The relationship between standard automated perimetry and GDx VCC measurements

PURPOSE: To investigate the relationship between retinal light sensitivity measured with standard automated perimetr

Nonconjugate adaptation of human saccades to anisometropic spectacles: Meridian-specificity

Abstract Recently it has been demonstrated that saccades become different in size in the two eyes if a subject is adapted to anisometropic spectacles, which provide visual images of different magnitude to the two eyes. These nonconjugate adaptations adequately meet the requirements of those spectacles and, once acquired, they persist (with some reduction) even during monocular viewing. We now demonstrate that such nonconjugate adaptations of saccades can be meridian-specific, if there is a pressure for such meridian-specificity. This pressure was provided by means of a cylindrical spectacle-lens. Adaptations along a vertical, horizontal or oblique meridian did not transfer to the orthogonal meridian. These results demonstrate a capability of saccadic adaptation to deal with calibration problems restricted not only to one eye, but even to one specific plane of muscular action. Our results also suggest that the meridian-specific adaptations of oblique saccades take place at a stage before the decomposition of motor commands into separate horizontal and vertical components. The meridian-specific nonconjugacies were also expressed in smooth-pursuit eye movements. Post-saccadic drift adapted only along the horizontal meridian

Asymmetrical adaptation of human saccades to anisometropic spectacles

Saccades are the rapid eye movements which enable us to voluntarily shift our gaze from one visual target to another. They serve to bring newly selected visual targets to the fovea of each of the two eyes, which is a small part of the retina with high visual acuity. This accurate, binocular control of saccades requires a high quality of oculomotor coordination. During the course of a lifetime, the various structures involved in the generation and the control of saccades may be subject to change, due to, for example, growth, ageing, disease or injury. These changes will undoubtedly affect saccadic control, and, consequently, jeopardize its quality. To safeguard its proper functioning, the oculomotor system will therefore have to adapt adequately to such changes. As these changes probably take place haphazardly, at different places, with different time-courses and with different degrees of severity, the saccadic subsystem should be capable of adapting specifically to such non-uniform changes. Adaptation of saccades has been described in the literature subsequent to local, physical damage to external eye muscles, as well as to purely visual stimuli (for a review, see Chapter 2). The aim of this thesis was to assess both qualitatively and quantitatively how the sa~cadic subsystem responds to a consistent visual pressure for an asymmetrical adaptation, i.e., adaptation that is different for each of the two eye

Upper eyelid motility in blepharoptosis and in the aging eyelid

PURPOSE. To study the metrics of lid saccades in blepharoptosis and to distinguish any differences in the dynamics of eyelid movements that are related to the cause of blepharoptosis and to aging. METHODS. The lid and vertical eye saccades of 7 patients with congenital blepharoptosis and those of 18 patients with aponeurogenic blepharoptosis, either involutional or rigid-contact-lens-induced, were recorded with electromagnetic search coils. For each saccade, two parameters were assessed: amplitude and peak velocity. Two age-matched control groups were assessed in the same manner. Repeated measures analysis of variance was used to investigate any observed differences between the included groups. RESULTS. Congenital and rigid-contact-lens-induced blepharoptosis were readily distinguishable from one another, as well as from the age-matched control group, in both lid saccadic amplitude and peak velocity. For example, 40 degrees downward lid saccades in the congenital blepharoptosis group averaged 22.9 degrees +/- 4.0 degrees (SD), whereas 30.0 degrees +/- 4.7 degrees lid saccades were made by the age-matched control group. The subjects in the two groups with aponeurogenic blepharoptosis also made lid saccades that were distinctive for their group (P: < 0.02), in both amplitude and peak velocity. For 40 degrees downward saccades in involutional and rigid-contact-lens-induced blepharoptosis, lid saccadic amplitude averaged 32.7 degrees +/- 4.3 degrees and 40.3 degrees +/- 3.5 degrees, respectively. Lid saccadic peak velocity declined significantly with age. Lid saccadic peak velocity for 40 degrees upward saccades in the younger control group averaged 401.7 +/- 11.4 deg/sec, whereas the older control group achieved an average peak velocity of 360.7 +/- 60.4 deg/sec. The lid saccadic dynamics in the involutional blepharoptosis group proved to be similar (P: > 0.05) in saccadic amplitude and peak velocity to those of age-matched controls. CONCLUSIONS. In diffe

Automated detection of wedge-shaped defects in polarimetric images of the retinal nerve fibre layer

