E. Arimura

Correlations between M-CHARTS and PHP Findings and Subjective Perception of Metamorphopsia in Patients with Macular Diseases

PURPOSE To assess the correlations between a patients subjective perception of metamorphopsia and the clinical measurements of metamorphopsia by M-CHARTS and PreView PHP (PHP). METHODS The authors designed a 10-item questionnaire focusing on the symptoms of metamorphopsia and verified its validity with a Rasch analysis. M-CHARTS measured the minimum visual angle of a dotted line needed to detect metamorphopsia, and PHP used the hyperacuity function for detection. Subjects were 39 patients with idiopathic epiretinal membrane (ERM), 22 patients with idiopathic macular hole (M-hole), 19 patients with age-related macular degeneration (AMD), and 51 healthy controls. RESULTS Rasch analysis suggested the elimination of one question. The nine-item questionnaire score significantly correlated to the M-CHARTS score in ERM (r = 0.59; P = 0.0004) but not in M-hole and to the PHP result in AMD (r = -0.29; P = 0.04) but not in ERM. Eighty percent of ERM patients with greater horizontal M-CHARTS score subjectively perceived horizontal metamorphopsia more often. M-CHARTS showed better sensitivities than PHP in both ERM (89% vs. 42%) and AMD (74% vs. 68%) and better specificity (100% vs. 71%) in healthy controls. Rasch analysis indicated that the present form of the questionnaire is better suited for moderate to severe cases of metamorphopsia than for mild cases. CONCLUSIONS The questionnaire appears to be a valid assessment of patient subjective perception of metamorphopsia and can be used to supplement the clinical measurements of metamorphopsia by M-CHARTS and PHP in patients with macular diseases.

Detectability of glaucomatous changes using SAP, FDT, flicker perimetry, and OCT.

PurposeTo compare the detectability between glaucomatous visual field changes using standard automated perimetry (SAP), frequency doubling technology (FDT), short-wavelength automated perimetry (SWAP), and flicker perimetry and structural changes using optical coherence tomography (OCT). ParticipantsFifty-nine eyes of fifty-nine patients with open-angle glaucoma, 24 eyes of 24 glaucoma suspects (GSs), and 40 eyes of 40 healthy age-matched subjects. MethodsAll subjects underwent Humphrey visual field analyzer II 24-2 full threshold (SAP), Swedish interactive threshold algorithm-SWAP, FDT (30-1, 30-5, 24-2-1, 24-2-5), flicker perimetry on Octopus 311 (4-zone probability 38S), and Stratus OCT [fast retinal nerve fiber layer thickness (NFLT) and fast optic disc]. To evaluate the visual field, FDT and flicker used the number of abnormal points, whereas SAP used mean deviation (MD) and SWAP used both the number of abnormal points and MD. The areas under the receiver operating characteristic curves [area under the curve (AUCs)] and sensitivities at fixed specificities were used to assess the detectability of glaucoma. ResultsThe AUC for FDT 30-1, 30-5, 24-2-1, 24-2-5, flicker perimetry, SWAP (MD), and SWAP (number of abnormal points) were 0.95, 0.94, 0.88, 0.89, 0.99, 0.88, and 0.88 in the early glaucoma group and 0.67, 0.69, 0.65, 0.70, 0.80, 0.64, and 0.66 in the GS group, respectively. In the early glaucoma and GS groups, all OCT parameters had an AUC >0.81 except the disc area parameter. Especially, average NFLT had the highest AUC of 0.94 in the OCT parameters. ConclusionsFDT, SWAP, flicker perimetry, and OCT are all useful methods for discriminating between healthy eyes and eyes with early glaucoma. Among all 10 OCT parameters, NFLT has the highest sensitivity for detecting early glaucomatous changes in GS patients.

Quantification of changes in metamorphopsia and retinal contraction in eyes with spontaneous separation of idiopathic epiretinal membrane.

BackgroundTo quantify changes in metamorphopsia and retinal contraction in eyes with idiopathic epiretinal membrane (ERM) before and after a spontaneous separation of ERM.MethodsAmong 92 eyes of 92 patients with idiopathic ERM who were followed up at our hospital, 5 eyes of 5 patients had experienced a spontaneous separation of ERM during the follow-up period. Patient’s metamorphopsia was assessed horizontally and vertically by a metamorphopsia chart developed by our group, M-CHARTS, to obtain the horizontal (MH) and vertical (MV) metamorphopsia scores. Difference in the scores before and after the membrane separation represents change in patient’s metamorphopsia. Changes in retinal contraction were also evaluated horizontally and vertically with our original software for fundus image analysis. The difference between M-CHARTS scores and distances of retinal vessel movements with before and after membrane separation were measured.ResultsAll five subjects showed a decrease in the retinal contraction. Improved visual acuity was observed in three subjects, and no change was seen in the other two. Four subjects obtained better metamorphopsia scores after the membrane separation, while the other one was not detected with metamorphopsia by M-CHARTS either before or after the separation. In subjects with an improved MV, horizontal retinal movement was seen larger than the vertical movement. Similarly, the subjects with an improved MH indicated a larger vertical retinal movement than the horizontal movement.ConclusionsThe direction of patient’s metamorphopsia closely associated with the direction of retinal contraction before and after a spontaneous separation of ERM.

Herpes Simplex Virus-2 Quantification by Real-time Polymerase Chain Reaction in Acute Retinal Necrosis

after treatment even though a high dose of ACV was administered. Second, 4 weeks after treatment, VZV-DNA was negative in PCR even though cells and flare could be observed in the anterior chamber of the diseased eye. PCR has been performed successfully to detect viral DNA in ocular samples. Nagae et al. reported that in 12 eyes of 9 patients with viral retinitis, causative viral DNA was detected by PCR either from the tear fluid (1/12, 8%), the aqueous (6/7, 86%), or the vitreous (1/1, 100%). However, is PCR the most dependable procedure during treatment? Mochizuki suggested that viral DNA detected by PCR in the anterior chamber might turn negative naturally about 60 days after onset of the disease, either as an effect of ACV therapy or as a result of the autoimmune disease. However, the case reported here is only one example; more reports and further information are necessary to reach a conclusion.

Surgical therapies for Acanthamoeba keratitis by phototherapeutic keratectomy and deep lamellar keratoplasty.

Purpose: To report the efficacy of phototherapeutic keratectomy (PTK) and deep lamellar keratoplasty (DLKP) in the treatment of Acanthamoeba keratitis. Methods: Two patients with delayed diagnosis of Acanthamoeba keratitis failed to respond to multiple systemic and topic antiamoebic agents supplemented by twice-weekly corneal scraping. Three weeks into such therapy, one developed a ring-shaped subepithelial infiltration and PTK was performed. The other was treated with DLKP for progressive keratitis that had invaded the midstromal layer after 50 days of medical therapy. Results: Improvements were observed immediately after the operations and medical therapy was gradually discontinued. Best-corrected visual acuity improved to 20/20 for both patients. Conclusions: PTK and DLKP were found to be effective surgical procedures, especially for advanced Acanthamoeba keratitis that fails to respond to medical therapy and corneal debridement.