Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.533
Filtrar
1.
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
2.
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
3.
Doc Ophthalmol ; 139(3): 235-245, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31338649

RESUMO

BACKGROUND: Sellar region tumor growth represents an important cause of visual loss due to mechanical compression of the optic nerve apparatus. Many investigations have used non-invasive tools to evaluate the visual field consequences of this damage, and good associations have been reported between psychophysical and electrophysiological perimetries. Few reports have considered the tumor size as a predictor of visual field loss. AIMS: In the present study, we evaluated the association between the visual perimetry measured by Humphrey visual field analyzer and multifocal visual evoked cortical potential (mfVECP) and the tumor size. METHODS: Our sample was composed of 14 patients diagnosed with sellar tumors by magnetic resonance imaging. We accounted the number of sectors with negative visual responses for both methods. A simple logistic regression analysis was used to evaluate the association between the tumor dimensions and the visual field features RESULTS: Three patients had preserved visual fields, three patients showed hemianopic defects, and eight patients had generalized visual field losses at both evaluations. We observed that the three maximum diameters of the tumor and total tumor volume had different predictive abilities regarding the extent of visual field loss when using psychophysical and mfVECP data. The maximum craniocaudal diameter of the tumor was the better predictor of the psychophysical measurements, whereas for the mfVECP results, all tumor dimensions and volumes had similar values that predict visual field losses. CONCLUSION: Tumor size as a predictor of visual loss has potential to assist in the clinical intervention and to prevent the irreversible visual impairment caused by tumors of the sellar region.


Assuntos
Adenoma/patologia , Potenciais Evocados Visuais/fisiologia , Neoplasias Hipofisárias/patologia , Retina/fisiopatologia , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adenoma/diagnóstico por imagem , Adulto , Idoso , Eletrorretinografia , Feminino , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Psicofísica , Adulto Jovem
4.
Semin Ophthalmol ; 34(4): 334-339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31146612

RESUMO

Objective: Microperimetry (MP) is used to assess visual sensitivity mediated by the central retina. As such, MP performance is a candidate outcome measure for gene therapy trials. Herein, we review MP results in three inherited retinal disorders for which gene therapy trials have been initiated-choroideremia, Stargardt disease, and X-linked juvenile retinoschisis. Each of these disorders typically presents in childhood and each has distinct effects on the central retina. Outcomes and Results: Our review indicates that microperimetry is feasible in each of these conditions. The MP sensitivity maps vary among conditions consistent with known effects of each of the three conditions. There is, however, within each of the three disorders considerable variability in fixation stability and in the pattern of sensitivity loss. Conclusions: Microperimetry is a valuable tool for monitoring functional aspects of central retina in an individual patient, especially in combination with other modalities such as OCT, autofluorescence, and acuity and thus may contribute to evaluating the efficacy of gene treatments. Variability of the MP parameters raises some cautions in application of MP as an outcome measure in treatment trials that may have small sample sizes. Nonetheless, we suspect that MP will continue to have a rightful place in future gene therapy trials.


Assuntos
Coroideremia/fisiopatologia , Degeneração Macular/congênito , Retinosquise/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Coroideremia/diagnóstico , Ensaios Clínicos como Assunto , Fixação Ocular/fisiologia , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/fisiopatologia , Retinosquise/diagnóstico
5.
Int J Mol Sci ; 20(10)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31117170

RESUMO

Recessively-inherited NR2E3 gene mutations cause an unusual retinopathy with abnormally-increased short-wavelength sensitive cone (S-cone) function, in addition to reduced rod and long/middle-wavelength sensitive cone (L/M-cone) function. Progress toward clinical trials to treat patients with this otherwise incurable retinal degeneration prompted the need to determine efficacy outcome measures. Comparisons were made between three computerized perimeters available in the clinic. These perimeters could deliver short-wavelength stimuli on longer-wavelength adapting backgrounds to measure whether S-cone vision can be quantified. Results from a cohort of normal subjects were compared across the three perimeters to determine S-cone isolation and test-retest variability. S-cone perimetry data from NR2E3-ESCS (enhanced S-cone syndrome) patients were examined and determined to have five stages of disease severity. Using these stages, strategies were proposed for monitoring efficacy of either a focal or retina-wide intervention. This work sets the stage for clinical trials.


