Blue-on-yellow perimetry and corneal thickness in patients with ocular hypertension

AIM: To evaluate the frequency of blue-on-yellow perimetry (B/YP) deficits in ocular hypertension (OHT) patients and to correlate these findings with central corneal thickness (CCT), and to investigate the influence of age, refraction and gender on the B/YP results in OHT patients. METHODS: The B/YP and CCT were checked respectively in 72 OHT patients with normal white-on-white perimetry (W/WP) and normal optic nerve head. The B/YP was tested by Octopus 101 automated perimetry using G2 strategy, while the CCT was checked with DGH-550 ultrasound pachymeter. All patients were chosen randomly one eye for statistical analysis, a binary regression model was used to determine the independent contribution of variables included in the model, and the differences of the intraocular pressure (TOP), CCT, age, refraction and gender between the normal B/YP group and abnormal B/YP group were compared. RESULTS: Forty-nine out of 72 patients with OHT showed normal B/YP results, whereas 23 of 72 patients (31.9%) demonstrated abnormal B/YP results. CCT showed a correlation with the B/YP results (B=-0.038, SE=0.019, P=0.044), whereas none of the TOP, age, refraction and gender was found to be correlated with the B/YP results. The mean CCT in OHT patients with abnormal B/YP group was lower than that with normal B/YP group (t=2.066, P=0.043). There was a significant positive correlation between TOP and CCT (R(2)=0.513, P=0.000). CONCLUSION: The mean CCT in OHT patients with abnormal B/YP results was lower than that with normal B/YP results. There was a significant positive correlation between TOP and CCT in OHT patients. The age, refraction and gender didn't influence the B/YP results in OHT patients.

Comparison of isolated-check visual evoked potential and standard automated perimetry in early glaucoma and high-risk ocular hypertension

AIM：To compare the diagnostic performance of isolatedcheck visual evoked potential（ic VEP） and standard automated perimetry（SAP）,for evaluating the application values of ic VEP in the detection of early glaucoma.METHODS：Totally 144 subjects（288 eyes） were enrolled in this study.ic VEP testing was performed with the Neucodia visual electrophysiological diagnostic system.A 15% positive-contrast（bright） condition pattern was used in this device to differentiate between glaucoma patients and healthy control subjects.Signal-to-noise ratios（SNR） were derived based on a multivariate statistic.The eyes were judged as abnormal if the test yielded an SNR≤1.SAP testing was performed with the Humphrey Field Analyzer II.The visual fields were deemed as abnormality if the glaucoma hemifield test results outside normal limits;or the pattern standard deviation with P〈0.05;or the cluster of three or more non-edge points on the pattern deviation plot in a single hemifield with P〈0.05,one of which must have a P〈0.01.Disc photographs were graded as either glaucomatous optic neuropathy or normal by two experts who were masked to all other patient information.Moorfields regression analysis（MRA） used as a separate diagnostic classification was performed by Heidelberg retina tomograph（HRT）.RESULTS：When the disc photograph grader was used as diagnostic standard,the sensitivity for SAP and ic VEP was 32.3% and 38.5% respectively and specificity was 82.3% and 77.8% respectively.When the MRA Classifier was used as the diagnostic standard,the sensitivity for SAP and ic VEP was 48.6% and 51.4% respectively and specificity was 84.1% and 78.0% respectively.When the combined structural assessment was used as the diagnostic standard,the sensitivity for SAP and ic VEP was 59.2%and 53.1% respectively and specificity was 84.2% and 84.6% respectivlely.There was no statistical significance between the sensitivity or specificity of SAP and ic VEP,regardless of which diagnostic standard was based on.CONCLUSION：The diagnostic performance of ic VEP is not better than that of SAP in the detection of early glaucoma.

