OBJECTIVES: To compare the rate of progression of visual field loss in mean defect (MD) decibels (dB)/year in primary open angle glaucoma (POAG) versus primary angle closure glaucoma (PACG) patients managed in a tertiary hospital and to assess the impact of baseline age, baseline MD, and intraocular pressure (IOP) on the rate of progression of visual field loss. METHODS: This was a retrospective review of medical records of patients who were seen at the Glaucoma Clinic of a tertiary hospital from August to October 2018. The following data were recorded: diagnosis, number of reliable automated visual fields (AVFs), number of years followed, baseline age, baseline MD, MD of all subsequent AVFs, IOP at the time of each test, and IOP-lowering interventions. Rate of visual field progression expressed in dB/year was calculated using linear regression analysis. T–test was done to compare the baseline data and rates of progression of visual field loss between the POAG and PACG cohorts. Correlation using Pearson’s r and multivariate analyses were performed to evaluate the effect of baseline age, baseline MD, and IOP on rate of progression of visual field loss. RESULTS: The mean rates of progression of visual field loss in POAG and PACG eyes were 0.12 ± 0.68 dB/year and 0.10 ± 0.59 dB/year, respectively (p=0.8525). Despite treatment, 4.35% of the study eyes were identified as fast progressors while 1.09% were catastrophic progressors. In the POAG group (n=33), laser treatment was negatively correlated with rate of progression of visual field loss (r= -0.5072, p=0.0026). Multivariate analysis showed that baseline MD (p=0.017), mean IOP on follow–up (p=0.020), and laser treatment (p=0.004) were significant factorsaffecting the rate of progression of visual field loss in POAG eyes. In the PACG group (n=59), both baseline MD (r= -0.2798, p=0.0318) and mean IOP on follow–up (r= 0.368, p=0.0041) correlated with rate of progression of visual field loss. Only mean IOP on follow–up was found to be significant on multivariate analysis. CONCLUSION: While most glaucoma patients managed in a tertiary hospital have a slow rate of progression of visual field loss, a few were still identified as fast and catastrophic progressors. Factors associated with rate of progression of visual field loss were baseline MD, mean IOP on follow–up, and laser treatment for POAG, and mean IOP on follow–up for PACG.
Visual Fields ; Visual Field Tests ; Vision Disorders ; Glaucoma

Objectives: Refractive changes have been studied after muscle surgery in literature but most results are inconsistent. It has been postulated that changes in corneal tension after muscle surgery may cause a change in corneal curvature resulting in the change in refraction postoperatively. This study investigated changes in corneal topography and clinical refraction after horizontal rectus muscle surgery. Methods: Twenty-one eyes of 13 patients underwent horizontal rectus muscle surgery via limbal approach. Manifest refraction, cycloplegic refraction, and corneal topography were measured preoperatively, and postoperatively at day 1 and weeks 1, 2, 4 and 8. The proportion of subjects with at least 0.5 D change from preoperative measurements and the proportion of subjects that needed new prescription postoperative were also computed. Analysis of the results were done using the Friedman test to identify significant differences among measurements at different time periods with post-hoc analysis utilized to identify specific time periods with significant changes from preoperative measurements. Results: Mean corneal keratometry, horizontal, vertical, and oblique astigmatism, obtained topographically showed no significant difference from preoperative measurements. The statistically significant difference in corneal astigmatism in the recession group at day 1, week 4 and week 8 postoperatively was not confirmed when converted to power vectors in both vertical/horizontal (J0) and oblique (J45) astigmatism. Clinical refraction showed a transient myopic shift in spherical equivalent, statistically significant only on postoperative day 1 in the recession group. There was no statistically significant difference in clinical astigmatism. There was ≥ 0.5 D change in spherical equivalent in 60% in both study groups by the end of follow-up. The shift in J0 was more than 10% in the recession group. More than fifty percent (52.4%) needed new prescription for glasses. Conclusion No statistically significant change in corneal topography and clinical refraction following horizontal rectus muscle surgery were found. Patients should still be refracted at least 2 weeks postoperatively to check if there is a need for change in prescription glasses to improve alignment and/or improve vision.
