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Cypel MC, Berezovsky A, Fernandes AG, Watanabe SS, Kimie Higashi Mitsuhiro MR, Ferraz NN, Sacai PY, Furtado JM, Morales PH, Muñoz S, Cohen JM, Belfort R, Salomão SR. Regional Disparities in Prevalence and Causes of Visual Impairment and Blindness, Cataract Surgical Coverage and Ocular Findings in Adults 50 Years and Older in Brazil: A Comparative Analysis between Two Population-Based Cross-Sectional Surveys Performed Within a 10-Year Interval. Semin Ophthalmol 2023; 38:656-664. [PMID: 37154578 DOI: 10.1080/08820538.2023.2209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate disparities in the prevalence and causes of visual impairment and blindness, cataract surgical coverage, and ocular findings in older adults from two Brazilian geo-socio-demographic areas, São Paulo and Parintins cities. METHODS Data from two population-based studies including participants 50 years and older from the cities of São Paulo (São Paulo Eye Study - SPES, 2004) and Parintins (Brazilian Amazon Region Eye Survey - BARES, 2014) were aggregated. RESULTS A total of 5318 participants (3677 from SPES;1641 from BARES) were included. The prevalence of severe visual impairment (SVI) and blindness were, respectively, 0.74% (0.46-1.02) and 0.77% (0.48-1.05) in SPES and 1.72% (1.09-2.35) and 3.44% (2.55-4.33) in BARES. SVI and blindness were associated with BARES study [OR = 2.27 (1.30-3.95); p = .004 - SVI] [OR:4.07 (2.51-6.60); p < .001- blindness]; and older age [OR = 10.93 (4.20-28.45); p < .001 - SPES; OR = 17.96 (8.75-36.83); p < .001 - BARES] while higher education level was a protective factor [OR = 0.21 (0.05-0.95) - SPES; p = .042; OR = 0.21 (0.05-0.91); p = .037 - BARES]. Cataract was the main cause of bilateral severe visual impairment (25.93% in SPES and 64.29% in BARES) and bilateral blindness (21.43% in SPES and 35.71% in BARES). Cataract surgical coverage was significantly lower in BARES (36.32%) compared to SPES (57.75%). CONCLUSION The prevalence of SVI and blindness was three times higher in older adults from the Brazilian Amazon compared to those living in São Paulo city, despite a 10-year interval between the two studies. These disparities should be mitigated by initiatives to promote access to eye care services targeting underprivileged and remote Brazilian areas.
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Affiliation(s)
- Marcela Colussi Cypel
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Adriana Berezovsky
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sung Song Watanabe
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Nivea Nunes Ferraz
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Paula Yuri Sacai
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - João Marcello Furtado
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, Brazil
| | - Paulo Henrique Morales
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sergio Muñoz
- Department of Public Health-CIGES, Universidad de La Frontera, Temuco, Chile
| | - Jacob Moysés Cohen
- Divisão de Oftalmologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Rubens Belfort
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Instituto da Visão, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, Brazil
| | - Solange Rios Salomão
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
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Watanabe SES, Quercia AZF, Sacai PY. Electrophysiological findings in extensive macular atrophy with pseudodrusen. Doc Ophthalmol 2023; 147:121-130. [PMID: 37392267 DOI: 10.1007/s10633-023-09941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To present electroretinogram findings in extensive macular atrophy with pseudodrusen (EMAP) and describe associated systemic factors. DESIGN Retrospective case series. METHODS Data on medical history, visual symptoms, multimodal imaging findings, and visual field were collected from the medical records of patients with extensive macular atrophy with pseudodrusen who attended a visual electrophysiology laboratory. Electrophysiological tests, including full-field electroretinogram, multifocal electroretinogram and photopic negative response, were performed. RESULTS Eighteen patients (10 [56%] females, age 49-66 years) were included. Of these, 17 (94%) had a history of rheumatic fever in childhood and/or adolescence, 7 (39%) had cardiovascular disease, 4 (22%) had autoimmune disease, and 10 (56%) had inflammatory conditions. The primary visual complaints were nyctalopia (95%), followed by visual field loss (67%) and dyschromatopsia (67%). The key retinal findings included retinal pigmented epithelium atrophy in the macular region and subretinal drusenoid deposits. Regarding electrophysiological results, 100% of patients had abnormalities on multifocal electroretinogram, 94% displayed alterations in photopic negative response, and 78% showed changes in the full-field electroretinogram. CONCLUSIONS In this cohort, electrophysiologic evaluation demonstrated diffuse retinal dysfunction affecting all layers of the retina in patients with EMAP. The disease is associated with immune-mediated systemic conditions, chiefly rheumatic fever.
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Affiliation(s)
| | | | - Paula Yuri Sacai
- G6 Electrophysiology Laboratory, Rua Doutor Diogo de Faria, 1202, São Paulo, Brazil
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Dotto PG, Salomão SR, Fernandes AG, Mitsuhiro MRKH, Ferraz NN, Furtado JM, Watanabe SS, Cypel M, Sacai PY, Cunha CC, Vasconcelos GC, Morales PH, Cohen MJ, Cohen JM, Campos M, Muñoz S, Belfort R, Berezovsky A. Impact of pterygium on central corneal thickness measured by optical coherence tomography in older adults. Eur J Ophthalmol 2023:11206721231154433. [PMID: 36726300 DOI: 10.1177/11206721231154433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). METHODS BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension <3 mm, ≥3 mm not reaching the pupillary margin or ≥3 mm reaching the pupillary margin). CCTs were obtained and measurements from the more severely affected eye were included. Images were analyzed offline by masked observers. RESULTS A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygium in either eye, were examined. The mean CCT evaluated by multiple linear regression and adjusted for demographic variables and pterygium severity was 521 ± 34 μm (median = 521; range = 304-665). Decreased CCT was significantly associated with age and pterygium severity. Individuals aged 65-74 years had CCT 7 μm thinner than those aged 45-54 years (p = 0.044), individuals aged 75 years and older had CCT 15 μm thinner than those aged 45-54 years (p = 0.001), and eyes with severe pterygium had CCT 33 μm thinner than eyes without pterygium (p < 0.001). CONCLUSIONS The CCT analysis in this population-based sample shows that a thinner cornea is associated with pterygium severity and older age.
