When macular diseases involves the fovea, patients' central vision is significantly reduced. A central dark spot appears in the visual field, and their visual function indicators, such as reading speed and fixation stability, are significantly impaired, which seriously affects the patients' quality of life. The human body's response to the damage of the fovea region is a spontaneous adaptation strategy adopted by the brain. The brain will select the paracentral region as the pseudo fovea to serve as the fixation site of the eye, however, the development of patient's own residual vision is not maximized by this adaptation behavior. In recent years, through continuous research, it has been discovered that the automatic eye position recognition and automatic eye tracking system in the microperimeter can accurately detect specific retinal sites, combined with the biofeedback training mode, and can combine fundus examination with biofeedback training. It can help patients with age-related macular degeneration, pathological myopia macular degeneration, Stargardt's disease, macular hole and other macular diseases to choose the best retinal site as an eye movement benchmark, maximize the patient's residual vision and improve the patient's visual function.
ObjectiveTo investigate the difference in microperimetry between acute and chronic central serous chorioretinopathy (CSC). MethodsCross-sectional cases study. A consecutive series of 208 patients (221 eyes) with CSC diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in the study. The patients were divided into acute group (136 patients, 143 eyes) and chronic group (72 patients, 78 eyes) according to the duration and FFA. There were no statistical difference in sex (χ2=0.012, P=0.912) and mean age (t=-1.492, P=0.137) between two groups. All eyes received the examination of microperimetry and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). The mean retinal sensitivities (MS) and fixation rate in the central 2°(P1) and 4° (P2) were determined. ResultsThe mean value of logMAR BCVA in acute group and chronic group were 0.32±0.23 and 0.48±0.33, there was significant difference (Z=-3.353, P=0.001). In acute group and chronic group, the MS were (21.25±5.06) and (15.82±7.23) dB, P1 were (76.36±25.78)% and (55.01±32.34)%, P2 were (92.21±13.06)% and (79.83±23.11)%. There were statistical differences in MS (Z=-5.456, P < 0.001), P1 (Z=-4.629, P < 0.001) and P2 (Z=-4.265, P < 0.001) between two groups. In acute group, fixation was stable in 98 eyes (68.5%), relative unstable in 30 eyes (21.0%), unstable in 15 eyes (10.5%). In chronic group, fixation was stable in 30 eyes (38.5%), relative unstable in 22 eyes (28.2%), unstable in 26 eyes (33.3%). The difference of fixation between two groups was statistically significant (χ2=23.196, P < 0.001). ConclusionMS, fixation rate and fixation stability in chronic CSC eyes were all decreased compared with acute CSC eyes.
Transsynaptic retrograde degeneration of optic neuropathy (TRDON) refers to the degeneration and/or apoptosis of presynaptic neurons (retinal ganglion cells) caused by damage to the lateral geniculate body and post-geniculate visual pathway. At present, the pathogenesis of TRDON is secondary apoptosis of Pβ-type retinal ganglion cells, resulting in the atrophy of optic tract, thinning of the retinal nerve fiber layer and retinal ganglion cell layer thickness and declining of retinal microvascular density, which are consistent with the visual field defect attributed to the primary disease. Of which, the thinning of the retinal ganglion cell layer thickness is considered as the characteristic of TRDON. Now, there is little understanding and related research on TRDON in China. Clinicians should pay attention to the characteristics and severity, occurrence time and location of the above structural changes in these patients through optical coherence tomography, and monitor the activity and progress of the lesions, so as to determine the cut-off point for drug intervention and the drug targets for developing new treatment methods, and bring benefits for patients in partial visual function recovery and disability reduction.
Objective To observe the clinical characteristics of non arteritic anterior ischemic optic neuropathy (NAION) in patients of different genders. MethodsA retrospective clinical analysis. A total of 183 cases (246 eyes) of NAION with complete diagnosis and treatment confirmed by Departments of Neuro-ophthalmology/Acupuncture and Moxibustion of Eye Hospital, China Academy of Chinese Medical Sciences from June 2018 to December 2023 were included. Among them, 101 cases (138 eyes) were male and 82 cases (108 eyes) were female. Their age was (59.2±9.8) years. The number of right and left eyes were 120 and 126, respectively. The patient's gender, age, disease course, history of hypertension, history of diabetes, history of hyperlipidemia, history of smoking and drinking, best corrected visual acuity (BCVA), intraocular pressure, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness were recorded in detail. Visual field defects were classified into diffuse defects, ring scotoma, fan-shaped or wedge-shaped defects, upper and lower half defects, arcuate scotoma, and quadrantanopia. Logistic regression analysis was utilized to determine whether gender was an independent factor affecting the degree of visual field impairment in NAION. ResultsCompared with female patients, male patients showed earlier onset age, a shorter interval between binocular onsets, a higher morbidity rate of hyperlipidemia, and a higher proportion with history of smoking and drinking, with statistically significant differences (P＜0.05). There was no statistically significant difference in disease duration, intraocular pressure, pRNFL thickness, and intraocular perfusion pressure between patients of different genders (P＞0.05). Female patients exhibited better BCVA than male patients, but the difference was not statistically significant (P＞0.05). The degree of visual field impairment in female patients was significantly better than that in males. Males' visual field defects were mostly in the lower half, while females' defects were mostly of arcuate scotoma, with statistically significant differences (P＜0.05). The results of multiple logistic regression analysis showed that the gender of male was an independent risk factor for severe visual field impairment in NAION patients (odds ratio=2.936, 95% confidence interval 1.275-6.763, P=0.011). ConclusionsMale NAION patients have an earlier onset age and a shorter interval between the initial and contralateral eye onset. Male patients exhibit a more severe degree of visual field impairment, which is mostly manifested as lower half visual field defect. While female patients tend to develop arcuate scotoma. After adjusting for other influencing factors, the gender of male remains an independent risk factor for severe visual impairment in NAION patients.
