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At least 307 records · Page 17Linked to original sources
PubMed1975

The visual field and nerve head in angle-closure glaucoma. A comparison of the effects of acute and chronic angle closure.

Eighteen unilaterally affected acute angle-closure glaucoma patients were seen a period of time after the acute episode, and 11 unilateral chronic angle-closure patients were seen while under control. Visual fields, optic nerve heads, and vision were assessed using the normal eye as a control. Nerve fiber bundle defects were seen in seven of the acute and nine of the chronic angle-closure cases. None of the acute, but five of the chronic angle-closure patients, showed asymmetry of cupping, while pallor was seen in seven of the acute and nine of the chronic patients. No significant difference in reduction of vision was seen between the two groups. The duration of pressure is a possible reason for cupping in glaucoma.

Acute Disease↗
PubMed1975

Retinal ischemia in diabetic retinopathy.

Eight patients with proliferative diabetic retinopathy developed extensive retinal arteriolar and capillary obstruction. Ophthalmoscopy showed many white, thread-like retinal arterioles associated with capillary and venous dilatation. Widespread retinal arteriolar and capillary nonperfusion was demonstrated by fluorescein angiography. Ischemic maculopathy resulted in severe loss of visual acuity in some eyes. The severe degree of retinal ischemia was accompanied by optic disc pallor and neovascularization and a high incidence of rubeosis iridis with neovascular glaucoma. Patients with this variety of diabetic retinopathy have a poor prognosis of retaining useful vision.

Adolescent↗
PubMed1976

Funduscopic appearance of papilledema with optic tract atrophy.

In a child with a hypothalamic glioma, elevated intracranial pressure and retrograde optic tract atrophy produced distinctive patterns of papilledema and disc pallor in each eye. On the side of the tract lesion, the disc was swollen nasally and was pale temporally. In the contralateral fundus, the swollen optic disc was bisected horizontally by a pale atrophic band. These funduscopic signs exemplify a rare instance in neuro-ophthalmologic diagnosis wherein specific lateralizing and localizing information can be deduced solely from the appearance of papilledema.

Astrocytoma↗
PubMed1979

Optic disc parameters and onset of glaucomatous field loss. I. Methods and progressive changes in disc morphology.

Serial stereoscopic fundus photographs taken in known relationship to the onset of glaucomatous visual field loss on 12 eyes were intermixed with those from 206 age- and race-matched controls and analyzed in randomized masked fashion. Progressive changes in the size, shape, or contour of the disc, and a newly described parameter, thickness of the nerve fiber layer as it crosses the disc rim, were readily apparent by the time of onset of glaucomatous field loss in all but two abnormal eyes (one case). In the latter instance, direct comparison of stereophotos indicated progressive pallor of the remaining disc tissue. Serial stereophotographs appear superior to fundus drawings for anticipating glaucomatous field loss.

Glaucoma↗
PubMed1979

Dominant optic atrophy. The clinical profile.

We examined 24 individuals in four family pedigrees with dominantly inherited optic atrophy (DOA); 12 patients met the criteria for diagnosis of DOA and two were suspect. Our data indicate that (1) insidious onset usually occurred in childhood, but subjective visual symptoms may evolve in adulthood; (2) visual function was minimally (20/25) to moderately (20/400) abnormal, could be strikingly asymmetric in an individual (eg, 20/30 in the right eye and 20/200 in the left eye), and showed considerable intrafamilial and interfamilial variation; (3) visual field defects consisted of central and centrocecal scotomas, but no peripheral isopter abnormalities were found; (4) color-vision screening with Hardy-Rand-Rittler plates revealed dyschromotopsias, but only Farnsworth-Munsell 100-hue examination disclosed the typical tritan defects; (5) pattern-reversal visual-evoked responses were characterized by diminished amplitudes and prolonged latencies, consistent with neural conduction defects; (6) disc pallor was limited to the temporal segment in all cases, and 16 of 24 eyes showed focal temporal excavation, which is probably pathognomonic of DOA.

Adolescent↗
PubMed1980

Optic atrophy. Differential diagnosis by fundus observation alone.

