Scotoma Research Papers - Academia.edu (original) (raw)

PURPOSE. To correlate the dimension of the visual field (VF) tested by Goldman kinetic perimetry with the extent of visi- bility of the highly reflective layer between inner and outer segments of photoreceptors (IOS) seen in optical... more

PURPOSE. To correlate the dimension of the visual field (VF) tested by Goldman kinetic perimetry with the extent of visi- bility of the highly reflective layer between inner and outer segments of photoreceptors (IOS) seen in optical coherence tomography (OCT) images in patients with retinitis pigmen- tosa (RP). METHODS. In a retrospectively designed cross-sectional study, 18 eyes of 18 patients

A technique for accurate superimposition of computerized perimetry data onto the corresponding retinal locations seen on fundus photographs was developed. The technique was designed to take into account: 1) that the photographic field of... more

A technique for accurate superimposition of computerized perimetry data onto the corresponding retinal locations seen on fundus photographs was developed. The technique was designed to take into account: 1) that the photographic field of view of the fundus camera varies with ametropia-dependent camera focusing 2) possible distortion by the fundus camera, and 3) that corrective lenses employed during perimetry magnify or minify the visual field. The technique allowed an overlay of perimetry data of the central 60 degrees of the visual field onto fundus photographs with an accuracy of 0.5 degree. The correlation of localized retinal morphology to localized retinal function was therefore limited by the spatial resolution of the computerized perimetry, which was 2.5 degrees in the Dicon AP-2500 perimeter employed for this study. The theoretical assumptions of the technique were confirmed by comparing visual field records to fundus photographs from patients with morphologically well-defined non-functioning lesions in the retina.

This study aimed to evaluate more precisely the benefit of macular hole surgery. Design: The design was a prospective study of 40 eyes in 40 patients examined before and after surgery of full-thickness macular holes with a scanning laser... more

This study aimed to evaluate more precisely the benefit of macular hole surgery. Design: The design was a prospective study of 40 eyes in 40 patients examined before and after surgery of full-thickness macular holes with a scanning laser ophthalmoscope (SLO).

The introduction of multifocal stimulus recording has enhanced our ability to examine the human visual field with electrophysiologic techniques. We have adapted the multifocal pattern visual evoked potential (PVEP) to detect visual field... more

The introduction of multifocal stimulus recording has enhanced our ability to examine the human visual field with electrophysiologic techniques. We have adapted the multifocal pattern visual evoked potential (PVEP) to detect visual field loss. In glaucoma patients we sought to determine the extent to which the PVEP amplitudes correlate with perimetric thresholds. Multifocal pseudorandomly alternated pattern stimuli, which were cortically scaled in size, were presented with use of the VERIS-Scientific system. Bipolar occipital straddle electrode positions were used. The visual field up to 25 Њ of eccentricity was investigated. Forty-three glaucoma patients with reproducible visual field defects were tested. The bipolar PVEP corresponded well with Humphrey visual field defects, showing loss of signal in the scotoma area. For Humphrey quadrant threshold totals and PVEP quadrant amplitudes, the correlation coefficient was strong (r ϭ 0.49, P Ͻ 0.0001). The multifocal PVEP demonstrates good correspondence with the topography of the visual field. This technique represents the first practical application of the multifocal PVEP to objective detection of visual field defects in glaucoma. ( Surv Ophthalmol 43 [Suppl 1] :S199-S209, 1999.

IMPORTANCE With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL)... more

IMPORTANCE With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL) have been identified in association with acute macular neuroretinopathy (AMN).

Teilnahmemöglichkeiten-kostenfrei im Rahmen des jeweiligen Zeitschriftenabonnements-individuelle Teilnahme durch den Erwerb von CME.Tickets auf CME.springer.de Zertifizierung Diese Fortbildungseinheit ist mit 3 CME-Punkten zertifiziert... more

Teilnahmemöglichkeiten-kostenfrei im Rahmen des jeweiligen Zeitschriftenabonnements-individuelle Teilnahme durch den Erwerb von CME.Tickets auf CME.springer.de Zertifizierung Diese Fortbildungseinheit ist mit 3 CME-Punkten zertifiziert von der Landesärztekammer Hessen und der Nord rheinischen Akademie für Ärztliche Fort-und Weiterbildung und damit auch für andere Ärzte kammern anerkennungsfähig. Hinweis für Leser aus Österreich und der Schweiz Gemäß dem Diplom-Fortbildungs-Programm (DFP) der Österreichischen Ärztekammer werden die auf CME.springer.de erworbenen CME-Punkte hierfür 1:1 als fachspezifische Fortbildung anerkannt. Der Ophthalmologe ist zudem durch die Schweizerische Gesellschaft für Ophthalmologie mit 1 Credit pro Modul anerkannt.

