Search

AIM: To evaluate visual field of the unilateral visually impaired applicants by a custom program test of Humphrey perimeter, which was indispensable for car driving.METHODS: A retrospective study was performed. The process of a custom defined Humphrey ‘1 EYE Screening' program was set covers field region from temporal 90° to nasal 60°, and over 30° vertically away from the horizontal line. The candidates were qualified eligibility by range of visual field and reliability of the results. This study conducted statistics on the applicants who fulfilled the test from July 1st, 2016 to June 30th, 2017, and compared the impact factors of the pass rate.RESULTS: After excluding repeated measurement reports, this study included 618 subjects, the most common causes of these eyes impaired were ocular trauma(49.7%)and unhealed amblyopia(29.3%). A total of 497 candidates(80.4%)passed the test. 85 of the 121 failure cases(70.2%)were due to a limitation of the nasal visual field(less than 60°), and 12 cases were failed by fixation loss because of nystagmus or poor cooperation. Compared with the test failure group, the subjects in the passing group are older, the average correct response points is more, and the average test time is shorter, all with statistically significant differences(P2=7.264, P=0.007).CONCLUSION: The custom program ‘1 EYE Screening' of Humphrey perimetry can be used to qualify eligibility of driving for unilateral visual impaired applicants. In order to prevent peripheral interfering from eye frames, corneal contact lenses were recommended for applicants with refractive errors.

Yumi Kotoda, 1 Masakazu Kotoda, 2 Masakazu Ogiwara, 3 Hiroyuki Kinouchi, 3 Hiroyuki Iijima 1 1Department of Ophthalmology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan; 2Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan; 3Department of Neurosurgery, University of Yamanashi, Chuo, Yamanashi 409-3898, JapanCorrespondence: Yumi Kotoda 1110 Shimokato, Chuo, Yamanashi 409-3898, JapanTel +81-55-273-9657Fax +81-55-273-6757Email ykanai@yamanashi.ac.jpPurpose: The purpose of this study was to quantitatively investigate light sensitivity asymmetry both between left and right eyes and between upper and lower quadrant in the 30-degree visual field of patients with visual field defects caused by pituitary adenoma.Patients and Methods: Preoperative Humphrey 30– 2 perimetry results were reviewed retrospectively using the charts of 28 pituitary adenoma patients who underwent surgery. Inter-eye light sensitivity comparisons of the temporal and nasal hemifields between the left and right eyes were conducted in each patient to study left-right asymmetry. Upper-lower asymmetry was investigated by comparing the frequency of severe scotoma (light sensitivity 5 dB or less) in the upper and lower visual field quadrants in the temporal and nasal hemifields.Results: Left-right asymmetry was demonstrated in 61% of cases in the temporal hemifield and in 57% of cases in the nasal hemifield. Severe scotoma test points were investigated in the worse eye of each patient and were more frequent in the superotemporal quadrant of the visual field compared with the inferotemporal quadrant (P = 0.00029) and in the inferonasal quadrant compared to the superonasal quadrant (P = 0.00268).Conclusion: Asymmetric visual field defects between left and right eyes are common in patients with pituitary adenoma. Severe scotoma is more frequent in the upper quadrant of the temporal hemifield and in the lower quadrant of the nasal hemifield.Keywords: bitemporal hemianopsia, pituitary adenoma, asymmetry, Humphrey perimetry, light sensitivity

Kyoichi Mizumoto,1 Masahiko Gosho,2 Masayoshi Iwaki,1 Masahiro Zako3 1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 3Department of Ophthalmology, Asai Hospital, Seto, Aichi, Japan Purpose: Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. Patients and methods: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Peri­operative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. Results: The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly. Conclusion: No significant disorders in ocular structural and functional parameters were found until long after RALP. Keywords: retinal nerve fiber layer, spectral domain optical coherence tomography, steep Trendelenburg position, Humphrey perimetry, robotic-assisted laparoscopic radical prostatectomy

