Graefe’s Archive for Clinical and Experimental Ophthalmology, 1990
Three methods clinically used for measuring spatial contrast sensitivity were performed monocular... more Three methods clinically used for measuring spatial contrast sensitivity were performed monocularly in normal subjects to compare their sensitivity and applicability. The methods tested were (1) the Von Békésy tracking procedure, (2) the Method of Increasing Contrast, both carried out on a Nicolet CS-2000 automated Vision Tester, and (3) the Vistech Contrast Test System, a photographic test chart. The results show that the threshold sensitivities of the Von Békésy tracking procedure and the Method of Increasing Contrast were not significantly different. For sensitivity to middle and high spatial frequency, the Vistech test chart was found to approximate the Method of Increasing Contrast. With automated testing, a slower rate of contrast progression and a larger visual angle produced lower thresholds of detection of the contrast-sensitivity function. Using a slow rate of contrast progression, both the Vistech test chart and the Method of Increasing Contrast were rapidly conducted, easy to administer, and gave good approximations of the spatial contrast-sensitivity function.
Visual loss is the main morbidity of idiopathic intracranial hypertension (IIH). The relationship... more Visual loss is the main morbidity of idiopathic intracranial hypertension (IIH). The relationship between papilledema grade and visual loss is unclear. The goal of this study was to determine whether there is a relationship between papilledema grade and visual loss. Fundus photographs of 478 patients with IIH were reviewed, and their degree of papilledema was graded using Frisén's scheme. We identified 46 patients (10%) with IIH and highly asymmetric papilledema, as defined by an interocular difference of two or more grades. Nine of these patients with active asymmetry agreed to return for a series of visual tests. They underwent three visual field tests-Humphrey visual field analyzer 24-2, motion perimetry, and ring perimetry. The perimetry outcome measures were mean deviation, foveal threshold, and means for eccentric zones (3 degrees, 9 degrees, 15 degrees, and 21 degrees). The patients participated also in visual acuity, Farnsworth-Munsell 100-hue, Pelli-Robson contrast sens...
PURPOSE. Frequency-doubling technology (FDT) perimetry was developed as a screening test for glau... more PURPOSE. Frequency-doubling technology (FDT) perimetry was developed as a screening test for glaucoma. Patients with damage to the neuro-ophthalmic sensory visual pathways have different patterns of visual loss than patients with glaucoma. The current study was designed to determine the sensitivity and specificity of FDT as a screening test, compared with conventional automated perimetry (CAP) in neuro-ophthalmic disorders and to
Journal of American Association for Pediatric Ophthalmology and Strabismus, 1998
Our purpose was to determine whether motion detection abnormalities in patients with anisometropi... more Our purpose was to determine whether motion detection abnormalities in patients with anisometropic amblyopia exist and to determine the extent of these abnormalities in the central and midperipheral visual field. We used of motion perimetry to evaluated 10 anisometropic subjects with no manifest strabismus. Each of 44 locations in the visual field corresponding to the test sites of the Humphrey 24-2 program was tested with circular patches of motion (random dot cinematograms) displayed on a computer screen. Stimulus patch size was reduced in a 2/1 staircase manner to determine the smallest patch of motion detectable at each test location (threshold). Data from 15 age-matched normal subjects were used as controls. Vision in the amblyopic eye ranged from 20/25 to count fingers. The overall mean size threshold for amblyopic eyes was elevated (61% +/- 73%) compared with fellow eyes and age-matched normal eyes (p < 0.03) (i.e., the moving patch of dots in the field had to be larger for it to be detected when viewing with the amblyopic eye). The increase in size threshold was consistent across the visual field and was not greater for central locations. The amblyopia caused by anisometropia is associated with an abnormality in motion detection that extends into the midperiphery of the visual field.
Page 1. The Pseudotumor Cerebri Syndrome Pseudotumor Cerebri, idiopathic intracranial Hypertensio... more Page 1. The Pseudotumor Cerebri Syndrome Pseudotumor Cerebri, idiopathic intracranial Hypertension, Benign intracranial Hypertension and Related conditions lan Johnston Brian Owler and johnPickard Cambridge Page 2. Bibliography Aboulker, H. (1919). ...
