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1.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504525

RESUMO

Upside-down reversal of vision (UDRV) is a rare form of metamorphopsia, or visual illusions that can distort the size, shape or inclination of objects. This phenomenon is paroxysmal and transient in nature, with patients reporting a sudden inversion of vision in the coronal plane, which typically remains for seconds or minutes, though occasionally persists for hours or days, before returning to normal. Distorted egocentric orientation (ie, the patient perceives the body to be tilted away from the vertical plane) is even more rare as a co-occurring phenomenon. To the best of our knowledge, this is the first reported case of a veteran who presented with UDRV and distorted egocentric orientation during hospitalisation on an inpatient physical medicine and rehabilitation setting following an elective hip surgery. This case serves not only to document the presence of rare visual illusions, but also illustrates the importance and value of an interdisciplinary team approach.


Assuntos
Doença de Graves/diagnóstico , Ilusões , Transtornos da Percepção/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Veteranos , Transtornos da Visão/diagnóstico , Idoso , Antitireóideos/uso terapêutico , Artroplastia de Quadril , Moldes Cirúrgicos , Endocrinologia , Doença de Graves/tratamento farmacológico , Luxação do Quadril/cirurgia , Hospitais de Veteranos , Humanos , Masculino , Metimazol/uso terapêutico , Neuropsicologia , Equipe de Assistência ao Paciente , Transtornos da Percepção/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Psiquiatria , Reoperação , Transtornos da Visão/fisiopatologia
2.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509892

RESUMO

Solar retinopathy (SR) results from unprotected solar eclipse viewing and also from gazing at the sun for a long duration. It has been known for a long that direct viewing of the sun causes visual disruption. Usually, there is a disruption of the inner segment-outer segment junction, but an association of central serous chorioretinopathy (CSCR) with SR is quite rare. We report a case of CSCR associated with solar eclipse viewing.


Assuntos
Coriorretinopatia Serosa Central/diagnóstico por imagem , Luz Solar/efeitos adversos , Adulto , Antioxidantes/uso terapêutico , Fenômenos Astronômicos , Coriorretinopatia Serosa Central/tratamento farmacológico , Coriorretinopatia Serosa Central/etiologia , Coriorretinopatia Serosa Central/fisiopatologia , Humanos , Masculino , Tomografia de Coerência Óptica , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia
3.
Curr Opin Ophthalmol ; 32(2): 92-97, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443958

RESUMO

PURPOSE OF REVIEW: Perimetry remains important for the diagnosis and management of glaucoma despite advances in imaging technology. The purpose of this review is to describe advances in the acquisition and analysis of visual field data and highlight novel techniques for performing perimetry. RECENT FINDINGS: Studies have focused on improving the detection of patients at highest risk of severe vision loss and the development of innovative testing strategies that allow for more frequent testing. Artificial intelligence has been utilized in research settings to improve detection and characterization of glaucomatous field damage. Furthermore, tablet-based strategies and virtual reality headsets show promise for glaucoma screening and remote monitoring of patients with glaucoma. SUMMARY: New testing strategies and research findings have improved our ability to identify patients with both paracentral and mid-peripheral visual field progression. New strategies have the potential to make visual field testing more efficient, reliable and accessible for patients with glaucoma.


Assuntos
Glaucoma/diagnóstico , Transtornos da Visão/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , Inteligência Artificial , Progressão da Doença , Humanos , Transtornos da Visão/fisiopatologia
4.
Curr Opin Ophthalmol ; 32(2): 83-91, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33470671