Relationship between short-wavelength automatic perimetry and Heidelberg retina tomograph parameters in eyes with ocular hypertension

AIMTo compare and correlate optic nerve head parameters obtained by Heidelberg retina tomograph (HRT) with short-wavelength automatic perimetry (SWAP) indices in eyes with ocular hypertension (OHT).METHODSOne hundred and forty-six patients with OHT included in the present study. All subjects had reliable SWAP and HRT measurements performed within a 2wk period. The eyes were classified as normal/abnormal according to visual field criteria and Moorfields regression analysis (MRA). Correlations between visual field indices and HRT parameters were analyzed using Pearson correlation coefficient (r).RESULTSTwenty-nine eyes (19.9%) had SWAP defects. Twenty-nine eyes (19.9%) were classified as abnormal according to global MRA. Six eyes (4.1%) had abnormal global MRA and SWAP defects. The k statistic is 0.116 (P=0.12) indicating a very poor agreement between the methods. No statistical significant correlation between HRT and SWAP parameters was detected.CONCLUSIONSWAP defects may coexist with abnormalities of optic disc detected by HRT in eyes with OHT. In most eyes, however, the two methods detect different glaucoma properties.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

AIM：To evaluate the refractive correction for standard automated perimetry（SAP）in eyes with refractive multifocal contact lenses（CL）in healthy young participants.METHODS：Twenty-nine eyes of 29 participants were included.Accommodation was paralyzed in all participants with 1%cyclopentolate hydrochloride.SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions：monofocal CL corrected for near distance（baseline）;multifocal CL corrected for distance（m CL-D）;and m CL-D corrected for near vision using a spectacle lens（m CL-N）.Primary outcome measures were the foveal threshold,mean deviation（MD）,and pattern standard deviation（PSD）.RESULTS：The foveal threshold of m CL-N with both the24-2 and 10-2 protocols significantly decreased by 2.2-2.5 d B（P〈0.001）,while that of m CL-D with the 24-2 protocol significantly decreased by 1.5 d B（P=0.0427）,as compared with that of baseline.Although there was no significant difference between the MD of baseline and m CL-D with the24-2 and 10-2 protocols,the MD of m CL-N was significantly decreased by 1.0-1.3 d B（P〈0.001）as compared with that of both baseline and m CL-D,with both 24-2 and 10-2 protocols.There was no significant difference in the PSD among the three refractive conditions with both the 24-2 and 10-2 protocols.CONCLUSION：Despite the induced mydriasis and the optical design of the multifocal lens used in this study,our results indicated that,when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs,distance correction without additional near correction is to be recommended.

Combined Hamartoma of the Optic Disc and Retinal Pigment Epithelium—3 Years of the Follow-Up with Semi-Automated Kinetic Perimetry

Aim: To present a case of hamartoma of the optic disc and Retinal Pigment Epithelium (RPE) and follow up of the visual function over three-years period. Methods: A seventeen-year-old boy has observed reduced visual acuity in his left eye. The visual acuity was 0.2 and there was RAPD in the left eye. Fundoscopy revealed an elevation of the optic disc obscuring disc vessels with epiretinal gliosis. Fluorescein angiography demonstrated hyperfluorescent saccular dilatations with leakage in the late phase. Ocular Coherence Tomography (OCT) showed hyperreflective elevation of the optic disc and epiretinal membrane. There was a juxtapapillary scotoma in Semi-automated Kinetic Perimetry (SKP). There was no systemic diseases. Results of blood tests, CT and MRI of CNV were normal. Results: After 3 years period of the follow-up the visual acuity was 0.1 and there was a progression of the visual field defect to the altitudinal scotoma in the upper hemisphere. Fluorescein anhiography and OCT revealed the same. Conclusion: Hamartoma of RPE and optic disc is a rare condition consisting of glial, vascular and RPE cells. It should be differentiated from optic disc oedema and vascular tumors of the retina. Assessment of the visual function is very important in the longitudinal follow-up.

