Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing

In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

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Predicting glaucoma prior to its onset using deep learning

10.1101/828681 ◽

2019 ◽

Author(s):

Anshul Thakur ◽

Michael Goldbaum ◽

Siamak Yousefi

Keyword(s):

Deep Learning ◽

Visual Field ◽

Optic Neuropathy ◽

Disease Onset ◽

Visual Fields ◽

Learning Model ◽

Glaucomatous Optic Neuropathy ◽

Learning Models ◽

Fundus Photographs ◽

Deep Learning Model

AbstractPurposeTo assess the accuracy of deep learning models to predict glaucoma development from fundus photographs several years prior to disease onset.DesignA deep learning model for prediction of glaucomatous optic neuropathy or visual field abnormality from color fundus photographs.ParticipantsWe retrospectively included 66,721 fundus photographs from 3,272 eyes of 1,636 subjects to develop deep leaning models.MethodFundus photographs and visual fields were carefully examined by two independent readers from the optic disc and visual field reading centers of the ocular hypertension treatment study (OHTS). When an abnormality was detected by the readers, subject was recalled for re-testing to confirm the abnormality and further confirmation by an endpoint committee. Using OHTS data, deep learning models were trained and tested using 85% of the fundus photographs and further validated (re-tested) on the remaining (held-out) 15% of the fundus photographs.Main Outcome MeasuresAccuracy and area under the receiver-operating characteristic curve (AUC).ResultsThe AUC of the deep learning model in predicting glaucoma development 4-7 years prior to disease onset was 0.77 (95% confidence interval 0.75, 0.79). The accuracy of the model in predicting glaucoma development about 1-3 years prior to disease onset was 0.88 (0.86, 0.91). The accuracy of the model in detecting glaucoma after onset was 0.95 (0.94, 0.96).ConclusionsDeep learning models can predict glaucoma development prior to disease onset with reasonable accuracy. Eyes with visual field abnormality but not glaucomatous optic neuropathy had a higher tendency to be missed by deep learning algorithms.

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Nonarteritic Anterior Ischemic Optic Neuropathy following COVID-19 Vaccination: Consequence or Coincidence

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/5126254 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Rika Tsukii ◽

Yuka Kasuya ◽

Shinji Makino

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Optic Disc ◽

Optic Neuropathy ◽

Visual Field Defect ◽

Anterior Ischemic Optic Neuropathy ◽

Ischemic Optic Neuropathy ◽

Optic Disc Swelling ◽

The Right ◽

Field Defect

To report a patient with nonarteritic anterior ischemic optic neuropathy (NA-AION) occurring soon after the COVID-19 vaccination. A 55-year-old woman presented with a 4-day history of inferior visual field disturbance in the right eye 7 days after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Examination revealed a best-corrected visual acuity of 20/20 in both eyes. A relative afferent pupillary defect was observed in the right eye. Fundoscopy revealed diffuse optic disc swelling in the right eye, which was prominent above the optic disc. Goldmann visual field testing identified an inferior altitudinal visual field defect with I/2 isopter in the right eye. Although typical complete inferior visual field defect was not detected, a diagnosis of NA-AION was made. The patient was followed without any treatment. During the 2-month follow-up period, the optic disc swelling was gradually improved, and visual acuity was maintained 20/20; however, the optic disc looked diffusely pale in the right eye. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION. The aim of this case report is to present this biological plausibility and to elucidate potential ophthalmological complications.