RESUMO

PURPOSE OF REVIEW: The study was undertaken to assess the current importance of clinical examination of the optic nerve head (ONH) in glaucoma management. RECENT FINDINGS: ONH changes in glaucoma are easily assessed with good specificity on examination, whereas imaging has not been able to identify pallor of the neuroretinal rim (NRR), disc hemorrhages, or vascular signs of acquired cupping. Glaucomatous neuropathy in primary open angle glaucoma (POAG) has extensive databases on imaging machines, however, other glaucomas such as primary angle closure glaucoma (PACG), juvenile open angle glaucoma (JOAG), congenital, and secondary glaucomas have been reported to have a significantly different ONH morphology. Clinical evaluation with knowledge of the underlying cause of glaucoma allows easy diagnosis of any abnormality, whereas the absence of an imaging database in such eyes makes diagnosis difficult on optical coherence tomography (OCT) and so forth. In eyes with congenital anomalies and dysplastic discs, clinical examination and history provide better identification of glaucomatous damage. Staging of glaucoma on ONH examination when perimetry is unreliable provides a means of determining the amount of damage and appropriate reduction of intraocular pressure (IOP). SUMMARY: Clinical examination of the ONH is very relevant for screening, diagnosis, staging, and management of all glaucomas, and is irreplaceable in detecting nonglaucomatous causes of ONH cupping and visual field defects similar to those in glaucoma.


Assuntos
Glaucoma/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Exame Físico , Humanos , Pressão Intraocular , Tonometria Ocular , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/métodos , Campos Visuais/fisiologia
5.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318255

RESUMO

Influenza-associated encephalopathy/encephalitis (IAE) can result in serious neurological complications. We report a 4-year-old healthy female child with the diagnosis of IAE. Her clinical course was complicated by temporary visual impairment and significant motor deficits. Her unique ophthalmological findings have little precedent in previous literature.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/virologia , Influenza Humana/complicações , Transtornos da Visão/diagnóstico , Transtornos da Visão/virologia , Encéfalo/patologia , Encéfalo/virologia , Encefalopatias/fisiopatologia , Pré-Escolar , Feminino , Humanos , Vírus da Influenza B , Imagem por Ressonância Magnética , Transtornos da Visão/fisiopatologia
6.
J Stroke Cerebrovasc Dis ; 29(11): 105186, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066925

RESUMO

BACKGROUND/OBJECTIVES: Stroke-related visual impairment and atrial fibrillation are both common following stroke. This study explores whether presence of visual impairment following stroke is associated with presence of atrial fibrillation (AF). SUBJECTS/METHODS: The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Standardised visual assessments included visual acuity, reading, visual fields, eye movements and visual perception. AF and blood pressure (BP) were measured on admission. Further data capture included stroke type, age, gender, stroke severity. Analysis included descriptive statistics, independent samples analysis and multivariate analysis for comparison of AF and visual impairment against covariates. RESULTS: 1500 stroke admissions were recruited of which 1204 stroke survivors had visual assessment. New onset stroke-related visual impairment (n = 703) was significantly associated with older age and stoke severity. AF and BP data were available for 889 stroke survivors. AF was present on admission for 258 stroke survivors and significantly associated with older age, stroke severity and discharge destination. A significant association was found for presence of AF and presence of visual impairment. However, stroke severity was a contributing factor for this association. High systolic BP (>140 mmHg) was present in 62% and high diastolic BP (>90 mmHg) in 29%, but not associated with presence of visual impairment. CONCLUSIONS: AF and visual impairment, independently, occur commonly in stroke. Although our results show an association between AF and visual impairment, this appears to be independently influenced by stroke severity. AF was not associated with type of visual impairment or extent of visual recovery. It remains unknown if AF causes more severe visual impairment.


Assuntos
Fibrilação Atrial/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Transtornos da Visão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Inglaterra/epidemiologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Visão Ocular , Acuidade Visual
7.
Middle East Afr J Ophthalmol ; 27(2): 86-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874040