In order to assess the contribution of fundus examination to the differential diagnosis of acuqired optic neuropathy, five ophthalmologists viewed 163 fundus stereophotographs of nine disease entities as "unknowns." Glaucoma, central retinal artery occlusion (CRAO), and ischemic optic neuropathy (ION) were diagnosed by at least one observer with an accuracy above 80%. The remaining conditions (optic neuritis; compressive, traumatic, and hereditary optic neuropathies) were correctly identified with less than 50% accuracy. Retinal arteriolar attenuation and sheathing were most helpful in differentiating CRAO and ION. Although pathologic disc cupping often identified glaucoma, it was also seen in 20% of eyes with optic atrophy not associated with glaucoma. Excavation was more profound in glaucoma than in nonglaucomatous optic atrophy, the latter demonstrating relatively greater neuroretinal rim pallor. In 6% of nonglaucomatous optic atrophy eyes, however, disc cupping was misdiagnosed as "glaucomatous." Only 11% of eyes with previously documented papillitis or ION left clues that allowed observers to identify preexisting disc swelling.

Diagnosis, Differential↗
PubMed1980

Nonglaucomatous excavation of the optic disc.

In order to test the hypothesis that glaucomatous and nonglaucomatous optic disc cupping can be distinguished ophthalmoscopically, three ophthalmologists experienced in assessing optic dics were asked to view fundus stereophotographs as "unknowns". Of 29 eyes with nonglaucomatous optic atrophy, 13 (44%) were misdiagnosed as showing glaucoma by at least one observer. Of four optic disc features specifically analyzed, neuroretinal rim pallor proved to be 94% specific for nonglaucomatous atrophy, while focal or diffuse obliteration of the neuroretinal rim was 87% specific for glaucoma. These two signs are the most useful in making the distinction. Thinning of the rim was more common in glaucoma than in nonglaucomatous atrophy, but was only 47% specific for glaucoma. Laminar dots were present in both types of excavation.

Diagnosis, Differential↗
PubMed1980

Two-point fluorophotometry in the evaluation of glaucomatous optic disc.

The two-point fluorophotometry technique was used to analyze quantitatively absolute fluorescein filling defects or hypofluorescent areas in glaucomatous optic discs. Significant differences were found between hypofluorescent and normal fluorescent areas. The hypofluorescent areas had slower and lesser filling of fluorescein and a slower disappearance of fluorescein compared with normal fluorescent areas. Also, the hypofluorescent areas showed a slow and persistent accumulation of fluorescein. Age, blood pressure, ocular pressure, and percent area of optic disc pallor were significantly correlated with changes in the circulation in the areas of normal fluorescence and hypofluorescence. This study suggests a decreased blood flow and a smaller vascular bed together with narrower vessels and increased permeability of the vessels in the hypofluorescent areas.

Age Factors↗
PubMed1981

Differences of adrenal stress control mechanisms in subjects with glaucoma and normal subjects. Effect of vasopressin and pyrogen.

Various types of glaucomatous and normal subjects were tested for the adequacy of the stress response of their hypothalamic-pituitary-adrenal axis to pyrogen and vasopressin. With pyrogen, a significant response of elevation of plasma cortisol levels was positively correlated with ocular pressure and changes of the optic disc. Those subjects with increased ocular pressure and optic disc cupping and pallor had greater rises of plasma cortisol levels. With vasopressin, a decreased response of plasma cortisol levels was negatively correlated with the degree of elevated ocular pressure. Those subjects with increased ocular pressure and lower tonographic outflow facilities had smaller rises of plasma cortisol levels. Both tests indicated a disturbance of the hypothalamic-pituitary-adrenal axis in subjects with glaucoma.

Female↗
PubMed1982

Idiopathic juxtafoveolar retinal telangiectasis.

Twenty-seven healthy adult patients had visual loss in one or both eyes because of exudation from juxtafoveolar retinal capillary telangiectasis of uncertain cause. These patients were subdivided as follows: group 1, men with uniocular involvement, intraretinal lipid exudation, and telangiectasis largely confined to the temporal half of the juxtafoveolar area; group 2, mostly men with symmetric areas of telangiectasis affecting the temporal half of the juxtafoveolar areas and minimal intraretinal exudation; group 3, both sexes with symmetric involvement of all of the parafoveolar capillary bed an minimal exudation; and group 4, one case of telangiectasis with occlusive perifoveolar capillary changes and familial optic disc pallor. The visual acuity prognosis in groups 1 through 3 is relatively good. Photocoagulation may be of some value in the treatment of patients in group 1.