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Electrophysiological evaluation in normal-tension glaucoma suspects: a pilot study

Modeling and Artificial Intelligence in Ophthalmology ◽

10.35119/maio.v1i3.33 ◽

2017 ◽

Vol 1 (3) ◽

pp. 9-30

Author(s):

Dario Messenio ◽

Giuseppe Marano ◽

Elia Biganzoli

Keyword(s):

Intraocular Pressure ◽

Evoked Potentials ◽

Visual Evoked Potentials ◽

Pattern Electroretinogram ◽

Normal Subjects ◽

Control Group ◽

Glaucomatous Optic Neuropathy ◽

Cell Integrity ◽

Fiber Layer ◽

Visual Evoked

Purpose: To evaluate the variations of intraocular pressure (IOP), morphometric papillary characteristics, perimetric indices and electrophysiological parameters (Pattern electroretinogram and visual evoked potentials) before and after topic hypotonization therapy in patients with suspect normal tension glaucoma.Methods: we evaluated 38 eyes of 20 patients with intraocular pressure < 21 mmHg (measured with Goldman applanation tonometry), initial glaucomatous optic neuropathy (valued with HRT: retinal fiber layer (RNFL) and/or linear cup/disk (linear C/D), minimal visual defects (Octopus 101: G2 program), visual acuity more than 15/20 with best correction and pathological electrophysiological parameters (valued with pattern electroretinogram and visual evoked potentials), free of systemic or other ocular diseases. All parameters were evaluated at the beginning of the study (T0) and after 12 months from the beginning of the therapy (T12). A randomized normal control group (27 eyes of 14 subjects) with apparent larger disc cupping underwent all exams at initial of study and after 12 months. Results:At T0, P100 Latency VEPs in LTG was slightly increased either at 15’ (12,9 msec) and 30’ (8,9 msec). At T0, P100 Amplitude VEPs in LTG group were reduced compared to normal subjects, with average differences of: -6.4 µV (95% C.I.: (-9.8, -3.0) µV) for 15'; and: -5.4 µV (95% C.I.: ( -8.9, -2.0) µV) for 30’. P50N95 complex amplitude PERG was reduced at T0 in LTG, with average differences: -0.9 (95% C.I.: ( -1.4, -0.4) µV), -0.8 (-1.3, -0.3) µV) for 15’ and 30’, respectively; than it improved after therapy, with average differences between T12 and T0 of 0.3 µV (95% C.I.: (0.1, 0.6) µV) and 0.5 µV (95% C.I.: ( 0.2, 0.8) µV). So IOP decreased at T12 in LTG group, with an average difference between T12 and T0 of -5.2 mmHg (95% C.I.: (-5.9, -4.4). mmHg). Finally, CRT was slight delayed in LTG group at T0. Conclusion: In a viewpoint of an integrated diagnostic, electrophysiological tests (VEPs and PERG) could provide a more sensitive measure of retinal ganglion cell integrity and help to distinguish between suspect normal-pressure glaucoma patients before perimetric alterations are evident and normal subjects with apparent larger disc cupping.

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On the Relation between Visual Spatial Attention and Visual Field Asymmetries

The Quarterly Journal of Experimental Psychology Section A ◽

10.1080/14640749208401297 ◽

1992 ◽

Vol 44 (3) ◽

pp. 529-555 ◽

Cited By ~ 83

Author(s):

T. A Mondor ◽

M.P. Bryden

Keyword(s):

Visual Field ◽

Visual Attention ◽

Visual Fields ◽

Stimulus Onset ◽

Right Visual Field ◽

Structural Factors ◽

Letter Identification ◽

Functional Capabilities ◽

Visual Spatial ◽

The Right

In the typical visual laterality experiment, words and letters are more rapidly and accurately identified in the right visual field than in the left. However, while such studies usually control fixation, the deployment of visual attention is rarely restricted. The present studies investigated the influence of visual attention on the visual field asymmetries normally observed in single-letter identification and lexical decision tasks. Attention was controlled using a peripheral cue that provided advance knowledge of the location of the forthcoming stimulus. The time period between the onset of the cue and the onset of the stimulus (Stimulus Onset Asynchrony—SOA) was varied, such that the time available for attention to focus upon the location was controlled. At short SO As a right visual field advantage for identifying single letters and for making lexical decisions was apparent. However, at longer SOAs letters and words presented in the two visual fields were identified equally well. It is concluded that visual field advantages arise from an interaction of attentional and structural factors and that the attentional component in visual field asymmetries must be controlled in order to approximate more closely a true assessment of the relative functional capabilities of the right and left cerebral hemispheres.