Assuntos
Oftalmopatias Hereditárias/diagnóstico , Mutação , Receptores Nucleares Órfãos/genética , Células Fotorreceptoras Retinianas Cones/fisiologia , Degeneração Retiniana/diagnóstico , Transtornos da Visão/diagnóstico , Testes de Campo Visual/métodos , Adolescente , Adulto , Idoso , Criança , Ensaios Clínicos como Assunto , Oftalmopatias Hereditárias/metabolismo , Oftalmopatias Hereditárias/fisiopatologia , Humanos , Pessoa de Meia-Idade , Células Fotorreceptoras Retinianas Cones/metabolismo , Degeneração Retiniana/metabolismo , Degeneração Retiniana/fisiopatologia , Transtornos da Visão/metabolismo , Transtornos da Visão/fisiopatologia , Adulto Jovem
6.
Graefes Arch Clin Exp Ophthalmol ; 257(7): 1481-1488, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037491

RESUMO

PURPOSE: To prospectively report the perimetric defects during a 6-month follow-up (FU) in patients with initially active ocular toxoplasmosis (OT). METHODS: Twenty-four patients were studied, including 11 eyes with chorioretinal toxoplasmosis proven with a positive aqueous humor sample and 13 eyes with a biologically unproven, chorioretinal lesion. Automated 24-2 SITA-Standard visual fields were performed at baseline, at the first, and sixth months of FU. A composite clinical severity score was calculated from visual acuity (VA), severity of vitreitis, chorioretinal lesion size, location of the lesion in zone 1, the presence of an initial macular or papillary edema, and long-term scarring. This provided a relative cutoff level of severity. Nine eyes out of the 24 eyes were considered severe (3 unproven and 6 proven OT). RESULTS: Initial and final visual field parameters (mean deviation [MD] and pattern standard deviation [PSD]) were significantly correlated (r = 0.873; p < 0.001, and r = 0.890; p < 0.001, respectively). During FU, only foveal threshold [FT] was correlated with VA at baseline (r = 0.48; p = 0.01) and at the 6-month FU visit (r = 0.547; p = 0.004). The MD initial predictive value of clinical severity was 0.739 according to the ROC curve. At baseline, severe and nonsevere OT exhibited no significant difference in term of MD (p = 0.06) and PSD (p = 0.1). During the FU, taking into account all the data, MD, PSD, visual function index [VFI], and FT were associated with the severity of toxoplasmosis (p = 0.018, 0.05, 0.016, and 0.02, respectively): the unproven group had a faster recovery of MD during FU (p = 0.05). CONCLUSION: Visual field parameters better reflected the chorioretinal destruction related to the toxoplasmosis lesion and the functional repercussions than VA alone. Interestingly, MD at presentation could be a discriminating factor of severity in active OT, and each visual field parameter follow-up could be a support to manage patients with active OT, especially in the severe group.


Assuntos
Antiprotozoários/uso terapêutico , Infecções Oculares Parasitárias/fisiopatologia , Monitorização Fisiológica/métodos , Toxoplasmose Ocular/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antiprotozoários/imunologia , Humor Aquoso/metabolismo , Humor Aquoso/parasitologia , DNA de Protozoário/análise , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/tratamento farmacológico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Fatores de Tempo , Toxoplasma/genética , Toxoplasma/imunologia , Toxoplasmose Ocular/diagnóstico , Toxoplasmose Ocular/tratamento farmacológico , Acuidade Visual , Adulto Jovem
7.
Invest Ophthalmol Vis Sci ; 60(6): 1898-1905, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042797

RESUMO

Purpose: To characterize visual loss across the full visual field in idiopathic intracranial hypertension (IIH) patients with mild central visual loss. Methods: We tested the full visual field (50° nasal, 80° temporal, 30° superior, 45° inferior) of 1 eye of 39 IIH patients by using static perimetry (size V) with the Open Perimetry Interface. Participants met the Dandy criteria for IIH and had at least Frisén grade 1 papilledema with better than -5 dB mean deviation (MD) centrally. Two observers (MW and AS) evaluated the visual field defects, adjudicated any differences, and reviewed optical coherence tomography data. Results: We found a greater MD loss peripherally than centrally (central 26°). The median MD (and corresponding median absolute deviations) was -1.37 dB (1.61 dB) for the periphery and -0.77 dB (0.87 dB) for the central 26°, P < 0.001. There were about 30% more abnormal test locations identified in the periphery (P = 0.12), and the mean defect depth increased with eccentricity (P < 0.001). The most frequent defect found was a temporal wedge (23% of cases) in the periphery with another 23% that included this sector with inferior temporal loss. Although the presence of papilledema limited correlation, 55% of the temporal wedge defects had optical coherence tomography retinal nerve fiber layer deficits in the corresponding superonasal location. Other common visual field defects were inferonasal loss, superonasal loss, and superior and inferior arcuate defects. Seven patients (18%) had visual field defects in the periphery with normal central visual field testing. Conclusion: In IIH patients, we found substantial visual loss both outside 30° of the visual field and inside 30° with the depth of the defect increasing linearly with eccentricity. Temporal wedge defects were the most common visual field defect in the periphery. Static threshold perimetry of the full visual field appears to be clinically useful in IIH patients.