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Affiliation(s)
- Pedro Gabriel Dotto
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Solange Rios Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Nívea Nunes Ferraz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - João Marcello Furtado
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, 544243Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sung Song Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcela Cypel
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Cristina Coimbra Cunha
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,37871Faculdade de Medicina da Universidade Federal do Pará - UFPA, Belém, PA, Brasil
| | - Galton Carvalho Vasconcelos
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Oftalmologia e Otorrinolaringologia, 28114Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil
| | - Paulo Henrique Morales
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcos Jacob Cohen
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Divisão de Oftalmologia, Departamento de Cirurgia, 67892Faculdade de Medicina da Universidade Federal do Amazonas - UFAM, Manaus, AM, Brasil
| | - Jacob Moysés Cohen
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Divisão de Oftalmologia, Departamento de Cirurgia, 67892Faculdade de Medicina da Universidade Federal do Amazonas - UFAM, Manaus, AM, Brasil
| | - Mauro Campos
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Sergio Muñoz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Salud Publica, 469458Universidad de La Frontera, Temuco, Chile
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
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Dotto PDF, Berezovsky A, Cappellano AM, Silva NSD, Sacai PY, Rocha DM, Andrade EPD, Silva FAB, Salomão SR. Grating visual acuity impairment assessed by sweep visually evoked potentials in children with optic pathway tumors unable to perform optotype acuity tests. Arq Bras Oftalmol 2021; 84:140-148. [PMID: 33567011 DOI: 10.5935/0004-2749.20210022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/04/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine visual impairment due to optic pathway tumors in children unable to perform recognition acuity tests. METHODS Grating visual acuity scores, in logMAR, were obtained by sweep visually evoked potentials (SVEP) in children with optic pathway tumors. The binocular grating visual acuity deficit was calculated by comparison with age-based norms and then assigned to categories of visual impairment as mild (from 0.10 to 0.39 logMAR), moderate (from 0.40 to 0.79 logMAR), or severe (≥0.80 logMAR). Interocular differences were calculated by subtraction and considered increased if >0.10 logMAR. RESULTS The participants were 25 children (13 boys; mean ± SD age, 35.1 ± 25.9 months; median age, 32.0 months) with optic pathway tumors (24 gliomas and 1 embryonal tumor), mostly located at the hypothalamic-chiasmatic transition (n=21; 84.0%) with visual abnormalities reported by parents (n=17; 68.0%). The mean grating acuity deficit was 0.60 ± 0.36 logMAR (median, 0.56 logMAR). Visual impairment was detected in all cases and was classified as mild in 10 (40.0%), moderate in 8 (32.0%), and severe in 7 (28.0%) children, along with increased interocular differences (>0.1 logMAR) (n=16; 64.0%). The remarkable ophthalmological abnormalities were nystagmus (n=17; 68.0%), optic disc cupping and/or pallor (n=13; 52.0%), strabismus (n=12; 48.0%), and poor visual behavior (n=9; 36.0%). CONCLUSION In children with optic pathway tumors who were unable to perform recognition acuity tests, it was possible to quantify visual impairment by sweep-visually evoked potentials and to evaluate interocular differences in acuity. The severity of age-based grating visual acuity deficit and interocular differences was in accordance with ophthalmological abnormalities and neuroimaging results. Grating visual acuity deficit is useful for characterizing visual status in children with optic pathway tumors and for supporting neuro-oncologic management.
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Affiliation(s)
- Patrícia de Freitas Dotto
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Adriana Berezovsky
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Andrea Maria Cappellano
- Programa de Neuro-Oncologia, Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e à Criança com Câncer, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Nasjla Saba da Silva
- Programa de Neuro-Oncologia, Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e à Criança com Câncer, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Paula Yuri Sacai
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Daniel Martins Rocha
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Erica Pinheiro de Andrade
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Frederico Adolfo B Silva
- Programa de Neuro-Oncologia, Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e à Criança com Câncer, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Solange Rios Salomão
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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5
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Botelho GIS, Salomão SR, Tengan CH, Karanjia R, Moura FV, Rocha DM, da Silva PBE, Fernandes AG, Watanabe SES, Sacai PY, Belfort R, Carelli V, Sadun AA, Berezovsky A. Impaired Ganglion Cell Function Objectively Assessed by the Photopic Negative Response in Affected and Asymptomatic Members From Brazilian Families With Leber's Hereditary Optic Neuropathy. Front Neurol 2021; 11:628014. [PMID: 33584522 PMCID: PMC7874135 DOI: 10.3389/fneur.2020.628014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose: The photopic negative response (PhNR) is an electrophysiological method that provides retinal ganglion cell function assessment using full-field stimulation that does not require clear optics or refractive correction. The purpose of this study was to assess ganglion cell function by PhNR in affected and asymptomatic carriers from Brazilian families with LHON. Methods: Individuals either under suspicion or previously diagnosed with LHON and their family members were invited to participate in this cross-sectional study. Screening for the most frequent LHON mtDNA mutations was performed. Visual acuity, color discrimination, visual fields, pattern-reversal visual evoked potentials (PRVEP), full-field electroretinography and PhNR were tested. A control group of healthy subjects was included. Full-field ERG PhNR were recorded using red (640 nm) flashes at 1 cd.s/m2, on blue (470 nm) rod saturating background. PhNR amplitude (μV) was measured using baseline-to-trough (BT). Optical coherence tomography scans of both the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) were measured. PhNR amplitudes among affected, carriers and controls were compared by Kruskal-Wallis test followed by post-hoc Dunn test. The associations between PhNR amplitude and OCT parameters were analyzed by Spearman rank correlation. Results: Participants were 24 LHON affected patients (23 males, mean age=30.5 ± 11.4 yrs) from 19 families with the following genotype: m.11778G>A [N = 15 (62%), 14 males]; m.14484T>C [N = 5 (21%), all males] and m.3460G>A [N = 4 (17%), all males] and 14 carriers [13 females, mean age: 43.2 ± 13.3 yrs; m.11778G>A (N = 11); m.3460G>A (N = 2) and m.14484T>C (N = 1)]. Controls were eight females and seven males (mean age: 32.6 ± 11.5 yrs). PhNR amplitudes were significantly reduced (p = 0.0001) in LHON affected (-5.96 ± 3.37 μV) compared to carriers (-16.53 ± 3.40 μV) and controls (-23.91 ± 4.83; p < 0.0001) and in carriers compared to controls (p = 0.01). A significant negative correlation was found between PhNR amplitude and total macular ganglion cell thickness (r = -0.62, p < 0.05). Severe abnormalities in color discrimination, visual fields and PRVEPs were found in affected and subclinical abnormalities in carriers. Conclusions: In this cohort of Brazilian families with LHON the photopic negative response was severely reduced in affected patients and mildly reduced in asymptomatic carriers suggesting possible subclinical abnormalities in the latter. These findings were similar among pathogenic mutations.
