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Investigative Ophthalmology & Visual... Mar 2021The purpose of this study was to quantify hyper-reflective lesions on en face optical coherence tomography (OCT) and study its functional relevance in macular... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The purpose of this study was to quantify hyper-reflective lesions on en face optical coherence tomography (OCT) and study its functional relevance in macular telangiectasia type 2 (MacTel).
DESIGN
This was a retrospective, cross-sectional cohort study.
METHODS
Baseline image and functional data from participants of a phase II clinical trial (NCT01949324) that studied the effect of Ciliary Neurotrophic Factor in patients with MacTel were analyzed. The projection of hyper-reflectivity within different layers on OCT was used to generate an en face view and measure the en face size of hyper-reflectivity. Ellipsoid zone (EZ)-loss was additionally evaluated, and en face images were superimposed onto microperimetry sensitivity maps, allowing to estimate mean retinal sensitivity within areas displaying hyper-reflectivity and EZ-loss, respectively. Best-corrected visual acuity (BCVA) and reading speed were also analyzed.
RESULTS
Fifty-two eyes from 52 patients were analyzed. Hyper-reflectivity was present in 32 eyes (62%), and EZ-loss in 50 (96%) eyes. Mean lesion size was 0.11 mm² (range = 0.01-0.26) for hyper-reflectivity and 0.51 mm² (range = 0.02-1.34) for EZ-loss, and lesion sizes correlated strongly (Spearman r = 0.79, P < 0.001). Although both hyper-reflectivity and EZ-loss were associated with a significant decrease in retinal sensitivity, mean sensitivity thresholds differed significantly between lesions (0.9 dB vs. 16.3 dB; P < 0.001), indicating an almost complete loss of sensitivity in hyper-reflective areas. No correlations were found between the size of hyper-reflectivity and BCVA (r = 0.09) or reading speed (r = -0.17).
CONCLUSIONS
En face OCT can be used to quantify the area of hyper-reflective lesions in MacTel. Hyper-reflectivity in MacTel is associated with severe functional impairment, leading to an almost complete loss of retinal sensitivity as observed on microperimetry.
Topics: Aged; Cross-Sectional Studies; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Retina; Retinal Telangiectasis; Retrospective Studies; Scotoma; Telangiectasia, Hereditary Hemorrhagic; Tomography, Optical Coherence; Visual Acuity; Visual Field Tests; Visual Fields
PubMed: 33661283
DOI: 10.1167/iovs.62.3.6 -
Transactions of the American... 1964
Topics: Diagnosis, Differential; Glaucoma; Humans; Ophthalmoscopy; Optic Nerve; Pathology; Peripheral Nervous System Diseases; Retinal Vessels; Scotoma; Vascular Diseases; Visual Fields
PubMed: 14269898
DOI: No ID Found -
Attention, Perception & Psychophysics Aug 2022Central vision loss disrupts voluntary shifts of spatial attention during visual search. Recently, we reported that a simulated scotoma impaired learned spatial...
Central vision loss disrupts voluntary shifts of spatial attention during visual search. Recently, we reported that a simulated scotoma impaired learned spatial attention towards regions likely to contain search targets. In that task, search items were overlaid on natural scenes. Because natural scenes can induce explicit awareness of learned biases leading to voluntary shifts of attention, here we used a search display with a blank background less likely to induce awareness of target location probabilities. Participants searched both with and without a simulated central scotoma: a training phase contained targets more often in one screen quadrant and a testing phase contained targets equally often in all quadrants. In Experiment 1, training used no scotoma, while testing alternated between blocks of scotoma and no-scotoma search. Experiment 2 training included the scotoma and testing again alternated between scotoma and no-scotoma search. Response times and saccadic behaviors in both experiments showed attentional biases towards the high-probability target quadrant during scotoma and no-scotoma search. Whereas simulated central vision loss impairs learned spatial attention in the context of natural scenes, our results show that this may not arise from impairments to the basic mechanisms of attentional learning indexed by visual search tasks without scenes.
Topics: Attention; Humans; Probability Learning; Reaction Time; Saccades; Scotoma
PubMed: 34921336
DOI: 10.3758/s13414-021-02416-9 -
Die Ophthalmologie Mar 2023
Topics: Humans; Scotoma; COVID-19; Visual Fields; Visual Field Tests
PubMed: 36085528
DOI: 10.1007/s00347-022-01726-z -
Experimental Eye Research Jun 2019Observers with central field loss typically fixate within a non-foveal region called the preferred retinal locus, which can include localized sensitivity losses, or...
