open-angle glaucoma patients. Methods: A prospective nested case-control study. Patients were collected from the Wenzhou glaucoma progression study in the Eye Hospital of Wenzhou Medical University during March 2014 and April 2018. In this study, the eyes were divided into a progression group and a non-progression group using the glaucoma progression analysis methods to analyze the risk factors for glaucomatous VF loss progression. Axial length (AL) and central corneal thickness (CCT) were measured using the Lenstar LS900. The baseline, fluctuation (standard deviation), mean, maximum, minimum and range of intraocular pressure (IOP) during the follow-up period were determined based on IOP measured at each follow-up. The IOP measurements were included from the baseline to the last visit (for the non-progression group), or to the visit at which VF loss progression was determined (for the progression group). The independent sample t-test, Mann-Whitney U inspection and Cox proportional hazards models were used for statistical analysis. Results: A total of 140 patients (140 eyes) were enrolled, including 67 males and 73 females. There were 19.3% of the eyes (27 of 140 eyes) showing VF loss progression. The median time to the endpoint for progression was 24.0 (16.0, 40.0) months. The AL in the progression group and non-progression group were 23.58 (23.05, 24.24) mm and 23.91 (23.10, 24.91) mm (P=0.111). The CCT in the two groups were 531.0 (512.0, 565.0) µm and 535.0 (518.5, 552.0) µm, respectively (P=0.897). The baseline age in the progression group and non-progression group was 71.0 (68.0, 74.0) years and 68.0 (58.0, 72.0) years, respectively (Z=-2.872, P=0.004). The slope of visual field index in the two groups was -3.50 (-7.10, -1.80)%/year and 0.40 (-0.60, 1.40)%/year, respectively (Z=-6.823, P<0.01). The mean IOP during the follow-up was (16.2±2.7) mmHg (1 mmHg=0.133 kPa) in the progression group and (15.1±2.4) mmHg in the non-progression group (t=-2.215, P=0.028). The IOP fluctuation in the progression group and non-progression group was (2.6±1.3) mmHg and (2.0±0.7) mmHg, respectively (t=-2.175, P=0.038). In the multivariate model, older baseline age (HR=1.080; 95%CI:1.019-1.143), higher baseline IOP (HR=1.120; 95%CI:1.016-1.236), higher mean IOP (HR=1.145; 95%CI:1.001-1.309) and higher IOP fluctuation (HR=1.750; 95%CI:1.193-2.566) were all significantly predictive risk factors for glaucomatous VF loss progression. Longer AL (HR=0.725; 95%CI:0.532-0.988) was a protective factor against VF loss progression. However, CCT was found to be not associated with VF loss progression. Conclusion: Baseline age, baseline IOP, mean IOP, IOP fluctuation and shorter AL are found to be risk factors for glaucomatous VF loss progression among eyes with primary open-angle glaucoma in Wenzhou. (Chin J Ophthalmol, 2019, 55: 777-784).


Assuntos
Córnea/anatomia & histologia , Glaucoma de Ângulo Aberto/fisiopatologia , Doenças do Nervo Óptico/fisiopatologia , Transtornos da Visão/fisiopatologia , Campos Visuais , Idoso , Estudos de Casos e Controles , Paquimetria Corneana , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Testes de Campo Visual
11.
Invest Ophthalmol Vis Sci ; 60(13): 4241-4248, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618760

RESUMO

Purpose: To assess the agreement between structural (optical coherence tomography [OCT]) and functional (visual field [VF]) glaucomatous damage with an automated method and deviation/probability maps, and to compare this method to a metric method. Methods: Wide-field spectral-domain OCT scans, including the disc and macula, and 24-2 and 10-2 VFs were obtained from 45 healthy control (H) eyes/individuals, and 53 eyes/patients with 24-2 mean deviation (MD) better than -6 dB diagnosed as "definite glaucoma" (DG) by experts. Abnormal structure-abnormal function (aS-aF) agreement was assessed with an automated topographic (T) method based upon VF pattern deviation and OCT probability maps. Results were compared to a metric (M) method optimized for accuracy, (abnormal 24-2 glaucoma hemifield test [GHT] or pattern standard deviation [PSD], or 10-2 PSD AND abnormal OCT [quadrant]). Results: For the T-method, 47 (88.7%) of the 53 DG eyes showed aS-aF agreement, compared to 2 (4.5%) of the 45 H eyes. The aS-aF agreement for these two H eyes was easily identified as mistaken, and did not replicate on a subsequent test. Without the 10-2, the aS-aF agreement decreased from 47 to 34 (64.2%) of 53 DG eyes. For the M-method, 37 (69.8%) of the 53 DG eyes showed aS-aF agreement, while omitting the 10-2 VF resulted in agreement in only 33 (62.3%) eyes. Conclusions: There is good agreement between structural and functional damage, even in eyes with confirmed early glaucomatous damage, if both 24-2 and 10-2 VFs are obtained, and abnormal locations on the VFs are compared to abnormal regions seen on OCT macular and disc scans. This can be done in an objective, automated fashion. (ClinicalTrials.gov number, NCT02547740.).


Assuntos
Glaucoma/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Macula Lutea/fisiopatologia , Masculino , Pessoa de Meia-Idade , Disco Óptico/fisiopatologia , Estudos Prospectivos , Testes de Campo Visual , Campos Visuais/fisiologia
12.
Invest Ophthalmol Vis Sci ; 60(13): 4270-4276, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618763

RESUMO

Purpose: Glaucoma affects many aspects of visual performance, including adaptation, and this may depend on ambient luminance. We determine the influence of glaucoma and luminance on temporal aspects of adaptation, specifically on contrast gain control and temporal modulation sensitivity (TMS). Methods: This case-control study included 12 glaucoma patients and 25 age-similar controls (50-70 years). Threshold perimetry was performed with a minimized testing grid (fovea and four peripheral locations). Stimuli (Goldmann size III 50 ms increment/decrement) were presented on a time-varying background with sinusoidally-modulated luminance (amplitude 60%; frequency 0-30 Hz; mean background luminance, 1 and 100 cd/m2). TMS (2.5-30 Hz) was measured in the same locations with a sinusoidally-modulated stimulus (Goldmann size IV, 334 ms) on a steady background (1 and 100 cd/m2). Results: In healthy subjects, contrast sensitivity decreased with increasing background modulation frequency and increased again at very high frequencies, indicating contrast gain control. Minimum sensitivity was located between 2.5 and 20 Hz, depending on luminance and eccentricity. In glaucoma patients, the same frequency dependency was found (P = 0.12) but with an overall reduced sensitivity (P = 1 × 10-5), independent of luminance (P = 0.20). Decrements differentiated better between glaucoma and healthy subjects than increments (P = 0.004). TMS was reduced in glaucoma (P = 5 × 10-6) across all frequencies and luminance levels, with complete loss for high frequencies at 1 cd/m2. Conclusions: Contrast gain control is largely unaffected in glaucoma, suggesting intact amacrine cell function. Perimetry with decrements or a high-frequency stimulus on a low-luminance background seems best to differentiate between glaucoma and healthy subjects.


Assuntos
Visão de Cores/fisiologia , Sensibilidades de Contraste/fisiologia , Glaucoma de Ângulo Aberto/fisiopatologia , Visão Mesópica/fisiologia , Retina/fisiologia , Campos Visuais/fisiologia , Idoso , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Testes de Campo Visual
13.
Ophthalmic Physiol Opt ; 39(6): 441-450, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31595548

RESUMO

PURPOSE: To investigate if the structure-function relationship between circumpapillary retinal nerve fibre layer (cpRNFL) thickness and visual field (VF) thresholds is stronger when using the Goldmann V target rather than the Goldman III target where glaucomatous damage is advanced. METHODS: Optical coherence tomography (OCT) and VF (Humphrey Field Analyzer 24-2 or 30-2) measurements with Goldmann III (SITA standard) and V (full-threshold) targets were carried out in 51 eyes of 51 patients with primary open angle glaucoma. The relationship between cpRNFL thicknesses in supero- and infero-temporal sectors, and VF sensitivity with the Goldmann III or V target was investigated. RESULT: Visual field sensitivities (dB) both with the Goldmann III target and Goldmann V target showed a floor effect in the structure-function relationship against cpRNFL thickness, at approximately 60 µm. There was no significant relationship between visual field sensitivity measured with the Goldmann V target (dB scale: p = 0.12, 1/Lambert scale: p = 0.40; linear mixed models) and cpRNFL thickness, when corresponding visual field sensitivity, measured with the Goldmann III target, was <20 dB. CONCLUSION: There was no improvement in the structure-function relationship using the Goldmann V target (full-threshold), compared to using the Goldmann III target (SITA standard), where glaucomatous damage was advanced.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Pressão Intraocular/fisiologia , Doenças do Nervo Óptico/diagnóstico , Células Ganglionares da Retina/patologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Doenças do Nervo Óptico/etiologia , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos
14.
Klin Monbl Augenheilkd ; 236(11): 1298-1303, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31639882

RESUMO

BACKGROUND: It has been assumed that visual field defects in optic disc drusen slowly increase with age or occur during adolescence and do not change substantially in later years. In our study, we aimed to validate these assumptions. MATERIAL AND METHODS: 255 consecutive cases with optic disc drusen were identified from the patient records of the University Eye Hospital Tübingen; the diagnosis was verified and visual fields were quantified as long as available and of sufficient quality. Additionally, visual acuity was evaluated. RESULTS: In 104 cases, quantifiable visual fields of sufficient quality for both eyes were available. In general, few patients with marked visual field defects could be detected. Only three patients showed visual field defects of ≥ 50% in both eyes. Both eyes were usually involved to approximately the same extent. Older age was correlated with more visual field defects. Only one patient remained below visual acuity of 0.3 in both eyes. DISCUSSION: By means of our patient base, a continuous slight decline in the visual field with age can be assumed. Marked visual field defects were rare. The same was true for visual acuity, which showed some mild decline above the age of 60 years.


Assuntos
Drusas do Disco Óptico , Disco Óptico , Acuidade Visual , Campos Visuais , Adolescente , Idoso , Humanos , Drusas do Disco Óptico/complicações , Testes de Campo Visual
15.
Invest Ophthalmol Vis Sci ; 60(12): 3835-3841, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31529080

RESUMO

Purpose: To assess the presence of binocular gain in macular telangiectasia type 2 (MacTel) and its correlation to paracentral scotomas. Methods: Sixty-eight patients with MacTel were consecutively recruited for a cross-sectional analysis. Best-corrected visual acuity (BCVA), reading acuity, and reading speed were tested monocularly and binocularly. Macular retinal sensitivity was examined with fundus-controlled perimetry (microperimetry). Scotomas were quantified by their size, their depth, and their proximity to the fovea. Results: Binocular reading speed and acuity were lower than monocular reading speed and acuity in the functionally better eye (142 vs. 159 words per minute and 0.43 vs. 0.28 log reading acuity determination, P < 0.001). Magnitude of binocular inhibition of reading speed was correlated to the degree of interocular functional difference (R2 = 0.61, P < 0.001). This correlation was not found for reading acuity or BCVA (R2 < 0.03). Binocular reading speed was negatively correlated to size of right and left eye scotomas, with bigger effect size for left eye scotomas. The magnitude of binocular inhibition was correlated to size of left eye scotomas, but not of right eye scotomas. When both eyes had similar scotoma characteristics, the right eye was more frequently the better reading eye. Conclusions: We provide evidence for the presence of binocular inhibition of reading performance in MacTel, likely due to binocular rivalry. This may result from the characteristic paracentral scotomas in noncorresponding retinal fields and, in particular, a disruptive projection of scotomas in reading direction arising from the left eyes. Patients may benefit from occluding one eye while reading.


Assuntos
Leitura , Telangiectasia Retiniana/fisiopatologia , Escotoma/fisiopatologia , Visão Binocular/fisiologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
16.
Curr Opin Ophthalmol ; 30(6): 500-505, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503074

RESUMO

PURPOSE OF REVIEW: There are an increasing number of publications related to dengue ophthalmic manifestations and multimodality imaging related to dengue. This review summarizes the current literature, describe ocular manifestations, current using of ocular imaging/investigations, and management of ocular dengue. RECENT FINDINGS: Ocular manifestations of dengue can be present in many stages of dengue fever including after the resolution of systemic disease. Most cases of ocular dengue will exhibit an improvement in vision spontaneously over time. Multimodal imaging such as optical coherence tomography, optical coherence tomography angiography, near-infrared imaging, and microperimetry plays an important role in the diagnosis, follow-up, quantitative measure, and help to understand the disease progression. SUMMARY: Dengue fever can lead to a variety of ocular manifestations. The mechanisms underlying dengue-related ocular complications remain unclear. Immune-mediated mechanisms and direct viral invasion are thought to play an important role. Ophthalmologists should carefully assess patients with dengue-related ophthalmic disease because some patients may have poor visual acuity and exhibit refractoriness to treatment. Treatment with systemic corticosteroids may benefit those patients with poor presenting visual acuity, progressive ocular symptoms, and lesions involving the optic nerve and/or threatening the macula.


Assuntos
Dengue/diagnóstico , Infecções Oculares Virais/diagnóstico , Transtornos da Visão/diagnóstico , Dengue/virologia , Infecções Oculares Virais/virologia , Angiofluoresceinografia , Humanos , Imagem Multimodal , Espectrofotometria Infravermelho , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/virologia , Testes de Campo Visual
17.
Expert Opin Ther Pat ; 29(10): 829-839, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31510806

RESUMO

Introduction: Glaucoma, a leading cause of irreversible blindness worldwide, is commonly diagnosed solely in advanced stages of the disease when important and irreversible losses of visual field have already occurred. The identification of effective biomarkers and methods for diagnostic purposes are main interests of the scientific community. Areas covered: This review presents an overview of the current diagnostic methods used for glaucoma and introduces the areas where new efforts are being done for the identification of more sensitive and specific biomarkers. The review then covers the patent literature of the period 2013-2019 regarding diagnostic approaches and biomarkers of glaucoma and the claimed methods for their qualitative and/or quantitative analysis. Expert opinion: In the absence of treatment, glaucoma can cause blindness in a few years. Early diagnostic tools are urgently needed, as this disease incidence is deemed to rapidly increase in the next decades. The current diagnosis of glaucoma, which is based on specific signs of the disease, such as high intraocular pressure, specific optic nerve head changes and visual field loss, is not enough anymore. Molecular genetics represents the area where most efforts are currently made to improve the early detection and monitoring of the disease progression.


Assuntos
Biomarcadores/metabolismo , Glaucoma/diagnóstico , Biologia Molecular/métodos , Animais , Progressão da Doença , Diagnóstico Precoce , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Patentes como Assunto , Testes de Campo Visual
18.
Middle East Afr J Ophthalmol ; 26(2): 60-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543661

RESUMO

PURPOSE: The purpose of the study is to evaluate the changes in contrast sensitivity (CS) after using the four different types of antiglaucoma eye drops in patients with primary open-angle glaucoma (POAG) by OPTEC-functional vision analyzer (FVA). METHODS: In this prospective study, eighty patients (80 eyes) with POAG were randomly divided into four groups. The groups were randomly received timolol maleate 0.5%, travoprost 0.004%, dorzolamide 2%, and brimonidine tartrate 0.2%. The medications were used in the eye that was randomly selected. The CS was assessed before and 15 min after the intervention by the FVA. The paired t-test was used to compare the difference between before and after the intervention. P < 0.05 was considered statistically significant. RESULTS: Fifteen minutes after the instillation of timolol maleate (Group A), the CS in three out of twenty patients at the spatial frequencies of 1.5, and 3 cycles per degree (cpd) was significantly decreased (P = 0.015). However, using travoprost (Group B) and dorzolamide (Group C), the CS in one out of twenty patients at low spatial frequencies (1.5 and 3 cpd) was decreased in the two groups, which was not statistically significant for these medications (P > 0.05). In Group D, after applying brimonidine tartrate, the CS in two out of twenty patients at the spatial frequency of 18 cpd was significantly decreased (P = 0.042). CONCLUSION: Our study showed that CS values at low and high spatial frequencies after applying timolol and brimonidine eye drops are temporarily reduced in patients with POAG.


Assuntos
Anti-Hipertensivos/uso terapêutico , Sensibilidades de Contraste/fisiologia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/fisiopatologia , Testes Visuais/instrumentação , Adulto , Tartarato de Brimonidina/uso terapêutico , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Sulfonamidas/uso terapêutico , Tiofenos/uso terapêutico , Timolol/uso terapêutico , Travoprost/uso terapêutico , Testes de Campo Visual , Campos Visuais/fisiologia
19.
Cesk Slov Oftalmol ; 75(2): 55-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31537073

RESUMO

The study provides an up-to-date overview of pathogenesis, functional and structural changes in normal tension glaucoma (NTG) and its differences from high tension glaucomas (HTG). The authors point to less known facts which make both diagnostic groups different. First of all, there are electrophysiological findings that verify pathology in the complete visual pathway in HTG in contrast to NTG where the retinal ganglion cell response is relatively normal but the abnormalities are in the visual pathway. This corresponds to the findings of functional magnetic resonance imaging of the brain with a significant decrease in activity in HTG compared to NTG. We found a higher decrease in activity in HTG following application of the colour paradigm compared to NTG where we did not see a similar difference. We also investigated the central corneal thickness (CCT) in both diagnostic groups. We did not find a statistically significant difference. However, we found the effect of CCT on progression of the changes in visual fields in HTG. In relation to suspicion of abnormally low cerebrospinal pressure and a possible cerebrovascular fluid flow disturbance in NTG, we examined the optic nerve thickness (OND) and optic nerve sheath diameter (OSD) at a distance of 4, 8, 16 and 20mm from the posterior pole of the eye. In the comparison with the healthy population, we did not find any abnormalities except for the width of the optic chiasma that was markedly lower in NTG. In relation to a possible impairment of cerebral perfusion we determined the degrees of cerebral atrophy using magnetic resonance imaging by measuring the bicaudate ratio (BCR) and white matter lesions using the Fazekas scale. We did not find a difference between HTG and NTG in BCR. We found statistically significant changes in BCR which correlated with the changes in visual fields. The higher values of the pattern defect were associated with increased brain atrophy (BCR). We did not detect similar relations in the Fazekas scale. We found a significant difference in this parameter among NTG, HTG and a control group. We found the most advanced changes in the patients with HTG. Conclusion: In HTG, impairment of retinal ganglion cells and subsequently also their axons, including visual cortex occurs because of a high intraocular pressure. In NTG, the retinal ganglion cells are relatively normal like the visual cortex, but alteration occurs in their axons. The cause is not a high intraocular pressure but most probably ischemia.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Disco Óptico , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/terapia , Humanos , Pressão Intraocular , Tomografia de Coerência Óptica , Testes de Campo Visual
20.
Invest Ophthalmol Vis Sci ; 60(12): 3992-4001, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31560765

RESUMO

Purpose: To investigate residual sensitivity within geographic atrophy (GA) secondary to age-related macular degeneration. Methods: Mesopic and dark-adapted (DA) cyan and red light sensitivity (Goldmann III) were investigated using fundus-controlled perimetry (microperimetry). Test points were placed within GA along an "iso-hull" with a distance of -0.645° to the atrophy boundary. The false-positive response rate was determined with suprathreshold stimuli to the optic disc (Heijl-Krakau method) and used to compute the expected sensitivity measurements for the assumption of absolute scotomata. The outermost visible retinal layer on spectral-domain optical coherence tomography at the location of each test point was determined. Results: Thirty eyes of 36 patients (75.55 ± 7.93 years; 19 female) from the prospective natural history study Directional Spread in Geographic Atrophy (NCT02051998), with a total of 1380 threshold determinations were analyzed. The measured sensitivities were significantly (P < 0.01) higher than the expected values for absolute scotomata (mean ± standard error of +6.92 ± 0.86 dB for mesopic, +2.57 ± 0.56 dB for DA cyan, and +4.93 ± 0.74 dB for DA red testing). For mesopic testing and DA red testing, the presence of a residual outer nuclear layer had a significant effect on this discrepancy (P < 0.001). There was no effect of fixation stability or any other reliability index on this discrepancy. Conclusions: Measured sensitivities within the inner junctional zone of GA may not be purely explained by patient-specific false-positive response rates or other reliability indices. The marked influence of the outer retinal configuration on measured sensitivity may be indicative of residual cone function within GA at the inner junctional zone.


Assuntos
Atrofia Geográfica/fisiopatologia , Luz , Degeneração Macular/complicações , Visão Mesópica/fisiologia , Retina/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Adaptação à Escuridão/fisiologia , Reações Falso-Positivas , Feminino , Angiofluoresceinografia , Atrofia Geográfica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Retina/efeitos da radiação , Sensibilidade e Especificidade , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
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