A 53-year-old Caucasian woman with long-standing, well controlled, severe rheumatoid arthritis, treated with methotrexate, salazopyrin, naprosyn, prednisone and plaquenil, presented with progressive visual loss in each eye. She had a past... more

A 53-year-old Caucasian woman with long-standing, well controlled, severe rheumatoid arthritis, treated with methotrexate, salazopyrin, naprosyn, prednisone and plaquenil, presented with progressive visual loss in each eye. She had a past history of non-necrotizing anterior scleritis that was treated with increased doses of prednisone. She developed left then right central scotomas, reduced vision and optic atrophy. Eventually a diagnosis of methotrexate-induced optic atrophy was made.

Injury to the primary visual cortex (V1) typically leads to loss of conscious vision in the corresponding, homonymous region of the contralateral visual hemifield (scotoma). Several studies suggest that V1 is highly plastic after injury... more

Injury to the primary visual cortex (V1) typically leads to loss of conscious vision in the corresponding, homonymous region of the contralateral visual hemifield (scotoma). Several studies suggest that V1 is highly plastic after injury to the visual pathways, whereas others have called this conclusion into question. We used functional magnetic resonance imaging (fMRI) to measure area V1 population receptive field (pRF) properties in five patients with partial or complete quadrantic visual field loss as a result of partial V1+ or optic radiation lesions. Comparisons were made with healthy controls deprived of visual stimulation in one quadrant ["artificial scotoma" (AS)]. We observed no large-scale changes in spared-V1 topography as the V1/V2 border remained stable, and pRF eccentricity versus cortical-distance plots were similar to those of controls. Interestingly, three observations suggest limited reorganization: (i) the distribution of pRF centers in spared-V1 was shifted slightly toward the scotoma border in 2 of 5 patients compared with AS controls; (ii) pRF size in spared-V1 was slightly increased in patients near the scotoma border; and (iii) pRF size in the contralesional hemisphere was slightly increased compared with AS controls. Importantly, pRF measurements yield information about the functional properties of spared-V1 cortex not provided by standard perimetry mapping. In three patients, spared-V1 pRF maps overlapped significantly with dense regions of the perimetric scotoma, suggesting that pRF analysis may help identify visual field locations amenable to rehabilitation. Conversely, in the remaining two patients, spared-V1 pRF maps failed to cover sighted locations in the perimetric map, indicating the existence of V1-bypassing pathways able to mediate useful vision.

Brain neuronal dysfunction has been implicated in pathogenesis of migraine but direct evidence is lacking. Scintillating scotoma of migraine is generally believed to originate at the visual cortex. While cortical spreading depression is a... more

Brain neuronal dysfunction has been implicated in pathogenesis of migraine but direct evidence is lacking. Scintillating scotoma of migraine is generally believed to originate at the visual cortex. While cortical spreading depression is a relatively late physiological alteration in migraine, its protective role in neuronal ischaemia is increasingly being recognized. Atenolol, nadolol, or verapamil prevent migraine but do not readily cross the blood–brain barrier or critically influence any brain or peripheral neuronal function. Typical migraine headache, aura, or scintillating scotoma has not been reported following enucleation or evisceration of the eye. In humans, pain and temperature fibres from only the ophthalmic division of the trigeminal nerve reach the upper cervical spinal segments. Pain in migraine attacks including occipital and nuchal discomfort reflects selective involvement of the ophthalmic nerve. Photophobia is largely a retinal reflex involving the ophthalmic division of the trigeminal nerve. Key clinical features of the migrainous scintillating scotoma are consistent with retinal origin. Spreading depression in the retina is well-established. A subtle regional ocular sympathetic deficit prevails in migraine patients and possibly impairs regulation of intraocular choroidal blood volume and intraocular pressure. Several first-line migraine prophylactic agents lower the intraocular pressure. The neuro-ophthalmological basis for a monocular origin of migrainous scintillating scotomata due to mechanical deformation of the posterior segment of the corneo-scleral envelope consequent to choroidal venous congestion and rise in intraocular pressure is presented. Study of distribution and displaceability of the migrainous scintillating scotoma can settle its site of origin. Headache of migraine possibly arises from a similar mechanical deformation of the anterior eye segment followed by antidromic discharge in the trigeminovascular system. Lateralizing negative deficits such as homonymous hemianopia probably reflect vasospastic complications of migraine. A rational explanation for the most characteristic clinical features of migraine and a new template to elucidate the pharmacological basis of anti-migraine drugs is offered.

Purpose: Loss of retinal ganglion cells in in non-optic neuritis eyes of Multiple Sclerosis patients (MS-NON) has recently been demonstrated. However, the pathological basis of this loss at present is not clear. Therefore, the aim of the... more

Purpose: Loss of retinal ganglion cells in in non-optic neuritis eyes of Multiple Sclerosis patients (MS-NON) has recently been demonstrated. However, the pathological basis of this loss at present is not clear. Therefore, the aim of the current study was to investigate associations of clinical (high and low contrast visual acuity) and electrophysiological (electroretinogram and multifocal Visual Evoked Potentials) measures of the visual pathway with neuronal and axonal loss of RGC in order to better understand the nature of this loss.

