Anterior Chamber Angle Evaluation Using Gonioscopy: Consistency and Agreement between Optometrists and Ophthalmologists

SIGNIFICANCE In our intermediate-tier glaucoma care clinic, we demonstrate fair to moderate agreement in gonioscopy examination between optometrists and ophthalmologists, but excellent agreement when considering open versus closed angles. We highlight the need for increased consistency in the evaluation and recording of angle status using gonioscopy. PURPOSE The consistency of gonioscopy results obtained by different clinicians is not known but is important in moving toward practice modalities such as telemedicine and collaborative care clinics. The purpose of this study was to evaluate the description and concordance of gonioscopy results among different practitioners. METHODS The medical records of 101 patients seen within a collaborative care glaucoma clinic who had undergone gonioscopic assessment by two clinicians (one optometrist and either one general ophthalmologist [n = 50] or one glaucoma specialist [n = 51]) were reviewed. The gonioscopy records were evaluated for their descriptions of deepest structure seen, trabecular pigmentation, iris configuration, and other features. These were compared between clinicians (optometrist vs. ophthalmologist) and against the final diagnosis. RESULTS Overall, 51.9 and 59.8% of angles were graded identically in terms of deepest visible structure when comparing between optometrist versus general ophthalmologist and optometrist versus glaucoma specialist, respectively. The concordance increased when considering ±1 of the grade (67.4 and 78.5%, respectively), and agreement with the final diagnosis was high (>90%). Variations in angle grading other than naming structures were observed (2.0, 30, and 3.9% for optometrist, general ophthalmologist, and glaucoma specialist, respectively). Most of the time, trabecular pigmentation or iris configuration was not described. CONCLUSIONS Fair to moderate concordance in gonioscopy was achieved between optometrists and ophthalmologists in a collaborative care clinic in which there is consistent feedback and clinical review. To move toward unified medical records and a telemedicine model, improved consistency of record keeping and angle description is required

Local biases drive, but do not determine, the perception of illusory trajectories

When a dot moves horizontally across a set of tilted lines of alternating orientations, the dot appears to be moving up and down along its trajectory. This perceptual phenomenon, known as the slalom illusion, reveals a mismatch between the veridical motion signals and the subjective percept of the motion trajectory, which has not been comprehensively explained. In the present study, we investigated the empirical boundaries of the slalom illusion using psychophysical methods. The phenomenon was found to occur both under conditions of smooth pursuit eye movements and constant fixation, and to be consistently amplified by intermittently occluding the dot trajectory. When the motion direction of the dot was not constant, however, the stimulus display did not elicit the expected illusory percept. These findings confirm that a local bias towards perpendicularity at the intersection points between the dot trajectory and the tilted lines cause the illusion, but also highlight that higher-level cortical processes are involved in interpreting and amplifying the biased local motion signals into a global illusion of trajectory perception

Local biases drive, but do not determine, the perception of illusory trajectories

When a dot moves horizontally across a set of tilted lines of alternating orientations, the dot appears to be moving up and down along its trajectory. This perceptual phenomenon, known as the slalom illusion, reveals a mismatch between the veridical motion signals and the subjective percept of the motion trajectory, which has not been comprehensively explained. In the present study, we investigated the empirical boundaries of the slalom illusion using psychophysical methods. The phenomenon was found to occur both under conditions of smooth pursuit eye movements and constant fixation, and to be consistently amplified by intermittently occluding the dot trajectory. When the motion direction of the dot was not constant, however, the stimulus display did not elicit the expected illusory percept. These findings confirm that a local bias towards perpendicularity at the intersection points between the dot trajectory and the tilted lines cause the illusion, but also highlight that higher-level cortical processes are involved in interpreting and amplifying the biased local motion signals into a global illusion of trajectory perception

Optimising the glaucoma signal/noise ratio by mapping changes in spatial summation with area-modulated perimetric stimuli