RESUMO

PURPOSE: An electronegative electroretinogram (ERG), defined as having a b:a wave ratio ≤1 in the scotopic flash ERG response, indicates relative inner retinal dysfunction. Causes vary depending upon the study population. In the Arabian Gulf, where inherited retinal disease is relatively prevalent, common diagnoses associated with electronegative ERGs have not been described. In this study, we report the frequency and causes of electronegative ERGs in a cohort of Emirati patients with inherited retinal disease. METHODS: A retrospective review was performed of all full-field ERGs done for Emirati patients in the Ocular Genetics Service of Cleveland Clinic Abu Dhabi from January 2017 to December 2019. Those who had an electronegative ERG in at least one eye were included in the study. RESULTS: Out of 137 patients, 9 probands (6.6%) had an electronegative ERG. The mean age at presentation was 24 years (range 5-48 years), and five patients (55.6%) were male. The final clinical diagnoses were congenital stationary night blindness (CSNB) (two TRPM1-related and one Oguchi disease), X-linked retinoschisis (XLRS) (one genetically confirmed and two not genetically tested), cone-rod dystrophy (one CRX-related and one not genetically tested), and enhanced S-cone syndrome (ESCS) (one NRL-related). The one patient who did not have bilateral electronegative ERGs was a male with XLRS whose fellow eye had an unrecordable ERG. CONCLUSIONS: In this series of Emirati patients, an electronegative ERG was most commonly associated with the inherited retinal diseases recessive CSNB and XLRS. An electronegative ERG was noted in a case of NRL-related ESCS.


Assuntos
Distrofias de Cones e Bastonetes/fisiopatologia , Eletrorretinografia , Oftalmopatias Hereditárias/fisiopatologia , Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Miopia/fisiopatologia , Cegueira Noturna/fisiopatologia , Retina/fisiopatologia , Degeneração Retiniana/fisiopatologia , Retinosquise/fisiopatologia , Transtornos da Visão/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Distrofias de Cones e Bastonetes/epidemiologia , Oftalmopatias Hereditárias/epidemiologia , Feminino , Doenças Genéticas Ligadas ao Cromossomo X/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Miopia/epidemiologia , Cegueira Noturna/epidemiologia , Degeneração Retiniana/epidemiologia , Retinosquise/epidemiologia , Estudos Retrospectivos , Emirados Árabes Unidos/epidemiologia , Transtornos da Visão/epidemiologia , Adulto Jovem
8.
J Vis Exp ; (161)2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32773761

RESUMO

Macular degeneration typically results in heterogeneous binocular central visual defects. Currently available approaches to assess central visual field, like the microperimetry, can test only one eye at a time. Therefore, they cannot explain how the defects in each eye affect the binocular interaction and real-world function. Dichoptic stimulus presentation with a gaze-controlled system could provide a reliable measure of monocular/binocular visual fields. However, dichoptic stimulus presentation and simultaneous eye-tracking are challenging because optical devices of instruments that present stimulus dichoptically (e.g., haploscope) always interfere with eye-trackers (e.g., infrared video-based eye-trackers). Therefore, the goals were 1) to develop a method for dichoptic stimulus presentation with simultaneous eye-tracking, using 3D-shutter glasses and 3D-ready monitors, that is not affected by interference and 2) to use this method to develop a protocol for assessing central visual field in subjects with central vision loss. The results showed that this setup provides a practical solution for reliably measuring eye-movements in dichoptic viewing condition. In addition, it was also demonstrated that this method can assess gaze-controlled binocular central visual field in subjects with central vision loss.


Assuntos
Movimentos Oculares/fisiologia , Visão Binocular/fisiologia , Campos Visuais/fisiologia , Adulto , Idoso , Feminino , Humanos , Degeneração Macular/fisiopatologia , Masculino , Estimulação Luminosa , Transtornos da Visão/fisiopatologia
9.
PLoS One ; 15(8): e0237796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804983

RESUMO

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.