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Complete Recovery from Blindness in Case of Compressive Optic Neuropathy due to Unruptured Anterior Cerebral Artery Aneurysm

Case Reports in Ophthalmology ◽

10.1159/000458753 ◽

2017 ◽

Vol 8 (1) ◽

pp. 157-162

Author(s):

Yurie Fukiyama ◽

Hidehiro Oku ◽

Yusuke Hashimoto ◽

Yuko Nishikawa ◽

Masahiro Tonari ◽

...

Keyword(s):

Visual Field ◽

Optic Neuropathy ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Complete Recovery ◽

Visual Field Defects ◽

Anterior Cerebral Artery Aneurysm ◽

The Right ◽

Cerebral Artery Aneurysm

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20. These findings suggest that aneurysmal lesions should be ruled out in case of unilateral optic neuropathy with hemianopic visual field defects and progressive visual loss.

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The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

Ophthalmology ◽

10.1016/j.ophtha.2010.02.015 ◽

2010 ◽

Vol 117 (11) ◽

pp. 2061-2066 ◽

Cited By ~ 49

Author(s):

Felipe A. Medeiros ◽

Luciana M. Alencar ◽

Pamela A. Sample ◽

Linda M. Zangwill ◽

Remo Susanna Jr. ◽

...

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Optic Disc ◽

Visual Field Loss ◽

Pressure Reduction ◽

Disc Hemorrhage ◽

Intraocular Pressure Reduction ◽

The Relationship

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Evidence of Post Trabeculectomy Optic Nerve Reperfusion by OCT Angiography

Ophthalmology Research An International Journal ◽

10.9734/or/2020/v12i430154 ◽

2020 ◽

pp. 35-39

Author(s):

Jigyasa Sahu

Keyword(s):

Intraocular Pressure ◽

Optic Nerve ◽

Nerve Fiber ◽

Structural Parameters ◽

Visual Fields ◽

Vessel Density ◽

Oct Angiography ◽

Prognostic Indicators ◽

Fiber Layer ◽

Nerve Fiber Layer

Aim: To describe a case of glaucoma which showed increase in optical coherence tomography (OCT) angiographic vessel densities after intraocular pressure reduction suggesting reperfusion of optic nerve. Presentation of Case: A 55 year old female with primary open angle glaucoma was taken up for trabeculectomy in view of inadequate control of intraocular pressure (IOP) despite maximal medical therapy. In addition to routine glaucoma assessment by visual fields and nerve fiber layer assessment by OCT, OCT angiographic evaluation of peripapillary vessel density was done preoperatively. Three months after trabeculectomy, her intraocular pressure decreased from 35mmHg to 14mmHg. Compared with the preoperative baseline value, the vessel density increased significantly in all quadrants after three months from surgery as demonstrated by OCT angiography. Discussion: This case report suggests that decreased optic nerve head perfusion due to high IOP can be reversed by reduction of IOP. Conclusion: Vascular parameters like angiographic vessel density can show reversible changes as decreased blood flow reinstates and thus can be better prognostic indicators than structural parameters like OCT retinal nerve fiber layer (RNFL) in glaucoma patients.

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Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

F1000Research ◽

10.12688/f1000research.8448.2 ◽

2016 ◽

Vol 5 ◽

pp. 762 ◽

Cited By ~ 9

Author(s):

Yalong Dang ◽

Pritha Roy ◽

Igor I. Bussel ◽

Ralitsa T. Loewen ◽

Hardik Parikh ◽

...