Identification of glaucomatous damage and progression by perimetry are limited by measurement and response variability. This study tested the hypothesis that the glaucoma damage signal/noise ratio is greater with stimuli varying in area, either solely, or simultaneously with contrast, than with conventional stimuli varying in contrast only (Goldmann III, GIII). Thirty glaucoma patients and 20 age-similar healthy controls were tested with the Method of Constant Stimuli (MOCS). One stimulus modulated in area (A), one modulated in contrast within Ricco's area (C R ), one modulated in both area and contrast simultaneously (AC), and the reference stimulus was a GIII, modulating in contrast. Stimuli were presented on a common platform with a common scale (energy). A three-stage protocol minimised artefactual MOCS slope bias that can occur due to differences in psychometric function sampling between conditions. Threshold difference from age-matched normal (total deviation), response variability, and signal/noise ratio were compared between stimuli. Total deviation was greater with, and response variability less dependent on defect depth with A, AC, and C R stimuli, compared with GIII. Both A and AC stimuli showed a significantly greater signal/noise ratio than the GIII, indicating that area-modulated stimuli offer benefits over the GIII for identifying early glaucoma and measuring progression

Theoretical Analysis of Competing Conformational Transitions in Superhelical DNA

We develop a statistical mechanical model to analyze the competitive behavior of transitions to multiple alternate conformations in a negatively supercoiled DNA molecule of kilobase length and specified base sequence. Since DNA superhelicity topologically couples together the transition behaviors of all base pairs, a unified model is required to analyze all the transitions to which the DNA sequence is susceptible. Here we present a first model of this type. Our numerical approach generalizes the strategy of previously developed algorithms, which studied superhelical transitions to a single alternate conformation. We apply our multi-state model to study the competition between strand separation and B-Z transitions in superhelical DNA. We show this competition to be highly sensitive to temperature and to the imposed level of supercoiling. Comparison of our results with experimental data shows that, when the energetics appropriate to the experimental conditions are used, the competition between these two transitions is accurately captured by our algorithm. We analyze the superhelical competition between B-Z transitions and denaturation around the c-myc oncogene, where both transitions are known to occur when this gene is transcribing. We apply our model to explore the correlation between stress-induced transitions and transcriptional activity in various organisms. In higher eukaryotes we find a strong enhancement of Z-forming regions immediately 5′ to their transcription start sites (TSS), and a depletion of strand separating sites in a broad region around the TSS. The opposite patterns occur around transcript end locations. We also show that susceptibility to each type of transition is different in eukaryotes and prokaryotes. By analyzing a set of untranscribed pseudogenes we show that the Z-susceptibility just downstream of the TSS is not preserved, suggesting it may be under selection pressure

The role of inflammation in epilepsy.

Epilepsy is the third most common chronic brain disorder, and is characterized by an enduring predisposition to generate seizures. Despite progress in pharmacological and surgical treatments of epilepsy, relatively little is known about the processes leading to the generation of individual seizures, and about the mechanisms whereby a healthy brain is rendered epileptic. These gaps in our knowledge hamper the development of better preventive treatments and cures for the approximately 30% of epilepsy cases that prove resistant to current therapies. Here, we focus on the rapidly growing body of evidence that supports the involvement of inflammatory mediators-released by brain cells and peripheral immune cells-in both the origin of individual seizures and the epileptogenic process. We first describe aspects of brain inflammation and immunity, before exploring the evidence from clinical and experimental studies for a relationship between inflammation and epilepsy. Subsequently, we discuss how seizures cause inflammation, and whether such inflammation, in turn, influences the occurrence and severity of seizures, and seizure-related neuronal death. Further insight into the complex role of inflammation in the generation and exacerbation of epilepsy should yield new molecular targets for the design of antiepileptic drugs, which might not only inhibit the symptoms of this disorder, but also prevent or abrogate disease pathogenesis

Populations norms for "sLURP" - An iPad app for quantification of visuomotor coordination testing

