Ocular Manifestations, Visual Field Pattern, and Visual Field Test Performance in Traumatic Brain Injury and Stroke

Purpose. To analyze ocular manifestations, visual field (VF) pattern, and VF test performance in traumatic brain injury (TBI) and stroke patients. Methods. This retrospective, cross-sectional study included 118 patients (236 eyes) with TBI and stroke who had undergone VF testing by standard automated perimetry with the central 24-2 threshold test. Clinical features including best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular manifestations, and VF test results including VF defect pattern, reliability, and global indices were analyzed and compared between the TBI and stroke patients. Results. In TBI patients, ocular manifestations included strabismus (11.1%), cataract (4.2%), and glaucoma suspect (2.8%), whereas in stroke patients, cataract (15.2%), strabismus (8.5%), diabetic retinopathy (4.9%), extraocular movement (EOM) limitation (3.0%), glaucoma suspect (3.0%), nystagmus (2.4%), drusen (1.2%), and vitreous hemorrhage (1.2%) were found. The VF test results showed that 47 eyes (85.5%) in TBI and 86 (65.2%) in stroke had VF defect; in TBI, the scattered pattern was the most common (56.4%), followed by homonymous hemianopsia (14.5%), homonymous quadrantanopia (10.9%), and total defect (3.6%), whereas in stroke, homonymous hemianopsia was the most common (31.8%), followed by scattered pattern (16.7%), homonymous quadrantanopia (12.1%), and total defect (4.5%). Only 15 eyes (27.3%) in TBI and 32 (24.2%) in stroke showed reliable VF indices. The mean deviation (MD) was −10.5 ± 7.1 dB in TBI and −9.5 ± 6.8 dB in stroke, and the pattern standard deviation (PSD) was 4.9 ± 3.3 dB in TBI and 6.1 ± 3.9 dB in stroke, without statistically significant differences between the two groups. Conclusion. Various ocular manifestations were found, and a considerable proportion of patients were experiencing VF defects and showed unreliable VF test performance. Our findings suggest that accurate evaluation and rehabilitation of visual function should be a matter of greater concern and emphasis in the management of TBI and stroke patients, besides systemic diseases.

Long-term reproducibility of optical coherence tomography angiography in healthy and stable glaucomatous eyes

Background/aimsTo assess and compare long-term reproducibility of optic nerve head (ONH) and macula optical coherence tomography angiography (OCTA) vascular parameters and optical coherence tomography (OCT) thickness parameters in stable primary open-angle glaucoma (POAG), glaucoma suspect and healthy eyes.MethodsEighty-eight eyes (15 healthy, 38 glaucoma suspect and 35 non-progressing POAG) of 68 subjects who had at least three visits within 1–1.5 years with OCTA and OCT imaging (Angiovue; Optovue, Fremont, California, USA) on the same day were included. A series of vascular and thickness parameters were measured including macular parafoveal vessel density (pfVD), ONH circumpapillary capillary density (cpCD), macular parafoveal ganglion cell complex (pfGCC) and ONH circumpapillary retinal nerve fibre layer (cpRNFL). A random effects analysis of variance model was used to estimate intraclass correlation (ICC) coefficients and long-term variability estimates.ResultsICC was lower for OCTA (pfVD 0.823 (95% CI 0.736 to 0.888) and cpCD 0.871 (0.818 to 0.912)) compared with OCT (pfGCC 0.995 (0.993 to 0.997) and cpRNFL 0.975 (0.964 to 0.984)). Within-subject test–retest SD was 1.17% and 1.22% for pfVD and cpCD, and 0.57 and 1.22 µm for pfGCC and cpRNFL. Older age and lower signal strength index were associated with decreasing long-term variability of vessel densities.ConclusionsOCTA-measured macula and ONH vascular parameters have good long-term reproducibility, supporting the use of this instrument for longitudinal analysis. OCTA long-term reproducibility is less than OCT-measured thickness reproducibility. This needs to be taken into consideration when serial OCTA images are evaluated for change.Trial registration numberNCT00221897.