Objective To investigate the distribution properties of multifocal pattern visual evoked potential across visual field. Methods Multifocal pattern visual evoked potentials(VEP) of 14 normals were measured with VERIS ScienceTM4.0The visual stimuli were dart board 60 with patterns which consisted of 60 patches arranged in dart board configuration spanning a 26deg; vis ual field. The temporal modulation of each patch was controlled by a special type of pseudorandom sequence called binary m-sequence. The electrodes were placed at equal distances 2 cm inferior to and 2 cm superior to and straddling the inion. The first slice of the second order kernel for each stimulus patch was analysed. The 60 patches were grouped into several sectors. The summed responses of these sectors were analysed and compared. Results Compared with that of the lower hemifield , the polarity of the multifocal VEP of the upper hemifield was reverse, and the latency delayed, the response density decreased. With the eccentricity increased, the response density of the multifocal VEP decreased. The properties of the multifocal VEP of the horizontal sectors were different from that of the vertical sectors. Conclusion VEP of many locations within visual field could be recorded simultaneously in a short time with the method of mutifocal VEP. The multifocal VEP showed different properties in different sectors within visual field. (Chin J Ocul Fundus Dis, 2001,17:280-283)
Objective To detect the difference of the light sensitivity in the central visual field between normal people and type Ⅱ diabetic patients without diabetic retinopathy, and evaluate the effect of perimetric examination in early diagnosis of diabetic retinopathy. Methods The light sensitivity at the 80 locations in the central field was measured by Dicon field analyzer (model TKS-4000) in 76 normal eyes of 44 normal volunteers aged from 45 to 72 years and 75 eyes of 40 type Ⅱ diabetic patients without retinopathy aged from 46 to 71 years. Results For the diabetic patients without diabetic retinopathy, the light sensitivity of locations decreased by 4-8 dB,and there were some decreased light sensitivity areas. The mean light sensitivity of three zones of the central field had significant reduction in the diabetic patients as compared with the control group(Plt;0.001). Conclusion The retinal neurosensory function of diabetic patients is damaged in some degrees before diabetic retinopathy occured, and no relationship is found between the decrease of retinal light sensitivity and localized blood-retinal barrier leakage. It is suggested that examination of central field with computerized perimetry has certain clinical significance in early diagnosis of diabetic retinopathy. (Chin J Ocul Fundus Dis, 2002, 18: 218-220)
Microperimetry is a procedure to assess retinal sensitivity while fundus is examined directly. It is a psychophysical method which is rapid, safe and non-invasive. It combines analysis of function and morphology and has an eye tracking system that can improve the fixation stability of patient with eccentric fixation and fixation instable. Microperimetry is supplement to visual function, perimetry, and other visual function parameters. As deepening of research, its clinical application value in ocular fundus diseases including age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa, Stargardt's disease, macular hole, rhegmatogenous retinal detachment and central serous chorioretinopathy needs to be further explored.
Objective To observe the characteristics of multifocal microperimetry and its relationship with visual acuity and multifocal ganglion cell complex (GCC) in nonarteritic anterior ischemic optic neuropathy (NAION). Methods A retrospective case study. A total of 38 patients (54 eyes) with NAION were enrolled in this study. 25 NAION eyes (25 patients) and 29 contralateral health eyes (29 patients) were randomly selected into case group and control group respectively. All eyes underwent best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscope, color fundus photography, optical coherence tomography (OCT), visual field and multifocal microperimetry. Logarithm of the minimum angle of resolution (logMAR) was used to calculate BCVA. There were no significantly differences on age (t=?0.647), gender, dominant eyes ( χ2=0.128, 0.099), intraocular pressure (t=0.376) between two groups (P>0.05). Macular GCC thickness, superior and inferior GCC thickness were measured by OCT, focal loss volume (FLV) and global loss volume (GLV) were obtained at the same time. Microperimetry were measured by macular integrity assessment instrument (MAIA microperimetry), and mean retinal sensitivities (MS) in macular area 10° and fixation rate in the macular central 2° and 4° were determined. The relationship between MS, macular GCC and BCVA were analyzed by Spearman correlation analysis. Results The mean logMAR BCVA of case group and control group were 0.68±0.79 and 0.07±0.06, respectively. There was significantly statistical difference in MS between two groups (t=?2.507, P=0.037). There were no significantly statistical difference in mean GCC (t=?1.245, P=0.259), superior and inferior GCC (t=?1.336, ?1.024; P=0.230, 0.346), FLV (t=1.058, P=0.331) and GLV (P=0.182) between two groups. The correlation between BCVA and MS (r=?0.809, P=?0.005) was observed. However, there were no correlation between BCVA and GCC, superior and inferior GCC, FLV, GLV (r=?0.98, ?0.466, ?0.061, 0.442, 0.442; P=0.817, ?0.244, 0.885, 0.273, 0.273). And also, there were no correlation between MS and GCC, superior and inferior GCC, FLV, GLV (r=0.238, 0.524, 0.286, 0.643, ?0.619; P=0.570, 0.183, 0.493, 0.086, 0.102). Conclusions MS reduced in early stage NAION eyes, which did not correlate with macular GCC.
