Faculty Bibliography

PURPOSE/OBJECTIVE:With the use of an interactive driving simulator, we examined the driving performance of older patients with either homonymous or quadrantic hemianopsia with primarily occipital lobe damage resulting from cerebrovascular accidents (CVA's). METHODS:We compared the performance of these patients with that of a normally sighted, age-similar control group and that of a normally sighted younger group. RESULTS:The driving performance of the patients was either worse than, or similar to, that of the older control group; all of the older individuals (both patients and normally sighted subjects) had worse performance than the younger group. CONCLUSIONS:Age-related effects combined with the effects of visual field losses in older patients with cerebrovascular accidents had a negative impact on driving skills.

Recent evidence suggests that retinal hypoxia and ischemia affect the standing potential of the eye and the activity of the photoreceptors. To test whether chronically elevated intraocular pressure would produce similar effects, we measured electro-oculograms in two groups of patients: ocular hypertensive patients and patients with primary open-angle glaucoma. There were significant differences among the average electro-oculogram ratios of these groups compared to age-similar controls. The control observers had an average light-peak/dark-trough ratio of 2.86, the ocular hypertensive patients had an average ratio of 2.44, and the patients with primary open-angle glaucoma had an average ratio of 2.07. This indicates that long-term elevations in intraocular pressure can decrease the light peak of the electro-oculogram, even in patients with no other evidence of glaucomatous damage. This deficit may have its origins in the sensitivity of the outer retina to choroidal ischemia

PURPOSE. To examine the sites of cone sensitivity loss in patients with retinitis pigmentosa by comparing focal electroretinographic and psychophysical modulation thresholds. METHODS. Both psychophysical and electrophysiologic increment threshold curves were obtained in retinitis pigmentosa patients and a group of age-matched, normally-sighted adults. RESULTS. The majority of the retinitis pigmentosa data could be accounted for by a vertical displacement of the normal curve. The retinitis pigmentosa patients showed similar patterns of cone sensitivity losses using both techniques. CONCLUSIONS. The combined electrophysiologic and psychophysical results provide support for an outer retina locus for these cone sensitivity losses. The data suggest that these deficits may be caused by a spatially independent loss of cone photoreceptors with normal adaptation properties in the remaining photoreceptors

PURPOSE. To study the effects of acetazolamide on central and peripheral visual function in patients with retinitis pigmentosa (RP) who showed no evidence of macular edema. METHODS. Thirteen patients with retinitis pigmentosa participated in a preliminary study. Measures of central and peripheral visual function were obtained before and after an 8 wk period on acetazolamide. An additional 10 patients participated in a cross-over study. They were placed on a placebo for an 8 wk period, then on acetazolamide for a second 8 wk period. RESULTS. None of the patients in the preliminary study showed significant changes in visual acuity, color vision, foveal cone pathway sensitivities, focal electroretinogram (ERG) amplitudes, or in any ERG parameter. Three patients, however, showed significant changes in visual field area and in dark-adapted thresholds. None of the patients in the cross-over study showed significant increases in visual field area. CONCLUSIONS. Given the results and the reports of side-effects, it is difficult to justify using acetazolamide to improve retinal function in RP patients who show no evidence of cystoid macular edema