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Affiliation(s)
- Gabriel Izan Santos Botelho
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Solange Rios Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Célia Harumi Tengan
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rustum Karanjia
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States.,Department of Ophthalmology, Doheny Eye Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Ottawa Eye Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Felipo Victor Moura
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniel Martins Rocha
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paula Baptista Eliseo da Silva
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung Eun Song Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Valerio Carelli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna School of Medicine, Bologna, Italy
| | - Alfredo Arrigo Sadun
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States.,Department of Ophthalmology, Doheny Eye Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Berezovsky A, Karanjia R, Fernandes AG, Botelho GIS, Bueno TLN, Ferraz NN, Sacai PY, Coupland SG, Sadun AA, Salomão SR. Photopic negative response using a handheld mini-ganzfeld stimulator in healthy adults: normative values, intra- and inter-session variability. Doc Ophthalmol 2020; 142:153-163. [PMID: 32681419 DOI: 10.1007/s10633-020-09784-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine normative values, intra- and inter-session variability for a range of parameters derived from the photopic negative response (PhNR) using a handheld mini-Ganzfeld stimulator in healthy normal adults. METHODS Light-adapted flash full-field electroretinograms (ERGs) were recorded from healthy individuals with no visual complaints, visual acuity equal to or better than 0.0 logMAR (20/20 Snellen), and negative family history for visual diseases. ERGs were recorded from both eyes using a DTL® type fiber electrode after dilation of the pupils with instillation of 1 drop of tropicamide eye drops (1%). The full-field PhNR stimulus conditions were produced by a LED-based ColorBurst™ (Diagnosys LLC, Lowell, MA, USA) handheld stimulator. Red flashes of 1, 5 and 7 cd.s/m2 on a blue background of 10 cd/m2 were presented. A-wave, b-wave and PhNR amplitude (determined by both baseline to trough-BT and peak to trough-PT) and peak times were analyzed. Normal limits were determined as 5% percentile for amplitudes and 95% percentile for latencies. Intra- and inter-session variability were assessed with Wilcoxon signed-rank test, intraclass correlation coefficient (ICC) and the coefficient of variability (COV). RESULTS Normative limits for PhNR amplitude (µV) using 1, 5 and 7 cd.s./m2 stimuli were, respectively: 20.81; 18.06 and 19.60 for BT and 69.11; 77.98; 76.51 for PT. Peak times (ms) normative limits for 1, 5 and 7 cd.s/m2 intensities were, respectively, 65.98; 78.20 and 77.96. Overall, intra-session variability assessed by coefficients of variation ranged from 1.35 to 10.28%. Inter-session variability disclosed significant intraclass correlation values for all PhNR parameters only for 1 cd.s/m2 stimuli. CONCLUSIONS The normative values provided by this study are clinically helpful in the diagnosis of inner retinal disorders, especially those affecting retinal ganglion cells such as glaucoma and other optic neuropathies. Further studies, including a larger sample with variable age range would extend the validity of the current results.