Astigmatism ; Oculomotor Muscles ; Ophthalmologic Surgical Procedures ; Vision Tests ; Strabismus

PURPOSE: To investigate correlations between macular retinal ganglion cell (RGC) layer thickness and best-corrected visual acuity (BCVA) and visual field parameters in patients with bilateral temporal optic atrophy.METHODS: Thirty eyes of 15 patients with bilateral temporal optic atrophy and 30 eyes of 15 normal subjects that were age- and sex-matched were included in the study. We measured the thicknesses of the RGC layers of posterior poles using optical coherence tomography volume scanning. The RGC layer was divided into nine zones based on the Early Treatment of Diabetic Retinopathy Study baseline. Possible correlations of the RGC layer with the BCVA and visual field parameters were determined.RESULTS: The RGC layer thickness was significantly thinner in all patients compared to those in the control group (p = 0.001). The RGC layer thicknesses in the inner superior, inner temporal, inner inferior, and inner nasal areas were significantly correlated with the BCVA (r = −0.650, r = −0.626, r = −0.616, and r = −0.636, respectively; p = 0.000). The RGC layer thicknesses in the outer superior, outer temporal, outer inferior, and outer nasal areas were significantly correlated with the mean deviation of the visual field test (r = 0.470, r = 0.349, r = 0.496, and r = 0.469, respectively; p < 0.05).CONCLUSIONS: In patients with bilateral temporal optic atrophy, the RGC layer thickness in the medial region was correlated with the BCVA, and the RGC layer thickness in the lateral region was correlated with the mean deviation of the visual field test.
Diabetic Retinopathy ; Humans ; Optic Atrophy ; Retinal Ganglion Cells ; Retinaldehyde ; Tomography, Optical Coherence ; Vision Disorders ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: We report a case of homonymous quadrantanopia caused by occipital lobe ulegyria. CASE SUMMARY: A 23-year-female was referred to our clinic because of a visual field defect incidentally discovered during preoperative evaluation for refractive surgery at another clinic. However, she did not report any symptoms. She had no systemic diseases. Visual acuity was 20/20 in both eyes, and the color vision test was normal. Both pupils exhibited normal responses to light and near stimulations. In fundus examinations, the right optic disc was normal and the left contained drusen. Automated perimetry revealed right lower homonymous quadrantanopia with macular sparing. Brain magnetic resonance imaging revealed areas of ulegyria involving the left occipital lobe, consistent with the visual field defect. A follow-up visual field test performed 5 months later yielded the same result. CONCLUSIONS: Neuroimaging should be performed in patients with homonymous visual field defects to determine the location and etiology of the brain lesions. Occipital lobe ulegyria can cause homonymous quadrantanopia in the absence of any neurological problem.
Brain ; Brain Injuries ; Color Vision ; Follow-Up Studies ; Hemianopsia ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Occipital Lobe ; Pupil ; Refractive Surgical Procedures ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To report a patient stung by a bee, who was diagnosed with sterile endopthalmitis and another patient diagnosed with optic neuritis, with decreasing visual acuity, after refined bee venom injection around the orbital tissue. CASE SUMMARY: A 82-year-old female visited our hospital for decreased visual acuity in the right eye and ocular pain due to a bee sting. The bee sting penetrated the sclera into the vitreous. In the anterior segment, severe cornea edema and anterior chamber cells were seen. Using ultrasonography, inflammation was seen around the intravitreal area. After 3 months, intravitreal inflammation regressed but the patient's visual acuity was light perception negative, and corneal opacity, neovascularization, and phthisis bulbi were detected. A 55-year-old male visited our hospital for ocular pain in the right eye and decreasing visual acuity after refined bee venom injection around the orbital tissue. The best-corrected visual acuity in the right eye was 15/100, there was moderate injection on the conjunctiva. A relative afferent pupillary defect, abnormal color vision test results, and a defect in the visual field test were observed. There was no pain during external ocular movement, and other general blood tests, and a brain MRI were normal. Based on these symptoms, methylprednisolone megatherapy was started for treatment of optic neuritis. After treatment, visual acuity of the right eye was 9/10 and all other clinical optic neuritis symptoms regressed. CONCLUSIONS: Based on these two cases, ocular toxicity from bee venom could result from both direct and indirect courses. Treatment using refined bee venom might be harmful, and caution is recommended in its use.
