George L. Spaeth

Background/aims: To determine the accuracy of an innovative paper-based, low-cost, easily accessed, portable method of evaluating the visual field (VF). Methods: Two groups of consecutive patients with glaucoma and controls were enrolled. Both eyes were assessed, and the Humphrey field analyser (HFA) (24-2) was used to identify patients with and without VF defects. The TsiogkaSpaeth grid (TS) grid test was performed in each eye of all participants. The Humphrey VF examination and the TS grid examination were conducted consecutively on the same day by two different examiners, prior to any other eye examinations. Sensitivity, specificity, and positive and negative predictive values of the TS grid scotoma area were assessed, using the results found with the HFA as the reference standard. A mixed-effects logistic regression model with a random intercept per participant was used to account for the correlation between eyes. Results: This prospective, cross-sectional study recruited 51 participants in a tertiary care hospital-based glaucoma department. Of them, 19 had glaucomatous defects in both eyes, 12 had defects in 1 eye only and 21 had no defects in either eye. The sensitivity and specificity of the TS grid test were 81.63% (95% CI 68% to 91.2%) and 84.91% (95% CI 72.4% to 93.3%), respectively, positive predicted value was 83.33% (95% CI 69.8% to 92.5%) and negative predictive value was 83.33% (95% CI 70.7% to 92.1%). The area under the curve was 0.83 (95% CI 0.76 to 0.91). There was a significant correlation between the TS grid test score and the VF Index of the HFA 24-2 (r=0.87, p<0.0001) and the mean deviation of the HFA 24-2 (r=0.85, p<0.0001). Conclusions: The TS grid test offers a reliable, low-cost alternative for VF examination in glaucoma patients. This method could be advantageous in clinical settings with limited access to traditional testing equipment. The TS grid has limitations, including difficulty of fixation loss testing and ensuring the correct fixation distance. The test’s self-administration reliability is uncertain, and some patients were unable to perform it. Other limitations concern the grid’s design and the small sample size of the study.

Keratoconus and central serous chorioretinopathy are two rare diseases. They can occur together in some individuals. We report a case of a 48-year-old man, who presented to our clinic with decreased visual acuity on his left eye. Physical examination, biomicroscopy, corneal topography, and optical coherence tomography revealed keratoconus and central serous chorioretinopathy. We discuss the possible connection between these two conditions.

Purpose To determine the prevalence of disposable tonometer versus non-disposable tonometer use in the UK and to determine methods of decontamination and frequency of replacement of prisms. A total of 137 ophthalmology departments were interviewed by telephone using a structured questionnaire. The main outcome measured were: types of tonometer prisms used in clinic (disposable, non-disposable and/or other) average disposable prisms used per clinic session average lifespan of non-disposable prisms prism preference by glaucoma and other teams within department. A cost and benefit analysis was then performed on the data acquired. Results One hundred and fifty-five departments were identified for the survey. Of these, 137 (88.3%) responded. Eighty-one departments (59.1%) used Tonosafe prisms alone, whereas 22 departments (16.1%) used Goldmann non-disposable prisms exclusively. Thirty-five departments (64%) on average have a change rate of 26.5% per year (range: 0–100, median: 20) attributed to damage, loss or theft. Sixteen departments (29%) reported that prisms were used until damaged or lost. Four departments (7%) were uncertain of their prism usage and could not provide further information. Conclusions Majority of eye departments in the UK opt for disposable prisms. This survey shows the perceived cost-effectiveness of disposable prisms is overestimated when the true cost of disinfection and damage is taken into account. Significant cost savings coupled with the low risk of infectivity (if decontaminated properly) should prompt clinicians and ophthalmic departments worldwide to reconsider the use of non-disposable prisms.

Purpose: To evaluate clinical parameters and their relationship to the presence of a relative afferent pupillary defect (RAPD). Materials and Methods: Retrospective chart review of 672 consecutive patients who presented to the Glaucoma Service at Wills Eye Hospital from January 1 through May 29, 2012. Swinging flashlight method (SFM) was used to test for RAPDs. Records of visual acuity, intraocular pressure (IOP), disc-damage likelihood scale (DDLS), cup/disc (C/D) ratio, visual field mean deviation (MD), optical coherence tomography (OCT), and Heidelberg retinal tomography (HRT) asymmetries were examined. We measured the prevalence of RAPDs as clinical asymmetries increase, calculated cut-off points for clinical asymmetries that optimized sensitivity and specificity in detecting RAPDs, and determined values of clinical asymmetries above which a RAPD always exists. Results: Upon exclusion, we studied 409 patients, 175 (42.8%) with RAPDs and 234 (57.2%) without. Age, visual acuity, IOP, DDLS, C/D ratio, MD, retina nerve fiber layer thickness by OCT, HRT C/D, and HRT rim area asymmetries all correlated with RAPD status (OCT and HRT parameters did not include enough patients for multivariable analysis or cut-off determination). Multivariable analysis indicated that IOP, DDLS, and MD asymmetries were significantly correlated with RAPD status (P-value<0.05). Although the optimal cut-off values for the variables retained in the final multivariable model had low sensitivity and moderate specificity, DDLS had the highest specificity of 0.86. Conclusions: IOP, DDLS, and MD asymmetries had the best correlation with RAPD status, and increased asymmetries in these parameters were associated with higher likelihood of RAPDs. DDLS score had the highest specificity in predicting a RAPD, and DDLS asymmetry scores ≥6 identified all cases of RAPDs.