Comparison of intraocular pressure peak and fluctuations among Filipino patients with non-glaucomatous eyes and glaucoma suspects using water drinking test and diurnal intraocular pressure

AIM: To compare the intraocular pressure (IOP) peaks and fluctuations using water drinking tests (WDTs) and mean diurnal IOP among Filipino patients with normal eyes and glaucoma suspects METHODS: This prospective study included normal and glaucoma suspect patients. Each patient underwent both WDT and mean diurnal examination on separate visits. For mean diurnal examination, IOP was recorded every 2h for 8h while in WDT, IOP was recorded prior to WDT, and post-WDT at 5, 15, 30, 45, and 60min. IOP peak was recorded as the highest IOP for both methods, and IOP fluctuation was recorded as highest IOP minus lowest IOP. RESULTS: With the comparison of diagnostic tests, both normal eyes and glaucoma suspect groups, the peak IOP was caught at 15min. Comparative analysis of both groups also showed that the peak IOP measurements were statistically higher for the WDT compared to mean diurnal IOP (P=0.039, P=0.048 under normal group and P=0.032 and P=0.031 under glaucoma suspect group). Similarly, the WDT had a statistically higher mean IOP fluctuation score than the mean diurnal IOP method in both groups (P=0.003, P=0.011 under normal group; P=0.002 and P=0.005 under glaucoma suspect group). CONCLUSION: This study shows that WDT is a comparable diagnostic exam in predicting IOP fluctuations than mean diurnal measurement. WDT is a promising diagnostic procedure for risk assessment in glaucoma.

Retinal Nerve Fibre Layer Assessment in Glaucoma and Glaucoma Suspect by Optical Coherence Tomography (OCT)

Background Glaucoma is a progressive optic neuropathy characterized by structural changes in the optic nerve head, retinal nerve fiber layer (RNFL) defect, and accompanying visual field damage (VFD). In glaucoma management, detecting progression is essential in both early and late stages of the disease. In patients with an established diagnosis of glaucoma, evidence of progression will influence a clinician’s decision whether to modify glaucoma therapy. In patients who are suspected of having the disease, progression detection can confirm the diagnosis, and help decide how to manage the patient. Although standard automated perimetry has been the most commonly used test to monitor glaucomatous progression, evidence suggests that in some eyes substantial structural damage can be detected before the development of clinically detectable VFD. Objective To compare retinal nerve fibre layer thickness between glaucoma and glaucoma suspects. Methods We conducted our cross sectional comparative study on Forty eight eyes from patients recruited from Ain Shams University Hospitals, Ophthalmology Department during the period from February 2019 to December 2019. The Forty eight eyes were recruited in this study and divided into 2 groups. Group A- (Twenty-four eyes with moderate open angle glaucoma) and Group B- (Twenty four eyes with criteria of glaucoma suspects). Results There was highly Significant difference as regards OCT parameters of the patients (p < 0.001 for all). As the mean value of Cup/disc ratio was lower in Glaucoma Suspected cases, while Total RNFL, RNFL Superior and RNFL Inferior was higher in Glaucoma Suspected cases than patients with Moderate glaucoma. This study showed that; by using ROC-curve analysis, cup to disc ratio (CDR) at a cutoff point (>0.59) detected patients with glaucoma, with excellent accuracy, sensitivity= 95% and specificity= 100%. Also, by using ROC-curve analysis, superior RNFL at a cutoff point (≤116) detected patients with glaucoma, with fair accuracy, sensitivity= 66% and specificity= 91%. While inferior RNFL at a cutoff point (≤113) detected patients with glaucoma, with good accuracy, sensitivity= 70% and specificity= 95%. Conclusion In conclusion, structural progression measured using SD OCT was associated with functional progression shown in VF loss in glaucoma suspect or preperimetric glaucoma eyes and in glaucomatous eyes. Average, inferior and superior RNFL attenuations were the most important risk factors for visual field progression.

Central macular OCTA parameters in glaucoma

Background/aimsTo investigate the relationship between the foveal avascular zone (FAZ) parameters assessed by optical coherence tomography angiography (OCTA) and central visual field parameters in glaucoma and healthy subjects.MethodsOne hundred and eighty-eight subjects (248 eyes), including 24 healthy (38 eyes), 37 glaucoma suspect (42 eyes, and 127 primary open angle glaucoma (POAG) patients (168 eyes), underwent imaging using OCTA and standard automated perimetry using the 24-2 and 10-2 Swedish Interactive Thresholding Algorithm. OCTA-based and OCT-based FAZ parameters (superficial FAZ area, FAZ circumference), foveal vessel density (FD300) and foveal thickness were measured. The correlation between FAZ parameters and visual field parameters was assessed using linear mixed model.ResultsAxial length adjusted-FAZ area was not different among the three groups (mean (95% CI)): in healthy 0.31 (0.27 to 0.36) mm2, glaucoma suspect 0.29 (0.26 to 0.31) mm2 and POAG eyes 0.28 (0.27 to 0.30) mm2 (p=0.578). FD300 was lower in glaucoma suspect 49.1% (47.9% to 50.4%) and POAG eyes 48.7% (48.1% to 49.4%) than healthy eyes 50.5% (49.3% to 51.7%) though the difference was not statistically significant (p=0.071). Lower FD300 was associated with worse 24-2 and 10-2 visual field mean deviation and foveal threshold in multivariable linear mixed models (all p<0.05). In addition, a smaller FAZ area was associated with lower intraocular pressure (IOP) (p=0.026).ConclusionsThe FD300, but not the FAZ area was correlated with 10° central visual field mean deviation and foveal threshold in healthy, glaucoma suspect and POAG eyes. In contrast, a smaller FAZ area was associated with lower IOP.