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Cataract Surgery ◽

Open Angle Glaucoma ◽

Age Groups ◽

Fiber Layer ◽

Primary Resistance ◽

Field Function ◽

Staging Systems ◽

Significant Difference

Prior glaucoma severity staging systems were mostly concerned with visual field function and retinal nerve fiber layer, but did not include intraocular pressure or medications to capture resistance to treatment. We recently introduced a simple index that combines pressure, medications, and visual field damage and applied it to stratify outcomes of trabectome surgery. In the analysis presented here, we combined data of trabectome alone and trabectome with same session cataract surgery to increase testing power and chances of effect discovery. This microincisional glaucoma surgery removes the primary resistance to outflow in glaucoma, the trabecular meshwork, and has been mostly used in mild glaucoma. Traditional glaucoma surgeries have a relatively high complication rate and have been reserved for more advanced disease stages. In the analysis presented here we include our data of trabectome combined with cataract surgery. This is a common practice pattern as both occur in the same age group with increasing frequency. For patients in higher glaucoma index (GI) groups, the intraocular pressure (IOP) reduction was 2.34+/-0.19 mmHg more than those in a GI group one level lower while holding everything else constant. Those who had undergone trabectome combined with phacoemulsification had an IOP reduction that was 1.29+/-0.39 mmHg less compared to those with trabectome alone. No statistically significant difference was found between genders and age groups while holding everything else constant. Hispanics had a 3.81+/-1.08 mmHg greater IOP reduction. Pseudoexfoliation and steroid glaucoma patients had an IOP reduction that was greater by 2.91+/-0.56 and 3.86+/-0.81 mmHg, respectively, than those with primary open angle glaucoma. These results suggest a role for trabectome-mediated ab interno trabeculectomy beyond mild forms of glaucoma. Additionally, the multifactorial glaucoma index demonstrates a role in staging patients when comparing glaucoma surgical modalities.

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Glaucoma Optic Neuropathy Progression: the Results of Long-Term Follow-Up

Ophthalmology in Russia ◽

10.18008/1816-5095-2019-1s-96-101 ◽

2019 ◽

Vol 16 (1S) ◽

pp. 96-101

Author(s):

N. I. Kurysheva ◽

V. N. Trubilin ◽

E. O. Shatalova ◽

L. V. Lepeshkina

Keyword(s):

Risk Factors ◽

Optic Neuropathy ◽

Glaucomatous Optic Neuropathy ◽

Progression Rate ◽

Channel Blockers ◽

Fiber Layer ◽

Glaucoma Progression ◽

Prostaglandin Analogues ◽

Long Term Follow Up

Purpose: to investigate the average speed and risk factors for the glaucomatous optic neuropathy (GON) progression during longterm observation. Patients and methods. The 10-year data of 750 patients were analyzed. The average GON progression rate was calculated on the basis of perimetry and optical coherent tomography data. Further, according to inclusion and exclusion criteria 128 patients were included into the group of retrospective analysis. Resultes. The following risk factors were established: initial cornealcompensated IOP (IOPcc) > 23.6 mm Hg (AUC 0.7), IOPcc after 5 years > 19.8 mm Hg (AUC 0.83), age > 69.5 years (AUC 0.6), corneal hysteresis < 9.9 mm Hg (AUC 0.6) and retinal nerve fiber layer < 92 μm (AUC 0.6). Patients with pseudoexfoliation syndrome, and patients taking systemic calcium channel blockers (p = 0.01) also had the higher risk of GON progression. Its rate was lower in patients with arterial hypertension (p = 0.015), and in patients who received prostaglandin analogues (risk was 5 times reduced, p = 0.04) and fixed combinations (risk was 2 times reduced, p = 0.018). IOPcc of higher than 17.6 mm Hg in the long-term period is the most pronounced risk factor for the progression of GON. It was determined that the average ROP of glaucoma progression among the patients was 0.6 dB/year for ROP1, 0.62 ± 1.09 μm/year for ROP2 and 0.95 ± 3.28 μm/year for ROP3, also each 1 dB/year decrease in photosensitivity (in group with glaucoma progression) was associated with further loss of RNFL (3.9 µm/year). Conclusion. The use of prostaglandin analogues and fixed combinations reduces this risk.

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