Purpose: To study the reduction in light sensitivity in areas where impaired retinal perfusion was established by fluorescein angiogram (FA) in eyes with branch retinal vein occlusion (BRVO) that recovered from retinal edema and hemorrhage.Design: Retrospective observational case series.Methods: A study of the reduction in light sensitivity demonstrated by total deviation display of the Humphrey perimetry program 30-2 in 43 eyes from 42 patients with BRVO, whose perfusion status was assessed by FA images taken at least 6 months after disease onset. Each of the 15 retinal squares in the FA images, corresponding to the 15 Humphrey test points around the fixation point in the affected vertical hemisphere, was classified as either perfused, partially perfused, or non-perfused. Correlation between light sensitivity and perfusion status was investigated by three evaluators in a total of 645 squares, 15 squares from each of the 43 subject eyes.Results: In 459 retinal squares (71.2%) with complete agreement on the perfusion status among the three evaluators, light sensitivity was significantly different among retinal squares of perfused (median: − 4.0 dB, n = 258), partially perfused (median: − 8.0 dB, n = 41), and non-perfused (median: − 16.0 dB, n = 160) (P < .000001, Kruskal-Wallis test).Conclusions: Light sensitivity is decreased in retinal areas exhibiting impaired perfusion, likely due to neuronal loss in the inner retinal layer in eyes with chronic BRVO. [ABSTRACT FROM AUTHOR]

Purpose: To determine visual field defects (VFDs) using methods of varying complexity and compare results with subjective symptoms in a population of newly operated temporal lobe epilepsy patients.Methods: Forty patients were included in the study. Two patients failed to perform VFD testing. Humphrey Field Analyzer (HFA) perimetry was used as the gold standard test to detect VFDs. All patients performed a web-based visual field test called Damato Multifixation Campimetry Online (DMCO). A bedside confrontation visual field examination ad modum Donders was extracted from the medical records in 27/38 patients. All participants had a consultation by an ophthalmologist. A questionnaire described the subjective complaints.Reults: A VFD in the upper quadrant was demonstrated with HFA in 29 (76%) of the 38 patients after surgery. In 27 patients tested ad modum Donders, the sensitivity of detecting a VFD was 13%. Eight patients (21%) had a severe VFD similar to a quadrant anopia, thus, questioning their permission to drive a car. In this group of patients, a VFD was demonstrated in one of five (sensitivity=20%) ad modum Donders and in seven of eight (sensitivity=88%) with DMCO. Subjective symptoms were only reported by 28% of the patients with a VFD and in two of eight (sensitivity=25%) with a severe VFD. Most patients (86%) considered VFD information mandatory.Conclusion: VFD continue to be a frequent adverse event after epilepsy surgery in the medial temporal lobe and may affect the permission to drive a car in at least one in five patients. Subjective symptoms and bedside visual field testing ad modum Donders are not sensitive to detect even a severe VFD. Newly developed web-based visual field test methods appear sensitive to detect a severe VFD but perimetry remains the golden standard for determining if visual standards for driving is fulfilled. Patients consider VFD information as mandatory. [ABSTRACT FROM AUTHOR]