Assuntos
Pseudotumor Cerebral/fisiopatologia , Escotoma/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico , Reprodutibilidade dos Testes , Células Ganglionares da Retina/patologia , Escotoma/etiologia , Escotoma/fisiopatologia , Tomografia de Coerência Óptica , Adulto Jovem
8.
Scand J Psychol ; 60(4): 289-294, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31131452

RESUMO

About 30-40% of stroke patients suffer from visual field defects following injury. These can interfere with the standard neuropsychological assessment and complicate the interpretation of tests that use visual materials. However, information about the integrity of a patient's central visual field is often unavailable. We, therefore, designed a screening tool, the computerized visual field test (c-VFT), specifically targeted at providing easily available, but rough, information about patients' central visual field. c-VFT was tested in two samples of stroke patients. Eleven patients were tested on c-VFT and on the Esterman test. Five patients were tested on c-VFT and the Humphrey Visual Field Analyzer (HFA), central 10-2. Criterion validity of the c-VFT was investigated by calculating quadrantwise intraclass correlation for both comparisons. For the HFA comparison, we also calculated point-to-point intraclass correlation, sensitivity, and specificity. Analyses revealed moderately good correspondence between c-VFT and the Esterman test, and between c-VFT and HFA 10-2, respectively. When looking specifically at test points within one degree of visual angle apart in the two tests, intraclass correlation increased. For these points, the sensitivity of c-VFT was 0.89 and specificity was 0.97. While the c-VFT is not designed to be diagnostic nor to replace the detailed visual field analysis, this study shows that it provides a reasonable screening of the central visual field. The test can easily be used and will be made freely available to neuropsychological clinicians and researchers.


Assuntos
Hemianopsia/diagnóstico , Acidente Vascular Cerebral/complicações , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Hemianopsia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Sensibilidade e Especificidade
9.
Semin Ophthalmol ; 34(4): 232-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31132292

RESUMO

Glaucoma is the leading cause of irreversible blindness worldwide. Early detection is of utmost importance as there is abundant evidence that early treatment prevents disease progression, preserves vision, and improves patients' long-term quality of life. The structure and function thresholds that alert to the diagnosis of glaucoma can be obtained entirely via digital means, and as such, screening is well suited to benefit from artificial intelligence and specifically machine learning. This paper reviews the concepts and current literature on the use of machine learning for detection of the glaucomatous disc and visual field.


Assuntos
Diagnóstico por Computador , Técnicas de Diagnóstico Oftalmológico , Glaucoma/diagnóstico , Aprendizado de Máquina , Transtornos da Visão/diagnóstico , Testes de Campo Visual/métodos , Glaucoma/fisiopatologia , Humanos , Doenças do Nervo Óptico/diagnóstico , Campos Visuais/fisiologia
10.
Invest Ophthalmol Vis Sci ; 60(5): 1760-1767, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31022297