To characterize the progression pattern of initial parafoveal scotomas (IPFSs) using crosssectional and longitudinal 10-2 visual field (VF) data. Design: Retrospective, observational study. Participants: Glaucoma patients with an IPFS in... more

To characterize the progression pattern of initial parafoveal scotomas (IPFSs) using crosssectional and longitudinal 10-2 visual field (VF) data. Design: Retrospective, observational study. Participants: Glaucoma patients with an IPFS in either hemifield based on 2 reliable 24-2 Swedish interactive threshold algorithm standard VFs (Ն3 adjacent points with PϽ0.05 within the central 10°of fixation, 1 point or more with PϽ0.01 lying at the innermost paracentral points, and no scotoma outside the central 10°) and at least 2 10-2 VFs (first and last VFs 1 year or more apart). Methods: To simulate a cohort with an extended follow-up, eyes with an IPFS were divided into subgroups based on the severity of glaucoma using their 10-2 VF pattern standard deviation (PSD). Cross-sectional data were used to create an average pattern deviation map that was generated by averaging pattern deviation map values of 10-2 VF point-by-point within each subgroup. Longitudinal data (eyes with 5 or more 10-2 VFs) was used to perform pointwise linear regression analysis of pattern deviation values. Patterns of IPFS progression were identified from these cross-sectional and longitudinal assessments. Main Outcome Measures: Average pattern deviation maps (cross-sectional) and maps of progression rates (longitudinal) in different disease severity subgroups. Results: Eighty eyes (80 patients) and 40 eyes (40 patients) with an IPFS were included for cross-sectional and longitudinal analyses, respectively. The mean age Ϯ standard deviation, 24-2 VF mean deviation, and 24-2 VF PSD for all eyes were 63Ϯ10 years, Ϫ3.27Ϯ2.18 dB, and 5.46Ϯ2.40 dB, respectively. Based on maps generated in both cross-sectional and longitudinal analyses, IPFS in the superior hemifield had an arcuate pattern initially that later deepened approximately 3°to 5°above fixation. The scotoma then elongated toward the physiologic blind spot and spread toward the nasal periphery, sparing the area corresponding to the papillomacular bundle. The IPFS in the inferior hemifield had a similar pattern, but was slightly farther from fixation. Conclusions: Superior and inferior IPFS have a similar characteristic pattern of progression, although the latter tend to be farther from fixation. Understanding these patterns should help in the management of such patients and in improving VF testing algorithms. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Horizontally scrolling text is, in theory, ideally suited to enhance viewing strategies recommended to improve reading performance under conditions of central vision loss such as macular disease, although it is largely unproven in this... more

Horizontally scrolling text is, in theory, ideally suited to enhance viewing strategies recommended to improve reading performance under conditions of central vision loss such as macular disease, although it is largely unproven in this regard. This study investigated if the use of scrolling text produced an observable improvement in reading performed under conditions of eccentric viewing in an artificial scotoma paradigm. Participants (n = 17) read scrolling and static text with a central artificial scotoma controlled by an eye-tracker. There was an improvement in measures of reading accuracy, and adherence to eccentric viewing strategies with scrolling, compared to static, text. These findings illustrate the potential benefits of scrolling text as a potential reading aid for those with central vision loss.

The visual field records of 45 eyes of 45 patients were evaluated to determine whether examination of the peripheral field of vision in patients with glaucoma and field defects adds useful information about the progression of visual field... more

The visual field records of 45 eyes of 45 patients were evaluated to determine whether examination of the peripheral field of vision in patients with glaucoma and field defects adds useful information about the progression of visual field damage. The central scotoma mass, foveal sensitivity, and the central and peripheral mass of the visual field were quantified from measurements on the Tubinger perimeter. Most of the information on visual field progression was contained in the scotoma mass. When both scotoma mass and foveal sensitivity were known, central or peripheral isoptres did not add statistically significant information on progression. Evaluation of scotomas and assessment of central isoptres or of foveal sensitivity made perimetry of the peripheral isoptres redundant. The appearance of fresh peripheral scotomas or the quantification of changes in peripheral scotomas was not examined in the current study, and they would of course be important when they occurred.

This article describes the optical coherence tomography (OCT) findings in 4 patients with degenerative retinoschisis and symptomatic retinal detachment. All patients underwent pars plana vitrectomy, fluid gas exchange, and endolaser... more

This article describes the optical coherence tomography (OCT) findings in 4 patients with degenerative retinoschisis and symptomatic retinal detachment. All patients underwent pars plana vitrectomy, fluid gas exchange, and endolaser treatment. The OCT appearance of retinoschisis and visual outcomes were variable. OCT appears to be useful in understanding the anatomy and extent of the retinoschisis, especially in cases associated with retinal detachment.