Purpose: Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. Patients and methods: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Perioperative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. Results: The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly. Conclusion: No significant disorders in ocular structural and functional parameters were found until long after RALP. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether postoperative light sensitivity recovers completely to the level prior to the development of rhegmatogenous retinal detachment (RRD) after successful surgery. Methods: We retrospectively studied 44 eyes of 44 patients with RRD who were successfully operated and who underwent Humphrey central 30-2 perimetry postoperatively. The averaged total deviation in Humphrey perimetry in the reattached retina was compared with that of the horizontal or vertical counterpart in the preoperatively non-detached retina. Results: The averaged total deviation in the reattached retina was significantly lower than in its counterpart (p < 0.0001). The averaged residual loss of light sensitivity did not correlate with postoperative visual acuity (p = 0.8047) or with its change (p = 0.1242). Conclusions: Light sensitivity in the detached retina in eyes with RRD does not completely recover after successful surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the potential use of mfERG as an objective functional test that can express inner and outer retinal changes during the early stages of glaucoma. Methods: One hundred and twenty-six eyes of 126 patients were included. There were 30 healthy (Group 1), 28 glaucoma suspect (Group 2), 48 early glaucoma (Group 3), and 20 advanced glaucoma cases (Group 4). After complete ophthalmic examination, Humphrey visual field analysis and mfERG were performed. These examinations were performed three times at 6-month intervals, and only the last examination results were used for the analysis. Visual fields global indices and mfERG implicit time and amplitudes were evaluated and analyzed by ring system (central 5°, 5°-10°, 10°-15° and >15°). One-way ANOVA and ROC curve analysis were used for statistical analysis. Results: There was no statistically (one-way ANOVA) significant differences in patient age between groups ( p = 0.126). For all rings, we detected statistically significant differences for the mean implicit time (latency) of the N1, P1, and N2 components between the advanced glaucoma and control subjects and between the advanced glaucoma and glaucoma suspects. The N2 amplitudes were significantly decreased in all rings in the advanced glaucoma patients when compared with control subjects. The N2 amplitude was significantly different between healthy subjects (Group 1) and early glaucoma subjects (Group 3) in the central 2° and 2°-5° rings. We used MedClac ROC curve analysis to identify the best parameters for discriminating between control subjects (Group 1) and early glaucoma patients (Group 3). The N2 implicit time for the central 2° ring ( p < 0.0001), N2 amplitude for the central 2° ring ( p = 0.0001), P1 implicit time for the 2°-5° ring ( p = 0.0001), N2 implicit time for the 2°-5° ring ( p = 0.0003), and N2 amplitude for the 2°-5° ring ( p = 0.001) had ≥0.7 AUC values and were the best parameters in the ROC curve analyses that included the VFA parameters Conclusion: Alterations of amplitudes and implicit times of N2 response in the central area may be able to detect glaucoma earlier than VFA. In addition, with progression to advanced glaucoma these changes can be significant in all retinal areas. Although implicit times of all mfERG components are significantly delayed in glaucoma, both delayed implicit time and decreased amplitude of N2 wave in the central area are effective predictors in early glaucoma diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the various perimetric parameters that best predict reduction of best-corrected visual acuity (BCVA) to worse than 0.5 in the near future in eyes with retinitis pigmentosa (RP). Methods: The most recent records obtained by Humphrey Field Analyzer (HFA) central 10-2 perimetry were studied for the right eyes of 123 patients (60 men and 63 women) with typical RP. The correlation between various parameters of perimetric sensitivity and BCVA was retrospectively studied. The receiver operating characteristic (ROC) curves were used to find the best parameter to discriminate eyes with BCVA ≥0.5 from those with BCVA <0.5. Results: Spearman rank correlation coefficients with logMAR BCVA were the highest for the foveal threshold (FT) and mean sensitivity of the test points within 1.4° of the fixation point (MS1.4). The ROC curve analysis revealed that the area under the curve was the largest for the MS1.4 among all the perimetric parameters for discriminating eyes with BCVA ≥0.5 from those with BCVA <0.5. The cutoff value of 30 dB showed 100 % specificity and 57 % sensitivity. Conclusions: The risk of vision decreasing below 0.5 in the near future may be predicted when the mean sensitivity within 1.4° of the fixation point in the HFA 10-2 reaches 30 dB in eyes with RP. [ABSTRACT FROM AUTHOR]

Purpose: To study the relationship between foveal sensitivity and visual acuity in eyes with macular disorders exhibiting macular thickening. Methods: We studied the relationship between foveal sensitivity, obtained as the 'foveal threshold' by use of Humphrey perimetry, and best-corrected visual acuity, converted to the logarithm of the minimum angle of resolution (logMAR), for 117 eyes with epiretinal membrane (ERM), 197 eyes with retinal vein occlusion associated with macular edema (RVOME), and 158 eyes with central serous chorioretinopathy (CSC). Results: Foveal sensitivity and logMAR correlated significantly for the eyes with ERM, RVOME, and CSC. Although mean foveal sensitivity was no different among the three diseases, mean logMAR was lower in eyes with CSC, i.e., visual acuity was better, than in those with ERM or RVOME ( P < 0.001). Conclusions: Light sense (foveal sensitivity) is related to spatial resolution (logMAR) at the center of the fovea, in eyes with ERM, RVOME, and CSC at different strengths depending on the disease. Less pronounced reduction of visual acuity compared with foveal sensitivity in eyes with CSC could explain the tendency of these patients to complain of dimness rather than acuity loss. [ABSTRACT FROM AUTHOR]

Purpose: To determine the best clinical measures of visual sensitivity for monitoring disease progression in eyes with retinitis pigmentosa (RP). Methods: This survey retrospectively studied results from the Humphrey perimetry central 10-2 program for 123 eyes with RP with regard to the correlation between years affected by RP and clinical measures of visual dysfunction, including mean deviation (MD), average sensitivity of 12 test points (CENT12), average sensitivity of 4 central points (CEN4), foveal threshold (FT), and logarithm of the minimum angle of resolution (LogMAR). Results: All these value correlated more highly with years of symptoms ( P < 0.001 for all) than with years since diagnosis. The correlation coefficient with years of symptoms decreased in the order MD, CENT12, CENT4, FT, and LogMAR. The order differed for a subset of 66 eyes with advanced RP having −15 dB or lower MD, and decreased in the order FT, CENT4, LogMAR and CENT12. Conclusion: Progression in eyes with RP could be well assessed by use of the MD of the Humphrey central 10-2 program in general and by use of FT, CENT4, and CENT12 in cases of advanced RP. [ABSTRACT FROM AUTHOR]