Delayed Detection of Predominantly Pericentral Hydroxychloroquine Toxicity in a Dominican Patient

2021 ◽  
pp. 247412642110342
Author(s):  
Saagar A. Pandit ◽  
Archana A. Nair ◽  
Nitish Mehta ◽  
Greg D. Lee ◽  
K. Bailey Freund ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Optical Coherence Tomography ◽  
Visual Field ◽  
Cystoid Macular Edema ◽  
Visual Fields ◽  
Field Testing ◽  
Visual Field Testing ◽  
External Limiting Membrane ◽  
Asian Patients ◽  
Sd Oct

Purpose: To describe delayed detection of pericentral hydroxychloroquine (HCQ) toxicity. Methods: 67-year-old Dominican woman with rheumatoid arthritis on HCQ presented for examination. Results: Spectral-domain optical coherence tomography (SD-OCT) demonstrated bilateral cystoid macular edema with parafoveal attenuation of the external limiting membrane (ELM) and the ellipsoid zone (EZ). ELM and EZ disruption was present in inferior macula. While subtle superior defects were present on 10-2 visual fields, superior pericentral defects were noted on 24-2 testing. Hyperautofluorescence along inferior arcades corresponded to SD-OCT and visual fields. Examination 2 years prior demonstrated nonspecific points of depression on 10-2 visual fields and normal central SD-OCT findings. EZ and ELM disruption was present in the perifoveal inferior macula. Conclusions: Early pericentral distribution of HCQ toxicity is not limited to Asian patients. Detecting pericentral HCQ toxicity involves reviewing entire macular cube on OCT. When OCT changes are suspected on parafoveal OCT B-scans, visual field testing with 24-2 may be more sensitive than 10-2.

Neuro-ophthalmology: Visual Fields

2021 ◽  
pp. 813-820
Author(s):  
Jacqueline A. Leavitt
Keyword(s):  
Visual Field ◽  
Visual System ◽  
Visual Fields ◽  
Field Evaluation ◽  
Field Testing ◽  
Outer Edge ◽  
Visual Field Testing ◽  
Clinical Process ◽  
Field Of Vision ◽  
Afferent Visual System

Visual field testing is an important part of the assessment of the afferent visual system. This chapter reviews the clinical process of visual field evaluation and the localization of lesions that affect the visual system. The visual field can be thought of as an island with an outer edge beyond which one cannot see and with an elevated center. The normal extent of the peripheral field of vision from the center is 90° to 100° temporally, 75° inferiorly, and 60° nasally and superiorly. Visual fields are subjective and should be considered only 1 part of the examination of the visual pathways.

scholarly journals Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
M. A. Nuijts ◽  
M. H. Degeling ◽  
I. Stegeman ◽  
A. Y. N. Schouten-van Meeteren ◽  
S. M. Imhof
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Brain Tumor ◽  
Visual Field ◽  
Visual Impairment ◽  
Visual Function ◽  
Field Testing ◽  
Optical Coherence ◽  
Visual Field Testing

Abstract Background Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. Methods/design The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. Discussion The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. Trial registration The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.

Testing Visual Fields in Children

2022 ◽  
pp. 67-85
Author(s):  
Jacky K. W. Kong
Keyword(s):  
Visual Field ◽  
Pediatric Population ◽  
Visual Fields ◽  
Frequency Doubling ◽  
Field Testing ◽  
Visual Field Testing ◽  
Frequency Doubling Technology ◽  
Kinetic Perimetry ◽  
Finger Counting ◽  
Physical Abilities

Visual fields in the pediatric population are an essential part of the eye exam that remain challenging to even the most experienced clinicians. Becoming educated in the multiple ways a child's visual field can be tested regardless of age and cognitive and physical abilities will allow the clinician to gain better insight into the child's function and in some cases, allow the clinician to identify pathological or neurological anomalies in the visual pathway. Gross visual field or functional visual field extent can be estimated by tests such as confrontation visual field testing, finger counting field testing, and white sphere kinetic perimetry. For threshold measurements of a child's visual fields, the Goldmann perimeter, or the more advanced computerized tests such as the Humphrey perimeter, Octopus perimeter, or frequency doubling technology perimeter can be used. Modifications can be made to certain tests to better suit the child's cognitive and physical abilities. The chapter covers different methods of visual field testing specific for the pediatric population.

scholarly journals External limiting membrane: retinal structural barrier in diabetic macular edema

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sandeep Saxena ◽  
Levent Akduman ◽  
Carsten H. Meyer
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Barrier Effect ◽  
External Limiting Membrane ◽  
Ellipsoid Zone ◽  
Structural Barrier ◽  
Sd Oct

AbstractAdvances in spectral-domain optical coherence tomography (SD-OCT) technology have enhanced the understanding of external limiting membrane (ELM) and ellipsoid zone (EZ) in diabetic macular edema. An increase in VEGF has been demonstrated to be associated with sequential ELM and EZ disruption on SD-OCT. An intact ELM is a prerequisite for an intact EZ in DME. Anti-VEGF therapy leads to restoration of barrier effect of ELM. The ELM restores first followed by EZ restoration.

Objective Visual Field Testing

JAMA ◽  
1963 ◽  
Vol 186 (8) ◽  
pp. 767 ◽  
Author(s):  
Richard M. Copenhaver
Keyword(s):  
Visual Field ◽  
Field Testing ◽  
Visual Field Testing

Swivel Arm Perimeter for Visual Field Testing in Different Body Positions

1993 ◽  
Vol 206 (1) ◽  
pp. 15-17 ◽  
Author(s):  
Josef Flammer ◽  
Philip Hendrickson ◽  
Andrea Lietz ◽  
Daniela Stümpfig
Keyword(s):  
Visual Field ◽  
Field Testing ◽  
Visual Field Testing
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