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Affiliation(s)
- Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Rustum Karanjia
- Doheny Eye Institute, Los Angeles, California, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Doheny Eye Center, Los Angeles, California, USA.,Ottawa Eye Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gabriel Izan Santos Botelho
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tatiane Luana Novele Bueno
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Nívea Nunes Ferraz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Stuart Glenn Coupland
- Ottawa Eye Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alfredo Arrigo Sadun
- Doheny Eye Institute, Los Angeles, California, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Doheny Eye Center, Los Angeles, California, USA
| | - Solange Rios Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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7
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Dotto PDF, Berezovsky A, Sacai PY, Rocha DM, Fernandes AG, Salomão SR. Visual function assessed by visually evoked potentials in adults with orbital and other primary intracranial tumors. Eur J Ophthalmol 2020; 31:1351-1360. [PMID: 32468859 DOI: 10.1177/1120672120925643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to assess visual function by visually evoked potentials in adults with orbital and other primary brain tumors affecting the optic pathway. METHODS In this retrospective case-control series, patients with orbital (intraconal and extraconal) or midline/chiasmatic tumors were included. Visually evoked potentials using pattern-reversal visually evoked potential and flash visually evoked potential stimuli were performed according to the international standards. Outcome measures were visually evoked potential parameters of amplitude (µV) and peak times (ms) measured both for the P100 component (pattern-reversal visually evoked potentials) and the N2P2 complex (flash visually evoked potential). Individual results were also compared with gender-based normative values. RESULTS A group of 21 adult patients (17 females) and age- and sex-matched controls were evaluated. Tumor location was intraconal (6 meningiomas, 3 hemangiomas, 1 glioma), extraconal (6 meningiomas), and midline (3 pituitary adenomas, 2 hypothalamic/chiasmatic low-grade gliomas). Abnormal fundus (76%), abnormal pupillary reflexes (71%), reduced visual acuity (62%), strabismus (48%), and proptosis (38%) were present. Visually evoked potential abnormalities were found in at least one eye of all cases. Affected eyes had significantly reduced amplitudes and prolonged peak times for pattern-reversal visually evoked potentials (p < .001) and significantly reduced amplitudes for flash visually evoked potential (p < .001). In unilateral orbital tumors, abnormally prolonged pattern-reversal visually evoked potential peak times were also detected in some contralateral eyes (n = 6/16). CONCLUSION Visually evoked potential abnormalities were found in all adult patients with orbital and other intracranial primary tumors, even in eyes with normal exam and good visual acuity. Visually evoked potential can be used as a non-invasive ancillary test to characterize and monitor visual function in subjects with these neoplastic lesions.
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Affiliation(s)
- Patrícia de Freitas Dotto
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Adriana Berezovsky
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Paula Yuri Sacai
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Daniel Martins Rocha
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Arthur Gustavo Fernandes
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Solange Rios Salomão
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
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Watanabe SES, Berezovsky A, Furtado JM, Kimie Higashi Mitsuhiro MR, Cypel M, Cohen MJ, Cohen JM, Cunha CC, Sacai PY, Ferraz NN, Vasconcelos GC, Morales PH, Campos M, Fernandes AG, Muñoz S, Belfort R, Salomão SR. Population-Based Cataract Surgery Complications and Their Impact on Visual Status in the Brazilian Amazon Region. Am J Ophthalmol 2019; 208:295-304. [PMID: 31377288 DOI: 10.1016/j.ajo.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate cataract surgery prevalence, complications, visual outcomes, and coverage in a population of older adults from the Brazilian Amazon region. DESIGN Population-based cross-sectional study. METHODS Individuals ≥45 years of age from urban and rural areas of Parintins City, Brazil, were identified by cluster random sampling. Participants underwent ophthalmic examination, including uncorrected visual acuity, acuity with presenting correction (APC), and best-corrected visual acuity (BCVA) from each eye. In those with previous cataract surgery, surgical technique and complications including its contribution to vision impairment were noted. The association of surgical complications and surgical coverage with sociodemographic variables was assessed by multiple logistic regression. RESULTS A total of 2,384 persons were determined to be eligible, and 2,041 (85.6%) were examined. Overall, prevalence of cataract surgery was 8.6%, with 11.3% urban and 5.0% rural. Surgical complications were associated with males, older age, and urban residency and were found in 60.4%, with posterior capsule opacification in 29.6% and posterior capsule rupture in 16.3%. Among the 270 eyes having cataract surgery, APC ≥20/32 was found in 44.4%, APC 20/40 to 20/63 in 20.8%, APC <20/63 to 20/200 in 14.4%, APC <20/200 to 20/400 in 2.6%, and APC <20/400 in 17.8%. Low surgical coverage was found with 57.9% of those with visual impairment due to cataract not being treated surgically. CONCLUSIONS Although a reasonable prevalence of cataract surgery was found, a high complication rate, poor visual outcomes, and low cataract surgery coverage indicated that actions to improve quality and appropriate postsurgical management should be planned and implemented by public health authorities.
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9
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Cunha CC, Berezovsky A, Furtado JM, Ferraz NN, Fernandes AG, Muñoz S, Watanabe SS, Sacai PY, Cypel M, Mitsuhiro MH, Morales PH, Vasconcelos GC, Cohen MJ, Campos M, Cohen JM, Belfort R, Salomão SR. Presbyopia and Ocular Conditions Causing Near Vision Impairment in Older Adults From the Brazilian Amazon Region. Am J Ophthalmol 2018; 196:72-81. [PMID: 30118685 DOI: 10.1016/j.ajo.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/25/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the prevalence and causes of near vision impairment (NVI) in a population of older adults from the Brazilian Amazon Region. DESIGN Population-based cross-sectional study. METHODS Cluster sampling was used in randomly selecting subjects 45 years of age and older from urban and rural areas of Parintins city, Brazil. Participants underwent ophthalmic examination, including uncorrected (UCNVA), presenting (PNVA), and best-corrected near visual acuity (BCNVA) from each eye; biomicroscopy; funduscopy; and subjective refraction, including testing with additional lenses for near vision optical correction. A principal cause for NVI was assigned by the ophthalmologist and presbyopia was defined as UCNVA ≤ 20/40 changing to > 20/40 with BCNVA. Free-of-charge glasses were provided for those in need. RESULTS A total of 2384 subjects were enumerated and 2025 had reliable NVA measurements from both eyes. The prevalence of NVI in the better-seeing eye was 96.5% with UCNVA, decreasing to 81.1% with PNVA and to 20.5% with BCNVA. Presbyopia was the principal cause of NVI in 71.8%, followed by cataract (16.5%) and pterygium (2.5%), and was associated with younger age and high schooling. Glasses for near vision were prescribed and provided to 1414 (69.8%) participants. CONCLUSIONS A high prevalence of NVI was detected even in those wearing glasses for near. Prescription and provision of low-cost reading glasses should be considered by Brazilian health authorities to address this easily and promptly correctable form of vision impairment.
