Cognitive and Vision Loss Affects the Topography of the Attentional Visual Field

Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient.Methods. In this paper we studied fundus photographs, optical coherence tomograph, Humphrey visual field 30-2, fundus autofluorescence images, fluorescein angiograms, and electroretinography.Results. Exam findings on presentation: a 34-year-old American Indian female presented with bilateral photopsias, early RPE irregularity, and an early temporal visual field defect. Progression RPE damage and visual field defect along with ERG findings support final diagnosis of AZOOR.Conclusion. AZOOR may initially be identified as a broader category of disease called the “AZOOR complex of disorders”. Specific visual field defects, ERG results, and clinical exam findings will help distinguish AZOOR from other similar disorders.

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Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome

BMC Ophthalmology ◽

10.1186/s12886-021-02028-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kirsty Michelle Clarke ◽

Vivi Riga ◽

Amy-lee Shirodkar ◽

Joel Meyer

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Visual Field ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Vision Loss ◽

Prone Positioning ◽

Disc Oedema ◽

Ischaemic Optic Neuropathy ◽

The Right

Abstract Background Non-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development. Case presentation : We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24 − 2 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye. Conclusions NAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.

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What do patients with glaucoma see: a novel iPad app to improve glaucoma patient awareness of visual field loss

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317034 ◽

2020 ◽

pp. bjophthalmol-2020-317034

Author(s):

Meghal Gagrani ◽

Jideofor Ndulue ◽

David Anderson ◽

Sachin Kedar ◽

Vikas Gulati ◽

...

Keyword(s):

Visual Field ◽

Vision Loss ◽

Peripheral Vision ◽

Glaucoma Patient ◽

Visual Field Loss ◽

Sensitivity Threshold ◽

Roc Curve Analysis ◽

The Mean ◽

Ipad App ◽

Field Defects

PurposeGlaucoma patients with peripheral vision loss have in the past subjectively described their field loss as ‘blurred’ or ‘no vision compromise’. We developed an iPad app for patients to self-characterise perception within areas of glaucomatous visual field loss.MethodsTwelve glaucoma patients with visual acuity ≥20/40 in each eye, stable and reliable Humphrey Visual Field (HVF) over 2 years were enrolled. An iPad app (held at 33 cm) allowed subjects to modify ‘blur’ or ‘dimness’ to match their perception of a 2×2 m wall-mounted poster at 1 m distance. Subjects fixated at the centre of the poster (spanning 45° of field from centre). The output was degree of blur/dim: normal, mild and severe noted on the iPad image at the 54 retinal loci tested by the HVF 24-2 and was compared to threshold sensitivity values at these loci. Monocular (Right eye (OD), left eye (OS)) HVF responses were used to calculate an integrated binocular (OU) visual field index (VFI). All three data sets were analysed separately.Results36 HVF and iPad responses from 12 subjects (mean age 71±8.2y) were analysed. The mean VFI was 77% OD, 76% OS, 83% OU. The most common iPad response reported was normal followed by blur. No subject reported dim response. The mean HVF sensitivity threshold was significantly associated with the iPad response at the corresponding retinal loci (For OD, OS and OU, respectively (dB): normal: 23, 25, 27; mild blur: 18, 16, 22; severe blur: 9, 9, 11). On receiver operative characteristic (ROC) curve analysis, the HVF retinal sensitivity cut-off at which subjects reported blur was 23.4 OD, 23 OS and 23.3 OU (dB).ConclusionsGlaucoma subjects self-pictorialised their field defects as blur; never dim or black. Our innovation allows translation of HVF data to quantitatively characterise visual perception in patients with glaucomatous field defects.

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Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

Journal of Psychology and Neuroscience ◽

10.47485/2693-2490.1010 ◽

2020 ◽

Keyword(s):

Case Report ◽

Visual Field ◽

Cerebral Artery ◽

Vision Loss ◽

Posterior Cerebral Artery ◽

Early Recognition ◽

Past History ◽

Neurological Deficits ◽

Visual Field Defects ◽

Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

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Lifetime visual outcomes of patients undergoing trabeculectomy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317004 ◽

2020 ◽

pp. bjophthalmol-2020-317004

Author(s):

Ruth Chen ◽

Anthony J King

Keyword(s):

