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      Macular sensitivity and fixation patterns in normal eyes and eyes with uveitis with and without macular edema

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          Abstract

          Purpose

          This study aims to investigate the relationship between macular sensitivity and thickness in eyes with uveitic macular edema (UME).

          Design

          This study is a prospective observational case series.

          Methods

          The setting for this study was clinical practice. The study included 59 (28 with UME, 31 without UME) eyes of 26 patients with uveitis and 19 eyes of 10 normal subjects. The procedure followed was fundus-related perimetry and retinal thickness map with an automated fundus perimetry/tomography system. Main outcome measures included quantification of macular sensitivity, fixation pattern, and relationship between macular sensitivity and thickness.

          Results

          Fixation stability revealed that 56 eyes (93.44%) had stable fixation (>75% within the central 2° of point of fixation); three eyes (6.56%) were relatively unstable (<75% of fixation points located within 2°, >75% located within 4°); and no eye had unstable fixation (<75% of fixation points located within 4°). Evaluation of fixation location revealed that 45 eyes (76.27%) had central fixation location (>50% of fixation point within 0.5 mm of foveal center); seven eyes (11.86%) had peri-central fixation location (25% << 50% within 0.5 mm); and seven eyes (11.86%) had eccentric (<25% of fixation point within 0.5 mm) fixation location. We measured macular sensitivity and corresponding thickness in 1,708 loci of 61 study eyes. Macular sensitivity increased by 0.02 dB (95% confidence interval, 0.00, 0.06) per 1 μm increase in the thickness for the thickness values ≤280 μm. Macular sensitivity decreased by 0.04 dB (95% CI, −0.08, −0.01) per 1 μm increase in the thickness for the thickness values >280 μm.

          Conclusions

          Perimetry quantification of macular sensitivity and retinal thickness, in association with other factors, may offer novel information regarding the impact of UME on retinal function.

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          Most cited references22

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          Causes and frequency of blindness in patients with intraocular inflammatory disease.

          Uveitis, an intraocular inflammatory disease, is a significant cause of visual impairment. It is not known how many patients with uveitis will retain visual acuity and how many develop visual impairment or even blindness. The aim of this study was to assess the frequency of blindness in patients with uveitis and, more specifically, to identify the clinical profile of patients at risk for visual loss. A cross sectional and retrospective study of 582 patients with uveitis who visited the ophthalmology departments of two university hospitals in the Netherlands was performed. Within the group of 582 patients, 203 (35%) exhibited blindness or visual impairment; bilateral legal blindness developed in 22 (4%) patients, 26 (4.5%) had one blind eye with visual impairment of the other, and nine (1.5%) had bilateral visual impairment. Unilateral blindness developed in 82 (14%) patients, whereas 64 (11%) exhibited unilateral visual impairment. The most important cause of both blindness and visual impairment was cystoid macular oedema (29% and 41%, respectively). Complications of uveitis were encountered in more than half of the patients and 23% underwent one or more surgical procedures. When the patients were subdivided according to anatomical site, those with panuveitis had the worst visual prognosis. The systemic diseases associated with a poor visual prognosis were juvenile chronic arthritis and sarcoidosis. Ocular toxoplasmosis was the most frequent cause of unilateral visual loss. Cystoid macular oedema is the most frequent complication of uveitis and its occurrence plays a decisive role in the visual outcome of this disease.
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            The possible impact of uveitis in blindness: a literature survey.

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              Preferred retinal locus development in patients with macular disease.

              To observe the development of the preferred retinal locus (PRL) in a group of patients with central scotomas caused by recent onset macular disease (MD). Prospective observational case series. Twenty-five individuals with bilateral central scotomas caused by MD. All patients had experienced visual loss in their better eye in the 2 weeks before recruitment. Patients were assessed at baseline and at 4 further visits for up to 12 months. At each visit, the retinal area used for fixation was assessed using a scanning laser ophthalmoscope, the infrared Gazetracker was used to determine the number of discrete retinal areas used for fixation in 5 positions of gaze, and reading speed was measured using MN-Read-style sentences. All 25 patients developed a PRL within 6 months. Sixteen patients (64%) made an adaptation whereby they were unaware of using an eccentric retinal area for fixation. Multiple fixation loci were exhibited by 11 patients at the end of the study. Nineteen patients used a consistent number of PRLs under all positions of gaze. Reading speed was not associated with PRL location or the presence of multiple PRLs. All of the patients in this study developed a repeatable preferred retinal locus within 6 months of visual loss in their second affected eye. Reading performance was better in patients who were not aware of using eccentric viewing strategies and who used a repeatable number of PRLs under all positions of gaze. These findings are relevant for counseling patients with MD and for the design of rehabilitation programs for patients with central vision loss.
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                Author and article information

                Contributors
                +1-410-5020766 , +1-410-5021712 , qnguyen4@jhmi.edu
                Journal
                J Ophthalmic Inflamm Infect
                J Ophthalmic Inflamm Infect
                Journal of Ophthalmic Inflammation and Infection
                Springer-Verlag (Berlin/Heidelberg )
                1869-5760
                14 December 2011
                14 December 2011
                June 2012
                : 2
                : 2
                : 65-73
                Affiliations
                [1 ]Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD USA
                [2 ]Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
                [3 ]Johns Hopkins Hospital, 600 North Wolfe Street Maumenee 745, Baltimore, MD 21287 USA
                Article
                52
                10.1007/s12348-011-0052-8
                3345050
                22167465
                d3e11fa3-0b51-4d23-96b7-141f3c150deb
                © The Author(s) 2011
                History
                : 19 September 2011
                : 9 November 2011
                Categories
                Original Research
                Custom metadata
                © Springer-Verlag 2012

                Ophthalmology & Optometry
                microperimetry,ophthalmology,medicine & public health,retinal thickness,uveitic macular edema,uveitis

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