To investigate whether the positive prism test response is due to the presence of a suppression scotoma or the absence of bifoveolar fixation. Fifty-one subjects with esotropia (microtropia, small-, moderate- or large-angle esotropia),... more

To investigate whether the positive prism test response is due to the presence of a suppression scotoma or the absence of bifoveolar fixation. Fifty-one subjects with esotropia (microtropia, small-, moderate- or large-angle esotropia), and 22 subjects with nonstrabismic anisometropic amblyopia were examined. The prism test was performed by using base-out prisms of two different powers (4-PD and 30-PD), and base-in prism of 20-PD, as well as base-down prism of 10-PD for each subject. All the subjects with esotropia showed a positive prism test response, whereas all the subjects with nonstrabismic anisometropic amblyopia had a negative prism test response. All the esotropic subjects showed positive response to all magnitudes and positions of the prisms tested. The positive response to the prism test does not indicate suppression scotoma in subjects with microtropia and small-angle esotropia because all the esotropic subjects showed the positive response regardless of the amount of deviation or the sensorial adaptation mechanisms. Also, the positive response, seen in the esotropic subjects, did not alter to negative by using the prisms of different powers and directions.

ABSTRACT The TV series Our Boys (2019), which deals with traumatic historical events, provides the basis for a discussion of blind spots (scotoma) as a metaphor for collective denial. This social blindness is one of the troubling... more

ABSTRACT
The TV series Our Boys (2019), which deals with traumatic historical
events, provides the basis for a discussion of blind spots (scotoma) as
a metaphor for collective denial. This social blindness is one of the
troubling phenomena of the current sociopolitical and cultural period
and bears in particular on the erasure in public consciousness of
moral infractions and processes of dehumanization. While myths,
legends, and stories have always been a means to represent social
processes, and a space to reflect on them, today digital media and TV
series in particular tell the unifying stories of the age. The article aims
to derive further knowledge about how denial and scotoma work in
society and explore how a TV series can point towards a remedy. To
this end, it focuses on locating and naming the medium’s methods
which allow this phenomenon to be represented and worked
through. The article shows how from episode to episode, Our Boys’
narrative structure, points of view, mise en scène and editing permit
a wider visual range. Expansion of the viewer’s visual field prompts
this process of working through, initiating a movement from denial
to taking responsibility for establishing a moral sociality.

Purpose: To investigate the relationship between optical coherence tomography (OCT)-derived measurements of retinal morphology and visual acuity in patients with neovascular age-related macular degeneration (AMD). Design: Retrospective... more

Purpose: To investigate the relationship between optical coherence tomography (OCT)-derived measurements of retinal morphology and visual acuity in patients with neovascular age-related macular degeneration (AMD). Design: Retrospective cross-sectional study. Participants: A total of 216 consecutive patients (216 eyes) newly diagnosed with neovascular AMD who underwent StratusOCT imaging at the time of diagnosis.

To test the ability of a new type of multifocal objective perimetry to identify glaucomatous visual field defects. A multichannel visual evoked potential was recorded using the ObjectiVision Accumap perimeter. One hundred patients (age,... more

To test the ability of a new type of multifocal objective perimetry to identify glaucomatous visual field defects. A multichannel visual evoked potential was recorded using the ObjectiVision Accumap perimeter. One hundred patients (age, 62.2 +/- 9.8 years, mean MD -6.5 +/- 4.17 dB) with open-angle glaucoma and confirmed glaucomatous visual field defects were tested and compared with the normal database of 100 normal subjects (age, 58.9 +/- 10.7 years). Both eyes were tested, but for determining sensitivity the eye with the lesser field defect was chosen if both qualified. The amplitude and intereye asymmetry coefficient for each zone of the field were calculated. A mean amplitude and multifocal objective perimetry severity index was calculated for each subject. In 95 of 100 (95%) patients with glaucoma Humphrey field defects were correlated with visual evoked potential amplitude reductions identifying a cluster of three or more abnormal zones. In two of five remaining patients with glaucoma the defect was detected on the intereye asymmetry analysis. Topographic location was well correlated with Humphrey fields. Mean amplitude was significantly reduced in 86 of the glaucoma cases (86%). The glaucoma severity index was abnormal in 93 glaucoma cases and showed a correlation with Humphrey MD (r = 0.67 right eyes, 0.69 left eyes). In 37 glaucoma cases with no scotoma by definition in the fellow eye, 22 (59.4%) had an abnormal multifocal objective perimetry, whereas only eight had some other aspect of their Humphrey visual field flagged as abnormal. Multifocal objective perimetry can assess the visual field and identify glaucomatous visual field defects. It may have the potential for identifying defects earlier than conventional perimetry.