ObjectiveTo evaluate visual field changes in early mild Parkinson's disease. Methods A total of 66 eyes of 33 cases with early mild Parkinson's disease and 72 eyes of 36 age-matched normal individuals were enrolled into the study. Humphrey Field Analyzer II was applied for central visual field test. The visual field indices of mean deviation (MD) and pattern standard deviation (PSD) were analyzed to evaluate the location and the characteristics of visual field defect in this study. ResultsVisual field indices MD (-3.4±2.5) dB was significantly changed in patients with PD when compared to the controls (-0.6±1.7) dB. PSD (4.3±2.6) was significantly higher in patients with PD than that in the control group (2.1±1.8) dB. Glaucoma hemifield test (GHT) assessment was within normal limits in the controls. Of the 33 patients (66 eyes) in PD, GHT showed outside normal limits in 31 eyes, borderline in 8 eyes, and within normal limits in 27 eyes. 31 eyes outside normal limits appeared glaucomatous visual field defects, in which 16 with nasal step and 5 with arcuate defect. ConclusionsVisual field indices including MD and PSD in early mild patients with PD were significantly worse than that in the controls group. GHT abnormalities could be found in early mild PD patients with visual field defects, including pericentral scotoma and nasal step, which mimicked glaucomatous changes.
ObjectiveTo observe the correlation between the thickness of foveal ganglion cell-inner plexiform layer (GCIPL) and visual field mean defect before and after gamma knife treatment in patients of sellar region tumors with optic chiasmal compression. MethodsThis was a prospective case series. 72 eyes of 37 consecutive patients suffering from optic chiasmal compression of sellar region tumors treated with gamma knife were enrolled in the study. According to the change of visual field before and after gamma knife treatment, the patients were divided into three groups. There were 13 eyes of 7 patients in group 1 with no vision defect pre-and post-treated, 34 eyes of 17 patients in group 2 with improvement of visual field defect after treatment, 25 eyes of 13 patients in groups 3 with no improvement or reorganization of visual field defect after treatment. Overall average thickness of GCIPL, and of the superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal retina were measured with the Cirrus high-definition spectral domain optical coherence tomography, and mean deviation (MD) with the Humphrey field analyzer before and 6 months after treatment. There was no significant difference in MD values between group 2 and 3 pre-treated (t=1.471, P=0.084). There was significant difference between all the groups in total average value of GCIPL thickness and the 6 quadrant GCIPL thickness values pre-treated (P < 0.05). Logistic regression model was applied to analysis of the correlation between GCIPL thickness and the improvement of visual field after treatment. ResultsThe MD values of the group 1, 2 and 3 were (-2.96 ±0.75), (-10.24 ±1.31), (-20.2 ±5.88) dB at 6 months after treatment. There was significant difference between group 2 and 3 of MD value after treatment (t=6.974, P=0.000). In group 1, there was no significant difference in mean GCIPL thickness and the 6 quadrant GCIPL thickness values between pre-and post-treated (t=0.882, P=0.395).The mean thickness of GCIPL, superonasal and inferonasal GCIPL was increased than pre-treated in group 2, and the difference was statistically significant (t=2.438, 4.630, 4.457; P=0.035, 0.001, 0.001). The mean thickness of GCIPL, superonasal and inferonasal GCIPL was decreased than pre-treated in group 3, and the difference was statistically significant (t=-2.387, -4.603, -4.975; P=0.041, 0.002, 0.001).Logistic regression analysis showed that the greater of the value of average GCIPL thickness of patients with visual field defect pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between the value of superonasal or inferonasal GCIPL and the improvement of the visual field post-treated (OR=5.374, 4.693; P=0.000, 0.000). There was no significant correlation between the value of superotemporal or upper or lower or inferotemporal GCIPL and the improvement of the visual field post-treated (OR=1.058, 1.101, 1.074, 1.056; P=0.183, 0.080, 0.162, 0.186). ConclusionsIn patients with optic chiasmal compression of sellar region tumor, the greater of the average GCIPL thickness pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between superonasal or inferonasal value of the GCIPL thickness and the improvement of visual field defect post-treated.