Currently the integrity of brain function that drives behavior is predominantly measured in terms of pure motor function, yet most human behavior is visually driven. A means of easily quantifying such visually-driven brain function for comparison against population norms is lacking. Analysis of eye-hand coordination (EHC) using a digital game-like situation with downloadable spatio-temporal details has potential for clinicians and researchers. A simplified protocol for the Lee-Ryan EHC (Slurp) Test app for iPad® has been developed to monitor EHC. The two subtests selected, each of six quickly completed items with appeal to all ages, were found equivalent in terms of total errors/time and sensitive to developmental and aging milestones known to affect EHC. The sensitivity of outcomes due to the type of stylus being used during testing was also explored. Populations norms on 221 participants aged 5 to 80+years are presented for each test item according to two commonly used stylus types. The Slurp app uses two-dimensional space and is suited to clinicians for pre/post-intervention testing and to researchers in psychological, medical, and educational domains who are interested in understanding brain function

The Influence of Cast Shadows on the Detection of Three-Dimensional Curved Contour Structure

Cast shadows have been shown to provide an effective ordinal cue to the depth position of objects. In the present study, two experiments investigated the effectiveness of cast shadows in facilitating the detection of spatial contours embedded in a field of randomly placed elements. In Experiment 1, the separation between the cast shadow and the contour was systematically increased to effectively signal different contour depth positions (relative to background elements), and this was repeated for patterns in which the lighting direction was above and from below. Increasing the shadow separation improved contour detection performance, but the degree to which sensitivity changed was dependent on the lighting direction. Patterns in which the light was from above were better detected than patterns in which the lighting direction was from below. This finding is consistent with the visual system assuming a “light-from-above rule” when processing cast shadows. In Experiment 2, we examined the degree to which changing the shape of the cast shadow (by randomly jittering the position of local cast shadow elements) affected the ability of the visual system to rely on the cast shadow to cue the depth position of the contour. Consistent with a coarse scale analysis, we find that cast shadows remained an effective depth cue even at large degrees of element jitter. Our findings demonstrate that cast shadows provide an effective means of signaling depth, which aids the process of contour integration, and this process is largely tolerant of local variations in lighting direction

Reducing Spatial Uncertainty Through Attentional Cueing Improves Contrast Sensitivity in Regions of the Visual Field With Glaucomatous Defects

Purpose: Current clinical perimetric test paradigms present stimuli randomly to various locations across the visual field (VF), inherently introducing spatial uncertainty, which reduces contrast sensitivity. In the present study, we determined the extent to which spatial uncertainty affects contrast sensitivity in glaucoma patients by minimizing spatial uncertainty through attentional cueing. Methods: Six patients with open-angle glaucoma and six healthy subjects underwent laboratory-based psychophysical testing to measure contrast sensitivity at preselected locations at two eccentricities (9.5° and 17.5°) with two stimulus sizes (Goldmann sizes III and V) under different cueing conditions: 1, 2, 4, or 8 points verbally cued. Method of Constant Stimuli and a single-interval forced-choice procedure were used to generate frequency of seeing (FOS) curves at locations with and without VF defects. Results: At locations with VF defects, cueing minimizes spatial uncertainty and improves sensitivity under all conditions. The effect of cueing was maximal when one point was cued, and rapidly diminished when more points were cued (no change to baseline with 8 points cued). The slope of the FOS curve steepened with reduced spatial uncertainty. Locations with normal sensitivity in glaucomatous eyes had similar performance to that of healthy subjects. There was a systematic increase in uncertainty with the depth of VF loss. Conclusions: Sensitivity measurements across the VF are negatively affected by spatial uncertainty, which increases with greater VF loss. Minimizing uncertainty can improve sensitivity at locations of deficit. Translational Relevance: Current perimetric techniques introduce spatial uncertainty and may therefore underestimate sensitivity in regions of VF loss