To investigate whether the presence of silent cerebral infarct (SCI) is related to field progression in patients with newly diagnosed normal-tension glaucoma (NTG). Prospective cohort study. A total of 286 eyes from 286 NTG patients: 64... more

To investigate whether the presence of silent cerebral infarct (SCI) is related to field progression in patients with newly diagnosed normal-tension glaucoma (NTG). Prospective cohort study. A total of 286 eyes from 286 NTG patients: 64 with SCI (SCI+) and 222 without SCI (SCI-). Patients were assigned to the SCI+ or SCI- group depending on the presence of SCI as detected by cranial computed tomography scan at baseline. Patients were followed-up at 4-month intervals for 36 months for visual field progression as per Anderson's criteria. The primary outcome was the association between SCI and field progression. Secondary outcomes include the prevalence of SCI in NTG patients and other risk factors associated with progression. There were no significant differences in the baseline intraocular pressures (IOPs), fluctuation amplitude of pretreatment IOP, baseline visual acuity, vertical cup-to-disc ratio, vertical disc diameter, presenting field indices, and central corneal thickness (CCT) between the 2 groups. Patients with SCI were significantly older compared with SCI- patients (72.4+/-10.7 vs. 63.2+/-14.2 years; P<0.001). Univariate analyses revealed age, fluctuation amplitude of pretreatment IOP, thinner CCT, presence of disc hemorrhage, systemic hypertension, arrhythmia, and SCI were significant for field progression. Silent cerebral infarct was present in 29.6% of field-progressed subjects versus 15.3% of field-stable subjects (P = 0.004). Kaplan-Meier survival analysis revealed that 65.6% of SCI+ versus 45.9% of SCI- patients had progressed (P = 0.003). Cox proportional hazards regression analysis showed disc hemorrhage (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.54-3.37; P<0.001), SCI (HR, 1.61; 95% CI, 1.09-2.36; P = 0.016), systemic hypertension (HR, 1.48; 95% CI, 1.04-2.10; P = 0.029), and CCT (per 30 mum of thinning; HR, 1.35; 95% CI, 1.16-1.75; P<0.001) were associated with field progression. Other variables significant in the univariate analysis were not significant in the regression model. The most common location of SCI was at the basal ganglia. Presence of SCI may be an independent risk factor for visual field progression in patients with NTG.

Mutations in the SPG7 gene encoding a mitochondrial protein termed paraplegin, are responsible for a recessive form of hereditary spastic paraparesis. Only few studies have so far been performed in large groups of hereditary spastic... more

Mutations in the SPG7 gene encoding a mitochondrial protein termed paraplegin, are responsible for a recessive form of hereditary spastic paraparesis. Only few studies have so far been performed in large groups of hereditary spastic paraplegia (HSP) patients to determine the frequency of SPG7 mutations. Here, we report the result of a mutation screening conducted in a large cohort of 135 Italian HSP patients with the identification of six novel point mutations and one large intragenic deletion. Sequence analysis of the deletion breakpoint, together with secondary structure predictions of the deleted region, indicate that a complex rearrangement, likely caused by extensive secondary structure formation mediated by the short interspersed nuclear element (SINE) retrotransposons, is responsible for the deletion event. Biochemical studies performed on fibroblasts from three mutant patients revealed mild and heterogeneous mitochondrial dysfunctions that would exclude a specific association of a complex I defect with the pathology at the fibroblast level. Overall, our data confirm that SPG7 point mutations are rare causes of HSP, in both sporadic and familial forms, while underlying the puzzling and intriguing aspects of histological and biochemical consequences of paraplegin loss. Hum Mutat 29(4), 522-531, 2008. r r 2008 Wiley-Liss, Inc.

Purpose of this study was to characterize retinal disease in Usher syndrome using fundus autofluorescence and optical coherence tomography. Study included 54 patients (26 male, 28 female) aged 7-70 years. There were 18 (33%) USH1 and 36... more

Purpose of this study was to characterize retinal disease in Usher syndrome using fundus autofluorescence and optical coherence tomography. Study included 54 patients (26 male, 28 female) aged 7-70 years. There were 18 (33%) USH1 and 36 (67%) USH2 patients. 49/52 (94%) patients were found to carry at least one mutation in Usher genes. Ophthalmological examination included assessment of Snellen visual acuity, color vision with Ishihara tables, Goldmann visual fields (targets II/1-4 and V/4), microperimetry, fundus autofluorescence imaging and optical coherence tomography. Average age at disease onset (nyctalopia) was significantly lower in USH1 than USH2 patients (average 9 vs. 17 years, respectively; p < 0.01); however no significant differences were found regarding type of autofluorescence patterns, frequency of foveal lesions and CME, rate of disease progression and age at legal blindness. All representative eyes had abnormal fundus autofluorescence of either hyperautofluorescent ring (55%), hyperautofluorescent foveal patch (35%) or foveal atrophy (10%). Disease duration of more than 30 years was associated with a high incidence of abnormal central fundus autofluorescence (patch or atrophy) and visual acuity loss.