Visual Field ◽

End Of Life ◽

Vision Loss ◽

Demographic Data ◽

Service Evaluation ◽

Mean Deviation ◽

Female Ratio ◽

Age At Surgery ◽

Evaluation Point ◽

Severe Vision Loss

BackgroundThe most important outcome for patients undergoing trabeculectomy is to maintain the quality of life in their remaining years. This study quantifies end of life vision in terms of visual acuity (VA) and visual field status.MethodsA prospective service evaluation of patients undergoing trabeculectomy (from 2000 to 2012) who died prior to the study evaluation point (November 2018). Demographic data including socioeconomic status were collected and change in clinical measurement for the cohort between time of surgery and death was measured.Results160 of 659 patients had died (24.3%), 4 were excluded due to insufficient data, leaving 156 patients (196 eyes) for evaluation. Male-to-female ratio was 3:2, 86% of patients were Caucasian. Mean age at surgery on first eye was 76.5 years (SD 9.0). Life expectancy post-trabeculectomy was 7.5 years (0.1–17.2). Mean change in VA was logarithm of the mean angle of resolution (LogMAR) 0.32 (SD 0.59) and visual field mean deviation progressed at a median of −0.44 dB/year (from −5.98 to 3.9) for eyes with at least a year of follow-up. Severe vision loss (loss of ≥10 letters on LogMAR) occurred in 78 eyes (40%) of which 18 (9%) were due to glaucoma, 69 patients (44%) required glaucoma drops at end of life.ConclusionTrabeculectomy is successful in slowing or preventing further glaucoma progression and thus maintaining visual function in the majority of eyes for the remainder of life. For those with severe vision loss at the end of life, only one in four was due to further progression of their glaucoma.

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Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313350 ◽

2019 ◽

Vol 103 (11) ◽

pp. 1600-1604 ◽

Cited By ~ 9

Author(s):

Sean T Garrity ◽

Joo Yeon Jung ◽

Olivia Zambrowski ◽

Francesco Pichi ◽

Daniel Su ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Field ◽

Vision Loss ◽

Tertiary Care ◽

Fundus Photography ◽

Visual Field Defects ◽

Optical Coherence ◽

Humphrey Visual Field ◽

Hydroxychloroquine Retinopathy ◽

Field Defects

Background/AimsHydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.MethodsData from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.ResultsSeventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.ConclusionPatients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.

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Seeing without the Occipito-Parietal Cortex: Simultagnosia as a Shrinkage of the Attentional Visual Field

Behavioural Neurology ◽

10.1155/2004/836830 ◽

2004 ◽

Vol 15 (1-2) ◽

pp. 3-13 ◽

Cited By ~ 43

Author(s):

François Michel ◽

Marie-Anne Henaff

Keyword(s):

Visual Field ◽

Visual Attention ◽

Parietal Cortex ◽

Experimental Approach ◽

Normal Subjects ◽

Natural Scenes ◽

Attentional Resources ◽

Tunnel Vision ◽

Attentional Visual Field ◽

Striking Contrast

Following bi-parietal lesions patient AT showed a severe inability to relocate her attention within a visual field which perimetry proved to be near-normal. An experimental approach with tasks testing visuo-spatial attention demonstrated a shrinkage of A.T.’s attentional visual field. With her visual attention narrowed to a kind of functional tunnel vision, the patient exhibited simultanagnosia (Wolpert, 1924), a symptom previously described in 1909 by Balint under the label of Psychic paralysis of “Gaze”. In striking contrast AT showed an efficient and effortless perception of complex natural scenes, which, according to recent work in normal subjects, necessitate few if any attentional resources.

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Minocycline-Associated Pseudotumor Cerebri with Severe Papilledema

Journal of Ophthalmology ◽

10.1155/2009/203583 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Simon R. Bababeygy ◽

Michael X. Repka ◽

Prem S. Subramanian

Keyword(s):

Visual Field ◽

Surgical Management ◽

Vision Loss ◽

Case Series ◽

Visual Field Loss ◽

Pseudotumor Cerebri ◽

Drug Discontinuation ◽

Unusual Complication ◽

Limited Condition ◽

Nonobese Patients

Background. Pseudotumor cerebri is an acknowledged but unusual complication of oral minocycline use. Vision loss and papilledema have been described as mild and transient, and some authors suggest that treatment is not needed.Methods. Case series of 2 patients with severe papilledema and visual field loss.Results. Severe pseudotumor cerebri developed in 2 nonobese patients taking minocycline. Their disease required further treatment even upon drug discontinuation because of visual field loss and papilledema.Conclusions. Minocycline-associated pseudotumor cerebri is not always a self-limited condition and may require aggressive medical or surgical management.