Aged, 80 and over ; Anterior Chamber ; Bee Venoms ; Bees ; Bites and Stings ; Brain ; Color Vision ; Conjunctiva ; Cornea ; Corneal Opacity ; Edema ; Female ; Hematologic Tests ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; Middle Aged ; Optic Neuritis ; Orbit ; Pupil Disorders ; Sclera ; Ultrasonography ; Visual Acuity ; Visual Field Tests

PURPOSE: To report a case of frosted branch angiitis (FBA) associated with Epstein-Barr virus (EBV) infection in a child. CASE SUMMARY: A 7-year-old boy presented with bilateral blurred vision. On ophthalmic examination, his best-corrected visual acuity was 20/25 in the right eye and 20/32 in the left eye. The pupils were equal, round, and reactive to light without a relative afferent pupillary defect. He had normal color vision in both eyes. Slit-lamp examination revealed no abnormalities in the anterior parts of the eyes. Fundoscopic examination revealed prominent white sheathing retinal vasculitis predominantly on the veins in all quadrants, as well as macular edema and irregular foveal reflex in both eyes. Fluorescein angiography showed normal blood flow, but late diffuse staining and leakage of the affected vessels. Spectral domain optical coherence tomography (SD-OCT) showed thickening of the vessel walls, swelling due to hyperreflective material, and hyperreflective retinal depositions. Serological tests and the serum polymerase chain reaction for EBV were positive. A diagnosis of FBA associated with EBV was made. He was treated with systemic acyclovir and steroids. The response was rapid, with improvement in visual acuity to 20/20 in both eyes by day 3. After 7 weeks, all clinical signs resolved and SD-OCT examination showed normal vessel wall thickness and the absence of hyperreflective depositions. CONCLUSIONS: EBV may present with FBA even in the absence of a systemic sign of primary EBV infection. Thus, EBV should be considered as the etiology of FBA.
Acyclovir ; Child ; Color Vision ; Diagnosis ; Epstein-Barr Virus Infections ; Fluorescein Angiography ; Herpesvirus 4, Human ; Humans ; Macular Edema ; Male ; Polymerase Chain Reaction ; Pupil ; Pupil Disorders ; Reflex ; Retinal Vasculitis ; Retinaldehyde ; Serologic Tests ; Steroids ; Tomography, Optical Coherence ; Vasculitis ; Veins ; Visual Acuity

PURPOSE: To report a case of bilateral optic disc edema associated with hypocalcemia. CASE SUMMARY: A 48-year-old woman visited our ophthalmology department with decreased vision and disturbance of the visual field in the right eye, which began 2 days prior to presentation. The patient history indicated she had undergone total thyroidectomy 3 months prior and was given an oral calcium preparation. She had no eye pain, headache, tinnitus or diplopia. Her best corrected visual acuity of both eyes was 1.0, and color vision was normal in both eyes although a mild relative afferent pupillary defect was present in the right eye. Severe bilateral optic disc edema was present in the right eye. A Humphrey visual field test revealed an enlarged blind spot and peripheral nasal step scotoma in the right eye. The Cerebrospinal fluid (CSF) opening pressure was within the normal range and there were no abnormal findings regarding CSF. Additionally, there were no remarkable findings on brain magnetic resonance imaging nor neurologic tests. Her serum calcium was 5.9 mg/dL (normal range: total calcium 8.7-10.6 mg/dL), and an intravenous calcium supplement was started. Visual disturbance and optic disc edema improved 2 days after replacement and the optic disc edema completely dissolved 2 months later. CONCLUSIONS: Hypocalcemia may cause bilateral optic disc edema and can be recovered through adequate calcium supplementation, and it is necessary to prevent and promptly detect this rare complication.