The analysis of macular perimetry with octopus 900 in acute central serous chorioretinopathy

Background:To find the changes of macular perimetry(MP) and the correlations between MP and best correct visual acuity(BCVA) in different phases of the acute central serous chorioretinopathy(CSC).Methods:Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively.MP at 2°,4°and BCVA in the active and resolved phase were collected and analyzed.The differences of these parameters in CSC eyes and fellow eyes were analyzed.Spearman correlation was used for analysis of correlation between MP and BCVA.Results:From 29 eyes with CSC analysed 27 eyes(93.10%) recovered to the previous VA.Compared with the active phase,MP at 2°,4° and BCVA were significantly improved in the resolved phase(P=0.000,0.000,0.000,respectively).MP at 2°,4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase(P=0.000,0.000,0.000,respectively).In the resolved phase there was no significant difference between the CSC eyes and fellow eyes(P=0.339,0.141,0.161,respectively).BCVA was shown to significantly correlate with MP at 2° in the active phase(ρ=-0.630,P<0.001).Conclusions:The acute CSC often had a good prognosis both in BCVA and MP.MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC.

A Comparative Evaluation of Humphrey Perimetry and the Multi-channel Pattern Visual Evoked Potentials

Purposes: To compare the multi-channel pattern visual evoked potentials to Humphrey perimetry in the assessment of central visual function in primary open angle glaucoma. Methods: The multi-channel checkerboard reversal PVEPs waves to full-field and half-field stimulus of 25 normal persons and 74 patients with primary open angle glaucoma were recorded and analyzed, All patients were examined using Humphrey Field Analyzer. The area of visual field corresponding to the area of retina stimulated during multi-channel PVEPs testing were analysed, straight-line correlation and regression analyses of the various multi-channel PVEPs parameters and the total dB losses were performed.Results: The multi-channel PVEPs demonstrated a low detection rate compared with Humprey perimetry in the early glaucoma, absolute latency and field loss were correlated in the late stage of glaucoma, and absolute amplitude and field loss were not correlated. Conclusions: In relation to signalling early loss the multi-channel PVEPs

Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition

Objective:To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing.Methods:In this retrospective pre-post study,an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020.Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses.As part of routine practice,glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition;taped examinations were excluded from analysis.Clinical and demographic characteristics,mean deviation,and pattern standard deviation were evaluated within a two year period before and after eyelid surgery.Results:The final analysis included 60 eyes of 38 patients.Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses.Among patients with ptosis,the margin reflex distance-1 was not associated with change in mean deviation after surgery(Pearson R^(2)=0.0061;P=0.700).Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery.Conclusions:Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields.Unreliable visual fields could be a sign of eyelid interference in this population.

葡萄膜炎性黄斑水肿对视功能的影响

目的:探讨葡萄膜炎性黄斑水肿对视力、视野损害的相关性。方法:此研究为单中心、回顾性的、对临床中发现的中间、后部或全葡萄膜炎治疗的特征性对照研究。葡萄膜炎性黄斑水肿患者132例248眼,接受视力、频域光学相干断层扫描、微视野检测。结果:葡萄膜炎性黄斑水肿与视力、视野的损害具有明显的相关性(P<0.05)。不同类型的黄斑水肿对应不同的视力损害:不伴有黄斑中心凹厚度增加的囊腔型可产生中等程度的视力损害,平均10个字母;不伴有囊腔而仅有黄斑中心凹厚度增加型可产生更大程度的视力损害,平均19个字母;而同时伴有囊腔、黄斑中心凹厚度增加的黄斑囊样水肿型可产生最大程度的视力损害,平均26个字母。入选的所有黄斑水肿都产生了不同程度的视野损害:与黄斑中心凹的的厚度密切相关,即厚度越大,视野损害的范围越广,差异具有统计学意义(P<0.05),而与是否具有囊腔关系不大。结论:黄斑水肿对应的视功能损害提示我们在以后的葡萄膜炎治疗过程中,对黄斑水肿的治疗也应作为一个重要方面去关注;对葡萄膜炎性黄斑水肿的视功能损害评估,应该从视力和微视野两方面关注。