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Linking Multi-Modal MRI to Clinical Measures of Visual Field Loss After Stroke

Frontiers in Neuroscience ◽

10.3389/fnins.2021.737215 ◽

2022 ◽

Vol 15 ◽

Author(s):

Anthony Beh ◽

Paul V. McGraw ◽

Ben S. Webb ◽

Denis Schluppeck

Keyword(s):

White Matter ◽

Visual Field ◽

Brain Imaging ◽

Vision Loss ◽

Receptive Fields ◽

Visual Field Loss ◽

Visual Pathway ◽

Sensitivity Threshold ◽

Treatment Pathways ◽

Cortical Areas

Loss of vision across large parts of the visual field is a common and devastating complication of cerebral strokes. In the clinic, this loss is quantified by measuring the sensitivity threshold across the field of vision using static perimetry. These methods rely on the ability of the patient to report the presence of lights in particular locations. While perimetry provides important information about the intactness of the visual field, the approach has some shortcomings. For example, it cannot distinguish where in the visual pathway the key processing deficit is located. In contrast, brain imaging can provide important information about anatomy, connectivity, and function of the visual pathway following stroke. In particular, functional magnetic resonance imaging (fMRI) and analysis of population receptive fields (pRF) can reveal mismatches between clinical perimetry and maps of cortical areas that still respond to visual stimuli after stroke. Here, we demonstrate how information from different brain imaging modalities—visual field maps derived from fMRI, lesion definitions from anatomical scans, and white matter tracts from diffusion weighted MRI data—provides a more complete picture of vision loss. For any given location in the visual field, the combination of anatomical and functional information can help identify whether vision loss is due to absence of gray matter tissue or likely due to white matter disconnection from other cortical areas. We present a combined imaging acquisition and visual stimulus protocol, together with a description of the analysis methodology, and apply it to datasets from four stroke survivors with homonymous field loss (two with hemianopia, two with quadrantanopia). For researchers trying to understand recovery of vision after stroke and clinicians seeking to stratify patients into different treatment pathways, this approach combines multiple, convergent sources of data to characterize the extent of the stroke damage. We show that such an approach gives a more comprehensive measure of residual visual capacity—in two particular respects: which locations in the visual field should be targeted and what kind of visual attributes are most suited for rehabilitation.

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A Smart Context-Aware Hazard Attention System to Help People with Peripheral Vision Loss

Sensors ◽

10.3390/s19071630 ◽

2019 ◽

Vol 19 (7) ◽

pp. 1630 ◽

Cited By ~ 2

Author(s):

Ola Younis ◽

Waleed Al-Nuaimy ◽

Fiona Rowe ◽

Mohammad Alomari

Keyword(s):

Visual Field ◽

Vision Loss ◽

Peripheral Vision ◽

False Positive Rate ◽

False Negative ◽

False Negative Rate ◽

Visual Field Defects ◽

Context Aware ◽

Motion Model ◽

Positive Rate

Peripheral vision loss results in the inability to detect objects in the peripheral visual field which affects the ability to evaluate and avoid potential hazards. A different number of assistive navigation systems have been developed to help people with vision impairments using wearable and portable devices. Most of these systems are designed to search for obstacles and provide safe navigation paths for visually impaired people without any prioritisation of the degree of danger for each hazard. This paper presents a new context-aware hybrid (indoor/outdoor) hazard classification assistive technology to help people with peripheral vision loss in their navigation using computer-enabled smart glasses equipped with a wide-angle camera. Our proposed system augments users’ existing healthy vision with suitable, meaningful and smart notifications to attract the user’s attention to possible obstructions or hazards in their peripheral field of view. A deep learning object detector is implemented to recognise static and moving objects in real time. After detecting the objects, a Kalman Filter multi-object tracker is used to track these objects over time to determine the motion model. For each tracked object, its motion model represents its way of moving around the user. Motion features are extracted while the object is still in the user’s field of vision. These features are then used to quantify the danger using five predefined hazard classes using a neural network-based classifier. The classification performance is tested on both publicly available and private datasets and the system shows promising results with up to 90% True Positive Rate (TPR) associated with as low as 7% False Positive Rate (FPR), 13% False Negative Rate (FNR) and an average testing Mean Square Error (MSE) of 8.8%. The provided hazard type is then translated into a smart notification to increase the user’s cognitive perception using the healthy vision within the visual field. A participant study was conducted with a group of patients with different visual field defects to explore their feedback about the proposed system and the notification generation stage. The real-world outdoor evaluation of human subjects is planned to be performed in our near future work.

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