Assuntos
Doenças do Nervo Óptico/complicações , Hemorragia Retiniana/complicações , Vasos Retinianos/patologia , Transtornos da Visão/etiologia , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Disco Óptico/diagnóstico por imagem , Disco Óptico/fisiopatologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/fisiopatologia , Retina/diagnóstico por imagem , Retina/patologia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Testes de Campo Visual/estatística & dados numéricos , Campos Visuais/fisiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-32482781
13.
Invest Ophthalmol Vis Sci ; 61(5): 24, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32416605

RESUMO

Purpose: The axial separation between the iris and the intraocular lens (IOL) in pseudophakic eyes can cause rays originating from the far temporal field to miss the IOL, resulting in negative dysphotopsia (ND). We developed an experimental model to test the hypothesis that obstruction of rays from the far temporal field can generate ND and an accompanying loss of visual sensitivity in the far temporal field. Methods: The right eyes of 10 phakic subjects were fitted with soft contact lenses containing a 5.50-mm central clear zone and a 12-mm outer diameter opaque annulus. In three of the subjects, eyes were dilated with 1% tropicamide solution, and effective aperture diameters were determined optically (pupil camera) and psychophysically (narrow beam detection). Visual field extent (Goldmann bowl) and temporal and inferotemporal meridian sensitivities (Octopus perimeter) were measured. A wide-angle model was constructed to quantify the impact of the annular opacity on retinal illuminance. Results: All 10 subjects observed a dark crescent in the far temporal and inferotemporal fields. The opaque annulus reduced effective horizontal pupil diameters from 8 mm to 5.5 mm on-axis and from >2 mm to <1 mm at 90°. Perimetry revealed a 10° reduction in temporal and inferotemporal field extent and increasing loss of sensitivity beyond 70°. The wide-angle model confirmed significant vignetting (>50% beyond 70°), approaching zero retinal illuminance beyond 85°. Conclusions: Vignetting of rays originating from the far temporal field by axially separated apertures can create symptoms mirroring perceptual reports of negative dysphotopsia in symptomatic pseudophakic patients.


Assuntos
Cristalino/fisiologia , Modelos Teóricos , Transtornos da Percepção/fisiopatologia , Transtornos da Visão/fisiopatologia , Campos Visuais/fisiologia , Adulto , Lentes de Contato Hidrofílicas , Feminino , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Midriáticos/administração & dosagem , Ajuste de Prótese , Pupila/efeitos dos fármacos , Retina/efeitos da radiação , Tropicamida/administração & dosagem , Testes de Campo Visual , Adulto Jovem
14.
Am J Ophthalmol ; 218: 304-313, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32387432

RESUMO

PURPOSE: To predict the visual field (VF) of glaucoma patients within the central 10° from optical coherence tomography (OCT) measurements using deep learning and tensor regression. DESIGN: Cross-sectional study. METHODS: Humphrey 10-2 VFs and OCT measurements were carried out in 505 eyes of 304 glaucoma patients and 86 eyes of 43 normal subjects. VF sensitivity at each test point was predicted from OCT-measured thicknesses of macular ganglion cell layer + inner plexiform layer, retinal nerve fiber layer, and outer segment + retinal pigment epithelium. Two convolutional neural network (CNN) models were generated: (1) CNN-PR, which simply connects the output of the CNN to each VF test point; and (2) CNN-TR, which connects the output of the CNN to each VF test point using tensor regression. Prediction performance was assessed using 5-fold cross-validation through the root mean squared error (RMSE). For comparison, RMSE values were also calculated using multiple linear regression (MLR) and support vector regression (SVR). In addition, the absolute prediction error for predicting mean sensitivity in the whole VF was analyzed. RESULTS: RMSE with the CNN-TR model averaged 6.32 ± 3.76 (mean ± standard deviation) dB. Significantly (P < .05) larger RMSEs were obtained with other models: CNN-PR (6.76 ± 3.86 dB), SVR (7.18 ± 3.87 dB), and MLR (8.56 ± 3.69 dB). The absolute mean prediction error for the whole VF was 2.72 ± 2.60 dB with the CNN-TR model. CONCLUSION: The Humphrey 10-2 VF can be predicted from OCT-measured retinal layer thicknesses using deep learning and tensor regression.