· Background: A study was carried out to measure the displacement of retinal ganglion cells subserving the cones within the human fovea. · Methods: Four human retinas were examined along the nasal or vertical hemi-meridians. Total... more

· Background: A study was carried out to measure the displacement of retinal ganglion cells subserving the cones within the human fovea. · Methods: Four human retinas were examined along the nasal or vertical hemi-meridians. Total displacement was estimated by adding the displacement due to fibres of Henle and bipolar cells, measured as the lateral extension of the Henle fibres and of the obliquely running fibre bundles within the inner nuclear layer, respectively. · Results: At the foveal border (0.5–0.8 mm or 1.8–2.9 deg eccentricity) the mean offset due to fibres of Henle and mean total lateral displacement was at a maximum of 0.32±0.03 mm and 0.37±0.03 mm, respectively. A steep decrease of displacement was found outside the foveal border out to an eccentricity of 2.0–2.5 mm. We were able to plot displacement along the vertical meridian in relation to eccentricity with good correlation between three eyes. The data were used to establish different mathematical functions describing the relation between eccentricity and displacement. These functions were applied to previously presented data on densities of retinal ganglion cells and cones. · Conclusions: The present estimates of displacement within the human central fovea offer the possibility of analysis of quantitative relations between cones and retinal ganglion cells. Our data provide predictive guidance by establishing that vitreo-retinal procedures causing damage to retinal ganglion cells up to 1 mm from the foveal centre could have implications for loss of information generated within the fovea.

Macular pucker (MP) and macular hole (MH) are vitreomaculopathies treated by vitrectomy and membrane peel. The complication of postoperative central scotoma can be associated with significant reduction in visual acuity (VA). We seek to... more

Macular pucker (MP) and macular hole (MH) are vitreomaculopathies treated by vitrectomy and membrane peel. The complication of postoperative central scotoma can be associated with significant reduction in visual acuity (VA). We seek to determine whether retinal nerve fiber layer (RNFL) disruption is the pathophysiologic basis of this defect. Mitigating clinical circumstances also were sought. Eleven eyes from 10 pseudophakic patients who had undergone vitrectomy with peeling for either MH or MP were studied with clinical measures, including optical coherence tomography (OCT). Membrane specimens were evaluated by immunohistochemistry for neurofilament, a marker for the inner retina. Ten eyes from 10 pseudophakic patients who underwent repeat surgery for persistent or recurrent pathology were evaluated to determine the relationship between the timing of reoperation and clinical outcome. Cases with a postoperative central scotoma (N=4) had worse VA (~20/600) compared to those without (...

A 20-year-old woman with bilateral mild blurring of vision presented with a bull's eye maculopathy and was diagnosed with Stargardt disease, confirmed with genetic testing. The authors present several novel multimodal imaging findings... more

A 20-year-old woman with bilateral mild blurring of vision presented with a bull's eye maculopathy and was diagnosed with Stargardt disease, confirmed with genetic testing. The authors present several novel multimodal imaging findings including multicolor and multi-spectral imaging that enhanced visualization of perifoveal flecks, fundus autofluorescence that revealed both perifoveal and perimacular rings of hyperautofluorescence, adaptive optics imaging that revealed unprecedented visualization of cones at the fovea due to decreased cone density, and spectral-domain optical coherence tomography that identified thickening and increased hyperreflectivity of the external limiting membrane as a possible transient biomarker of early Stargardt disease. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:257-261.].

Aim-To prospectively evaluate peripheral visual fields after vitrectomy for idiopathic macular holes. Methods-Goldmann perimetry was performed in 105 patients before, as well as 6 weeks and 12 months after macular hole surgery.... more

Aim-To prospectively evaluate peripheral visual fields after vitrectomy for idiopathic macular holes. Methods-Goldmann perimetry was performed in 105 patients before, as well as 6 weeks and 12 months after macular hole surgery. Results-Only one patient (<1%) with a stage III macular hole developed an asymptomatic postoperative visual field defect. The scotoma was wedge-shaped, peripherally located in the temporal quadrant, and remained unchanged during the following 12 months. Conclusion-Peripheral visual field defects after macular hole surgery can be a complication of very low incidence. A rather low pressure set during air-fluid exchange as well as special aspects of the surgical technique may be responsible for this low incidence of peripheral visual field defects. (Br J Ophthalmol 2001;85:549-551)

Aim: To examine whether high spatial resolution perimetry (HSRP) could identify fine scale scotomata which may not be apparent with conventional perimetry. The HSRP was performed in the nasal field, as this location is a recognised site... more

Aim: To examine whether high spatial resolution perimetry (HSRP) could identify fine scale scotomata which may not be apparent with conventional perimetry. The HSRP was performed in the nasal field, as this location is a recognised site for the early occurrence of glaucomatous defects. Method: 16 early glaucoma eyes, 17 glaucoma suspect eyes, and 20 age matched healthy control eyes underwent conventional automated perimetry using the 24-2 program of the Humphrey field analyser (HFA) and HSRP. The HSRP was performed in the nasal field by testing 9 × 9 degrees of 100 tested points separated by 1 degree and the results compared with the HFA 24-2 program. Results: Mean HSRP thresholds were significantly abnormal in the suspect and glaucoma eyes, with elevated levels of asymmetry between the superior and inferior nasal field. Overall, 7/17 (41%) suspect eyes (95% confidence interval 5/17 (29%) to 7/17 (41%)) had nasal scotomata on HSRP, although their HFA 24-2 fields failed to identify any defects. In glaucomatous eyes, 15/16 (94%) eyes had HSRP scotomata (95% CI 14/16 (88%) to 15/16 (94%)). In 12 these coexisted with HFA 24-2 defects at the same location, while in three eyes only HSRP identified scotomata in the nasal field.