Brain ; Calcium ; Cerebrospinal Fluid ; Color Vision ; Diplopia ; Edema* ; Eye Pain ; Female ; Headache ; Humans ; Hypocalcemia* ; Magnetic Resonance Imaging ; Middle Aged ; Ophthalmology ; Optic Disk ; Optic Nerve Diseases ; Papilledema ; Pupil Disorders ; Reference Values ; Scotoma ; Thyroidectomy ; Tinnitus ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis. CASE SUMMARY: A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epithelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABS IgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient's right eye improved to 20/20. CONCLUSIONS: We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an immunocompetent patient.
Anti-Bacterial Agents ; Cornea ; Diagnosis ; Doxycycline ; Edema ; Female ; Fluorescent Treponemal Antibody-Absorption Test ; Humans ; Immunoglobulin G ; Keratitis* ; Patient Rights ; Serologic Tests ; Sexually Transmitted Diseases ; Slit Lamp ; Steroids ; Syphilis* ; Syphilis, Latent ; Treponema pallidum ; Vision Disorders ; Visual Acuity ; Young Adult

PURPOSE: To evaluate the test-retest reliability and validity of the VAA-2000 Self Vision Tester. METHODS: A total of 108 eyes of 108 adults (55 men and 53 women) who visited Seoul National University Bundang Hospital from March to December 2015 and who had best corrected visual acuities of 20/200 or better, according to both Hahn's visual acuity test (using numbers and Landolt rings) and the VAA-2000 Self Vision Tester, were included. The test-retest reliability and validity of the VAA-2000 Self Vision Tester were assessed and compared with Hahn's visual acuity test performed using numbers and Landolt rings. The intraclass correlation, Pearson correlation, Bland-Altman plots, and Deming regression between the different tests were analyzed. RESULTS: The average best corrected visual acuity was 0.12 ± 0.17 logMAR measured with the VAA-2000 Self Vision Tester, and was 0.08 ± 0.20 logMAR with Hahn's visual acuity test using numbers and 0.08 ± 0.30 logMAR using Landolt rings. The VAA-2000 Self Vision Tester demonstrated high test-retest reliability (intraclass correlation coefficient = 0.903, p < 0.001) and acceptable validity when compared with Hahn's visual acuity test using numbers (r = 0.767, p < 0.001) and Landolt rings (r= 0.727, p < 0.001). CONCLUSIONS: The VAA-2000 Self Vision Tester possesses good reliability and acceptable validity when compared to Hahn's visual acuity test using numbers and Landolt rings.
Adult ; Humans ; Male ; Reproducibility of Results ; Seoul ; Vision Tests* ; Visual Acuity

PURPOSE: Our objective was to estimate the maximum color contrast sensitivity (MCCS) thresholds in individuals with chiasma opticum damage. METHODS: The pilot study tested 41 people with pituitary adenoma (PA) and 100 age- and gender-matched controls. Patients were divided into two groups according to PA size, PA ≤1 cm or PA >1 cm. A new MCCS test program was used for color discrimination. RESULTS: The mean total error score (TES) of MCCS was 1.8 in the PA ≤1 cm group (standard deviation [SD], 0.38), 3.5 in the PA >1 cm group (SD, 0.96), and 1.4 in the control group (SD, 0.31; p < 0.001). There was a positive correlation between tumor size and MCCS result (r = 0.648, p < 0.01). In the group that had PA-producing hormones, the TES was 2.5 (SD, 1.09), compared to 4.2 value in the non-functioning PA group of patients that did not have clinically significant hormone excess (SD, 3.16; p < 0.01). In patients with normal visual acuity (VA) or visual field MCCS, the TES was 3.3 (SD, 1.8), while that in patients with VA <0.00 was 4.6 (SD, 2.9). CONCLUSIONS: Results of the MCCS test TES were 1.9 times better in patients with PA ≤1 cm compared to patients with PA >1 cm (p < 0.01). In PA patients with normal VA, the TES was 2.35 times worse than that of healthy persons (p < 0.01).
Adenoma/*complications/diagnosis ; Adolescent ; Adult ; Aged ; Color Perception/physiology ; Color Perception Tests/*methods ; Contrast Sensitivity/*physiology ; *Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; *Optic Chiasm ; Pilot Projects ; Pituitary Neoplasms/*complications/diagnosis ; Time Factors ; Vision Disorders/*diagnosis/etiology/physiopathology ; Visual Fields ; Young Adult