Assuntos
Aprendizado Profundo , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico por imagem , Campos Visuais/fisiologia , Adulto , Idoso , Comprimento Axial do Olho , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/fisiopatologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Microscopia com Lâmpada de Fenda , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Testes de Campo Visual
15.
PLoS One ; 15(5): e0232758, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384099

RESUMO

This study investigated postoperative changes in metamorphopsia and aniseikonia in eyes that underwent vitrectomy for epiretinal membrane (ERM), macular hole (MH), or rhegmatogenous retinal detachment (RRD). In total, 166 eyes were included from 166 patients with ERM, MH, or RRD who underwent primary vitrectomy. Metamorphopsia and aniseikonia were quantified by M-CHARTS and the New Aniseikonia Test (NAT). Best-corrected visual acuity (BCVA), M-CHARTS, NAT assessments, and OCT examination were performed at 1, 3, and 6 months postoperatively. Of the 166 eyes, 65 had ERM, 21 had MH, 42 had macula-off RRD, and 38 had macula-on RRD. BCVA improved significantly between 1 and 6 months postoperatively in eyes with ERM, MH, and macula-off RRD (P = 0.0057, P = 0.0065, and P = 0.0021, respectively). M-CHARTS scores at 1 month postoperatively significantly decreased in eyes with ERM (P = 0.0034) and tended to decrease in eyes with MH (P = 0.068). NAT scores did not change between baseline and 1 month postoperatively in eyes with ERM or MH. Between 1 and 6 months postoperatively, M-CHARTS and NAT scores significantly decreased in eyes with macula-off RRD (P = 0.0064 and P = 0.0009, respectively), but not in eyes with ERM, MH, or macula-on RRD. At 6 months postoperatively, significant metamorphopsia was evident in 33.3% of eyes with ERM, 29.2% of eyes with MH, and 35.7% of eyes with macula-off RRD; 61.5% of eyes with ERM showed macropsia and 52.3% of eyes with macula-off RRD showed micropsia. In eyes with ERM, more central retinal thickness (CRT) correlated with postoperative BCVA, and deep retinal folds on enface OCT image correlated with postoperative metamorphopsia. In eyes with macula-off RRD, less CRT correlated with postoperative BCVA, and tended to correlate with postoperative micropsia. Macular morphologies could contribute to differences in postoperative visual acuity, metamorphopsia, and aniseikonia.


Assuntos
Aniseiconia/etiologia , Membrana Epirretiniana/cirurgia , Macula Lutea/cirurgia , Descolamento Retiniano/cirurgia , Transtornos da Visão/etiologia , Vitrectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aniseiconia/diagnóstico por imagem , Aniseiconia/fisiopatologia , Membrana Epirretiniana/diagnóstico por imagem , Membrana Epirretiniana/fisiopatologia , Feminino , Humanos , Macula Lutea/diagnóstico por imagem , Macula Lutea/fisiopatologia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico por imagem , Descolamento Retiniano/fisiopatologia , Fatores de Tempo , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/fisiopatologia , Acuidade Visual , Adulto Jovem
16.
Phys Ther ; 100(9): 1582-1594, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32367131

RESUMO

OBJECTIVE: Patients with bilateral vestibulopathy (BVP) have severe balance deficits, but it is unclear which balance measures are best suited to quantify their deficits and approximate the diversity of their self-reports. The purpose of this study was to explore measures of balance control for quantifying the performance of patients with BVP related to different balance domains, allowing targeted assessment of response to intervention. METHODS: MEDLINE, Web of Science, and Embase were systematically searched on October 9, 2019. The Scottish Intercollegiate Guidelines Network checklist for case-control studies was applied to assess each individual study's risk of bias. Standardized mean differences (SMD) were calculated based on the extracted numeric data and reported according to the type of sensory perturbation in the balance tasks. RESULTS: Twelve studies (1.3%) met the eligibility criteria and were analyzed, including data of 176 patients with BVP, 196 patients with unilateral vestibulopathy, and 205 healthy controls between 18 and 92 years old. In general, patients with BVP were either unable to maintain (or had reduced) balance during tasks with multisensory perturbations compared with healthy controls (range of mean SMD = 1.52-6.92) and patients with unilateral vestibulopathy (range of absolute mean SMD = 0.86-1.66). CONCLUSIONS: During clinical assessment to quantify balance control in patients with BVP, tasks involving multisensory perturbations should be implemented in the test protocol. IMPACT: As patients with BVP show difficulties with movement strategies, control of dynamics, orientation in space, and cognitive processing, clinicians should implement these aspects of balance control in their assessment protocol to fully comprehend the balance deficits in these patients.