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Affiliation(s)
- Cristina Coimbra Cunha
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Adriana Berezovsky
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - João Marcello Furtado
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Nívea Nunes Ferraz
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Sergio Muñoz
- Universidad de La Frontera, Departamento de Salud Publica, Temuco, Chile
| | - Sung Song Watanabe
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Paula Yuri Sacai
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Marcela Cypel
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Márcia Higashi Mitsuhiro
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Paulo Henrique Morales
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Galton Carvalho Vasconcelos
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Marcos Jacob Cohen
- Universidade Federal do Amazonas (UFAM), Faculdade de Medicina, Departamento de Cirurgia, Divisão de Oftalmologia, Manaus, Brazil
| | - Mauro Campos
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Jacob Moysés Cohen
- Universidade Federal do Amazonas (UFAM), Faculdade de Medicina, Departamento de Cirurgia, Divisão de Oftalmologia, Manaus, Brazil
| | - Rubens Belfort
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Solange Rios Salomão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil.
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Karanjia R, Berezovsky A, Sacai PY, Cavascan NN, Liu HY, Nazarali S, Moraes-Filho MN, Anderson K, Tran JS, Watanabe SE, Moraes MN, Sadun F, DeNegri AM, Barboni P, do Val Ferreira Ramos C, La Morgia C, Carelli V, Belfort R, Coupland SG, Salomao SR, Sadun AA. The Photopic Negative Response: An Objective Measure of Retinal Ganglion Cell Function in Patients With Leber's Hereditary Optic Neuropathy. Invest Ophthalmol Vis Sci 2017; 58:BIO300-BIO306. [PMID: 29049835 DOI: 10.1167/iovs.17-21773] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The photopic negative response (PhNR) is a slow negative component of a flash photopic full-field ERG that has been shown to be specific for retinal ganglion cell (RGC) activity. Direct evaluation of RGC function is desirable in patients with Leber's hereditary optic neuropathy (LHON) in which the loss of central acuity can make it difficult to monitor patients with standard metrics. The purpose of this study was to evaluate the use of PhNR as an objective noninvasive clinical metric in LHON. Methods Full-field photopic ERG recordings were collected in subjects with the mt.11778G>A/ND4 LHON mutation using a red on blue stimulus. The PhNR was identified using a computer-based automated detection system, and data were manually examined to remove movement artifacts. Results The PhNR amplitude was compared between controls (n = 13), carriers (n = 17), and affected (n = 6). Mean PhNR amplitude decreased significantly across groups (P < 0.0001). Post hoc Tukey's test revealed a significant decrease in PhNR amplitude between carriers and controls (P < 0.05) and between carriers and affected (P < 0.01). Conclusions We are able to demonstrate that the PhNR amplitude is significantly decreased in patients affected by LHON compared to carriers in a well-described pedigree. Surprisingly, there was also a decrease in PhNR in carriers, suggesting potential subclinical RGC dysfunction in some carriers. This is important in patients affected with LHON who typically have a dense central scotoma. The PhNR may be a useful objective outcome measure for future clinical trials.
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Affiliation(s)
- Rustum Karanjia
- Doheny Eye Institute, Los Angeles, California, United States.,Doheny Eye Centers of UCLA, Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States.,Ottawa Eye Institute, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Nivea Nunes Cavascan
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Henry Yuheng Liu
- Ottawa Eye Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Samir Nazarali
- Ottawa Eye Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kirsten Anderson
- Doheny Eye Institute, Los Angeles, California, United States.,Doheny Eye Centers of UCLA, Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States
| | | | - Sung EunSong Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Federico Sadun
- Department of Ophthalmology, Ospedale Parodi Delfino, Colleferro, Rome
| | | | | | | | - Chiara La Morgia
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.,Unit of Neurology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Valerio Carelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.,Unit of Neurology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Stuart Glenn Coupland
- Ottawa Eye Institute, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Solange Rios Salomao
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Alfredo A Sadun
- Doheny Eye Institute, Los Angeles, California, United States.,Doheny Eye Centers of UCLA, Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States
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11
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Quagliato EMAB, Rocha DM, Sacai PY, Watanabe SS, Salomão SR, Berezovsky A. Retinal function in patients with the neuronal ceroid lipofuscinosis
phenotype. Arq Bras Oftalmol 2017; 80:215-219. [DOI: 10.5935/0004-2749.20170053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 01/18/2017] [Indexed: 11/20/2022] Open
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Soares TDS, Sacai PY, Berezovsky A, Rocha DM, Watanabe SES, Salomão SR. Pattern-reversal visual evoked potentials as a diagnostic tool for ocular malingering. Arq Bras Oftalmol 2016; 79:303-307. [PMID: 27982208 DOI: 10.5935/0004-2749.20160087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/15/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose: To investigate the contributions of transient pattern-reversal visual evoked potentials in the diagnosis of ocular malingering at a Brazilian university hospital. Methods: Adult patients with suspected malingering in one or both eyes were referred for visual evoked potential testing. Data from patients' medical records were reviewed and analyzed retrospectively. Data analysis included the distance optotype visual acuity based on a ETDRS retro-illuminated chart and the transient pattern-reversal visual evoked potential parameters of latency (milliseconds) and amplitude (microvolts) for the P100 component, using checkerboards with visual subtenses of 15' and 60'. Motivations for malingering were noted. Results: The 20 subjects included 11 (55%) women. Patient ages ranged from 21 to 61 years (mean= 45.05 ± 11.76 years; median= 49 years). In 8 patients (6 women), both eyes exhibited reduced visual acuity with normal pattern-reversal visually evoked potential parameters (pure malingerers). The remaining 12 patients (7 men) exhibited reduced vision in only 1 eye, with simulated reduced vision in the contralateral eye (exaggerators). Financial motivation was noted in 18 patients (9 men). Conclusion: Normal pattern-reversal visually evoked potential parameters with suspected ocular malingering were observed in a 20 patient cohort. This electrophysiological technique appeared to be useful as a measure of visual pathway integrity in this specific population.
