236 research outputs found
Metamorphopsia: An Overlooked Visual Symptom
No full textMetamorphopsia is a common symptom in different macular disorders. Micropsia and macropsia are special types of metamorphopsia. Recent theories suggest that both retinal and cortical mechanisms are involved in the development and changes of metamorphopsia. Different functional tests have been proposed for the evaluation of metamorphopsia: from the Amsler grid to the hand-held mobile devices for home monitoring. This review addresses some new insights into the pathophysiology of metamorphopsia and different available tests for the evaluation of this symptom in most common macular disorders. The importance of quantification of metamorphopsia in macular diseases is confirmed by the most recent therapeutic approaches. © 2015 S. Karger AG
Normal Values for Fundus Perimetry with the Microperimeter MP1
No full textNormal values for fundus perimetry with the microperimeter MP1. Midena E, Vujosevic S, Cavarzeran F; Microperimetry Study Group. Collaborators (12)Luciani F, Cappello E, Tollot L, Carpineto P, Capris P, Convento E, Midena E, Radin PP, Varano M, Vujosevic S, Tedeschi E, Parodi MB. SourceDepartment of Ophthalmology, University of Padova, Padova, Italy. [email protected] Abstract PURPOSE: To identify age-stratified normal light sensitivity values for microperimetry (fundus perimetry) and to evaluate the short-term repeatability of the MP1 microperimeter in normal volunteers. DESIGN: Multicenter, prospective, observational study. PARTICIPANTS: One hundred ninety subjects. METHODS: One hundred ninety eyes of 190 healthy volunteers (age range, 20-75 years) underwent automatic, full-threshold microperimetry of the central field (20 x 20 degrees, 77 stimulated points) with the MP1 microperimeter (Nidek Technologies, Gamagori, Japan). Fixation was documented simultaneously. A subgroup of 10 subjects was retested after 1 hour and 1 week to determine the repeatability of this technique. MAIN OUTCOME MEASURES: By linear regression analyses, light sensitivity values were obtained from 4 fundus areas and were analyzed for differences related to region, age, and, in a subset of subjects, repeat testing over time and right and left eye variability. Short-term repeatability for each area was evaluated by calculating intraclass correlation coefficients. RESULTS: Linear regression analysis showed a significantly greater (P<0.0001) mean macular sensitivity of 19.6+/-0.5 dB in the 20 to 29 years of age group compared with 18.6+/-1.5 dB in the oldest age group of 70 to 75 years. These results were confirmed by the fifth percentile of light sensitivity threshold distribution. Normal and 95% confidence interval age-stratified values were calculated. When results for all 190 subjects were analyzed by region, the superior retinal sector showed significantly lower mean sensitivity values than other sectors (P<0.01, Bonferroni test). In a subset of 10 subjects, repeatability of the test performed at 3 separate visits showed consistent values over time in all areas (P<0.01, intraclass correlation coefficients). CONCLUSIONS: Automatic fundus perimetry with the MP1 microperimeter allows for an accurate, repeatable, topographically specific examination of the retinal threshold in selected retinal areas. These findings are the first extensive database of age-related, normal MP1 microperimetry results available to clinicians. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. Comment in Ophthalmology. 2011 Jun;118(6):1224; author reply 1224-5. PMID: 20472294 [PubMed - indexed for MEDLINE
Diagnosing and monitoring diabetic macular edema: structural and functional tests.