To determine whether patients with ocular hypertension (OHT) have elevated motion perimetry thres... more To determine whether patients with ocular hypertension (OHT) have elevated motion perimetry thresholds. Motion perimetry uses a customized computer graphics program to detect the ability to identify a coherent shift in position of 50% of dots in a defined circular area against a background of fixed dots. Motion size threshold is defined as the smallest circular area in which dot motion is detected. Subjects respond by touching the area of the computer monitor with a light pen where motion stimuli are perceived. Reaction times (milliseconds) to stimuli and localization error (number of pixels from target center) are also obtained for each trial. University hospital ophthalmology clinic. Twenty-seven patients with OHT and 27 age-matched normal subjects. One eye was tested in each subject. Random dot motion stimuli size thresholds and total deviation probability plot data, reaction times, and spatial localization errors. The patients with OHT had more abnormal test points in the total deviation probability plot analysis compared with the controls (P < .001, chi 2). The abnormal test points were concentrated in the superior and inferior nasal regions. Six subjects had nerve fiber bundlelike defects to motion stimuli. Six subjects (5 overlapping with the probability plot analysis) had abnormal glaucoma hemifield test results. The patients with OHT also had significantly greater localization errors. Motion threshold perimetry may be a more sensitive method to detect visual field abnormalities in OHT than conventional automated perimetry.
RESULTS. For the 30-2 threshold test, a significant difference in mean deviation was found among ... more RESULTS. For the 30-2 threshold test, a significant difference in mean deviation was found among the three instruction types (P 5 0.001) and between the two age groups (P 5 0.001). Although differences were small in the younger subjects (2.04 dB), the means for the responses from liberal to conservative differed by 6.57 dB in the older subjects. Thresholds obtained
METHODS. Twenty-four patients with nonglaucomatous optic neuropathies and 18 patients with a rela... more METHODS. Twenty-four patients with nonglaucomatous optic neuropathies and 18 patients with a relative homonymous or bitemporal hemianopia were tested with both conventional perimetry (Humphrey 24-2 program) and "back to back" SITA standard tests (SITA 1, SITA 2) to approximate the test time of the FT test conditions. Also, 28 normal subjects between the ages of 20 and 80 were tested
Previous reports suggest an association between the degree of optic nerve head edema and CSF pres... more Previous reports suggest an association between the degree of optic nerve head edema and CSF pressure (CSFp) in idiopathic intracranial hypertension (IIH). We hypothesized that CSFp would be associated with Frisén papilledema grade (FPG) and other clinical features, and that FPG would modify the CSFp response to acetazolamide in participants in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). In the IIHTT, eligible patients underwent lumbar puncture (LP) prior to enrollment and were randomly assigned to one of two treatment groups: acetazolamide plus supervised diet or placebo plus supervised diet. Trial eligibility required baseline CSFp ≥250 mm H2O or ≥200 mm H2O with compelling clinical or imaging IIH findings. Associations between CSFp and FPG and other clinical features were examined at baseline. The effect of acetazolamide on 6-month change in CSFp was examined in those with low FPG (grades I-III) and those with high FPG (grades IV-V) at baseline. All 165 enro...
To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hyperten... more To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome. A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation. Fundus photography, optical coherence tomography (OCT) of the optic disc and macula, and perimetry were used to determine the causes and prognosis of vision loss. Segmentation of the macula OCT was performed using the Iowa Reference Algorithm to determine the retinal ganglion cell-inner plexiform layer complex (GCL-IPL) thickness. Outer retinal changes alone caused decreased BCVA at initial presentation in 22 eyes (46%): subretinal fluid in 16, chorioretinal folds in 5, and peripapillary choroidal neovascularization in 1. The vision loss was reversible except for some eyes with chorioretinal folds. Optic neuropathy ...