Assuntos
Vestibulopatia Bilateral/fisiopatologia , Equilíbrio Postural/fisiologia , Transtornos das Sensações/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Viés , Vestibulopatia Bilateral/etiologia , Feminino , Análise da Marcha/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Visão/fisiopatologia , Adulto Jovem
17.
Doc Ophthalmol ; 141(3): 313-318, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32472235

RESUMO

PURPOSE: To report a case of melanoma-associated retinopathy (MAR) with autoantibodies against the transient receptor potential cation channel, subfamily M, member 1 (TRPM1) with asymmetric severe vision loss. METHODS: We evaluated a patient with heel skin melanoma showing progressive vision loss in both eyes confirmed with a baseline ophthalmic examination, fluorescein angiography, spectral domain optical coherence tomography (OCT), visual field test, and full-field electroretinogram (ERG). Immunofluorescence assays and western blot analysis revealed autoantibodies in the patient's serum. RESULTS: The patient's best-corrected visual acuities were 20/50 in the right eye and hand motion in the left eye. Visual field test showed severely depressed visual fields especially in the left eye. Fluorescein angiography and OCT revealed extrafoveal choroidal neovascularization in the left eye. The patient had an electronegative ERG, suggesting MAR, and autoantibodies against TRPM1 and aldolase C were detected in the patient's blood sample. CONCLUSIONS: The clinical features of MAR patients with positive anti-TRPM1 autoantibodies can be manifested as severe vision loss, and the identification of autoantibodies can be helpful for confirming the diagnosis.


Assuntos
Autoanticorpos/sangue , Melanoma/imunologia , Síndromes Paraneoplásicas Oculares/imunologia , Retina/fisiopatologia , Neoplasias Cutâneas/imunologia , Canais de Cátion TRPM/imunologia , Transtornos da Visão/fisiopatologia , Western Blotting , Eletrorretinografia , Angiofluoresceinografia , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Síndromes Paraneoplásicas Oculares/patologia , Neoplasias Cutâneas/patologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
18.
Sci Rep ; 10(1): 8482, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439862

RESUMO

The Paralympic classification system for visual impairment only assesses static visual acuity and static visual field despite many Paralympic sports being dynamic in nature. As a first step towards determining whether motion perception tests should be used in Paralympic classification, we assessed whether motion coherence thresholds could be measured when visual acuity or visual fields were impaired at levels consistent with the current Paralympic classification criteria. Visual acuity and visual field impairments corresponding to Paralympic classification criteria were simulated in normally sighted individuals and motion coherence thresholds were measured. Mild-to-moderate visual acuity impairments had no effect on motion coherence thresholds. The most severe Paralympic class of acuity impairment (≥2.6 logMAR) significantly elevated thresholds. A trend towards superior motion coherence thresholds in the peripheral visual field compared to the central visual field was also present. Global motion perception appears to be measurable under simulated visual impairments that are consistent with the Paralympic classification. Poorer global motion perception was found for visual acuities >2.6 logMAR and visual fields <10° in diameter. Further research is needed to investigate the relationship between global motion perception and sports performance in athletes with real visual impairment.


