Susan C. Benes

Corneal Edema Related to Accidental Hibiclens Exposure

Five patients developed corneal edema presumably caused by accidental preoperative ocular exposure to Hibiclens. In all cases, the patients complained of ocular pain after surgery. Conjunctival inflammation and corneal epithelial defects were found in all patients. Between two and ten weeks after exposure, stromal and epithelial edema, with a predilection for the inferior cornea initially, developed in all patients. The corneal edema resolved in three patients in approximately six months, leaving mild stromal scarring and reduced endothelial cell counts. The corneal edema in the other two patients progressed to diffuse bullous keratopathy, which eventually required penetrating keratoplasty. We recommend that Hibiclens be avoided in preoperative preparation of the facial skin to prevent accidental ocular exposure.

Comparison of red-green, blue-yellow and achromatic losses in glaucoma

Achromatic losses in glaucoma would be expected to be greater than, or equal to, red-green chromatic losses if the following assumptions are made: (1) the function of the remaining axons is either unchanged or non-selectively reduced; (2) red-green chromatic information is signaled by the midget ganglion cell system; and (3) the function of the magnocellular system is reduced at least as much as that of the midget ganglion cells. This prediction was tested by measuring red-green (along with blue-yellow) mixture thresholds for 1 deg, 0.2 sec test spots presented on a color monitor on a white background of 50 cd/m2. Ellipses were fitted to plots of green contrast as a function of red contrast (or yellow as a function of blue), and major and minor axes of these ellipses were taken as measures of chromatic and achromatic thresholds, respectively. The study population consisted of 29 eyes in 29 patients with early glaucoma; control data were derived from a data bank of 83 normal eyes. Red-green losses were significantly (P < 0.05) greater than achromatic losses in 6 out of the 11 eyes which showed significant losses of either chromatic or achromatic sensitivity (or both). It is concluded that, for these eyes, at least one of the above three assumptions is incorrect.

Red-green mixture thresholds in congenital and acquired color defects

A color television display was used to measure thresholds for mixtures of red and green on a white background; red and green components could be either incremental, decremental or zero. Ellipses are fitted to a plot of green contrast as a function of red contrast, and it is argued that the length of the ellipse is a measure of red-green color discrimination and the width of the ellipse is a measure of luminance discrimination. It is shown that the technique reliably distinguishes normals from congenital color defectives and also protan from deutan subjects. For some cases of acquired color defects (e.g. optic neuritis), there is a roughly equal loss of color and luminance discrimination whereas, in other cases (e.g., hereditary optic atrophies), the loss of color discrimination is much greater than the loss of luminance discrimination.

Color mixture thresholds measured on a color television. A new method for analysis, classification and diagnosis of neuro-ophthalmic disease

A color television display can be used to determine color and brightness discrimination thresholds using identical adaptation conditions and experimental technique. The color discrimination threshold is measured by using an equiluminous test spot - i.e. one which differs in color from the surrounding screen but has the same luminance. Because there is no brightness clue, the subject is forced to detect such a spot by using color discrimination. It is shown how color and brightness thresholds may be determined from threshold measurements of different color-mixtures even though it is not known beforehand which stimulus will be equiluminous for the subject. Results are shown for normal subjects, congenital color defectives and for two patients having optic nerve disease who show respectively non-selective and selective loss of color discrimination compared to brightness discrimination. Normal control data are presented, illustrating the effect of eccentricity, optical blur, viewing distance, pupil size and age. It is concluded that the technique is relatively insensitive to moderate variations in these factors and that it is more sensitive in detecting selective color loss than a spectral sensitivity technique which has been described previously.

Selective damage to chromatic mechanisms in neuro-ophthalmic diseases I. Review of published evidence.

Acquired color deficiencies may correspond to a general, non-selective loss of visual sensitivity. We summarise evidence for the opposite view that, in some cases, chromatic sensitivity can be more (or less) reduced than achromatic sensitivity. This evidence is based on: (1) Disproportion between chromatic and achromatic isopters; (2) Differential damage to red-green and blue-yellow color vision; (3) Detection static perimetry; (4) The foveal photochromatic interval; (5) The two color threshold technique; (6) Spectral sensitivity on a white background; (7) Single unit and histological studies of the retina and lateral geniculate nucleus; (8) Lesions of the prestriate color area; (9) Selective damage to achromatic processes.Possible problems of interpretation are considered and a new technique for comparing chromatic and achromatic sensitivity is briefly described.