Observers with central field loss typically fixate within a non-foveal region called the preferred retinal locus, which can include localized sensitivity losses, or micro-scotomas (Krishnan and Bedell, 2018). In this study, we simulated micro-scotomas at the fovea and in the peripheral retina to assess their impact on reading speed. Ten younger (<36 years old) and 8 older (>50 years old) naïve observers with normal vision monocularly read high and/or low contrast sentences, presented at or above the critical print size for young observers at the fovea and at 5 and 10 deg in the inferior visual field. Reading material comprised MNREAD sentences and sentences taken from novels that were presented in rapid serial visual presentation (RSVP) format. Randomly distributed 13 × 13 arc min blocks corresponding to 0-78% of the text area (corresponding to ∼0-17 micro-scotomas/deg) were set to the background luminance to simulate micro-scotomas. A staircase algorithm estimated maximum reading speed from the threshold exposure duration for each combination of retinal eccentricity, contrast and micro-scotoma density in both age groups. Log(RSVP reading speed) decreased significantly with simulated micro-scotoma density and eccentricity. Across conditions, reading speed was slower with low-compared to high-contrast text and was faster in younger than older normal observers. For a given eccentricity and contrast, a higher density of random element losses maximally affected older observers with normal vision. These outcomes may explain some of the reading deficits observed in older observers with central field loss.
Topics: Adult; Aged; Computer Simulation; Female; Fovea Centralis; Humans; Male; Middle Aged; Pilot Projects; Reading; Scotoma; Visual Field Tests; Visual Fields; Young Adult
PubMed: 29959926
DOI: 10.1016/j.exer.2018.06.027 -
Journal of Vision Apr 2024Older adults show decline in visual search performance, but the underlying cause remains unclear. It has been suggested that older adults' altered performance may be...
Older adults show decline in visual search performance, but the underlying cause remains unclear. It has been suggested that older adults' altered performance may be related to reduced spatial attention to peripheral visual information compared with younger adults. In this study, 18 younger (M = 21.6 years) and 16 older (M = 69.1 years) participants performed pop-out and serial visual search tasks with variously sized gaze-contingent artificial central scotomas (3°, 5°, or 7° diameter). By occluding central vision, we measured how attention to the periphery was contributing to the search performance. We also tested the effect of target eccentricity on search times and eye movements. We hypothesized that, if attention is reduced primarily in the periphery in older adults, we would observe longer search times for more eccentric targets and with central occlusion. During the pop-out search, older adults showed a steeper decline in search performance with increasing eccentricity and central scotoma size compared with younger adults. In contrast, during the serial search, older adults had longer search times than younger adults overall, independent of target eccentricity and scotoma size. Longer search times were attributed to higher cost-per-item slopes, indicating increased difficulty in simultaneously processing complex symbols made up of separable features in aging, possibly stemming from challenges in spatially binding individual features. Altogether, our findings point to fewer attentional resources of simultaneous visual processing to distribute over space or separable features of objects, consistent with decreased dorsal visual stream functioning in aging.
Topics: Humans; Aged; Aging; Eye Movements; Scotoma; Visual Perception
PubMed: 38591941
DOI: 10.1167/jov.24.4.8 -
Retina (Philadelphia, Pa.) Nov 2023To describe specific clinical, multimodal imaging, and natural history features of an unusual variant of acute zonal occult outer retinopathy. (Observational Study)
Observational Study
PURPOSE
To describe specific clinical, multimodal imaging, and natural history features of an unusual variant of acute zonal occult outer retinopathy.
METHODS
Retrospective, observational, longitudinal, multicenter case series. Patients exhibiting this unusual clinical condition among cases previously diagnosed with acute zonal occult outer retinopathy were included. Multimodal imaging, laboratory evaluations, and genetic testing for inherited retinal diseases were reviewed.
RESULTS
Twenty eyes from 10 patients (8 females and 2 males) with a mean age of 54.1 ± 13.3 years (range, 38-71 years) were included. The mean follow-up duration was 13.1 ± 5.3 years (range, 8-23 years). Presenting symptoms were bilateral in 7 patients (85% of eyes) and included scotomata and photopsia. All patients had bilateral lesions at presentation involving the peripapillary and far peripheral retina. Baseline optical coherence tomography showed alteration of the retinal pigment epithelium and photoreceptor layers corresponding to zonal areas of fundus autofluorescence abnormalities. Centrifugal and centripetal progression of the peripapillary and far-peripheral lesions, respectively, occurred over the follow-up, resulting in areas of complete outer retinal and retinal pigment epithelium atrophy.
CONCLUSION
Initial alteration of photoreceptors and retinal pigment epithelium and a stereotypical natural course that includes involvement of the far retinal periphery, characterize this unusual condition. It may represent a variant of acute zonal occult outer retinopathy or may be a new entity. We suggest to call it multizonal outer retinopathy and retinal pigment epitheliopathy .
