Baseline Visual Field Profile of Optic Neuritis
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The purpose of the present study was to determine the baseline visual field characteristics in 448 patients with acute optic neuritis who were entered into the Optic Neuritis Treatment Trial. The severity and pattern of visual field loss in both the affected and fellow eyes were classified. For affected eyes, diffuse visual field loss was present in 48.2% of eyes, central or centrocecal scotoma was present in 8.3% of eyes, altitudinal or other nerve-fiber bundle-type defects were present in 20.1% of eyes, and a variety of other defects were present in 23.4% of eyes. Visual field involvement was present in the fellow eye at baseline in 308 (68.8%) of the 448 patients. Evidence of a chiasmal or retrochiasmal visual field defect was present in 2.9% of the patients. Since a wide variety of visual field defects can occur with an acute attack of optic neuritis, the pattern of visual field loss is of limited utility in distinguishing optic neuritis from ischemic optic neuropathy and other optic nerve disorders. Asymptomatic visual field defects in the fellow eye are common.Keywords:
Optic neuritis
Central scotoma
Neuritis
Objective To describe the characteristics of the lesion of vision field and to evaluate the relationship between the lesion of vision field types and recurrence in idiopathic optic neuritis(ION) patients.Methods ION inpatients in Tongren Hospital,Department of Neuro-Ophthalmology were enrolled during Aug 2010 to July 2013.Humphrey perimetry vision fields were collected for each patient and evaluated combining with prognosis.Results Two hundred and twenty-five patients(337 eyes) with ION were included in the study.Seventy-two cases(32%) were diagnosed as multiple sclerosis related optic neuritis(MS-ON),50 cases(22.2%) were neuromyelitisoptica related optic neuritis(NMO-ON),37 cases(16.4%) were solitary isolated inflammatory optic neuritis(SION) and 66 cases(29.3%) were recurrent inflammatory optic neuritis(RION).Visual field changes showed that arcuate scotoma was seen in 10 eyes(3%),altitudinal visual field defects in 25 eyes(7.4%),central scotoma in 33 eyes(9.8%),paracentrol scotoma in 8 eyes(2.4%),step visual field defect in 3 eyes(0.9%),enlarged blind spot in 3 eyes(0.9%),quadrant blind in 25 eyes(7.4%),peripheral field defects in 42 eyes(12.5%),diffuse defects in 173 eyes(51.3%) and the normal field of vision in 15 eyes(4.5%).There was significant difference between MS-ON and NMO-ON,RION(P = 0.003,0.002),but not between MS-ON and SION,NMO-ON and RION,RION and SION(P = 0.227,0.112,0.575) on visual field changes.Conclusions Vision changes were varied in ION patients.Diffuse defects were the most common type in ION patients.There were some focal characteristics of visual field defects in different clinical subtypes of ION.It was important to distinguish different clinical subtypes of ION in the acute phase of ION by explicating the type of visual field defect.
Optic neuritis
Central scotoma
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Central scotoma
Stargardt disease
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To measure the area of central scotoma obtained with semi-automated kinetic perimetry (SKP) in patients suffering from tobacco-alcohol toxic neuropathy (TATN).Twelve eyes of six patients with TATN were examined with SKP. Area of central scotoma was measured in square degrees (deg2). Additionally, static automated perimetry (SAP) within 60° was performed in each patient.Area of central scotoma was 41.8 deg2 for III4e isopter, 22.9 deg2 for I4e isopter and 16.1 deg2 for I2e isopter in TATN patients. SAP revealed central scotoma in all patients. There was 100% of accordance between two methods.SKP is comparable with SAP in assessing central scotoma. SKP offers advantage of measuring central scotoma and assessing remaining peripheral visual field in TATN, even with low incidence and prevalence of this clinical entity.