The study purpose was to examine vision-specific and overall health-related quality of life (QOL)... more The study purpose was to examine vision-specific and overall health-related quality of life (QOL) at baseline in Idiopathic Intracranial Hypertension Treatment Trial patients who were newly diagnosed and had mild visual loss. We also sought to determine the associations between vision-specific QOL scores and visual symptoms, visual function, pain, headache-related disability, and obesity. We assessed QOL using the 36-Item Short Form Health Survey, National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), and 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement. We compared these results with those of previously reported idiopathic intracranial hypertension (IIH) QOL studies. We assessed relationships between QOL and other clinical characteristics. Among 165 participants with IIH (161 women and 4 men with a mean age ± SD of 29.2 ± 7.5 years), vision-specific QOL scores were reduced compared with published values for disease-free controls. Scores of participants were comparable ...
To describe the methods used by the Photographic Reading Center (PRC) of the Idiopathic Intracran... more To describe the methods used by the Photographic Reading Center (PRC) of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and to report baseline assessments of papilledema severity in participants. Stereoscopic digital images centered on the optic disc and the macula were collected using certified personnel and photographic equipment. Certification of the camera system included standardization and calibration using a model eye. Lay readers assessed disc photos of all eyes using the Frisén grade and performed quantitative measurements of papilledema. Frisén grades by PRC were compared with site investigator clinical grades. Spearman rank correlations were used to quantify associations among disc features and selected clinical variables. Frisén grades according to the PRC and site investigator's grades, matched exactly in 48% of the study eyes and 42% of the fellow eyes and within one grade in 94% of the study eyes and 92% of the fellow eyes. Frisén grade was stron...
To test the hypothesis that variability of conventional automated perimetry can be reduced using ... more To test the hypothesis that variability of conventional automated perimetry can be reduced using size V stimuli for patients with glaucomatous visual field damage. Ten patients with glaucoma and five age-matched control volunteers were tested with the Humphrey Field Analyzer program 24-2 or 30-2, after which the method of constant stimuli was used to measure frequency-of-seeing curves. This was done by controlling the perimeter with a custom program run by a personal computer. At two widely separated visual field locations on the program 24-2 or 30-2 grid, stimuli were presented in 2 dB intervals to at least 10 dB on either side of the estimated program 24-2 or 30-2 threshold. This protocol was performed for each of three stimulus sizes (Goldmann sizes I, III, and V). For the patients with glaucoma, one test location was chosen in an area of normal visual field sensitivity, the other in an area of 10 to 20 dB loss. Control subjects were tested at the (3 degrees, 3 degrees) and (-21 ...
Intracranial hypertension (IH) mimicking pseudotumor cerebri (i.e., idiopathic IH) has been repor... more Intracranial hypertension (IH) mimicking pseudotumor cerebri (i.e., idiopathic IH) has been reported in individuals with systemic lupus erythematosus (SLE) since the 1960s. Although various mechanisms have been proposed (e.g., venous thrombosis, medication side effect, and immunologic or inflammatory disease) none have been proven to be causal. Retrospective chart review of patients with IH and SLE at a single tertiary care institution. In a cohort of IIH patients the percentage of patients in our study with SLE was 1% (4 in 410). Three out of the four patients had serologic evidence for a hypercoagulable state but only one had cerebral venous sinus thrombosis. Two patients had onset or worsening of IH in close temporal relationship to steroid withdrawal. The course, treatment, and prognosis of our patients with SLE and intracranial hypertension did not differ significantly from our clinical experience with IIH or with the published natural history data for IIH. The association of S...
The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are laboratory tests that h... more The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are laboratory tests that have been said to have a strong correlation with a positive temporal artery biopsy in patients with suspected giant cell arteritis (GCA). Published reports suggest that the CRP is a more sensitive diagnostic indicator of GCA and can be elevated when the ESR is normal. It is also clear that the CRP and ESR can both be normal or both be elevated in patients with biopsy-proven GCA and that the CRP can be elevated when the ESR is normal. The purpose of this study was to ascertain if the CRP can be normal when the ESR is elevated in biopsy-proven GCA. Retrospective, longitudinal, comparative study. One hundred nineteen patients from 6 major tertiary-care university-affiliated medical centers. The charts from 119 patients with temporal artery biopsies positive for GCA were reviewed for age, gender, pretreatment ESR, and pretreatment CRP. The ESR in millimeters per hour Westergren was graded as ...
