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Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma
Clinical Ophthalmology
Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma
Dimitris Papaconstantinou 1
Ilias Georgalas 0
George Kalantzis 1
Efthimios Karmiris 1
Chr ysanthi Koutsandrea 1
Andreas Diagourtas 1
Ioannis Ladas 1
Gerasimos Georgopoulos 1
0 G Genimatas” Hospital , NHS, Athens , Greece
1 Department of Ophthalmology, University of Athens , Athens , Greece
PowerdbyTCPDF(ww.tcpdf.org) Purpose: To study acquired color vision and visual field defects in patients with ocular hypertension (OH) and early glaucoma. Methods: In a prospective study we evaluated 99 eyes of 56 patients with OH without visual field defects and no hereditary color deficiencies, followed up for 4 to 6 years (mean = 4.7 ± 0.6 years). Color vision defects were studied using a special computer program for Farnsworth-Munsell 100 hue test and visual field tests were performed with Humphrey analyzer using program 30-2. Both tests were repeated every six months. Results: In fifty-six eyes, glaucomatous defects were observed during the follow-up period. There was a statistically significant difference in total error score (TES) between eyes that eventually developed glaucoma (157.89 ± 31.79) and OH eyes (75.51 ± 31.57) at the first examination (t value 12.816, p 0.001). At the same time visual field indices were within normal limits in both groups. In the glaucomatous eyes the earliest statistical significant change in TES was identified at the first year of follow-up and was -20.62 ± 2.75 (t value 9.08, p 0.001) while in OH eyes was −2.11 ± 4.36 (t value 1.1, p = 0.276). Pearson's coefficient was high in all examinations and showed a direct correlation between TES and mean deviation and corrected pattern standard deviation in both groups. Conclusion: Quantitative analysis of color vision defects provides the possibility of follow-up and can prove a useful means for detecting early glaucomatous changes in patients with normal visual fields.
Patients and methods
This prospective study involves glaucoma suspects that were examined in the
glaucoma department of the University Ophthalmology Hospital in Athens, Greece.
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Patients that were classified as glaucoma suspects fulfilled
one of the following criteria:
1. OH was unilateral or bilateral with an intraocular pressure
(IOP) 21 mmHg, without optic nerve head abnormalities
or visual field defects.
2. POAG ‘in the contra-lateral eye’. In this occasion the
eye to be examined did not have glaucomatous defects
in fundoscopy or Humphrey visual field (HVF) testing.
All eyes involved in the study had never received
antiglaucoma medication. The exclusion criteria were the following:
• Congenital color vision defects
• Presence of ophthalmic disease of any kind
• Abnormality of the refraction media (cataract)
• Best corrected visual acuity (VA) less than 16/20
• Lack of ability for scheduled follow up
The aim of the study was to determine whether there is a
correlation between the manifestation of color vision defects
and glaucomatous visual field defects.
All patients were examined and followed up according
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from F 4. Gonioscopy
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Medical history
A thorough past medical and ophthalmological history
including hereditary diseases of other family members was
recorded for all patients. The excluding criteria involved
patients with any disease that could affect visual function
(diabetes mellitus, anemia, blood disorders, collagen
disorders, administration of medicines, etc). Patients with
congenital color vision defects or previous ophthalmic surgery
or any eye disorder were also excluded from the study.
Visual acuity
Visual acuity was tested by one physician on the same
optotype. Patients eligible for the study had VA equal to or
more than 16/20 with maximum best corrected refraction
less than six dioptres.
Slit-lamp examination
Slit-lamp examination was performed with a Haag–Streit
900 slit-lamp.
The cornea was examined for topographic anomalies
(pterygium, corneal scarring, etc) that could obstruct the
accurate evaluation of IOP with a Goldmann applanation
tonometer (GAT) and also for possible hazing that could
influence VA.
The anterior chamber (AC) depth was evaluated, iris was
examined for local atrophies, colobomas, neovascularization,
presence of pseudo-exfoliation material, irregularities in the
pupil, and the transparency of the crystalline lens. In case that an
irregularity or an ophthalmic disease was observed the patient
was considered no longer eligible to participate in the survey.
Gonioscopy
Gonioscopy was performed on the slit-lamp using the
indirect Goldmann gonioscope. Patients (...truncated)