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Primary Pituitary Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Christopher M. Jones, John Ayuk
Patients with pituitary tumours should be considered at risk of apoplexy and should be provided with information regarding relevant signs and symptoms. In those who are not known to harbour pituitary adenomas, a detailed history is required to identify symptoms of pituitary dysfunction.19 Subsequent clinical examination should focus on the cranial nerves and visual fields for confrontation. More formal assessment of the visual fields can be undertaken using the Humphrey visual field analyser or Goldmann perimeter and can be undertaken once the patient is clinically stable.
Examination of the Nervous System
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Tim Fowler, John Scadding, Nick Losseff
With one eye covered, the patient faces the examiner and is asked to fix his gaze on that of the examiner. Using a 5 mm red pin, the target is brought from outside the peripheral extent of the field into each of the four quadrants to detect any impairment. First the patient is asked to say when they first see the pin (often described as dark) and after this to repeat the test asking them to say when they first perceive the pin as red. Each eye is tested separately and any peripheral defect is often matched in the initial peripheral field (dark) and that of the smaller field to red. Peripheral defects as hemianopias, quadrantanopias and altitudinal defects should be detectable using this technique. Visual fields should be recorded in the notes with the right-eye field on the right and the left-eye field on the left (Figure 3.2). More accurate visual field testing is now carried out using automated perimeters with a computer printout, for example, the Humphrey visual field analyser. In a subsequent examination, both eyes should be tested together to look for any visual inattention or neglect (see later). Here, small finger movements can be used as targets.
Therapeutic Effects of Idebenone on Leber Hereditary Optic Neuropathy
Published in Current Eye Research, 2020
Xiujuan Zhao, Yuxin Zhang, Lin Lu, Hui Yang
VF defects are sometimes more sensitive than VA measurements in detecting visual function abnormalities. As shown previously, some LHON patients showed subtle pattern deviations (abnormalities) in the unaffected eye on automated perimetry, although there was no change in the overall MD.17 The same study demonstrated that these subclinical findings typically worsened rapidly over a period of weeks to months, resulting in similar central scotomatous damage. LHON at different stages was characterized by different focal VF defects:19 VF defects in LHON patients within 1 wk after onset occurred mostly in central or paracentral scotoma, which was enlarged around the ceco-central defect, but these were connected to form a blind spot after 3–6 mon. Furthermore, the damage was first apparent in the papillomacular bundle and gradually expanded outward. More sensitive equipment,18 such as the Humphrey visual field analyser (10–2) or scanning laser ophthalmoscope microperimetry, might be better able to quantify these early changes. In this study, there was a definite improvement of VF defect in the idebenone group compared to the control group. However, this difference was only significant in the worst eye and both eyes. Although the MD improved in the best eyes, the improvement was not statistically significant. The trend in the change in VF defects was inconsistent with the improvement in VA.
Combined neurosurgical and orbital intervention for spheno-orbital meningiomas - the Manchester experience
Published in Orbit, 2020
J. Young, F. Mdanat, A. Dharmasena, P. Cannon, B. Leatherbarrow, C. Hammerbeck-Ward, S. Rutherford, S. Ataullah
Snellen charts were used to record visual acuity. A change in visual acuity of two or more lines was used to determine either an improvement or a deterioration of visual acuity. The Humphrey visual field analyser (Humphrey Systems, Carl Zeiss Meditec Inc, Dublin, CA, USA) or a Goldmann visual field machine was used to record the visual fields, unless visual acuity was too reduced to allow their use. Ishihara plates were used to measure colour vision. Any reduction in colour vision was noted and considered to represent a significant impairment of visual function. Proptosis of the affected eye was measured using a Hertel exophthalmometer. Proptosis was defined as a difference of 2 mm or more compared to the fellow eye. The pupillary assessment was performed via the swinging light test. This uses a bright torch to compare the afferent arms of the light reflex pathway, a discrepancy between these demonstrates a relative afferent pupillary defect (RAPD).14
Evaluation of Significance Maps and the Analysis of the Longitudinal Time Course of the Macular Ganglion Cell Complex Thicknesses in Acquired Occipital Homonymous Hemianopia Using Spectral-domain Optical Coherence Tomography
Published in Neuro-Ophthalmology, 2020
Tsutomu Yamashita, Atsushi Miki, Katsutoshi Goto, Syunsuke Araki, Go Takizawa, Yoshiaki Ieki, Junichi Kiryu, Akio Tabuchi, Yasuyuki Iguchi, Kazumi Kimura, Yoshiki Yagita
A clinical example is shown in Figure 6. This 39-year-old woman suddenly noticed a right-sided visual field defect. Her best corrected visual acuity was 1.5 OU. The fundus (including red-free fundus photographs) (Figure 6a) appeared to be normal in both eyes. A Humphrey visual field analyser showed right homonymous hemianopia, which was more dense superiorly (Figure 6b,c). MRI revealed an infarct in the left posterior cerebral artery territory of the brain (Figure 6d). At three months after the onset, the GCC thickness and the cpRNFL thickness OU were within the normal range in both eyes (Figure 6e,f). After 28 months, the areas with GCC thinning in both eyes were found to be in accordance with the hemianopic visual field defect (the nasal retina of the right eye and the temporal retina of the left eye) (Figure 6e). In the significance map of the cpRNFL thickness, there were areas with significant thinning in the inferior temporal portions of the right eye and the inferior temporal portions of the left eye (Figure 6f).