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Clinical Examination in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Selvakumar Ambika, Krishnakumar Padmalakshmi
Automated perimetry is the most popular form of visual field testing. It is more sensitive, reproducible, standardized, less dependent on the technician and inter-technician variability less important; however, it is lengthy and tedious. Humphrey visual field 30-2 program tests 76 points in the central 30 degrees. The test locations are 6 degrees apart from each other (Figure 1.17).
Evaluation and Investigation of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Tumours with suprasellar extension may lead to peripheral visual field defects. The classical bitemporal hemianopia is not always seen; however, some degree of visual field defect is frequently observed even in patients who do not complain of visual symptoms. Perimetry is the preferred method of visual field testing. Testing should be conducted in all patients with sellar lesions that are in contact with the optic chiasm.
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
Because central vision is typically not affected, formal visual field testing is helpful for assessing and monitoring visual dysfunction. Ophthalmic imaging including OCT is helpful for monitoring optic nerve swelling and RGC injury.
Quality of Life in Patients with Idiopathic Intracranial Hypertension and the Impact of the COVID-19 Pandemic
Published in Neuro-Ophthalmology, 2022
Neşe Çelebisoy, Ayşın Kısabay Ak, Hüseyin Nezih Özdemir, Figen Gökçay, Erhan Eser
The mean duration of symptoms prior to diagnosis with IIH was 3.4 ± 1.9 months (range: 1–7 months). The delay in admission to hospital was mainly due to the transformation of the clinics to COVID-19 clinics between March 2020 and June 2020. The mean CSF opening pressure was 402.2 ± 153.7 (range: 270–740) mmCSF. The visual acuity at onset was 0.0 logMAR in 12, 0.1 logMAR in 10, 0.2 logMAR in two, 0.3 logMAR in three, 0.4 logMAR in one, and 0.5 logMAR in two patients. Funduscopic examination revealed grade 1 papilloedema in nine, grade 2 papilloedema in seven, grade 3 papilloedema in 10, grade 4 papilloedema in two, and grade 5 papilloedema in two patients. The mean PMD at onset was −9.5 ± 4.2 (range: −1.3 to −17.4) dB. There were 22 patients with mild-to-moderate and eight patients with severe visual field loss.
Adaptation to post-stroke homonymous hemianopia – a prospective longitudinal cohort study to identify predictive factors of the adaptation process
Published in Disability and Rehabilitation, 2022
Claire Howard, Gabriela Czanner, Brinton Helliwell, Fiona J. Rowe
Adaptation to hemianopia is the process by which individuals change their behaviours to become better suited to a new visual world. To adapt to their loss of vision, stroke survivors with hemianopia are required to make adaptations and adjustments to their everyday life [12]. How successfully they make these adaptations and the time course of this process will depend on many factors. The factors may concern the extent of visual field loss itself, other stroke-related sequelae, as well as other social and personal factors [13]. Factors that are important for the adaptation process to hemianopia remain unknown. A systematic review of the literature exploring the factors that influence how a person adapts to post-stroke visual field loss highlighted a lack of evidence in this area [13].
Outcome Measures to Assess Dry Eye Severity: A Review
Published in Ocular Immunology and Inflammation, 2022
Kyle J. Hirabayashi, Esen K. Akpek, Sumayya Ahmad
In glaucoma, the primary outcome is visual field loss. Two landmark trials, the Ocular Hypertension Treatment Study and the Early Manifest Glaucoma Trial, offer examples of how interventions can affect the outcome of interest.69,70 The Ocular Hypertension Treatment Study demonstrated that elevated intraocular pressure (IOP) was closely linked to reproducible visual field loss or reproducible optic disc damage and that patients receiving topical ocular antihypertensives had a 50% rate reduction in developing the disease.69 Based on this study, topical antihypertensives have become a mainstay in the medical management and prevention of open-angle glaucoma. The Early Manifest Glaucoma Trial showed that patients receiving laser trabeculoplasty and topical anti-hypertensives had a lower incidence of visual field loss as compared to those without any initial treatment.70 Both of these studies have been practice-changing in treating early glaucomatous changes with IOP-lowering modalities as soon as they are detected. The key point is that reduction of IOP was found to be closely linked to an objective, reproducible metric that relates to patient function: visual field loss.