颅内血管畸形的神经眼科表现分析

背景颅内血管畸形可因畸形血管破裂出血或本身占位性病变压迫视路而表现出不同的神经眼科改变，但因该病发病率相对较低，目前国内外仅有该病神经眼科表现的个案报道，尚缺乏系统临床研究。目的了解颅内血管畸形患者的神经眼科表现。方法系统性回顾分析2007年6月至2013年6月在中山大学附属第三医院收治的100例颅内血管畸形患者的一般情况、首发症状、神经眼科症状及体征、临床影像学检查资料等。结果100例颅内血管畸形患者中出现神经眼科表现者20例，占20％。20例伴有神经眼科改变的患者中，仅1例以视物模糊为首发症状，其余均以神经系统症状为首发而就诊。主要的神经眼科表现为视野缺损，占50％；视力下降占45％；瞳孔异常占35％。其他表现包括视神经萎缩1例，占5％；视盘水肿1例，占5％；动眼神经麻痹1例，占5％。CT和MRI检查发现，有眼科症状的20例患者中脑动静脉畸形者12例，占60％，病灶分别位于枕叶4例、顶枕叶3例、颞叶3例、额叶1例和中脑1例；海绵状血管瘤患者7例，占35％，病灶分别位于顶叶、枕叶、扣带回、海绵窦、颞叶、顶颞叶和桥脑，各1例；小脑静脉瘤合并海绵状血管瘤1例，占5％。20例患者中14例伴颅内出血，占70％，出血部位分别位于蛛网膜下腔6例和脑出血8例。结论颅内血管畸形患者可有不同的神经眼科表现，多由畸形血管破裂出血引起，应引起眼科医师重视。

蓝/黄视野检查法和白/白视野检查法阈值变异的对比研究

目的:比较蓝/黄视野检查法[Blue-on-yellow（B/Y）perimetry]和白/白视野检查法[White-on-white（W/W）perimetry]阈值变异的情况,评价B/Y视野检查法的可重复性。方法:应用Octopus 101全自动视野计分别对12例（24眼）正常人、16例（32眼）原发性开角型青光眼（Primary open angle glaucoma,POAG）和 7例（14眼）可疑POAG患者分别进行B/Y视野检查和W/W视野检查。所有受检者在2周内再次分别进行上述两种视野检查。将两种视野检查的阈值进行点对点阈值变异分析和比较。结果:在所有受检者中,B/Y视野检查的全视野总的平均阈值变异（2.61±0.94）decibels（dB）大于 W/W视野检查的阈值变异（2.11±0.90）dB,但差异无显著性意义（P=0.6244）。正常人 B/Y视野检查的全视野总的平均阈值变异（2.07±0.54）dB明显大于W/W视野检查的阈值变异（1.50±0.34）dB（P=0.0006）,而可疑POAG和POAG组,两种视野检查的全视野总的平均阈值变异差异无显著性意义（P=0.0523和 0.9371）。正常人和可疑POAG组中,有部分离心度处的阈值变异,两种视野检查法之间差异有显著性意义,而在POAG组中,两种视野检查法各相应离心度之间差异均无显著性意义。结论:正常人B/Y视野检查的阈值变异大于W/W视野检查的阈值变异。

蓝/黄视野与标准白色视野检测在早期青光眼诊断中敏感性的比较

目的 探讨蓝 /黄视野计与标准白色视野计检查在原发性开角型青光眼早期诊断中的价值。方法 采用瑞士产Octopus10 1型全自动视野计对早期原发性开角型青光眼 2 2例 44眼、对照组正常人 2 0例 40眼进行B/Y及W /W检测 ,视野检测采用tG2 测试程序 ,将中心 3 0°视野内全视网膜光敏感度均值及各象限光敏感度均值 (dB)进行比较。结果 两种视野计检测正常人B/Y较W/W检测全视网膜光敏感度均值低 ,相差 4 2 4dB。早期开角型青光眼B/Y较W /W检测全视网膜光敏感度均值差为 5 5 8dB ,对应各象限视网膜光敏感度均值差 5dB以上 ,视网膜光敏感度均值依次为鼻下>颞下 >鼻上 >颞上 ,以B/Y检测出的缺损面积大且深。早期开角型青光眼组 44眼B/Y检测视野阳性 3 2眼 ,( 72 73 % ) ,W /W检测视野阳性 17眼 ( 3 8 64 % ) ,两种视野计检测结果的异常率有显著差异 (P <0 0 5 )。结论 B/Y与W/W检测结果有良好的符合性 ,检测早期开角型青光眼的视野改变B/Y较W/W敏感。