Assuntos
Desempenho Atlético/estatística & dados numéricos , Simulação por Computador , Movimentos Oculares/fisiologia , Percepção de Movimento , Paratletas , Esportes para Pessoas com Deficiência/normas , Transtornos da Visão/fisiopatologia , Adolescente , Adulto , Humanos , Esportes para Pessoas com Deficiência/classificação , Campos Visuais , Adulto Jovem
19.
PLoS One ; 15(4): e0231748, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298375

RESUMO

The purpose of the study was to evaluate the diagnostic accuracy of visual function tests in intermediate age-related macular degeneration (iAMD). A total of 62 subjects (38 patients with iAMD and 24 controls) were included and underwent several functional assessments: Best-corrected visual acuity (BCVA), low luminance visual acuity (LLVA), visual acuity (VA) measured with the Moorfields Vanishing Optotypes Acuity Charts (MAC), contrast sensitivity with the Pelli-Robson test, reading speed using the International Reading Speed texts (IReST) and mesopic and dark-adapted microperimetry (S-MAIA, CenterVue, Padova, Italy). Groups were compared using non-parametric Wilcoxon rank sum tests and ROC analyses. Linear regression was used to control for confounding. Results showed that all visual function test performances except the IReST were significantly reduced in iAMD patients compared to controls (p < 0.05). These effects did not alter after controlling for age and sex. Best discrimination between iAMD and controls yield the combination of LLVA and contrast sensitivity as well as MAC-VA and contrast sensitivity (ROC area under the curve 0.95 and 0.93, respectively). Our results suggest that LLVA, MAC-VA, contrast sensitivity and mesopic and dark-adapted microperimetry can capture visual impairment characteristic for iAMD. Best discrimination against iAMD is achieved with a combination of two tests.


Assuntos
Degeneração Macular/fisiopatologia , Transtornos da Visão/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Sensibilidades de Contraste , Estudos Transversais , Adaptação à Escuridão , Feminino , Humanos , Luz , Modelos Lineares , Degeneração Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Transtornos da Visão/fisiopatologia , Testes Visuais/estatística & dados numéricos , Testes de Campo Visual
20.
Am J Ophthalmol ; 216: 44-54, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32224104

RESUMO

PURPOSE: To determine the change in global and regional Humphrey visual fields (VF) after glaucoma drainage device (GDD) implantation over a 3-year follow-up period. DESIGN: Retrospective interventional case series. METHODS: Patients undergoing GDD placement from between 2010 and 2015 with reliable preoperative and yearly postoperative VF measurements were included. Clinical parameters were compared between preoperative and follow-up visits, including visual acuity, intraocular pressure (IOP), number of glaucoma medications, global VF metrics (mean deviation [MD]), pattern standard deviation (PSD), CIGTS (Collaborative Initial Glaucoma Treatment Study) score of total deviation probability (CIGTS_TDP) and pattern deviation probability (CIGTS_PDP), and regional metrics (regional total deviation (TD), regional pattern deviation (PD), and regional CIGTS_TDP and CIGTS_PDP). Multivariate regression analyses were performed to determine risk factors for VF worsening after GDD surgery. RESULTS: A total of 106 eyes from 95 patients were included. Mean IOP ± SD was reduced from 23.1 ± 8.5 mm Hg to 12.7 ± 3.1 mm Hg at 3-year follow-up (P < .001). MD, PSD, and global CIGTS_PDP showed no significant changes in follow-up, whereas global CIGTS_TDP showed mild progression from 10.7 to 12.8 at 3-year follow-up (P = .01). No regional metrics showed worsening at follow-up examinations. Defects in the superior hemifield were more common than in the inferior hemifield at baseline and follow-up examinations for all regional metrics. Pre-operative number of glaucoma medications was associated with worsening on CIGTS_TDP. CONCLUSIONS: Overall, GDD surgery is effective at stabilizing VF function over 3 years of follow-up. The superior hemifield is affected more than other regions. The number of pre-operative glaucoma medications is associated with mild VF progression, measured by CIGTS_TDP.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Implantação de Prótese , Campos Visuais/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia
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