Eccentric viewing is a common strategy used by people with central vision loss (CVL) to direct the eye such that the image falls onto functioning peripheral retina, known as the preferred retinal locus (PRL). It has been long acknowledged... more

Eccentric viewing is a common strategy used by people with central vision loss (CVL) to direct the eye such that the image falls onto functioning peripheral retina, known as the preferred retinal locus (PRL). It has been long acknowledged that we do not know whether the PRL used in a fixation test is also used when performing tasks. We present an innovative method to determine whether the same PRL observed during a fixation task was used to watch videos and whether poor resolution affects gaze location. The gaze of a group of 60 normal vision (NV) observers was used to define a democratic center of interest (COI) of video clips from movies and television. For each CVL participant (N = 20), we computed the gaze offsets from the COI across the video clips. The distribution of gaze offsets of the NV participants was used to define the limits of NV behavior. If the gaze offset was within this 95% degree confidence interval, we presumed that the same PRL was used for fixation and video w...

To investigate rates of visual field progression and factors associated with progression rate in open-angle glaucoma in clinical glaucoma care. Methods: We performed a retrospective chart review of all patients with manifest primary... more

To investigate rates of visual field progression and factors associated with progression rate in open-angle glaucoma in clinical glaucoma care. Methods: We performed a retrospective chart review of all patients with manifest primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) followed ‡ 5 years with ‡5 SITA Standard fields. Exclusion criteria were minimal. Demographics, intraocular pressure values (IOP), treatment and treatment changes, and visual field (VF) data were recorded. VF progression rates were calculated as slopes of mean deviation (MD) over time. Results: Five hundred and eighty-three patients were eligible. Three hundred and sixty-seven (62%) had POAG and 221 (38%) PEXG. Median MD at study start was)10.0 dB. Mean follow-up time was 7.8 years (SD ± 1.2); mean number of VF tests was 8.9 (SD ± 2.8). Progression rates varied very much among patients with a mean of)0.80 dB ⁄ year (SD ± 0.82; median rate,)0.62), and 5.6% of patients progressed at rates worse than)2.5 dB per year A negative slope of MD values was observed in 89% of patients. Mean IOP of all visits decreased over the study period from 20.15 to 18.10 mmHg. Higher age and mean IOP, and more intensive treatment were associated with more rapid progression, while PEXG and IOP variation were not, if treatment intensity was taken into account. Conclusion: Rates of visual field progression in manifest glaucoma with field loss in ordinary clinical care were highly variable. Progression rates rapid enough to influence quality of life were common.

Purpose. Age-related macular degeneration is the leading cause of vision loss among Americans aged Ͼ65 years. Currently, no effective treatment can reverse the central vision loss associated with most age-related macular degeneration.... more

Purpose. Age-related macular degeneration is the leading cause of vision loss among Americans aged Ͼ65 years. Currently, no effective treatment can reverse the central vision loss associated with most age-related macular degeneration. Digital image-processing techniques have been developed to improve image visibility for peripheral vision; however, both the selection and efficacy of such methods are limited. Progress has been difficult for two reasons: the exact nature of image enhancement that might benefit peripheral vision is not well understood, and efficient methods for testing such techniques have been elusive. The current study aims to develop both an effective image enhancement technique for peripheral vision and an efficient means for validating the technique. Methods. We used a novel contour-detection algorithm to locate shape-defining edges in images based on natural-image statistics. We then enhanced the scene by locally boosting the luminance contrast along such contours. Using a gaze-contingent display, we simulated central visual field loss in normally sighted young (aged 18 -30 years) and older adults (aged 58 -88 years). Visual search performance was measured as a function of contour enhancement strength ["Original" (unenhanced), "Medium," and "High"]. For preference task, a separate group of subjects judged which image in a pair "would lead to better search performance." Results. We found that although contour enhancement had no significant effect on search time and accuracy in young adults, Medium enhancement resulted in significantly shorter search time in older adults (about 13% reduction relative to Original). Both age-groups preferred images with Medium enhancement over Original (2-7 times). Furthermore, across age-groups, image content types, and enhancement strengths, there was a robust correlation between preference and performance. Conclusions. Our findings demonstrate a beneficial role of contour enhancement in peripheral vision for older adults. Our findings further suggest that task-specific preference judgments can be an efficient surrogate for performance testing. (Optom Vis Sci 2012;89:1374-1384

The pattern electroretinogram and the visual evoked potential were recorded simultaneously with various stimulus fields and artificial scotomata of increasing sizes. In contrast to an earlier study, a smaller check size (20') and two... more

The pattern electroretinogram and the visual evoked potential were recorded simultaneously with various stimulus fields and artificial scotomata of increasing sizes. In contrast to an earlier study, a smaller check size (20') and two stimulus field sizes (20 ° x 20 ° and 10 ° x 10 °) for the scotomata were used. With a concentric decreasing stimulus field, a reduction of both the pattern electroretinogram and visual evoked potential was found. Both showed a simultaneous reduction of amplitudes, but, compared with the amplitude in the full field, the reduction was more extensive for the pattern electroretinogram at each test field size. This implies a greater contribution to the pattern electroretinogram from more eccentric retinal parts. An artificial central scotoma of increasing size in the 20 ° x 20 ° field had less influence on the pattern electroretinogram than on the visual evoked potential. The percentage amplitude loss of the visual evoked potential was more pronounced. The visual evoked potential was eventually abolished by a scotoma size from 10 ° x 10 ° upward, while the pattern electroretinogram was still registrable. When scotomata of similar size were introduced in a smaller (10 ° x 10 °) field, percentage pattern electroretinogram and visual evoked potential amplitude losses were less separated than in a larger (20 ° x 20 °) test field.

In normal vision, shifts of attention and gaze are tightly coupled. Here we ask if this coupling affects performance also when central vision is not available. To this aim, we trained normal-sighted participants to perform a visual search... more

In normal vision, shifts of attention and gaze are tightly coupled. Here we ask if this coupling affects performance also when central vision is not available. To this aim, we trained normal-sighted participants to perform a visual search task while vision was restricted to a gaze-contingent viewing window ("forced field location") either in the left, right, upper, or lower visual field. Gaze direction was manipulated within a continuous visual search task that required leftward, rightward, upward, or downward eye movements. We found no general performance advantage for a particular part of the visual field or for a specific gaze direction. Rather, performance depended on the coordination of visual attention and eye movements, with impaired performance when sustained attention and gaze have to be moved in opposite directions. Our results suggest that during early stages of central visual field loss, the optimal location for the substitution of foveal vision does not depend on the particular retinal location alone, as has previously been thought, but also on the gaze direction required by the task the patient wishes to perform.

To determine the ability of blue-on-yellow multifocal visual evoked potentials (BonY mfVEP) to identify functional loss in preperimetric glaucoma. Prospective case series. Thirty patients with glaucomatous optic discs and normal standard... more

To determine the ability of blue-on-yellow multifocal visual evoked potentials (BonY mfVEP) to identify functional loss in preperimetric glaucoma. Prospective case series. Thirty patients with glaucomatous optic discs and normal standard visual fields. All patients underwent BonY mfVEP, dilated optic disc stereophotography, and optical coherence tomography (Fast RNFL protocol). Optic disc photographs were assessed by 2 independent examiners in a masked fashion. The mfVEP amplitude asymmetry and latency values were analyzed and compared topographically with findings of disc assessment. Average retinal nerve fiber layer (RNFL) thickness, RNFL asymmetry, and sectors with RNFL thinning were compared between patients with and without mfVEP defects. Fourteen (46.7%) patients demonstrated significant abnormality on amplitude asymmetry deviation plots of BonY mfVEP. In all 14 cases, the defect was monocular and corresponded to the eye with the worse disc. In 13 of 14 patients, the defect also corresponded to the location of the worst affected rim. Average RNFL thickness of eyes with mfVEP defects was 81.2+/-9.9 microm, significantly lower than that of patients without defects (90+/-10.5 microm; P = 0.035). Mean asymmetry of RNFL (better minus worse eye) also was significantly higher for patients with mfVEP defects compared with those without such defects (9.0+/-6.4 microm vs. 3.0+/-7 microm; P = 0.03). Average latency of both eyes of glaucomatous patients was delayed compared with that of controls, with no difference in latency between worse and better eyes of glaucoma patients. There was no association of latency delay with either the location of disc changes or mfVEP amplitude defects. Amplitude asymmetry of the BonY mfVEP seems to be a promising tool to identify functional loss in preperimetric glaucoma. Proprietary or commercial disclosure may be found after the references.

Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the... more

Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the pathophysiology of glaucoma. To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography. Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a 6.7 × 6.7-mm2 area centered at the optic nerve head. The RNFL microcirculation was measured within an annulus region centered at the optic nerve head divided into superior and inferior hemispheres. Blood flux index (the mean flow signal intensity in the vessels) and vessel area density (the percentage of the detected vessels in the annulus) were measured. Differences in microcirculation between the hemispheres in eyes with glaucoma and normal eyes and corre...