Novel utilisation of ultrawide-field fundus photography for detecting retinal nerve fibre layer defects in glaucomatous eyes

Background/aimsEvaluation of the retinal nerve fibre layer (RNFL) is important for identifying glaucomatous damage. Ultrawide-field fundus photography (UWP) imaging is increasingly used in the ophthalmological field; however, it is unknown whether it can be used for detecting RNFL defects (RNFLDs). We investigated whether RNFLD can be detected with UWP images and compared the clinical effectiveness of three types of images for detecting RNFLD: conventional red-free RNFL photography (RFP), non-mydriatic UWP and digitally converted green separation of non-mydriatic UWP (G-UWP).MethodsEyes with glaucoma or glaucoma suspect and normal control eyes meeting the eligibility criteria were consecutively enrolled from September 2019 to April 2020. Their conventional RFP, non-mydriatic UWP and G-UWP images were assessed for detecting RNFLD to evaluate the sensitivity and specificity for detecting RNFLD.ResultsThree image sets of 196 participants (84 normal control, 25 glaucoma suspect and 87 glaucoma) were obtained. The sensitivity of G-UWP (94.6%; 95% CI 88.7 to 98.0) and RFP (92.9%; 95% CI 86.4 to 96.9) was higher than that of UWP (82.1%; 95% CI 73.8 to 88.7; p<0.05). The sensitivities of G-UWP and RFP are comparable. The specificity of G-UWP (78.6%; 95% CI 68.3 to 86.8) and UWP (75.0%; 95% CI 64.4 to 83.8) was comparable, but both were lower than that of RFP (98.8%; 95% CI 93.5 to 100.0; p<0.05).ConclusionNon-mydriatic UWP images can be used to detect RNFLD. Non-mydriatic G-UWP showed comparable sensitivity but lower specificity to conventional RFP. Non-mydriatic G-UWP could be used as a convenient and useful diagnostic tool for screening glaucoma in clinical settings.

COMPARISON OF RETINAL NERVE FIBER LAYER THICKNESS(RNFL) IN NORMAL AND GLAUCOMA PATIENTS WITH OPTICAL COHERENCE TOMOGRAPHY(OCT)

Optical coherence tomography (OCT) has proved to be valuable in the detection of glaucomatous damage. With its high resolution and proven measurement reproducibility, OCT has the potential to become an important tool for glaucoma detection. This manuscript presents the capabilities of the OCT technology evaluate retinal nerve ber layer thickness in normal and glaucoma patients Method: -A prospective, non-randomized, observational cross-sectional study was done at Rotary eye hospital, Navsari, from September 2019 to March 2020. Groups were divided in Control and glaucoma group and further Glaucoma patients were also subdivided in to Glaucoma Suspect, OHT, NTG and POAG. Patient went under comprehensive examination and selected patient went undergone measuring average retinal nerve ber layer thickness (RNFL) was by using ZEISS CIRRUS HD OCT. Results: - In overall 120 eyes of patients, 60 eyes of control group & 60 eyes of glaucoma groups were analysed. The average RNFL measurement were signicantly thinner in glaucoma group with compared control groups were 80±14 and 89±12, (P<0.01). All four quadrant RNFL thickness were analysed in Glaucoma Suspect, OHT, NTG and POAG which was statistically highly signicant. Superior quadrant RNFL thickness among groups were 105±17, 112±16, 90±17 and 85±18 m respectively (p= < 0.01).Mean RNFL thickness showed a decrease in thickness from Non-Glaucoma to Primary Open angle glaucoma (POAG) shows statistically signicant difference. Conclusions: OCT is important instrument for measuring RNFL thickness. Study shows difference in normal and glaucoma patients and different types of glaucoma patients. OCT measurement will help in early detection of glaucoma as well as in keeping an eye on progression of glaucoma.