No full textDiabetic macular edema remains a major cause of visual impairment in adults despite the use of intensive glycemic control, photocoagulation therapy and new intravitreal drugs in the treatment of this disease. Although early diagnosis and treatment lead to better results, we still have patients who become legally blind. Therefore, better structural and functional characterization of this disease is necessary in order to customize treatment
Retinal Layers Changes in Human Preclinical and Early Clinical Diabetic Retinopathy Support Early Retinal Neuronal and Müller Cells Alterations
No full textPurpose. To evaluate the changes in thickness of individual inner and outer macular and peripapillary retinal layers in diabetes. Methods. 124 subjects (124 eyes) were enrolled: 74 diabetics and 50 controls. Macular edema, proliferative diabetic retinopathy (DR), any intraocular treatment and refractive error >6 diopters were the main exclusion criteria. Full ophthalmic examination, stereoscopic fundus photography, and spectral domain-OCT were performed. After automatic retinal segmentation (layering) in 5 layers, the thickness of each layer was calculated, and values compared among groups. Results. Thirty patients had no DR, 44 patients had non proliferative DR. A significant increase of inner plexiform and nuclear layers was found in DR eyes versus controls (P<0.001). A significant decrease (P<0.01) of retinal nerve fiber layer (RNFL) and at specific sites of retinal ganglion cell layer (P=0.02) was documented in the macula. In the peripapillary area there were no differences between diabetics and controls. Conclusions. Decreased RNFL thickness and increased INL/OPL thickness in diabetics without DR or with initial DR suggest early alterations in the inner retina. On the contrary, the outer retina seems not to be affected at early stages of DM. Automatic intraretinal layering by SD-OCT may be a useful tool to diagnose and monitor early intraretinal changes in DR
Controversies in pharmacological treatment of inflammatory component of macular edema
No full textMacular edema (ME) is a common, final pathway for many different ocular and systemic diseases. The most common diseases include: diabetic retinopathy (DR), retinal vascular disorders (such as central and branch retinal vein occlusion), and uveitis. The complex and multifactorial pathophysiological mechanisms leading to ME, are still poorly understood. Inflammation plays a crucial role in the genesis of ME, as demontrsated by significant increase of different cytokines and chemokines, (besides vascular endothelial growth factors-VEGF) in ocular fluids. Currently, intravitreal steroids and anti-VEGF drugs are the most used treatments in ME of retinal vascular origin. This review will address the most important (with highest level of scientific evidence and longest followup) results on the use of intravitreal steroids and anti-VEGF drugs, starting from molecular basis to the most updated randomized clinical trials. © 2015 Bentham Science Publishers
Local and Systemic Inflammatory Biomarkers of Diabetic Retinopathy: An Integrative Approach
No full textPURPOSE. To review the usefulness of local and systemic inflammatory biomarkers of diabetic retinopathy (DR) to implement a more personalized treatment. METHODS. An integrated research (from ophthalmologist and diabetologist point of view) of most significant literature on serum, vitreous, and aqueous humor (AH) biochemical biomarkers related to inflammation at early and advanced stages of DR (including diabetic macular edema [ DME] and proliferative DR) was performed. Moreover, novel imaging retinal biomarkers of local "inflammatory condition'' were described. RESULTS. Multiple inflammatory cytokines and chemokines are increased in DR in both serum as well as in the eye (vitreous and AH). Nevertheless, local rather than systemic production of proinflammatory cytokines seems more relevant in the pathogenesis of both DR and DME. In the eye, retinal glia cells (macroglia and microglia) together with RPE are major sources of proinflammatory and angiogenic modulators. Retinal imaging allows for noninvasive clinical evaluation of retinal inflammatory response induced by diabetes mellitus. CONCLUSIONS. Proinflammatory cytokines/chemokines play an essential role in the pathogenesis of DR. Therefore, circulating biomarkers and retinal imaging aimed at assessing inflammation have emerged as useful tools for monitoring the onset and progression of DR. In addition, "liquid biopsy'' of AH seems a good option in patients with advanced stages of DR requiring intravitreous injections. This strategy may permit us to implement a more personalized with better visual function outcome. Further evaluation and validation of circulating and local biomarkers, as well as multimodal imaging is needed to gain new insights into this issue
Microperimetry: Technical remarks
No full textRecently, the advancement in the technology of microperimetry devices has improved the capability to detect and understand visual function alterations. Furthermore, new software allow clinicians to precisely follow the evolution of the disease or the effect of different therapeutic choices or to perform visual rehabilitation for patients with low vision. In this chapter, the technical features of two microperimeters, namely, MP-1 (Nidek, Gamagori, Japan) and MAIA (CenterVue, Padova, Italy), are illustrated, with some correlations with clinical practice
Diabetic Retinopathy in Italy: Epidemiology Data and Telemedicine Screening Programs
No full textIn Italy, the number of people living with diabetes is about 3.5 million (5.5% of the population), with an increase by about 60% in the last 20 years and with 1 person out of 3 older than 65 years. The Italian Health Service system estimates that 10 billion euros is spent annually on caring for patients with diabetes, a figure that increases yearly. No national data on prevalence and incidence of legal blindness in patients with diabetes and no national registry of patients with diabetic retinopathy (DR) are currently available. However, the available epidemiological data (in several locations throughout the country) are consistent with those reported in other European countries. The use of telemedicine for the screening of DR in Italy is confined to geographically limited locations. The available data in the literature on implementation and use of telematic screening proved to be successful from patient, caregiver, and authorities point of view. This review addresses the available epidemiological data on DR and telematic screening realities in Italy and thus may help in establishing a national screening program
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