Adult↗
PubMed1984

Principles of photometry of the papilla.

To enhance the qualitative information gained by photographing the optic nerve head, we built a silicon photovoltaic detector (photodiode) in the image plane of a fundus camera (Zeiss). It permitted quantitative evaluation of the relative brightness of the illuminated papilla. Following construction of the device and during the early course of more than 260 measurement sessions (on more than 130 subjects), several heretofore unknown sources of error were encountered and subsequently dealt with, resulting in a margin of error for the entire system of between 0.3% and 1.2%. Pallor of the optic nerve head induced by artificial ocular hypertension can be well reproduced by this method.

Humans↗
PubMed1985

Niemann-Pick disease--type C. Ocular histopathologic and electron microscopic studies.

The presence of lipid storage was demonstrated in type C Niemann-Pick disease by histopathologic and ultrastructural studies. Pleomorphic membranous inclusions, with variable proportions of light and dark granular material, were observed within the conjunctival fibrocytes, endothelial cells and pericytes, keratocytes, lens epithelium, retinal ganglion cells, retinal pigment epithelium, fibrocytes in the uveal tract, and optic nerve fibrous astrocytes. Only optic nerve and retinal ganglion cell involvement had clinical counterparts represented by optic nerve pallor and perimacular gray discoloration.

Child↗
PubMed1988

Modified optic nerve sheath decompression provides long-term visual improvement for pseudotumor cerebri.

Twenty-three patients with chronic papilledema associated with pseudotumor cerebri underwent "modified" optic nerve sheath decompression for treatment of visual acuity and visual field loss. Instead of removing a single, rectangular section of optic nerve meninges, the operation was modified by making at least three longitudinal incisions in the sheath and then lysing arachnoid adhesions with a tenotomy hook. Twenty-one of the 23 patients demonstrated improved visual function after the initial surgery for a mean (+/- SD) follow-up of 21.5 +/- 12.3 months (median, 25 months; range, three to 45 months) without reoperation or reinstitution or oral corticosteroid and diuretic therapies. The two patients failing to improve after the first surgical procedure initially had a single meningeal window created and subsequently improved following reoperation with the modified procedure. Twelve of 21 patients with bilateral visual loss had improved visual function bilaterally after unilateral surgery. Six of the 21 patients needed bilateral surgery, and the other three had minor visual field defects in the second eye not severe enough to warrant surgery. Preoperative optic disc pallor did not predict a poor postoperative result. Optic nerve surgery improved the visual function in six patients who had failed to recover vision after one or more lumbar-peritoneal shunts.

Adolescent↗
PubMed1989

Superior segmental optic hypoplasia. A sign of maternal diabetes.

In a review of 10 patients with superior segmental optic nerve hypoplasia, all of whom were the children of diabetic mothers, 17 of 20 eyes had one or more of four characteristic findings in the optic disc: relative superior entrance of the central retinal artery, pallor of the superior disc, superior peripapillary halo, and thinning of the superior peripapillary nerve fiber layer. We believe that the presence of these four signs of superior segmental optic nerve hypoplasia strongly suggests maternal diabetes.

Adult↗
PubMed1989

Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals. A randomized, double-masked, long-term clinical trial.

We conducted a randomized, double-masked, long-term clinical trial to determine whether topical timolol therapy was effective in delaying or preventing the onset of glaucomatous damage in moderate-risk ocular hypertensive subjects. In 62 patients, one eye was chosen randomly to receive timolol therapy twice daily while the fellow eye received placebo. During the course of the study, the mean +/- SD difference in intraocular pressure between the timolol-treated and the placebo-treated eyes was 2.3 +/- 2.6 mm Hg. Reproducible visual field loss developed in 4 timolol-treated eyes and 10 placebo-treated eyes. Progressive optic disc cupping was noted in 4 timolol-treated and 8 placebo-treated eyes. Using a computerized image analysis system, the mean +/- SD increase in optic disc pallor during the course of the study was 0.86% +/- 2.4% in the timolol-treated eyes as opposed to 1.80% +/- 3.6% in the placebo-treated eyes. This study provides evidence that lowering intraocular pressure by medical treatment reduces the incidence of glaucomatous damage in ocular-hypertensive individuals.