To investigate the relationship between reaction time (RT), stimulus intensity and visual field e... more To investigate the relationship between reaction time (RT), stimulus intensity and visual field eccentricity. We generated frequency of seeing (FOS) curves and measured RTs by testing 10 perimetrically experienced normal subjects with a Humphrey perimeter controlled by a custom program. Subjects were tested from 10 degrees to 50 degrees eccentricity along the nasal horizontal meridian in 10 degrees increments. A range of 20 dB, centered on threshold, was tested in 1 dB steps along with 60 and 0 dB intensities as catch trials. Twenty repetitions for each intensity at each location were used. Linear regression showed a significant increase in suprathreshold RT (to the 0 dB stimulus) with increasing eccentricity. The RT at the calculated FOS 50% threshold was prolonged by about 200 ms compared with the RT using the 0 dB target at the equivalent eccentricities. Also, when the difference between the RT at 0 dB stimulus and the RT at threshold was regressed against visual field eccentricity there was a significant decrease with eccentricity. When the RT(pi) (RT prolongation from threshold relative to the 0 dB stimulus) was plotted as a function of decreasing stimulus attenuation, the results fit the function RT(pi)=a+bi(3) (i=stimulus intensity) with r(2)>0.94 at all eccentricities. However, the slope of the function flattened with increasing eccentricity. Using conventional automated perimetry stimuli in perimetrically experienced young subjects, suprathreshold RT increases but threshold RT prolongation decreases with increasing visual field eccentricity. RT fits a power function with decreasing stimulus attenuation but the slope flattens with eccentricity. This relationship found along the nasal horizontal meridian may allow use of RT to cross-check threshold results or to define response windows for reliability indices of conventional automated perimetry.
Graefe’s Archive for Clinical and Experimental Ophthalmology, 1990
Three methods clinically used for measuring spatial contrast sensitivity were performed monocular... more Three methods clinically used for measuring spatial contrast sensitivity were performed monocularly in normal subjects to compare their sensitivity and applicability. The methods tested were (1) the Von Békésy tracking procedure, (2) the Method of Increasing Contrast, both carried out on a Nicolet CS-2000 automated Vision Tester, and (3) the Vistech Contrast Test System, a photographic test chart. The results show that the threshold sensitivities of the Von Békésy tracking procedure and the Method of Increasing Contrast were not significantly different. For sensitivity to middle and high spatial frequency, the Vistech test chart was found to approximate the Method of Increasing Contrast. With automated testing, a slower rate of contrast progression and a larger visual angle produced lower thresholds of detection of the contrast-sensitivity function. Using a slow rate of contrast progression, both the Vistech test chart and the Method of Increasing Contrast were rapidly conducted, easy to administer, and gave good approximations of the spatial contrast-sensitivity function.
Visual loss is the main morbidity of idiopathic intracranial hypertension (IIH). The relationship... more Visual loss is the main morbidity of idiopathic intracranial hypertension (IIH). The relationship between papilledema grade and visual loss is unclear. The goal of this study was to determine whether there is a relationship between papilledema grade and visual loss. Fundus photographs of 478 patients with IIH were reviewed, and their degree of papilledema was graded using Frisén's scheme. We identified 46 patients (10%) with IIH and highly asymmetric papilledema, as defined by an interocular difference of two or more grades. Nine of these patients with active asymmetry agreed to return for a series of visual tests. They underwent three visual field tests-Humphrey visual field analyzer 24-2, motion perimetry, and ring perimetry. The perimetry outcome measures were mean deviation, foveal threshold, and means for eccentric zones (3 degrees, 9 degrees, 15 degrees, and 21 degrees). The patients participated also in visual acuity, Farnsworth-Munsell 100-hue, Pelli-Robson contrast sens...
