Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma

Clinical Ophthalmology, Mar 2009

Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma Dimitris Papaconstantinou1, Ilias Georgalas2, George Kalantzis1, Efthimios Karmiris1, Chrysanthi Koutsandrea1, Andreas Diagourtas1, Ioannis Ladas1, Gerasimos Georgopoulos11Department of Ophthalmology, University of Athens, Athens, Greece; 2“G Genimatas” Hospital, NHS, Athens, GreecePurpose: 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.Keywords: color vision defects, glaucoma, hereditary, vision field

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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. 8 1 0 2 l u J 2 1 n o 7 0 2 . 6 4 . 9 5 . 7 3 y b / m o c . s rse l.y ep on 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 .vdoww lsunae t1o. aTparkoitnogcoml ethdaictainlvhoisltvoerdy: /:sw rseo 2. Measurement of VA / p p tth ro 3. Slit-lamp examination from F 4. Gonioscopy ded 5. Fundoscopy lnao 6. Phasing of IOP odw 7. HVF testing lyog 8. Assessment of visual perception lom 9. Follow-up a h t h p O l a c ili n C 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)


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Dimitris Papaconstantinou, Ilias Georgalas, George Kalantzis, Efthimios Karmiris, Chrysanthi Koutsandrea, Andreas Diagourtas, Ioannis Ladas, Gerasimos Georgopoulos. Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma, Clinical Ophthalmology, 2009, pp. 251-257, DOI: 10.2147/OPTH.S5194