联合多种视功能检查对原发性开角型青光眼早期诊断的意义

目的:了解原发性开角型青光眼视觉电生理和计算机自动视野检查结果的变化特点并对其视功能状况进行综合分析,以寻找比较敏感和特异的参数,为原发性开角型青光眼较早期(视野改变出现前)和早期诊断提供依据。方法:对36例(70眼)原发性开角型青光眼患者、8例(12眼)可疑性青光眼患者、30例(60眼)正常对照者分别进行视网膜振荡电位(OPs)、视网膜电图(PERG)、视诱发电位(PVEP)和Humphery计算机自动视野检查。结果:在原发性开角型青光眼视野改变出现前,PERG的异常率较高,而于疾病的早期、中期和晚期,则表现为自动视野和PERG的异常率较高。原发性开角型青光眼患者OPs与C/D负相关,与视野指数、眼压和视力无相关性;PERG振幅与视野指数和眼压负相关,与C/D和视力无相关性;PVEP潜伏期与视野指数和C/D正相关,而与眼压无相关性。结论:统计学结果提示,对原发性开角型青光眼不同的表现形式,可选用不同的视功能检查指标。在视野改变出现前,如眼底未见明显改变,仅表现为眼压升高,PERG可能为比较敏感的参考指标;而一旦眼底发生改变,尽管眼压不高,可考虑选用OPs或PVEP作为观察指标。对早期、中期和晚期青光眼,PERG和自动视野的诊断和监测价值较好。联合多种视功能检查对原发性开角型青光眼早期或较早期(视野改变出现前)诊断具?

高度近视患者中医证候与年龄、视野的相关性研究

目的研究高度近视患者中医证侯与年龄、视野的关系。方法高度近视患者157例(278只眼),根据年龄分为10～29岁组,30～49岁组,50～69岁组和70～89岁组,所有患者填写中医证候量化表、病例报告表,并行眼底检查和视野检查。对不同年龄患者的眼底病变、证侯特点进行统计;对证侯积分、年龄和视野指数进行多元线性回归分析。结果高度近视患者随着年龄增加,眼底发生病变的比例增加,同时中医证候由气阴两虚向肝肾亏虚转变。其中医证候积分与年龄及平均光敏感度(mean sensitivity MS)有相关性,得出的回归方程为:中医证候积分=13.416+0.394×年龄-0.410×MS(F=55.362,P=0.000)。结论随着年龄增长,高度近视患者的证侯类型有从气阴两虚逐渐向肝肾亏虚转变的趋势。中医证侯的轻重程度与患者年龄、视野MS值存在线性依存关系。

氩激光治疗糖尿病视网膜病变后视野的变化

目的 探讨氩激光视网膜光凝 (argon laser pan-retinal photocoagulation)治疗糖尿病性视网膜病变手术前后患者视野的改变。方法 对 5 6例 98眼行氩激光视网膜光凝治疗 ,治疗前后测定黄斑阈值敏感度和中心 30°视野平均阈值敏感度的改变。结果 黄斑阈值敏感度治疗前后无明显差别 ,中心 30°视野平均阈值敏感度下降。结论 视网膜光凝有效地阻止 DR的进一步发展 ,防止患者视力下降 ,对中心视力不受影响 。

