Purpose: To document the magnitude of any learning effect for short-wave length automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard...Purpose: To document the magnitude of any learning effect for short-wave length automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard automated perimetry (SAP). Design: Experimental study. Participants: Thirty-five patients (22 with OHT and 13 with OAG) who had previously undergone at least 3 threshold SAP visual field examinations with the Humphrey Field Analyzer (HFA; Carl Zeiss Meditech Inc.,Dublin,CA),and 9 patients with OHT who had not previously undertaken any form of perimetry. Methods: Each patient attended for SWAP on 5 occasions,each separated by 1 week. At each visit,both eyes were examined using Program 24-2 of the HFA; the right eye was always examined before the left eye. Main Outcome Measures: (1) Change over the 5 examinations,in each eye,of the visual field indices Mean Deviation (MD),Short-term Fluctuation (SF),Pattern Standard Deviation (PSD),and Corrected Pattern Standard Deviation. (2) Change in each eye between Visits 1 and 5 in proportionate Mean Sensitivity (pMS) for the central annulus of stimulus locations compared with that for the peripheral annulus thereby determining the influence of stimulus eccentricity on any alteration in sensitivity. (3) Change between Visits 1 and 5 in the number and magnitude of the Pattern Deviation (PD) probability levels associated with any alteration in sensitivity. Results: The MD,SF,and PSD each improved over the 5 examinations (each at P< 0.001). The improvement in pMS between Visits 1 and 5 was greater for the peripheral annulus than for the central annulus by approximately two fold for the patients with OAG. Considerable variation was present between patients,within and between groups,in the number of locations exhibiting an improving sensitivity between Visits 1 and 5 by 1 or more PD probability levels. Conclusions: Care should be taken to ensure that,during the initial examinations,apparent field loss with SWAP in patients exhibiting a normal field by SAP is not the result of inexperience in SWAP. Apparently deeper or wider field loss in the initial examinations with SWAP compared with that exhibited by SAP in OAG also may arise from inexperience in SWAP.展开更多
PURPOSE. To assess systemic and ocular vascular reactivity in response to warm and cold provocation in untreated patients with primary open-angle glaucoma an d normal control subjects. METHODS. Twenty-four patients wi...PURPOSE. To assess systemic and ocular vascular reactivity in response to warm and cold provocation in untreated patients with primary open-angle glaucoma an d normal control subjects. METHODS. Twenty-four patients with primary openangle glaucoma and 22 normal control subjects were subjected to a modified cold press or test involving immersion of the right hand in 40°C warm water followed by 4 °C cold water exposure, and finger and ocular blood flow were assessed by means of peripheral laser Doppler flowmetry and retinal flowmetry, respectively. Fing er and body temperature as well as intraocular pressure, systemic blood pressure , systemic pulse pressure, heart rate, and ocular perfusion pressure were also m onitored. RESULTS. The patients with glaucoma demonstrated an increase in diasto lic blood pressure (P=0.023), heart rate (P=0.010), and mean ocular perfusion pr essure (P=0.039) during immersion of the tested hand in 40°C water. During cold provocation, the patients demonstrated a significant decrease in finger (P=0.00 03) and ocular blood flow (the parameter velocity measured at the temporal neuro retinal rim area; P=0.021). Normal subjects did not demonstrate any blood flow o r finger temperature changes during immersion of the tested hand in 40°C water (P >0.05); however, they exhibited increases in systolic blood pressure (P=0.034 ) and pulse pressure (P= 0.0009) and a decrease in finger blood flow (P=0.0001) during cold provocation. In normal subjects, the ocular blood flow was unchanged during high and low temperature challenge. CONCLUSIONS. Cold provocation elicit s a different blood pressure, and ocular blood flow response in patients with pr imary open-angle glaucoma compared with control subjects. These findings sugges t a systemic autonomic failure and ocular vascular dysregulation in POAG patient s.展开更多
文摘Purpose: To document the magnitude of any learning effect for short-wave length automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard automated perimetry (SAP). Design: Experimental study. Participants: Thirty-five patients (22 with OHT and 13 with OAG) who had previously undergone at least 3 threshold SAP visual field examinations with the Humphrey Field Analyzer (HFA; Carl Zeiss Meditech Inc.,Dublin,CA),and 9 patients with OHT who had not previously undertaken any form of perimetry. Methods: Each patient attended for SWAP on 5 occasions,each separated by 1 week. At each visit,both eyes were examined using Program 24-2 of the HFA; the right eye was always examined before the left eye. Main Outcome Measures: (1) Change over the 5 examinations,in each eye,of the visual field indices Mean Deviation (MD),Short-term Fluctuation (SF),Pattern Standard Deviation (PSD),and Corrected Pattern Standard Deviation. (2) Change in each eye between Visits 1 and 5 in proportionate Mean Sensitivity (pMS) for the central annulus of stimulus locations compared with that for the peripheral annulus thereby determining the influence of stimulus eccentricity on any alteration in sensitivity. (3) Change between Visits 1 and 5 in the number and magnitude of the Pattern Deviation (PD) probability levels associated with any alteration in sensitivity. Results: The MD,SF,and PSD each improved over the 5 examinations (each at P< 0.001). The improvement in pMS between Visits 1 and 5 was greater for the peripheral annulus than for the central annulus by approximately two fold for the patients with OAG. Considerable variation was present between patients,within and between groups,in the number of locations exhibiting an improving sensitivity between Visits 1 and 5 by 1 or more PD probability levels. Conclusions: Care should be taken to ensure that,during the initial examinations,apparent field loss with SWAP in patients exhibiting a normal field by SAP is not the result of inexperience in SWAP. Apparently deeper or wider field loss in the initial examinations with SWAP compared with that exhibited by SAP in OAG also may arise from inexperience in SWAP.
文摘PURPOSE. To assess systemic and ocular vascular reactivity in response to warm and cold provocation in untreated patients with primary open-angle glaucoma an d normal control subjects. METHODS. Twenty-four patients with primary openangle glaucoma and 22 normal control subjects were subjected to a modified cold press or test involving immersion of the right hand in 40°C warm water followed by 4 °C cold water exposure, and finger and ocular blood flow were assessed by means of peripheral laser Doppler flowmetry and retinal flowmetry, respectively. Fing er and body temperature as well as intraocular pressure, systemic blood pressure , systemic pulse pressure, heart rate, and ocular perfusion pressure were also m onitored. RESULTS. The patients with glaucoma demonstrated an increase in diasto lic blood pressure (P=0.023), heart rate (P=0.010), and mean ocular perfusion pr essure (P=0.039) during immersion of the tested hand in 40°C water. During cold provocation, the patients demonstrated a significant decrease in finger (P=0.00 03) and ocular blood flow (the parameter velocity measured at the temporal neuro retinal rim area; P=0.021). Normal subjects did not demonstrate any blood flow o r finger temperature changes during immersion of the tested hand in 40°C water (P >0.05); however, they exhibited increases in systolic blood pressure (P=0.034 ) and pulse pressure (P= 0.0009) and a decrease in finger blood flow (P=0.0001) during cold provocation. In normal subjects, the ocular blood flow was unchanged during high and low temperature challenge. CONCLUSIONS. Cold provocation elicit s a different blood pressure, and ocular blood flow response in patients with pr imary open-angle glaucoma compared with control subjects. These findings sugges t a systemic autonomic failure and ocular vascular dysregulation in POAG patient s.