Detecting retinal lesions with automated perimetry

This paper considers the clinical problems associated with the detection of localized retinal lesions using automated perimeters. We present four case studies of patients who had documented macular lesions, some about the size of the papilla, but who had normal visual field results when tested with automated perimeters using central threshold programs. Three factors were identified that limit an automated perimeter in detecting a lesion. These are: 1. misalignment between the test grid and lesion, 2. subject threshold fluctuations and, 3. inappropriate use of grey scales.

Assessment of Pastoral Needs among Medical Outpatients

Reports research findings on samples of hospital outpatients, hospital inpatients, and well persons from the community in an attempt to explore the content and extent of pastoral needs among medical/surgical outpatients. Analyzes and presents statistical data which lead to the conclusion that the spiritual needs of outpatients manifest greater similarity to healthy persons in the community than to hospital inpatients. Notes limitations of the study and discusses praxis implications for chaplains.

Stem Cell Ophthalmology Treatment Study (SCOTS): bone marrow-derived stem cells in the treatment of Leber's hereditary optic neuropathy.

The Stem Cell Ophthalmology Treatment Study (SCOTS) is currently the largest-scale stem cell ophthalmology trial registered at ClinicalTrials.gov (identifier: NCT01920867). SCOTS utilizes autologous bone marrow-derived stem cells (BMSCs) to treat optic nerve and retinal diseases. Treatment approaches include a combination of retrobulbar, subtenon, intravitreal, intra-optic nerve, subretinal, and intravenous injection of autologous BMSCs according to the nature of the disease, the degree of visual loss, and any risk factors related to the treatments. Patients with Leber′s hereditary optic neuropathy had visual acuity gains on the Early Treatment Diabetic Retinopathy Study (ETDRS) of up to 35 letters and Snellen acuity improvements from hand motion to 20/200 and from counting fingers to 20/100. Visual field improvements were noted. Macular and optic nerve head nerve fiber layer typically thickened. No serious complications were seen. The increases in visual acuity obtained in our study were encouraging and suggest that the use of autologous BMSCs as provided in SCOTS for ophthalmologic mitochondrial diseases including Leber′s hereditary optic neuropathy may be a viable treatment option.

Differences between Perimetric Thresholds for White and Equiluminous Red, Blue and Yellow in a Nerve Fiber Bundle Defect

Perimetric thresholds were measured for a case of nerve fiber bundle defect, at 221 central positions using white and equiluminous red, blue and yellow spots generated on a color television display. The defect was much more clearly delineated with equiluminous red rather than with white spots; yellow and blue spots yielded losses which were intermediate between red and white. Blue and yellow spots yielded significantly different patterns of loss; this suggests that they may be signalled by different optic nerve axons (e.g. blue-ON, yellow-OFF and yellow-ON, blue-OFF respectively).

Stem Cell Ophthalmology Treatment Study (SCOTS): improvement in serpiginous choroidopathy following autologous bone marrow derived stem cell treatment

We report results in a 77-year-old male patient with visual loss from long-standing serpiginous choroidopathy treated with bone marrow derived stem cells (BMSC) within the Stem Cell Ophthalmology Treatment Study (SCOTS). SCOTS is an Institutional Review Board approved clinical trial and the largest ophthalmology stem cell study registered at the National Institutes of Health to date (ClinicalTrials.gov Identifier: NCT01920867). Eight months after treatment by a combination of retrobulbar, subtenon, intravitreal and intravenous injection of BMSC, the patients best corrected Snellen acuity improved from 20/80– to 20/60+1 in the right eye and from 20/50– to 20/20–3 in the left eye. The Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity continued to improve over the succeeding 8 months and the optical coherence tomography macular volume increased. The increases in visual acuity and macular volume are encouraging and suggest that the use of BMSC as provided in SCOTS may be a viable approach to treating serpiginous choroidopathy.