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Fluorescein Angiography; Retinal Diseases; Retinal Pigments; Retrospective Studies; Scotoma; Tomography, Optical Coherence; Visual Fields
PubMed: 37748093
DOI: 10.1097/IAE.0000000000003927 -
Clinical & Experimental Optometry Jan 2002The Valsalva manoeuvre comprises forcible exhalation against the closed glottis, thereby creating a sudden increase in the intrathoracic or intra-abdominal pressure. A...
The Valsalva manoeuvre comprises forcible exhalation against the closed glottis, thereby creating a sudden increase in the intrathoracic or intra-abdominal pressure. A simultaneous rapid rise in intraocular venous pressure may result in the spontaneous rupture of perifoveal capillaries, leading to a characteristic clinical picture of a preretinal haemorrhage in an otherwise healthy eye. The haemorrhage typically occurs at the macula and in the vast majority of cases resolves without compromising visual acuity. Valsalva maculopathy is an isolated and self-limited event. A case of Valsalva maculopathy in a young healthy male attributable to an incontrovertible Valsalva stress associated with weightlifting is presented.
Topics: Adult; Humans; Male; Retinal Hemorrhage; Scotoma; Valsalva Maneuver; Weight Lifting
PubMed: 11952395
DOI: 10.1111/j.1444-0938.2002.tb03071.x -
BMC Ophthalmology Jan 2024In this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection. (Review)
Review
BACKGROUND
In this study, we report a case series of acute macular neuroretinopathy (AMN) associated with COVID-19 infection.
METHODS
This retrospective observational study was conducted at Beijing Tongren Hospital. We reviewed patients who were diagnosed with AMN within one month of testing positive for COVID-19 using real-time reverse transcription-polymerase chain reaction (RT-PCR).
RESULTS
A total of 11 AMN patients (20 eyes) were included in the study. The mean age was 33.8 ± 12.6 years. The average interval between a positive COVID-19 PCR test and the onset of ocular symptoms was 2.8 ± 2.5 days. The mean follow-up period for the patients was 12.5 ± 3.8 weeks. Imaging characteristics of AMN patients following COVID-19 infection included areas of low reflectivity on near-infrared reflectance (NIR) imaging, hyperreflective lesions at the level of the outer plexiform layer (OPL) and outer nuclear layer (ONL) and disruption of the ellipsoid zone (EZ) on spectral domain optical coherence tomography (SD-OCT) B-scans. Visual field examinations revealed parafoveal scotomas that closely corresponded to the clinical lesions. Optical coherence tomography angiography (OCT-A) demonstrated impaired perfusion in the deep retinal vascular plexus. Fluorescein angiography (FA), indocyanine green angiography (ICGA), and spontaneous fundus autofluorescence showed no significant abnormalities. During follow-up, partial improvement in retinal lesions was observed in NIR imaging and SD-OCT in some patients, but a proportion of patients still exhibited persistent retinal damage and no improvement in visual field scotomas.
CONCLUSION
COVID-19-related AMN share similar clinical and imaging features with AMN due to other causes, as evidenced by the persistent presence of visual field scotomas over a longer duration.
TRAIL REGISTRATION
https://www.chictr.org.cn/ ; identifier: ChiCTR2100044365.
Topics: Humans; Young Adult; Adult; Middle Aged; Scotoma; COVID-19; White Dot Syndromes; Retina; Face; Observational Studies as Topic
PubMed: 38200478
DOI: 10.1186/s12886-024-03283-2 -
Acta Psychologica Sep 2021Several studies have shown that impairments in a sensory modality can induce perceptual deficits in tasks involving the remaining senses. For example, people with...
Several studies have shown that impairments in a sensory modality can induce perceptual deficits in tasks involving the remaining senses. For example, people with retinal degenerative diseases like Macular Degeneration (MD) and with central scotoma show biased auditory localization abilities towards the visual field's scotoma area. This result indicates an auditory spatial reorganization of cross-modal processing in people with scotoma when the visual information is impaired. Recent works showed that multisensory training could be beneficial to improve spatial perception. In line with this idea, here we hypothesize that audio-visual and motor training could improve people's spatial skills with retinal degenerative diseases. In the present study, we tested this hypothesis by testing two groups of scotoma patients in an auditory and visual localization task before and after a training or rest performance. The training group was tested before and after multisensory training, while the control group performed the two tasks twice after 10 min of break. The training was done with a portable device positioned on the finger, providing spatially and temporally congruent audio and visual feedback during arm movement. Our findings show improved audio and visual localization for the training group and not for the control group. These results suggest that integrating multiple spatial sensory cues can improve the spatial perception of scotoma patients. This finding ignites further research and applications for people with central scotoma for whom rehabilitation is classically focused on training visual modality only.
Topics: Cues; Humans; Movement; Retina; Scotoma; Space Perception
PubMed: 34365274
DOI: 10.1016/j.actpsy.2021.103384