RESUMO

Purpose: Macular telangiectasia type 2 (MacTel) is a bilateral neurodegenerative disorder of the central macula. Previous findings indicated more functional impairment in low light conditions. We sought to further characterize retinal dysfunction using dark-adapted two-color fundus-controlled perimetry ("scotopic microperimetry"). Methods: Participants of the MacTel Natural History Observation Registry study and age-matched healthy controls underwent retinal imaging including dual wavelength autofluorescence macular pigment optical density (MPOD) measurement. Retinal sensitivity was assessed with scotopic microperimetry using cyan (505 nm) and red (627 nm). Disease was graded into classes of MPOD loss (0 to 3). For perimetry analysis, the differences of the mean sensitivities (MacTel minus controls) were compared at each test location and the results were aggregated to global indices. Results: Thirty-four eyes (19 patients, mean age 62.2 years) were compared with 25 eyes (25 controls, mean age 61.5 years). Both cyan and red sensitivity were lower in MacTel. This was more pronounced at one- and three-degree eccentricity. Eyes with MPOD class 0 did not exhibit a functional deficit. Class 1 had impaired cyan, but normal red sensitivity. Class 2 and 3 behaved similarly and had impaired cyan and red sensitivity with a relatively higher cyan impairment. Conclusions: Rods might be compromised to a greater extent than cones. Linking to previous studies, our results might also hint toward (postreceptoral) dysfunction of the cone system in very early disease stages. Macular pigment loss and global perimetry indices seemed to reflect functional impairment and might be useful as adjunct measures for disease progression.


Assuntos
Visão de Cores/fisiologia , Adaptação à Escuridão/fisiologia , Células Fotorreceptoras Retinianas Cones/fisiologia , Células Fotorreceptoras Retinianas Bastonetes/fisiologia , Telangiectasia Retiniana/fisiopatologia , Campos Visuais/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fundo de Olho , Humanos , Pigmento Macular/metabolismo , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Testes de Campo Visual/métodos
11.
Graefes Arch Clin Exp Ophthalmol ; 257(6): 1277-1287, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30944987

RESUMO

PURPOSE: To evaluate the screening accuracy of an Eye Movement Perimetry (EMP) in comparison with Frequency Doubling Perimetry (FDP) and to investigate the patient preference and perception towards these visual field screening methods. METHODS: A total of 104 healthy subjects (mean age (SD) of 48 (14) years) and 73 glaucoma patients (mean age (SD) of 52 (13) years) were recruited. All the participants underwent a comprehensive ophthalmic evaluation including the 24-2 SITA standard protocol on the Humphrey Field Analyzer (HFA). This was followed by the 26-point protocol in EMP and the C-20-1 protocol in FDP. During EMP, all subjects were instructed to fixate a central target and to look at the detected peripheral target, followed by refixation of the central target and Saccadic Reaction Time (SRT) towards each of the "seen" stimuli was calculated. Next, a questionnaire was administered to evaluate the patient preference and perception towards the perimetry techniques. Mean SRTs and Robin scores were used to plot Receiver Operating Characteristics (ROC) curves to determine the screening accuracies. From the questionnaire survey, the frequency distributions of the responses were calculated. RESULTS: Robin score and SRT were significantly increased in glaucoma patients in comparison with the age-matched healthy subjects (p < 0.001). The ROC analysis revealed comparable Area Under the Curve (AUC) values (0.95, p = 0.81) with a specificity of 95.2% for FDP and 96.2% for EMP with a sensitivity of 87.7%. Thirty-seven percent of the older age group (≥ 40 years) and 65% of severe glaucoma patients showed preference for EMP over FDP. CONCLUSIONS: This study results indicate that the customized protocol in EMP provides efficient and rapid means of screening visual field defects in glaucoma, which compared well with FDP. Elderly healthy participants and patients with moderate and severe glaucomatous defects preferred EMP as it permitted natural reflexive eye movements thereby resembling a real-life test setting.


Assuntos
Movimentos Oculares , Glaucoma/diagnóstico , Preferência do Paciente , Seleção Visual/métodos , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Estudos Transversais , Feminino , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Adulto Jovem
12.
Invest Ophthalmol Vis Sci ; 60(5): 1403-1411, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30943288

RESUMO

Purpose: The purpose of this study was to evaluate the concordance of a temporal raphe architecture estimated using optical coherence tomography (OCT) and MP-3 microperimetry. Methods: We enrolled 25 eyes with either an upper or lower glaucomatous hemifield defect, as detected on the Humphrey visual field 30-2 test. A structural temporal raphe was extrapolated from visible end points of retinal nerve fiber bundles present in a perimetrically normal hemiretina on an en face Spectralis OCT image. A functional temporal raphe was drawn as a line from the fovea to the border of at least a 10-dB difference in sensitivity, at vertically adjacent test points, with at least three consecutive pairs among 25 test points placed at 8° to 18° from the fovea (2° intervals) on the MP-3. An angle determined by the optic disc center, the fovea, and the temporal raphe line (the DFR angle) was calculated. Correlations and agreement of the OCT- and MP-3-derived DFR angles and factors affecting discordance of the two estimates were evaluated. Results: Despite no significant demographic differences, the functional DFR angle (mean ± SD, 171.8° ± 3.5°) was significantly larger than that of the structural DFR angle (166.5° ± 3.2°) in 14 eyes with upper hemifield defects and vice versa in 11 eyes with lower hemifield defects (163.4° ± 3.0° vs. 170.5° ± 3.2°). The mean deviation was significantly associated with the functional and structural DFR angle difference in eyes with only upper hemifield defects. Conclusions: The structural temporal raphe was more deviated to the perimetrically normal hemiretina side than to the functional temporal raphe, thereby suggesting that a structural change may precede a functional loss.