Purpose: Automated glaucoma detection in images obtained by scanning laser polarimetry is currently insensitive to local abnormalities, impairing its performance. The purpose of this investigation was to tes

Monitoring of stable glaucoma patients

A high workload for ophthalmologists and long waiting lists for patients challenge the organization of ophthalmic care. Tasks that require less specialized skills, like the monitoring of stable (well controlled) glaucoma patients could be substituted from ophthalmologists to other professionals (substitution in person). In addition, care could perhaps be provided in an ambulatory setting (substitution in location of care). To date, little is known about substituting care in ophthalmology, the organizational and professional dynamics involved and any consequences for both the quality of care and cost effectiveness. Glaucoma is the name given to a group of eye diseases characterized by damage to the optic nerve yielding gradual, irreversible loss of visual field. Glaucoma is often related to too high an intraocular pressure (IOP) and is age related. The usual care for glaucoma patients consists of diagnosis, lifelong monitoring, and treatment and is provided by ophthalmologists. However, monitoring stable glaucoma patients will presumably not require the specialist expertise of an ophthalmologist and may be carried out by less specialized professionals. Therefore, the quality of care given to stable glaucoma patients was evaluated when provided by ophthalmic technicians or optometrists based on pre-set protocols and under supervision of ophthalmologists in a Glaucoma follow-up unit (GFU) within The Rotterdam Eye Hospital (REH). The objective of this study is to evaluate an organizational intervention, a GFU for monitoring stable glaucoma patients in a hospital setting, staffed by non-physician Health Care Professionals instead of ophthalmologists. Furthermore, conditions will be formulated that need to be fulfilled to successfully substitute the monitoring care for stable glaucoma patients to a primary care optometrist (substitution in person as well as in location). The conditions will be b

A very short version of the Visual Function Questionnaire (VFQ-3oo7) for use as a routinely applied Patient-Reported Outcome Measure

Background: Patient-reported outcome measures (PROMs) are valuable supplements in regular care to facilitate routine monitoring of quality of life from the patient’s perspective. The 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) is a widely used PROM in ophthalmology. However, the NEI-VFQ-25 is too time-consuming and cumbersome for routine evaluations in regular care. The aim of this study is to construct a 7-item questionnaire of which only 3 items are presented to the patient, by means of routing. This VFQ 3 out of 7 (VFQ-3oo7) should have a minimal loss of information compared with the NEI-VFQ-25. Methods: An historical database including 3293 administrations of the NEI-VFQ-25 was constructed involving patients with retinal detachment, cataract, corneal diseases, glaucoma, macular degeneration, uveal melanoma and a normal population sample. The data were subjected to Rasch analyses, in particular a generalized partial credit model. Items were sorted on the latent trait and divided into seven categories. From each category, the item with the highest discriminative value was selected. Through routing, only three out of the seven remaining questions are used, where the answers navigate patients to a fitting trait level. Results: A one-dimensional structure was considered fitting. The VFQ-3oo7 showed a small loss of information compared with the total score of the NEI-VFQ-25: correlation 0.927 and a relative precision of 0.868. Conclusion: The very short, but valid, VFQ-3oo7 can be applied to evaluate the patient's perceived vision-related health status in routine evaluations of treatments in regular care, with a small burden for patients

Bayesian hierarchical modeling of longitudinal glaucomatous visual fields using a two-stage approach

The Bayesian approach has become increasingly popular because it allows to fit quite complex models to data via Markov chain Monte Carlo sampling. However, it is also recognized nowadays that Markov chain Monte Carlo sampling can become computationally prohibitive when applied to a large data set. We encountered serious computational difficulties when fitting an hierarchical model to longitudinal glaucoma data of patients who participate in an ongoing Dutch study. To overcome this problem, we applied and extended a recently proposed two-stage approach to model these data. Glaucoma is one of the leading causes of blindness in the world. In order to detect deterioration at an early stage, a model for predicting visual fields (VFs) in time is needed. Hence, the true underlying VF progression can be determined, and treatment strategies can then be optimized to prevent further VF loss. Because we were unable to fit these data with the classical one-stage approach upon which the current popular Bayesian software is based, we made use of the two-stage Bayesian approach. The considered hierarchical longitudinal model involves estimating a large number of random effects and deals with censoring and high measurement variability. In addition, we extended the approach with tools for model evaluation. Copyrigh

Creating patient value in glaucoma care

Purpose: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of a quality cost mode