Jia Jia Lek

Rapid contrast adaptation in glaucoma and in aging.

PURPOSE The visual system rapidly adapts to contrast changes, often with each fixation. One key anatomical site underpinning contrast adaptation is the retinal ganglion cell dendrites, where degenerative changes occur in glaucoma. This study investigated the effects of early glaucoma and aging on rapid contrast adaptation. METHODS Contrast detection and discrimination thresholds were measured in central vision for briefly presented (94 ms) Gabor patches with and without adaptation to 50% contrast Gabor patches (1000 ms). Fourteen people with glaucoma (aged 58-77 years), 17 age-similar controls (aged 50-72 years), and 19 younger adults (aged 20-31 years) participated. Detection thresholds were measured at various time points (47, 106, 200, 400, 600, and 1000 ms) post adaptation. Discrimination thresholds were measured post adaptation relative to a reference contrast below (30%), equivalent to (50%), or above (70%) the adaptor. RESULTS The glaucoma group demonstrated elevated unadapted detection (P < 0.0001) and discrimination (P = 0.01) thresholds relative to age-similar controls. In normal observers, aging elevated unadapted thresholds (detection: P < 0.0001; discrimination: P < 0.0001). At 47 ms post adaptation, the glaucoma group demonstrated reduced effects of adaptation relative to controls (P = 0.009). Adaptation was also reduced when the reference contrast (50%) was equivalent to the adaptor (P = 0.02). Aging did not alter adaptation of normal observers. CONCLUSIONS Glaucoma alters rapid contrast adaptation while aging does not. Contrast adaptation is key to visual processing in natural visual environments. Our results imply that glaucoma produces abnormalities in natural visual experiences in central vision.

Clinical impact of migraine for the management of glaucoma patients.

Migraine is a common and debilitating primary headache disorder that affects 10-15% of the general population, particularly people of working age. Migraine is relevant to providers of clinical eye-care because migraine attacks are associated with a range of visual sensory symptoms, and because of growing evidence that the results of standard tests of visual function necessary for the diagnosis and monitoring of glaucoma (visual fields, electrophysiology, ocular imaging) can be abnormal due to migraine. These abnormalities are measureable in-between migraine events (the interictal period), despite patients being asymptomatic and otherwise healthy. This picture is further complicated by epidemiological data that suggests an increased prevalence of migraine in patients with glaucoma, particularly in patients with normal tension glaucoma. We discuss how migraine, as a co-morbidity, can confound the results and interpretation of clinical tests that form part of contemporary glaucoma evaluation, and provide practical evidence-based recommendations for the clinical testing and management of patients with migraine who attend eye-care settings.

Visual object categorisation in people with glaucoma.

Purpose There is evidence that people with glaucoma exhibit difficulties with some complex visual tasks such as face recognition, motion perception and scene exploration. The purpose of this study was to determine whether glaucoma affects the ability to categorise briefly presented visual objects in central vision. Methods Visual categorisation performance of 14 people with glaucoma (primary open angle glaucoma and preperimetric) and 15 age-matched controls was measured, assessing both accuracy and response times. Grey level photographs of objects (size) were presented for 28 ms foveally. Perimetric thresholds were normal for all participants within the central 3°. Two levels of contrasts were included: one medium level at 50% and one with high contrast at 100%. Results On average, accuracy was significantly decreased by 7% (p=0.046) for the medium contrast stimuli in patients with glaucoma (87% of correct response, SD: 5%) compared with controls (94% of correct response, SD: 4.7%). Group average response times were significantly slower for the patients relative to the control group (712 ms, SD: 53 ms compared with 643 ms, SD: 34 ms for the control group; p<0.01). Performance was equivalent in the two groups when the picture contrast was 100%. Conclusions The impairment observed in the categorisation task supports previous work that demonstrates that people with glaucoma can have greater difficulties with complex visual tasks than is predicted by their visual field loss. The performance was equivalent to age-matched controls when contrast was maximised.

RESTORATIVE RETINAL LASER THERAPY: Present state and future directions.

Because of complications and side effects, conventional laser therapy has taken a back seat to drugs in the treatment of macular diseases. Despite this, research on new laser modalities remains active. In particular, various approaches are being pursued to preserve and improve retinal structure and function. These include micropulsing, various exposure titration algorithms, and real-time temperature feedback control of short-pulse continuous wave lasers, and ultra-short-pulse nanosecond lasers. Some of these approaches are at the preclinical stage of development, whereas others are available for clinical use. Cell biology is providing important insights into the mechanisms of action of retinal laser treatment. We outline the technological bases of current laser platforms, their basic science, therapeutic concepts, clinical experience, and future directions for retinal laser treatment.

Longitudinal Changes in Retinotopic Rod Function in Intermediate Age-Related Macular Degeneration

Purpose Although impairment of rod function in the early stages of age-related macular degeneration (AMD) has been well recognized, data on longitudinal changes in rod function at multiple retinal locations remain limited. This study investigated the longitudinal changes in retinotopic rod function in eyes with intermediate AMD (iAMD). Methods Complete ophthalmic examination, multimodal imaging, and scotopic perimetry were performed at baseline and at 12-month follow-up. Perimetric scotopic retinal sensitivities for the 505-nm stimulus were repeatedly measured for 20 minutes after exposing to a single photobleach (∼30%). The rod intercept time (RIT) and retinal sensitivity at seven retinal loci within the central 12° were ascertained. Using the 95% limit of measurement variability derived from the control eyes as a reference, the proportion of test points with a significant change in retinal sensitivity or RIT at follow-up was determined. Results Twenty iAMD and 6 control eyes were included. Decline in rod function was detected at 12-month follow-up in eyes with iAMD, but not in control eyes. Approximately 25% of test points in iAMD eyes showed a significant increase in RIT compared to 6% of test points with a decrease in RIT over the 12-month period (P < 0.001). Similarly, 40% of test points demonstrated a reduction in retinal sensitivity compared to the 7% of test points with an increase in retinal sensitivity at follow-up (P < 0.001). Conclusions There are detectable retinotopic changes in rod function over 12 months in iAMD eyes, indicating an ongoing disease progression in rod impairment or loss with time.