Assuntos
Fóvea Central/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Disco Óptico/fisiopatologia , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Estudos Prospectivos , Células Ganglionares da Retina/patologia
13.
Invest Ophthalmol Vis Sci ; 60(5): 1547-1555, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30995293

RESUMO

Purpose: To evaluate the disease progression in patients with clinical and genetic diagnoses of choroideremia during a long-term follow-up and to investigate the relationship between pathogenic variants in the CHM/REP1 gene and disease phenotypes. Methods: We performed a retrospective longitudinal study on 51 affected men by reviewing medical charts at baseline and follow-up visits to extract the following ocular findings: best-corrected visual acuity, Goldmann visual field, optical coherence tomography, microperimetry. Data obtained from the analysis of DNA and mRNA were reevaluated for genetic classification of patients. Results: The longitudinal analysis showed a significant (P < 0.001) worsening of best-corrected visual acuity with a mean rate of 0.011 logMar per year before 50 years and 0.025 logMar per year after 50 years. Similarly, V4e Goldmann visual field area significantly (P ≤ 0.01) decreased at a mean rate of 2.7% per year before 40 years and 5.7% after 40 years. Moreover, we observed a significant (P < 0.05) decrease of macular sensitivity with a mean rate of 5.0% per year and a decrease of mean macular thickness with a mean rate of 0.8% per year. We classified our patients into two groups according to the expression of the CHM/REP1 gene transcript and observed that mutations leading to mRNA absence are associated with an earlier best-corrected visual acuity and Goldmann visual field loss. Conclusions: Our analysis of morphological and functional parameters in choroideremia patients showed a slow disease progression, particularly in the first decades of life. Overall, reevaluation of clinical and molecular data suggests exploring the genotype-phenotype relationship based on CHM/REP1 transcript expression.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Coroideremia/genética , Regulação da Expressão Gênica/fisiologia , Escotoma/fisiopatologia , Acuidade Visual/fisiologia , Campos Visuais/fisiologia , Adolescente , Adulto , Criança , Coroideremia/diagnóstico por imagem , Coroideremia/fisiopatologia , Progressão da Doença , Seguimentos , Estudos de Associação Genética , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual/métodos , Adulto Jovem
14.
PLoS One ; 14(4): e0214875, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951547

RESUMO

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.


Assuntos
Aprendizado Profundo , Testes de Campo Visual/estatística & dados numéricos , Adulto , Idoso , Algoritmos , Bases de Dados Factuais , Progressão da Doença , Feminino , Previsões , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Espaço-Temporal , Testes de Campo Visual/métodos , Campos Visuais
15.
Invest Ophthalmol Vis Sci ; 60(4): 1122-1131, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901388

RESUMO

Purpose: Dark-adapted visual fields were obtained from patients with inherited retinal degeneration (IRD) and controls to evaluate the effect that age, retinal region, and disease had on scotopic sensitivity. Intra- and intersession test-retest repeatabilities for patients and controls were measured to establish significant change for longitudinal studies. Methods: A total of 41 patients with IRD and 30 controls had one eye dilated and dark-adapted for 40 minutes. Scotopic sensitivity was measured with a Medmont dark-adapted chromatic (DAC) perimeter (size V stimulus, 200-ms duration, background luminance < 0.0001 cd/m2, dynamic range 0-75 decibel [dB]). Mixed effects analysis was performed to analyze age, retinal eccentricity, and sensitivity. The intra-/intersession coefficients of repeatability (CR) were calculated for controls and patients with IRD. Results: Each additional year was associated with lower sensitivity (-0.22 dB) per year in normal controls over age 50 compared to younger controls (12-49 years). The superior field had lower sensitivity than the inferior, but the nasal field was not different compared to the temporal field in normal controls. The CR for intra- and intersession testing on mean sensitivity (MS)/pointwise sensitivity (PWS) were ±1.5/±8.5 and ±3.3/±9.8 dB, respectively, for patients with IRD. Control MS/PWS CR were ±1.5/±6.1 dB for intrasession and ±1.7/±6.8 dB for intersession DAC perimetry. Conclusions: The DAC perimeter is an important asset because it tests a wide field of scotopic vision. The CR are comparable to those of other perimetry devices. Effects of age and retinal region should be considered when assessing scotopic sensitivity measured with the DAC perimeter.