视野缺损对蝶鞍区肿瘤诊断及治疗的意义

目的:探讨视野缺损对蝶鞍区肿瘤诊断及治疗的意义。方法:对22例(44只眼)蝶鞍区肿瘤患者的视野检查结果,其中包括眼科门诊患者8例(16只眼)、住院患者14例(28只眼),进行回顾性分析。结果:蝶鞍区肿瘤以垂体瘤居多(81.8%)。在首发症状中视力下降占大多数,为77.3%,并可伴有头痛或者其他症状如内分泌异常等。眼底检查视盘苍白者占多数(81.8%)。视野改变以垂直性偏盲为主要表现,其中典型的表现为双眼或单眼颞侧偏盲。常用手术治疗方式为经额颞幕上开颅手术及经蝶骨入路手术,术后视力、视野均有不同程度恢复。结论:蝶鞍区肿瘤中垂体瘤占大多数。视野改变可表现为垂直性偏盲、不规则视野缺损、视野向心性缩小等。

视野检查在青光眼早期诊断中的应用

视野检查作为视功能检测的一种方法 ,在青光眼的诊断、指导治疗、追踪随访中占有重要地位。近些年来一些具有较高敏感性和特异性的新型视野检测方法如蓝黄视野和黄斑阈值视野等为早期诊断及密切观测青光眼的发展提供了重要信息 ,提高了青光眼早期诊断水平。

早期原发性开角型青光眼倍频视野的改变

目的探讨早期原发性开角型青光眼(POAG)倍频视野(FDP)的表现.方法应用FDP的N-30全阈值程序和HFA视野计(HFA)中心30-2全阈值程序检查早期青光眼患者35例37眼、进展期青光眼患者36例43眼、晚期青光眼患者6例7眼;正常人21例25眼作为对照组.结果早期青光眼的FDP主要表现为相对性旁中心暗点和/或相对性的弓状暗点,上方弓形区(尤其是10°～20°的视野)和鼻侧视野在青光眼早期最易受到损害.FDP显示的视野损害与HFA的基本一致,但暗点的范围更大,部分早期青光眼病例HFA显示视野正常的部位FDP也可发现局限性暗点.早期青光眼FDP的三个视野指数(FMS、FMD、FPSD)与正常人比较差异有显著性意义,FDP的FMD与HFA的MD有较好的相关性(相关系数r=0.326,P=0.026).结论早期青光眼FDP的改变与HFA有较高的一致性,在POAG早期诊断中FDP可作为一种快速敏感的视功能检测方法.

视野检查法

视野计已成为一种被广泛应用的主要视功能检查手段,它具有独特的临床应用价值。随着视觉理论、现代检测技术及信息技术的进步,它将不断发展和完善。近年来学者们对其进行了大量的研究;本文就此作一综述。

25G玻璃体切除联合空气填充治疗特发性黄斑裂孔（英文）

目的:观察对于特发性黄斑裂孔行25G玻璃体切除联合空气填充治疗后的解剖和视功能结果。方法:前瞻性干预性分析。27例(30眼)特发性黄斑裂孔患者接受25G经睫状体平坦部玻璃体切除术,同时行白内障超声乳化抽吸联合人工晶体置入和玻璃体腔无菌空气填充。所有患者在术前和术后3mo进行最佳矫正视力(logMAR视力)、视野检查和多焦视网膜电流图(multifocal electroretinography,mfERG)检查,使用OCT明确黄斑裂孔闭合情况。结果:首次手术后28眼的黄斑裂孔闭合,平均logMAR视力由术前的0.72±0.22提高到术后的0.29±0.18(P<0.001)。中心10°视野检查中,平均偏差(mean deviation,MD)由术前的-3.59±1.83 dB减少到术后的-2.51±1.36dB(P<0.001),平均模式标准差(pattern standard deviation,PSD)由术前的1.86±0.68 dB减少到术后的1.33±0.32 dB(P=0.001)。MfERG中可见术后中心凹和旁中心凹区域的平均振幅明显升高,而4-6环区域的平均潜伏期明显延长(P<0.05)。疾病病程长短(P<0.001)和1环区域的术前N1波振幅(P=0.001)对术后最佳矫正视力有预测作用。结论:特发性黄斑裂孔患者行25G玻璃体切除联合空气填充,术后保持1d的面向下体位,有很好的解剖成功率和视功能结果。