Does eye examination order for standard automated perimetry matter?

PURPOSE: In spite of faster examination procedures, visual field (VF) results are potentially influenced by fatigue. We use large-scale VF data collected from clinics to test the hypothesis that perimetric fatigue effects are greater in the eye examined second. METHODS: Series of six Humphrey Swedish Interactive Testing Algorithm (SITA) VFs from 6901 patients were retrospectively extracted from a VF database from four different glaucoma clinics. Mean deviation (MD) was compared between first and second tested eyes. A surrogate measure of longitudinal MD variability over time was estimated from errors using linear regression of MD against time then compared between first and second tested eye. RESULTS: Right eye VF was tested consistently first throughout in 6320 (91.6%) patients. Median (interquartile range; IQR) MD in the first tested (right) eye and second tested (left) eye was -2.57 (-6.15, -0.58) dB and -2.70 (-6.34, -0.80) dB respectively (median reduction VF sensitivity of 0.13 dB; p < 0.001). Median (IQR) increase in our surrogate measure of longitudinal MD variability in the second eye tested was 3% (-43%, 50%); this effect was not associated with patient age or rest time between examinations. CONCLUSION: Statistically significant perimetric fatigue effects manifest on average in the second eye tested in routine clinics using Humphrey Field Analyzer SITA examinations. However, the average effects were very small and there was enormous variation among patients. We recommend starting with a right eye examination so that any perimetric fatigue effects, if they exist in an individual, will be as constant as possible from visit to visit

Outcomes measures in idiopathic intracranial hypertension.

IntroductionIdiopathic Intracranial Hypertension is condition characterised by raised intracranial pressure, papilledema, and normal neuroimaging (aside from radiological signs of raised intracranial pressure). Symptoms of idiopathic intracranial hypertension include chronic headaches and for some, visual loss. New treatments are an unmet clinical need.Areas coveredThe aim of this review is to present the evidence base and considered opinion on outcome measures to determine successful management of idiopathic intracranial hypertension.Expert opinionLess invasive measures of disease activity such as optical coherence tomography will continue to grow in this field, both as a measure of papilledema, and potentially as a surrogate for intracranial pressure and visual function. As a highly disabling aspect of the disease is headache, treatment outcomes for headache morbidity need to be appropriately chosen and standardized to allow comparison between trials

The investigation of acute optic neuritis: a review and proposed protocol

Optic neuritis is an inflammatory optic neuropathy that affects many patients with multiple sclerosis (MS) at some point during their disease course. Differentiation of acute episodes of MS-associated optic neuritis from other autoimmune and inflammatory optic neuropathies is vital for treatment choice and further patient management, but is not always straightforward. Over the past decade, a number of new imaging, laboratory and electrophysiological techniques have entered the clinical arena. To date, however, no consensus guidelines have been devised to specify how and when these techniques can be most rationally applied for the diagnostic work-up of patients with acute optic neuritis. In this article, we review the literature and attempt to formulate a consensus for the investigation of patients with acute optic neuritis, both in standard care and in research with relevance to clinical treatment trials