Assuntos
Visão Noturna/fisiologia , Retina/fisiopatologia , Degeneração Retiniana/fisiopatologia , Escotoma/fisiopatologia , Campos Visuais/fisiologia , Adolescente , Adulto , Idoso , Criança , Adaptação à Escuridão/fisiologia , Feminino , Seguimentos , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Degeneração Retiniana/genética , Escotoma/genética , Acuidade Visual , Testes de Campo Visual/métodos , Adulto Jovem
16.
PLoS One ; 14(2): e0211641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730917

RESUMO

BACKGROUND: The characteristics of the optic nerve head (ONH) in open angle glaucoma (OAG) patients with diabetes have not been reported. This study aimed to characterize the ONH structures and glaucomatous damage in diabetic OAG patients, using age-matched non-diabetic OAG patients and control subjects. METHODS: The locations of visual field defects of OAG patients were classified and the prelaminar thickness and lamina cribrosa depth were measured in 64 OAG patients with type 2 diabetes (OAG+DM), 68 OAG patients without diabetes (OAG-DM), and 36 controls. All participants were scanned by spectral domain-optical coherence tomography. The anterior prelaminar depth and lamina cribrosa depth were measured at the center of the reference line (the Bruch's membrane opening plane). The prelaminar tissue thickness was obtained by subtracting the anterior prelaminar depth from the anterior lamina cribrosa depth. RESULTS: The visual field defects in the OAG+DM group were more commonly found in the inferior hemifield (P = 0.010), and tended to involve the central visual field compared to the OAG-DM group (P = 0.044). In the comparison of ONH parameters, the prelaminar thickness was highest in the OAG+DM group, followed by the control subjects and the OAG-DM group (P = 0.035). Post-hoc testing showed that prelaminar thickness was significantly greater in the OAG+DM group than in the OAG-DM group (P = 0.033). The lamina cribrosa depth was deepest in the OAG+DM group, followed by the OAG-DM group and the control subjects (P = 0.006). CONCLUSIONS: Diabetic and non-diabetic OAG patients exhibit different characteristics of glaucoma, particularly increased prelaminar thickening in diabetics.


Assuntos
Diabetes Mellitus Tipo 2/patologia , Glaucoma de Ângulo Aberto/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Lâmina Basilar da Corioide/patologia , Estudos Transversais , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Disco Óptico/patologia , Doenças do Nervo Óptico/patologia , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/patologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
17.
Ophthalmology ; 126(6): 822-828, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30731101

RESUMO

PURPOSE: To determine the agreement of 6 established visual field (VF) progression algorithms in a large dataset of VFs from multiple institutions and to determine predictors of discordance among these algorithms. DESIGN: Retrospective longitudinal cohort study. PARTICIPANTS: Visual fields from 5 major eye care institutions in the United States were analyzed, including a subset of eyes with at least 5 Swedish interactive threshold algorithm standard 24-2 VFs that met our reliability criteria. Of a total of 831 240 VFs, a subset of 90 713 VFs from 13 156 eyes of 8499 patients met the inclusion criteria. METHODS: Six commonly used VF progression algorithms (mean deviation [MD] slope, VF index slope, Advanced Glaucoma Intervention Study, Collaborative Initial Glaucoma Treatment Study, pointwise linear regression, and permutation of pointwise linear regression) were applied to this cohort, and each eye was determined to be stable or progressing using each measure. Agreement between individual algorithms was tested using Cohen's κ coefficient. Bivariate and multivariate analyses were used to determine predictors of discordance (3 algorithms progressing and 3 algorithms stable). MAIN OUTCOME MEASURES: Agreement and discordance between algorithms. RESULTS: Individual algorithms showed poor to moderate agreement with each other when compared directly (κ range, 0.12-0.52). Based on at least 4 algorithms, 11.7% of eyes progressed. Major predictors of discordance or lack of agreement among algorithms were more depressed initial MD (P < 0.01) and older age at first available VF (P < 0.01). A greater number of VFs (P < 0.01), more years of follow-up (P < 0.01), and eye care institution (P = 0.03) also were associated with discordance. CONCLUSIONS: This extremely large comparative series demonstrated that existing algorithms have limited agreement and that agreement varies with clinical parameters, including institution. These issues underscore the challenges to the clinical use and application of progression algorithms and of applying big-data results to individual practices.