PURPOSE. Frequency-doubling technology (FDT) perimetry was developed as a screening test for glau... more PURPOSE. Frequency-doubling technology (FDT) perimetry was developed as a screening test for glaucoma. Patients with damage to the neuro-ophthalmic sensory visual pathways have different patterns of visual loss than patients with glaucoma. The current study was designed to determine the sensitivity and specificity of FDT as a screening test, compared with conventional automated perimetry (CAP) in neuro-ophthalmic disorders and to
Journal of American Association for Pediatric Ophthalmology and Strabismus, 1998
Our purpose was to determine whether motion detection abnormalities in patients with anisometropi... more Our purpose was to determine whether motion detection abnormalities in patients with anisometropic amblyopia exist and to determine the extent of these abnormalities in the central and midperipheral visual field. We used of motion perimetry to evaluated 10 anisometropic subjects with no manifest strabismus. Each of 44 locations in the visual field corresponding to the test sites of the Humphrey 24-2 program was tested with circular patches of motion (random dot cinematograms) displayed on a computer screen. Stimulus patch size was reduced in a 2/1 staircase manner to determine the smallest patch of motion detectable at each test location (threshold). Data from 15 age-matched normal subjects were used as controls. Vision in the amblyopic eye ranged from 20/25 to count fingers. The overall mean size threshold for amblyopic eyes was elevated (61% +/- 73%) compared with fellow eyes and age-matched normal eyes (p < 0.03) (i.e., the moving patch of dots in the field had to be larger for it to be detected when viewing with the amblyopic eye). The increase in size threshold was consistent across the visual field and was not greater for central locations. The amblyopia caused by anisometropia is associated with an abnormality in motion detection that extends into the midperiphery of the visual field.
Page 1. The Pseudotumor Cerebri Syndrome Pseudotumor Cerebri, idiopathic intracranial Hypertensio... more Page 1. The Pseudotumor Cerebri Syndrome Pseudotumor Cerebri, idiopathic intracranial Hypertension, Benign intracranial Hypertension and Related conditions lan Johnston Brian Owler and johnPickard Cambridge Page 2. Bibliography Aboulker, H. (1919). ...
To determine whether patients with ocular hypertension (OHT) have elevated motion perimetry thres... more To determine whether patients with ocular hypertension (OHT) have elevated motion perimetry thresholds. Motion perimetry uses a customized computer graphics program to detect the ability to identify a coherent shift in position of 50% of dots in a defined circular area against a background of fixed dots. Motion size threshold is defined as the smallest circular area in which dot motion is detected. Subjects respond by touching the area of the computer monitor with a light pen where motion stimuli are perceived. Reaction times (milliseconds) to stimuli and localization error (number of pixels from target center) are also obtained for each trial. University hospital ophthalmology clinic. Twenty-seven patients with OHT and 27 age-matched normal subjects. One eye was tested in each subject. Random dot motion stimuli size thresholds and total deviation probability plot data, reaction times, and spatial localization errors. The patients with OHT had more abnormal test points in the total deviation probability plot analysis compared with the controls (P < .001, chi 2). The abnormal test points were concentrated in the superior and inferior nasal regions. Six subjects had nerve fiber bundlelike defects to motion stimuli. Six subjects (5 overlapping with the probability plot analysis) had abnormal glaucoma hemifield test results. The patients with OHT also had significantly greater localization errors. Motion threshold perimetry may be a more sensitive method to detect visual field abnormalities in OHT than conventional automated perimetry.