Administration, Topical↗
PubMed1990

Ocular findings in primary hyperoxaluria.

Primary hyperoxaluria (primary oxalosis) is a rare autosomal recessive inborn error of glyoxylate metabolism that causes widespread calcium oxalate crystal deposition in diverse tissues. Because others have reported only occasional ocular involvement, we reviewed the ophthalmologic findings in our 24 patients with primary hyperoxaluria to document its funduscopic variability and to determine its visual prognosis and its possible systemic significance. Eight (30%) of our 24 patients with primary hyperoxaluria exhibited a bilaterally symmetrical retinopathy. The abnormalities were predominantly confined to the posterior pole and ranged from many small (100- to 200-microns) subretinal black ringlets to single large (2- to 3-disc diameter) geographic lesions. In 3 of the 8 patients with oxalate retinopathy, diffuse optic disc pallor was evident. Five patients with both normal-appearing optic discs and oxalate retinopathy had relatively good visual acuities. The maculopathy of primary hyperoxaluria caused mild visual impairment while optic nerve dysfunction associated with this disease appeared to be much visually debilitating. Also, the presence of oxalate maculopathy was associated with a more severe systemic course for the disease.

Acute Kidney Injury↗
PubMed1997

Clinical and genetic analysis of a family affected with dominant optic atrophy (OPA1)

OBJECTIVES: To refine the dominant optic atrophy locus, OPA1, on chromosome 3q and to characterize the phenotype of a 6-generation family pedigree affected with this disease. METHODS: Fifty-six family members had a complete eye examination. Clinical records of an additional 3 patients were reviewed. Goldmann perimetry and a 21-chip subtest of the Farnsworth-Munsell 100-Hue test were performed on selected patients. Affected patients, unaffected siblings, and potentially informative spouses were genotyped with short tandem repeat polymorphisms located on chromosome 3. The genotypic data were subjected to linkage analysis. RESULTS: Thirty-four family members were found to be clinically affected. Most experienced vision loss (20/40 or poorer) in the first decade of life. Most (9 of the 16 eyes) progressed to 20/800 or poorer visual acuity by age 60 years, while 2 patients maintained visual acuities of 20/40 at that age. Affected patients had a 2- to 10-fold increase in the error score of a 21-chip subtest of the Farnsworth-Munsell 100-Hue test compared with age-matched unaffected family members. The optic nerve examination revealed temporal pallor and excavation in all affected individuals. Linkage analysis revealed significant lod scores with 9 markers. The highest lod score, 10.1 (theta = 0) [corrected], was obtained with marker D3S2305. Analysis of recombinants narrowed the disease interval to approximately 3.8 centimorgans, flanked by D3S3669 (centromeric) and D3S1305 (telomeric). CONCLUSIONS: Most patients affected with dominant optic atrophy in this family progressed to legal blindness by middle age. Color vision testing is a sensitive method for detection of affected patients. The dominant optic atrophy locus, OPA1, has been refined by the identification of new flanking markers: D3S3669 (centromeric) and D3S1305 (telomeric).

Adolescent↗
PubMed1997

Does optic disc appearance distinguish ischemic optic neuropathy from optic neuritis?

OBJECTIVE: To determine whether characteristics of optic nerve swelling assist in distinguishing between optic neuritis and anterior ischemic optic neuropathy. METHOD: Optic nerve stereophotograph review by masked observers. RESULTS: Altitudinal swelling, pallor, arterial attenuation, and hemorrhage are found more commonly in anterior ischemic optic neuropathy than in optic neuritis. CONCLUSION: Optic disc appearance does help to distinguish anterior ischemic optic neuropathy from optic neuritis, although there are overlapping features.

Acute Disease↗