Assuntos
Algoritmos , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Conjuntos de Dados como Assunto , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos , Adulto Jovem
18.
Int Ophthalmol ; 39(10): 2373-2383, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30725244

RESUMO

PURPOSE: To evaluate discrete wavelet transform coefficients and identify descriptors of pattern electroretinogram (PERG) waveforms in order to determine PERG characteristics for optimizing the diagnosis of early primary open-angle glaucoma (POAG). METHODS: Pattern electroretinogram was performed in 30 normal eyes and 30 eyes with primary open-angle glaucoma according to the ISCEV protocol. The check size was 0.8° and 16°, and the color was black/white in both groups. The results were analyzed in time domain (TD) and discrete wavelet transform (DWT) using the MATLAB software. The mean value, standard deviation, and relative energy of level 6 and 7 detail coefficients (d6, d7) and level 7 approximation coefficients (a7) of Daubechies 4 (db4), Daubechies 8 (db8), Symlet 5 (sym5), Symlet 7 (sym7), and Coiflet 5 (coif5) wavelets were calculated. In all the mentioned wavelets, DWT descriptors were extracted. Signals were reconstructed by inverse DWT. All data obtained by TD and DWT analyses were compared between the two groups. RESULTS: In both check sizes, a significant attenuation of N95 amplitude was seen in the patient group. The relative energy of a7 of db8 increased significantly in the POAG group in the 0.8° check size. In larger check stimuli, the relative energy of d7 of coif5 decreased significantly and the standard deviation of d7 of sym7 increased markedly in glaucomatous patients (P < 0.05). In small stimuli, N95 descriptor (7N) of db8 had the highest value and showed a significant increase as compared to the POAG group. In the 16° check size, there was no significant difference. A strong correlation was seen between reconstructed signals and originals (r = 0.99). CONCLUSION: The DWT can quantify PERG responses more accurately. In agreement with TD and wavelet coefficients domain results, 7N of db8 decomposition can be used as a good indicator for early detection of POAG.


Assuntos
Eletrorretinografia/métodos , Glaucoma de Ângulo Aberto/diagnóstico , Testes de Campo Visual/métodos , Adulto , Estudos de Casos e Controles , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Campos Visuais/fisiologia , Análise de Ondaletas , Adulto Jovem
20.
Acta Ophthalmol ; 97(6): e833-e838, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30801992

RESUMO

PURPOSE: In spite of faster examination procedures, visual field (VF) results are potentially influenced by fatigue. We use large-scale VF data collected from clinics to test the hypothesis that perimetric fatigue effects are greater in the eye examined second. METHODS: Series of six Humphrey Swedish Interactive Testing Algorithm (SITA) VFs from 6901 patients were retrospectively extracted from a VF database from four different glaucoma clinics. Mean deviation (MD) was compared between first and second tested eyes. A surrogate measure of longitudinal MD variability over time was estimated from errors using linear regression of MD against time then compared between first and second tested eye. RESULTS: Right eye VF was tested consistently first throughout in 6320 (91.6%) patients. Median (interquartile range; IQR) MD in the first tested (right) eye and second tested (left) eye was -2.57 (-6.15, -0.58) dB and -2.70 (-6.34, -0.80) dB respectively (median reduction VF sensitivity of 0.13 dB; p < 0.001). Median (IQR) increase in our surrogate measure of longitudinal MD variability in the second eye tested was 3% (-43%, 50%); this effect was not associated with patient age or rest time between examinations. CONCLUSION: Statistically significant perimetric fatigue effects manifest on average in the second eye tested in routine clinics using Humphrey Field Analyzer SITA examinations. However, the average effects were very small and there was enormous variation among patients. We recommend starting with a right eye examination so that any perimetric fatigue effects, if they exist in an individual, will be as constant as possible from visit to visit.


Assuntos
Algoritmos , Glaucoma/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Idoso , Progressão da Doença , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA