Learning effect of humphrey matrix frequency doubling technology perimetry in patients with ocular hypertension

Aim: To evaluate the learning effect of Frequency Doubling Technology (FDT) perimetry using the Humphrey Matrix-FDT perimetry (Matrix) 24-2 full-threshold program on patients with 7 ocular hypertension experienced with standard automated perimetry. Methods: Twenty-four patients with Ocular hypertension underwent 5 full-threshold Matrix tests at intervals of 5 2 days. Learning effect was defined as an improvement at results for duration, perimetric indices, foveal sensitivity, Glaucoma Hemifield Test, and the number of points with a P < 5% and < 1% in the total and pattern deviation maps. Eccentricity, hemifield, and quadrant sensitivities were also addressed as Sources of differences in learning effect. Test-retest variability was also calculated for each repetition as the mean of the point-to-point interindividual standard deviations. Results: A learning effect was demonstrated for mean defect (P = 0.031, analysis of variance) and foveal sensitivity (P = 0.009) and it only affected the first test for both parameters. All the other parameters did not show any significant learning effect. The effect was independent From eccentricity and quadrant or hemifield sensitivities. Conclusions: The results of this study demonstrate that the learning effect for Matrix-FDT is mild and it may affect only the first test. Caution is needed in the analysis of the first Matrix-FDT examination and retest may be advisable in the presence of low mean defect

Exploring the Heidelberg Retinal Tomograph 3 diagnostic accuracy across disc sizes and glaucoma stages: a multicenter study

To investigate and compare the diagnostic accuracy of the Heidelberg Retinal Tomograph 3 (HRT3) diagnostic algorithms and establish whether they are affected by optic disc size and glaucoma severity

Relación entre la perimetría automatizada convencional y la topografía papilar realizada con el tomógrafo Heidelberg

espanolObjetivo: Determinar las correlaciones entre los parametros de la cabeza del nervio optico (CNO) obtenidos mediante el laser confocal de barrido (HRT), y los resultados de la perimetria automatizada convencional (PA) en sujetos normales, hipertensos oculares (HTO), sospechosos de glaucoma y glaucomatosos. Metodos: Cuatrocientos veintitres ojos fueron incluidos en el estudio y clasificados segun la presion intraocular basal, morfologia papilar y los resultados de la PA en 4 grupos: 87 normales, 192 hipertensos oculares, 70 sospechosos de glaucoma y 74 glaucomatosos. En los diferentes grupos diagnosticos, se calcularon los coeficientes de correlacion de Pearson entre los parametros de la CNO y la desviacion media (DM), la desviacion estandar de la media (DSM), el numero de puntos alterados en cada cuadrante del campo visual (superior-nasal, inferior-nasal, superior-temporal e inferior-temporal), el numero de puntos alterados segun los niveles de probabilidad y los valores umbral en cada punto de la PA. Resultados: En el grupo normal y de hipertensos oculares, se encontraron pocas correlaciones debiles entre los parametros del HRT y los resultados de la PA. La fuerza y el numero de correlaciones significativas aumentaron en el grupo de sospechosos de glaucoma. En el grupo de glaucomas, las correlaciones fueron mas fuertes, especialmente entre los cocientes excavacion/disco y anillo/disco con la DM (r=0,479) y entre el area de anillo con la DSM (r=0,444). Conclusiones: Se encontraron correlaciones debiles o moderadas entre algunos parametros de la CNO medidos con el HRT y los resultados de la PA, en el grupo de glaucomas. EnglishPurpose: To determine the correlations between optic nerve head (ONH) parameters measured with the Heidelberg Retina Tomograph (HRT), and the main outcomes of standard automated perimetry (SAP) in normal, ocular hypertensive, glaucoma suspects and glaucomatous subjects. Methods: Four hundred and twenty-three patients were enrolled in the study and classified into four groups depending on baseline intraocular pressure, optic nerve head morphology, and SAP results: 87 normal eyes, 192 ocular hypertensive eyes, 70 glaucoma suspects and 74 glaucomatous eyes. In the different diagnostic groups, Pearson's correlation coefficients were calculated between ONH parameters and mean deviation, pattern standard deviation (PSD), number of altered points in each quadrant of the visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number of points altered at different probability levels, and threshold values at each point of SAP. Results: In the normal and ocular hypertensive groups, only a few weak correlations were found between HRT and SAP parameters. The strength and number of significant correlations increased in the suspected glaucoma group. The glaucoma group had the strongest correlations, particularly between cup/disc ratio and rim/disc ratio with MD (r=0.479) and between rim area and PSD (r=0.444). Conclusions: Weak to moderate correlations were found between some ONH parameters obtained with the HRT and SAP results in the glaucoma grou

The circadian curve of intraocular pressure : can we estimate its characteristics during office hours?

PURPOSE: To verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP). METHODS: The 24-hour IOP curves of 29 healthy subjects (10 young adults, 19 elderly) and 30 patients with untreated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine and sitting (Goldmann tonometer) positions. Peak, mean, and fluctuation of 24-hour IOP curves were compared with office-hour measurements obtained in subjects in the sitting position alone and with combined pressures obtained in the sitting and supine positions (four measurements in each body position from 9 AM to 6 PM). The percentage of subjects with estimates of all IOP parameters within a cutoff of +/-1 (peak and mean) and +/-2 mm Hg (fluctuation) was calculated. RESULTS: Office-hour sitting measurements correctly identified peak, mean, and IOP fluctuation in 10% of the young adults, 32% of the elderly control subjects, and 20% of the patients with glaucoma, whereas the combination of supine and sitting measurements correctly identified them in 30%, 85%, and 46% of cases, respectively. It is noteworthy that office-hour measurements did not characterize any 24-hour parameter in 20% of patients with glaucoma. CONCLUSIONS: Compared with sitting measurements alone, the collection of supine and sitting office-hour measurements may enhance the correct identification of 24-hour IOP characteristics in both control subjects and untreated patients with glaucoma, thus reducing the need for obtaining 24-hour curves to a minority of patients

Age-related changes of the ocular surface : a hospital setting-based retrospective study

Purpose. To investigate the effects of age on the prevalence of ocular surface diseases (OSD), adherence to treatment, and recovery rates. Patients and Methods. Retrospective analysis of 3000 clinical records from a first-level general ophthalmology clinic. Patients with OSD were prospectively submitted a questionnaire to assess compliance and recovery rates. Results. OSD prevalence was 10.3%. Patients with OSD were significantly older than patients without it: 67.5 \ub1 20.3 versus 57.0 \ub1 22.0 years (P = 0.036). No significant difference in season distribution was shown. Dry eye disease (DED) represented 58% of OSD; its prevalence increased with age until 80 years old and suddenly decreased thereafter. Asymptomatic DED was 37%. Adherence to treatment in OSD was very high (94%); recovery rates were lower in patients aged 21-40 and 61-80 (resp., 65.5% and 77.8%) and this was associated with higher OSDI scores. Tear substitutes represented 50% of all prescribed medications; their use increased with age. Discussion. In a "reallife"low-tech setting, OSD showed a prevalence of 10.3%. DED was the most prevalent disease, and it was asymptomatic in more than 1/3 of cases

Circadian variations in central corneal thickness and intraocular pressure in patients with glaucoma

AIM: To analyse 24 hour variations in intraocular pressure (IOP) and central corneal thickness (CCT) in a group of glaucomatous patients. METHODS: 30 patients with primary open angle glaucoma were hospitalised and underwent circadian evaluations (at 8 pm, midnight, 4 am, 8 am, noon, and 4 pm) of supine and sitting IOP, respectively, measured using a Perkins and a Goldmann tonometer, and CCT measured using an ultrasonic pachymeter (the mean value of three measurements within 5 mum). All patients were treated with timolol 0.5% twice daily and latanoprost 0.005% once daily. RESULTS: Mean supine IOP was 15.3 (SD 3.7) mm Hg (range 10-25), with circadian fluctuations of 7.3 (3.3) mm Hg. Mean sitting IOP was 15.1 (3.9) mm Hg (range 8-26), with circadian fluctuations of 5.4 (3.1) mm Hg. Mean CCT was 534 (39) microm (range 443-637 microm) with circadian fluctuations of 16.5 (6.2) microm (range 6-31 microm). Both the within patient and within time point fluctuations in CCT were statistically significant (p<0.0001, ANOVA). CONCLUSIONS: The authors found considerable fluctuations in 24 hour IOP. The circadian fluctuations in CCT were small and, although statistically significant, did not seem to interfere with the circadian IOP assessment

Optical coherence tomography angiography in Purtscher-like retinopathy associated with dermatomyositis : a case report

Purpose: To describe a multimodal imaging diagnosis of retinopathy in dermatomyositis. Case presentation: A 21-year-old white woman with a history of fatigue and a cutaneous rash complained of visual impairment in her left eye. A funduscopic examination showed multiple confluent cotton-wool spots in both eyes. Swept source-optical coherence tomography presented macular edema in both eyes; optical coherence tomography angiography revealed superficial and deep capillary occlusion in all areas affected by cotton-wool spots; and fluorescein angiography showed vascular walls enhancement, veins dilatation, and capillary leakage. After large doses of intravenously administered glucocorticoid therapy, followed by a cyclophosphamide regimen, best corrected visual acuity returned to 20/20 in both eyes. Conclusions: This case report presents optical coherence tomography angiography clinical findings in a rare case of dermatomyositis-associated retinopathy, remarking the importance of a multi-imaging approach for a correct diagnosis and treatment of eye injuries, in order to avoid serious complications and permanent sequelae

An Evaluation of Therapeutic Noninferiority of 0.005% Latanoprost Ophthalmic Solution and Xalatan in Patients With Glaucoma or Ocular Hypertension.

PURPOSE: To assess the therapeutic noninferiority of 0.005% latanoprost ophthalmic solution versus Xalatan in the treatment of patients with primary open-angle glaucoma or ocular hypertension. PATIENTS AND METHODS: This was a double-masked, randomized, multicenter study. A total of 184 patients with a diagnosis of unilateral or bilateral primary open-angle glaucoma or ocular hypertension were randomly assigned to either 0.005% latanoprost ophthalmic solution or Xalatan for 12 weeks. The primary end-point was the change in intraocular pressure (IOP) at 12 weeks in the 2 groups. Noninferiority was reached if the 2-sided 95% confidence intervals (CI) for the difference between adjusted treatment means were entirely within the interval from -1.5 to +1.5 mm Hg. RESULTS: The difference between treatments in the change of IOP from baseline to the end of treatment was 0.12 mm Hg (95% CI: -0.47, 0.71) in the intention-to-treat population and 0 mm Hg (95% CI: -0.58, 0.57) in the per protocol population. There was no statistically significant difference between the 2 groups in terms of drug-related adverse events. The most commonly reported drug-related local adverse events were: ocular hyperemia, eyelashes growth, and eye irritation. CONCLUSIONS: This study demonstrates that 0.005% latanoprost ophthalmic solution is noninferior to Xalatan in lowering IOP and is generally well tolerate

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer

Purpose: To evaluate relative diagnostic precision and test–retest variability of 2 devices, the Compass (CMP, CenterVue, Padova, Italy) fundus perimeter and the Humphrey Field Analyzer (HFA, Zeiss, Dublin, CA), in detecting glaucomatous optic neuropathy (GON). Design: Multicenter, cross-sectional, case-control study. Participants: We sequentially enrolled 499 patients with glaucoma and 444 normal subjects to analyze relative precision. A separate group of 44 patients with glaucoma and 54 normal subjects was analyzed to assess test–retest variability. Methods: One eye of recruited subjects was tested with the index tests: HFA (Swedish interactive thresholding algorithm [SITA] standard strategy) and CMP (Zippy Estimation by Sequential Testing [ZEST] strategy), 24-2 grid. The reference test for GON was specialist evaluation of fundus photographs or OCT, independent of the visual field (VF). For both devices, linear regression was used to calculate the sensitivity decrease with age in the normal group to compute pointwise total deviation (TD) values and mean deviation (MD). We derived 5% and 1% pointwise normative limits. The MD and the total number of TD values below 5% (TD 5%) or 1% (TD 1%) limits per field were used as classifiers. Main Outcome Measures: We used partial receiver operating characteristic (pROC) curves and partial area under the curve (pAUC) to compare the diagnostic precision of the devices. Pointwise mean absolute deviation and Bland–Altman plots for the mean sensitivity (MS) were computed to assess test–retest variability. Results: Retinal sensitivity was generally lower with CMP, with an average mean difference of 1.85±0.06 decibels (dB) (mean ± standard error, P < 0.001) in healthy subjects and 1.46±0.05 dB (mean ± standard error, P < 0.001) in patients with glaucoma. Both devices showed similar discriminative power. The MD metric had marginally better discrimination with CMP (pAUC difference ± standard error, 0.019±0.009, P = 0.035). The 95% limits of agreement for the MS were reduced by 13% in CMP compared with HFA in participants with glaucoma and by 49% in normal participants. Mean absolute deviation was similar, with no significant differences. Conclusions: Relative diagnostic precision of the 2 devices is equivalent. Test–retest variability of MS for CMP was better than for HFA