RESULTS. For the 30-2 threshold test, a significant difference in mean deviation was found among ... more RESULTS. For the 30-2 threshold test, a significant difference in mean deviation was found among the three instruction types (P 5 0.001) and between the two age groups (P 5 0.001). Although differences were small in the younger subjects (2.04 dB), the means for the responses from liberal to conservative differed by 6.57 dB in the older subjects. Thresholds obtained
METHODS. Twenty-four patients with nonglaucomatous optic neuropathies and 18 patients with a rela... more METHODS. Twenty-four patients with nonglaucomatous optic neuropathies and 18 patients with a relative homonymous or bitemporal hemianopia were tested with both conventional perimetry (Humphrey 24-2 program) and "back to back" SITA standard tests (SITA 1, SITA 2) to approximate the test time of the FT test conditions. Also, 28 normal subjects between the ages of 20 and 80 were tested
Previous reports suggest an association between the degree of optic nerve head edema and CSF pres... more Previous reports suggest an association between the degree of optic nerve head edema and CSF pressure (CSFp) in idiopathic intracranial hypertension (IIH). We hypothesized that CSFp would be associated with Frisén papilledema grade (FPG) and other clinical features, and that FPG would modify the CSFp response to acetazolamide in participants in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). In the IIHTT, eligible patients underwent lumbar puncture (LP) prior to enrollment and were randomly assigned to one of two treatment groups: acetazolamide plus supervised diet or placebo plus supervised diet. Trial eligibility required baseline CSFp ≥250 mm H2O or ≥200 mm H2O with compelling clinical or imaging IIH findings. Associations between CSFp and FPG and other clinical features were examined at baseline. The effect of acetazolamide on 6-month change in CSFp was examined in those with low FPG (grades I-III) and those with high FPG (grades IV-V) at baseline. All 165 enro...
To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hyperten... more To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome. A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation. Fundus photography, optical coherence tomography (OCT) of the optic disc and macula, and perimetry were used to determine the causes and prognosis of vision loss. Segmentation of the macula OCT was performed using the Iowa Reference Algorithm to determine the retinal ganglion cell-inner plexiform layer complex (GCL-IPL) thickness. Outer retinal changes alone caused decreased BCVA at initial presentation in 22 eyes (46%): subretinal fluid in 16, chorioretinal folds in 5, and peripapillary choroidal neovascularization in 1. The vision loss was reversible except for some eyes with chorioretinal folds. Optic neuropathy ...
The study purpose was to examine vision-specific and overall health-related quality of life (QOL)... more The study purpose was to examine vision-specific and overall health-related quality of life (QOL) at baseline in Idiopathic Intracranial Hypertension Treatment Trial patients who were newly diagnosed and had mild visual loss. We also sought to determine the associations between vision-specific QOL scores and visual symptoms, visual function, pain, headache-related disability, and obesity. We assessed QOL using the 36-Item Short Form Health Survey, National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), and 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement. We compared these results with those of previously reported idiopathic intracranial hypertension (IIH) QOL studies. We assessed relationships between QOL and other clinical characteristics. Among 165 participants with IIH (161 women and 4 men with a mean age ± SD of 29.2 ± 7.5 years), vision-specific QOL scores were reduced compared with published values for disease-free controls. Scores of participants were comparable ...
To describe the methods used by the Photographic Reading Center (PRC) of the Idiopathic Intracran... more To describe the methods used by the Photographic Reading Center (PRC) of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and to report baseline assessments of papilledema severity in participants. Stereoscopic digital images centered on the optic disc and the macula were collected using certified personnel and photographic equipment. Certification of the camera system included standardization and calibration using a model eye. Lay readers assessed disc photos of all eyes using the Frisén grade and performed quantitative measurements of papilledema. Frisén grades by PRC were compared with site investigator clinical grades. Spearman rank correlations were used to quantify associations among disc features and selected clinical variables. Frisén grades according to the PRC and site investigator's grades, matched exactly in 48% of the study eyes and 42% of the fellow eyes and within one grade in 94% of the study eyes and 92% of the fellow eyes. Frisén grade was stron...