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Affiliation(s)
- Tarciana de Souza Soares
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paula Yuri Sacai
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Adriana Berezovsky
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Daniel Martins Rocha
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sung Eun Song Watanabe
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Solange Rios Salomão
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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13
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Andrade EP, Berezovsky A, Sacai PY, Pereira JM, Rocha DM, Salomão SR. Dysfunction in the fellow eyes of strabismic and anisometropic amblyopic children assessed by visually evoked potentials. Arq Bras Oftalmol 2016; 79:294-298. [DOI: 10.5935/0004-2749.20160085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/30/2016] [Indexed: 11/20/2022] Open
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Berezovsky A, Rocha DM, Sacai PY, Watanabe SS, Cavascan NN, Salomão SR. Visual acuity and retinal function in patients with Bardet-Biedl syndrome. Clinics (Sao Paulo) 2012; 67:145-9. [PMID: 22358239 PMCID: PMC3275121 DOI: 10.6061/clinics/2012(02)09] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 08/06/2011] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Bardet-Biedl syndrome is a genetic, multisystem disorder that causes severe visual impairment. This condition is characterized by retinal dystrophy, obesity, digit anomalies, renal disease, and hypogonadism. The purpose of this study was to analyze visual acuity and full-field electroretinogram findings in patients with the Bardet-Biedl syndrome phenotype. METHODS The visual acuity of a group of 23 patients (15 males) with ages ranging from 6-36 years (mean = 15.8 ± 6.4; median = 14.7) was assessed. Retinal function was evaluated by full-field electroretinography, and dark-adapted thresholds were assessed. RESULTS Visual acuity in the better-seeing eye was 20/40 or better in 5 patients (21.7%), 20/50-20/150 in 13 (56.5%) patients, 20/200-20/400 in 2 (8.7%) patients and worse than 20/400 in one (4.3%) patient. The mean acuity in the better-seeing eye was 0.7 ± 0.6 logMAR (20/100, Snellen equivalent). Scotopic rod and maximal responses were nondetectable in 21 (91.3%) patients, and cone responses were non-detectable in 15 (65.2%) patients. Elevated dark-adapted visual thresholds were observed in all 19 patients who were able to be assessed, with 10 (52.6%) patients having thresholds greater than 30 dB. CONCLUSIONS In a relatively young cohort of patients with Bardet-Biedl syndrome, only 21% had 20/40 or better vision. ERG scotopic responses were absent in the majority of cases, with cone responses being observed in less than half of cases. These findings showed the early deleterious effects in retinal function and visual acuity caused by this condition.
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Affiliation(s)
- Adriana Berezovsky
- Universidade Federal de São Paulo/Escola Paulista de Medicina, Departamento de Oftalmologia, Brazil.
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15
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Alves LD, Berezovsky A, Sacai PY, Pereira JM, Salomão SR. [Pattern-reversal electroretinogram (PERG): a normative study in adults]. Arq Bras Oftalmol 2010; 73:225-30. [PMID: 20730277 DOI: 10.1590/s0004-27492010000300003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 04/12/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine normative values for pattern-reversal electroretinogram (PERG) in healthy adult volunteers according to the standard protocol recommended by the International Society for Clinical Electrophysiology of Vision-ISCEV. METHODS Participants were 30 healthy volunteers (15 males) with ages from 18 to 61 years (mean= 30.8 +/- 8.7 yrs.; median= 29.5 yrs). Inclusion criteria were: visual acuity of 0.0 logMAR (20/20 Snellen) in each eye, absence of visual complaints, absence of media opacities, negative history for ocular or neurological diseases, negative family history for ocular and informed consent. PERG was recorded from each eye in a darkened room at 1 m from a high resolution display monitor. Stimuli were monochromatic checkerboards subtending 60, 15 e 7.5 minutes of visual angle reversing at 1.9 Hz. Responses were obtained from modified disposable fiber electrodes developed at UNIFESP. Latency (ms) for N35, P50 and N95 components as well as peak-to-peak amplitudes (microV) for N35-P50 and P50-N95 were determined. For normative values only one randomly chosen eye was included. Normal limits were calculated as 97.5% percentiles for latency and 2.5% percentile for amplitudes for each stimulus size. RESULTS Normal limits for N35, P50 and N95 latencies for 60', 15' and 7.5' stimuli were respectively: N35 - 40.1; 39.9 and 41.3 ms; P50 - 60.5; 64.4 and 65.6 ms and N95 - 103.4; 104.6 and 104.6 ms. For amplitude the normative values for N35-P50 and P50-N95 for 60', 15' and 7.5' were respectively: N35-P50 - 1.7; 1.6 and 0.9 microV; P50-N95 - 3.8; 2.8 and 1.5 microV. No gender differences were found either for latency or for amplitude in the three stimulus sizes. There was no correlation between PERG latency and amplitude with age, except for P50 amplitude for stimulus 15'(r=0.39; P=0.035). CONCLUSIONS Normative values were determined for PERG parameters of amplitude and latency for three stimulus sizes. These parameters are important for evaluating the normal functioning of retinal ganglion cells and the macula. The normative values obtained in this study are comparable to previous studies in the literature.