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We have observed that the majority of patients with bilateral macular disease utilize an eccentric region for viewing or fixation which is above the fovea or macula, its distance from the latter depending on the size of the central scotoma. The consistency of this behavior (exceptions occur but are rare1) can be demonstrated by visuscopy, serial fixation photography,2or perimetry.3Aulhorn, who made perimetric examinations of 100 patients with macular disease, did not find a single case in which the central scotoma was below the horizontal; that is, fixation was concerned during perimetry with an area below the macula.3 This tendency of eyes with loss of central vision to utilize a supramacular region gave rise to the question of how normal eyes behave when the fovea is temporarily deprived of its function. While in earlier studies2a scotoma was produced by dazzling the macula with
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Scotopic vision
Fovea centralis
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A visual field study of 50 cases of unilateral functional amblyopia revealed a relative central scotoma of 2-10 degrees width and 0.1 to 0.8 LU (log units of neutral density filters) depth in 29 out of 50 cases by static perimetry, while kinetic perimetry revealed a central scotoma in only 3 cases of paramacular fixation. In the majority of cases the eccentric area of fixation lay on the edge of the amblyopic scotoma, and it was identical to the point of peak retinal sensitivity.
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Patients with central scotoma use a preferred retinal locus (PRL) of fixation to perform visual tasks. Some of the conditions that cause central scotoma are progressive, and as a consequence, the PRL needs to be adjusted throughout the progression. The present study investigates the peripheral locus of fixation in subjects under a simulation of progressive central scotoma. Five normally sighted subjects participated in the study. A foveally centered mask of varying size was presented to simulate the scotoma. Initially, subjects developed a peripheral locus of fixation under simulation of a 6° scotoma, which was used as a baseline. The progression was simulated in two separate conditions: a gradual progression and an abrupt progression. In the gradual progression, the diameter of the scotoma increased by a fixed amount of either 1° or 2° of visual angle, thus scotomas of 8°, 10°, and 11° of visual angle were simulated. In the abrupt progression, the diameter was adjusted individually to span the area of the visual field used by the current peripheral locus of fixation. Subjects located the peripheral locus of fixation along the same meridian under simulation of scotoma progression. Furthermore, no differences between the fixation stability of the baseline locus of fixation and the incremental progression locus of fixation were found whereas, in abrupt progression, the fixation stability decreased significantly. These results provide first insight into fixation behavior in a progressive scotoma and may contribute to the development of training tools for patients with progressive central maculopathies.
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Visual angle
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Binocular perimetry with Aulhorn's Phase difference haploscope is described. Of 62 patients with primary micro-squint, 21 patients showed no scotoma, 15 patients showed a fixation or zero point scotoma of 0.5-1 degrees, 26 patients showed a larger scotoma (average: 3.7 degrees). In addition, 15 patients with larger angle and deep amblyopia were examined. The scotoma average was 8.8 degrees. A zero point scotoma was always present, whereas the central foveal scotoma was often missing.
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Unilateral central or centrocaecal scotoma may result from optic nerve compression. However, such defects bilaterally usually indicate non-compressive optic neuropathy of toxic or nutritional, hereditary, or demyelinating origin. Three cases are reported of patients who presented with somewhat atypical bilateral central or centrocaecal scotomata and were found to have suprasellar mass lesions demonstrated by CT scan and confirmed neurosurgically.
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Pathologies affecting central vision, such as Macular degeneration (MD), represents a growing health concern worldwide. These patients, deprived of central vision, tend to adopt spontaneous compensatory strategies, including the development of an eccentric locus of fixation, called preferred retinal locus (PRL). However, clinical evidence indicates that the process is often slow, taking up months, with some patients not developing a PRL at all. Developing a PRL seems to be one of the most effective compensatory strategies in MD, thus understanding mechanisms of PRL development has important translational value. Studies on MD are made difficult by several issues, including recruitment, compliance and heterogeneity, scotoma size. In recent years, eyetracking-guided, gaze-contingent simulation of central vision loss in healthy vision individuals has been used to understand oculomotor characteristics associated with central vision loss and test possible training intervention. In these studies, a circular occluder obstructing central vision is generated in real time on a computer screen while participants are engaged in visual tasks. Evidence from this paradigm suggests that MD-like oculomotor behavior, such as the development of a PRL, can be observed. Crucially, unlike in MD, this happens within few hours of exposure to the simulated scotoma. It has been suggested that the characteristics of the simulated scotoma play a role in this difference. Indeed, MD patients are often unaware of the location, size, and shape of their scotoma, unlike in simulated scotoma studies in which these features are readily available. Here, we trained MD patients with a gaze-contingent display that visualized their retinal scotoma on screen, with the goal of increasing their awareness of its characteristics. Behavioral and oculomotor changes following training, as measured by a series of assessments collected before and after training, will will be discussed. This promising technique could accelerate functional adaptation to central vision loss in clinical populations.
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