To test the hypothesis that variability of conventional automated perimetry can be reduced using ... more To test the hypothesis that variability of conventional automated perimetry can be reduced using size V stimuli for patients with glaucomatous visual field damage. Ten patients with glaucoma and five age-matched control volunteers were tested with the Humphrey Field Analyzer program 24-2 or 30-2, after which the method of constant stimuli was used to measure frequency-of-seeing curves. This was done by controlling the perimeter with a custom program run by a personal computer. At two widely separated visual field locations on the program 24-2 or 30-2 grid, stimuli were presented in 2 dB intervals to at least 10 dB on either side of the estimated program 24-2 or 30-2 threshold. This protocol was performed for each of three stimulus sizes (Goldmann sizes I, III, and V). For the patients with glaucoma, one test location was chosen in an area of normal visual field sensitivity, the other in an area of 10 to 20 dB loss. Control subjects were tested at the (3 degrees, 3 degrees) and (-21 ...
Intracranial hypertension (IH) mimicking pseudotumor cerebri (i.e., idiopathic IH) has been repor... more Intracranial hypertension (IH) mimicking pseudotumor cerebri (i.e., idiopathic IH) has been reported in individuals with systemic lupus erythematosus (SLE) since the 1960s. Although various mechanisms have been proposed (e.g., venous thrombosis, medication side effect, and immunologic or inflammatory disease) none have been proven to be causal. Retrospective chart review of patients with IH and SLE at a single tertiary care institution. In a cohort of IIH patients the percentage of patients in our study with SLE was 1% (4 in 410). Three out of the four patients had serologic evidence for a hypercoagulable state but only one had cerebral venous sinus thrombosis. Two patients had onset or worsening of IH in close temporal relationship to steroid withdrawal. The course, treatment, and prognosis of our patients with SLE and intracranial hypertension did not differ significantly from our clinical experience with IIH or with the published natural history data for IIH. The association of S...
The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are laboratory tests that h... more The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are laboratory tests that have been said to have a strong correlation with a positive temporal artery biopsy in patients with suspected giant cell arteritis (GCA). Published reports suggest that the CRP is a more sensitive diagnostic indicator of GCA and can be elevated when the ESR is normal. It is also clear that the CRP and ESR can both be normal or both be elevated in patients with biopsy-proven GCA and that the CRP can be elevated when the ESR is normal. The purpose of this study was to ascertain if the CRP can be normal when the ESR is elevated in biopsy-proven GCA. Retrospective, longitudinal, comparative study. One hundred nineteen patients from 6 major tertiary-care university-affiliated medical centers. The charts from 119 patients with temporal artery biopsies positive for GCA were reviewed for age, gender, pretreatment ESR, and pretreatment CRP. The ESR in millimeters per hour Westergren was graded as ...
To investigate the relationship between reaction time (RT), stimulus intensity and visual field e... more To investigate the relationship between reaction time (RT), stimulus intensity and visual field eccentricity. We generated frequency of seeing (FOS) curves and measured RTs by testing 10 perimetrically experienced normal subjects with a Humphrey perimeter controlled by a custom program. Subjects were tested from 10 degrees to 50 degrees eccentricity along the nasal horizontal meridian in 10 degrees increments. A range of 20 dB, centered on threshold, was tested in 1 dB steps along with 60 and 0 dB intensities as catch trials. Twenty repetitions for each intensity at each location were used. Linear regression showed a significant increase in suprathreshold RT (to the 0 dB stimulus) with increasing eccentricity. The RT at the calculated FOS 50% threshold was prolonged by about 200 ms compared with the RT using the 0 dB target at the equivalent eccentricities. Also, when the difference between the RT at 0 dB stimulus and the RT at threshold was regressed against visual field eccentricity there was a significant decrease with eccentricity. When the RT(pi) (RT prolongation from threshold relative to the 0 dB stimulus) was plotted as a function of decreasing stimulus attenuation, the results fit the function RT(pi)=a+bi(3) (i=stimulus intensity) with r(2)>0.94 at all eccentricities. However, the slope of the function flattened with increasing eccentricity. Using conventional automated perimetry stimuli in perimetrically experienced young subjects, suprathreshold RT increases but threshold RT prolongation decreases with increasing visual field eccentricity. RT fits a power function with decreasing stimulus attenuation but the slope flattens with eccentricity. This relationship found along the nasal horizontal meridian may allow use of RT to cross-check threshold results or to define response windows for reliability indices of conventional automated perimetry.
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