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Watanabe SES, Berezovsky A, Motono M, Sacai PY, Pereira JM, Sallum JMF, Gebrim LH, Salomão SR. Retinal function in patients treated with tamoxifen. Doc Ophthalmol 2010; 120:137-43. [PMID: 19911210 DOI: 10.1007/s10633-009-9203-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
Tamoxifen, an effective treatment of breast cancer, has been shown to cause ocular toxic effects. The purpose of this study was to determine retinal toxicity by full-field and focal electroretinograms (ERGs) in patients treated with tamoxifen. Fullfield and focal ERGs were obtained from three groups: Tamoxifen-14 females (47-72 years, mean 58.3 + or - 9.1) with normal fundus, treated with tamoxifen from 2 to 37 months; No Treatment-10 females (39-65 years, mean 50.1 + or - 8.7) with previous breast cancer diagnosis and before tamoxifen treatment; Control-13 normal female volunteers (41-81 years, mean 52.7 + or - 12.1). Peak-to-peak amplitude and b-wave implicit time were measured and statistically analyzed.Mean peak-to-peak amplitudes and implicit time from full-field and focal ERGs were comparable for the three different groups. Low-dosage tamoxifen showed no retinotoxic effect assessed by full-field and focal ERG in this small group of women with breast cancer.
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Affiliation(s)
- Sung Eun Song Watanabe
- Deptartment of Ophthalmology, Federal University of São Paulo, UNIFESP, São Paulo, Brazil.
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Ejzenbaum F, Salomão SR, Berezovsky A, Waiswol M, Tartarella MB, Sacai PY, Pereira JM. Amblyopia after unilateral infantile cataract extraction after six weeks of age. Arq Bras Oftalmol 2009; 72:645-9. [DOI: 10.1590/s0004-27492009000500009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 07/14/2009] [Indexed: 11/22/2022] Open
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Pereira JM, Salomão SR, Cinoto RW, Mendieta L, Sacai PY, Berezovsky A, Belfort R. [Eye care services evaluation in a low-income urban population of São Paulo City--Brazil]. Arq Bras Oftalmol 2009; 72:332-40. [PMID: 19668962 DOI: 10.1590/s0004-27492009000300010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 05/20/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate eye care services from the user's perspective in a low income population from the east zone of the city of São Paulo--Brazil. METHODS A household survey was performed using cluster sampling in three low income districts of the city of São Paulo--Brazil. From July/2004 to January/2005, 1055 interviews with an adult household representative were carried and an eye care system responsiveness questionnaire was administered through individual interview. RESULTS 71.56% of the participants were women. Respondents' age ranged from 18 to 92 years (41.42 +/- 15.67 years). Regarding schooling, 525 (49.77%) had four years or less; 489 (46.35%) between five and eleven years, 40 (3.79%) had eleven or more years of study. Eye care services need was reported as 712 (67.49%) declaring themselves or someone else of the household needing and obtaining services and 135 (12.80%) had never needed eye care. The most frequently cited barriers to obtain the eye care service by respondents was cost (77.29%), followed by unsuccessful attempt to obtain eye care (42.21%). General satisfaction for the criteria contained in the questionnaire was 63.37%. In the 36.63% dissatisfied respondents, the most frequently cited claim was the amount of time waited before consultation. CONCLUSION The main barriers to obtain eye care services were cost of medical appointment and lack of access to the services. 63.37% of the individuals in need who had received eye care in last 12 months were satisfied with the service provided.
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Affiliation(s)
- Josenilson Martins Pereira
- Setor de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
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Oshima A, Berezovsky A, Salomão SR, Sacai PY, Costa RA, Bordon AF, Farah ME. [Evaluation of the macular function by focal electroretinography and by fluorescein angiography in patients with neovascular age-related macular degeneration submitted to verteporfin photodynamic therapy]. Arq Bras Oftalmol 2009; 72:23-7. [PMID: 19347117 DOI: 10.1590/s0004-27492009000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 12/04/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate macular function by focal electroretinography and fluorescein angiography (FA) in patients with neovascular age-related macular degeneration submitted to verteporfin photodynamic therapy (VPT). METHODS Prospective study involving 22 patients with age-related macular degeneration and predominantly classic subfoveal neovascular membrane, in non consecutive series, treated with VPT and followed for 12 months. They had their best corrected visual acuity measured by ETDRS chart, changes of lesion measured by fluorescein angiography and cone function assessed by focal electroretinography at baseline and each 3-month follow-up. RESULTS All 22 patients completed the scheduled follow-up. After a mean of 3.5 sessions of treatment per patient, the mean visual acuity variation was not significant at the end of study. Eleven patients showed variation > or =1 line. 86% of patients achieved stabilization of lesion leakage at the end of the study. Focal electroretinography showed a mean of 194.88 nV in amplitude and 29.19 ms in latency and did not present a significant variation during treatment. CONCLUSIONS There were no significant differences in focal electroretinography amplitudes and latencies after a 9-month period. Visual acuity did not show important variations during the 12 months. The decrease of lesion size showed a significant difference at 12 months with negative correlation between the amplitude of focal electroretinography and best corrected visual acuity.
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Andrade EPD, Sacai PY, Berezovsky A, Salomão SR. [Pattern-reversal visual evoked potential abnormalities in patients with defined multiple sclerosis]. Arq Bras Oftalmol 2008; 70:943-8. [PMID: 18235904 DOI: 10.1590/s0004-27492007000600011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 08/06/2007] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Multiple sclerosis is an idiopathic demyelinating disease that may affect the optic nerve leading to acute unilateral visual loss, which could be observed by means of evoked visual potential (VEP). This exam is much valued for studying prechiasmatic visual paths in multiple sclerosis. PURPOSE To analyze the findings of pattern reversal VEP in patients with prior diagnosis of multiple sclerosis and to compare them to visual acuity. METHODS Twenty-four patients with a definite diagnosis of multiple sclerosis were submitted to pattern reversal VEP from October 2001 to March 2007. RESULTS In P100 component response, at 15' and 1 degree stimuli, 19 eyes presented latency response up to 115 ms in both stimuli, which coincided in 6 eyes with latency response between 116 and 135 ms; 11 eyes had a latency response higher than 135 ms, and four eyes did not respond to stimuli. Correlating visual acuity with P100 latency for 15', in Pearson r correlation, r=0.85 with p=0.000000123, and for 1 degree, r = 0.87 with p=0.0000000338. CONCLUSION Approximately 60.4% of patients presented abnormalities. However, the correlation between the P100 latency (15' and 1 degree) and visual acuity was statistically significant; therefore the better the visual acuity, the better the response to stimuli of the pattern-reversal VEP.
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Salomão SR, Ejzenbaum F, Berezovsky A, Sacai PY, Pereira JM. Age norms for monocular grating acuity measured by sweep-VEP in the first three years of age. Arq Bras Oftalmol 2008; 71:475-9. [DOI: 10.1590/s0004-27492008000400002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 03/07/2008] [Indexed: 11/21/2022] Open
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Noia LDC, Berezovsky A, Freitas DD, Sacai PY, Salomão SR. [Clinical and electroretinographic profile of commotio retinae]. Arq Bras Oftalmol 2007; 69:895-906. [PMID: 17273686 DOI: 10.1590/s0004-27492006000600020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 05/14/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate clinical, anatomic and electroretinographic changes in eyes that suffered blunt ocular trauma with commotio retinae. METHODS Patients who presented commotio retinae after unilateral blunt ocular trauma less then 72 hours before were submitted to visual acuity testing, biomicroscopy, binocular indirect ophthalmoscopy, fluorescein angiography, optical coherence tomography and full-field electroretinography. Full-field ERG was repeated after 15 and 30 days. RESULTS Sixteen patients were included in the study. On the first examination there was a statistically significant difference between affected and fellow eye in all response amplitudes, without b/a ratio alteration, and a delay in single-flash cone response and 30-Hz flicker implicit time. On the second examination, the difference between the eyes remained for oscillatory potentials, but disappeared on the last examination. In fluorescein angiography, all patients presented mottled hyperfluorescence and hypofluorescent areas, due to alterations in the pigment barrier. On optical coherence tomography, we found optically empty spaces at the site of the lesion. CONCLUSION Found changes suggested photoreceptor and ganglion cells, but not Müller cell functional alterations, as well as pigment mobilization. These changes disappeared 30 days after the trauma.
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Mendieta L, Berezovsky A, Salomão SR, Sacai PY, Pereira JM, Fantini SC. [Visual acuity and full-field electroretinography in patients with Usher's syndrome]. Arq Bras Oftalmol 2005; 68:171-6. [PMID: 15905936 DOI: 10.1590/s0004-27492005000200004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Usher's syndrome (US) is a group of genetically distinct autosomal conditions, characterized by sensorineural hearing loss accompanied by a retinal dystrophy indistinguishable from retinitis pigmentosa (RP). The purpose of this study was to analyze full-field electroretinography (ERG) and visual acuity (VA) among patients with type I and II Usher's syndrome. METHODS Electroretinography responses and visual acuity were studied in 22 patients (mean age at test = 26.8+/-16.8 years). Seventeen patients had SU type I and 5 patients were diagnosed as Usher's syndrome type II. RESULTS Mean visual acuity was 0.9 logMAR (20/160, Snellen equivalent) for patients with Usher's syndrome type I and 0.4 logMAR (20/50, Snellen equivalent) for patients with Usher's syndrome type II. Scotopic rod and maximal responses were non-detectable in both groups. Mean amplitude for oscillatory potentials was 14.5 microV+/-6.1 in Usher's syndrome type I and 12.6 microV+/-5.2 in Usher's syndrome type II. Cone responses were non-detectable in 95% of the patients with Usher's syndrome I and in 100% of patients with Usher's syndrome II. Mean amplitude for 30 Hz flicker photopic cone response was 3.1 microV+/-4.1 for Usher's syndrome type I and 1.0 microV+/-0.6 for type II with mean implicit time of 34.0 ms+/-6.2 (US I) and 35.8 ms+/-3.1 (type II). CONCLUSIONS Visual acuity was relatively preserved in both groups, however Usher's syndrome II group showed better visual acuity results. Electroretinography findings were severely reduced in both groups, with most patients showing non-detectable rod and cone responses.
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Affiliation(s)
- Luana Mendieta
- Departamento de Oftalmologia, Universidade Federal de São Paulo, São Paulo, SP.
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Berezovsky A, Pereira JM, Sacai PY, Fantini SC, Salomão SR. Acuidade visual e função de bastonetes em pacientes com retinose pigmentária. Arq Bras Oftalmol 2004. [DOI: 10.1590/s0004-27492004000500010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Berezovsky A, Salomão SR, Pereira JM, Sacai PY, Chojniak MMM. Eletrorretinograma multifocal em pacientes tratadas com tamoxifeno em baixa dosagem. Arq Bras Oftalmol 2004. [DOI: 10.1590/s0004-27492004000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Munhoz JS, Salomão SR, Berezovsky A, Sacai PY. Padronização normativa de eletro-oculografia em adultos. Arq Bras Oftalmol 2004. [DOI: 10.1590/s0004-27492004000200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sato M, Sacai PY, Berezovsky A, Salomão SR. Avaliação da função visual em pacientes com distrofia de cones. Arq Bras Oftalmol 2003. [DOI: 10.1590/s0004-27492003000300007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pereira JM, Mendieta L, Sacai PY, Salomão SR, Berezovsky A. Estudo normativo do eletrorretinograma de campo total em adultos jovens. Arq Bras Oftalmol 2003. [DOI: 10.1590/s0004-27492003000200005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sacai PY, Berezovsky A, Fantini SC, Salomão SR. Contribuição diagnóstica da avaliação eletrofisiológica visual em pacientes atendidos em hospital universitário. Arq Bras Oftalmol 2003. [DOI: 10.1590/s0004-27492003000200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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