- Email: [email protected]
Learning effect for frequency doubling perimetry in patients with glaucoma
vancomycin and demonstrates a low level of resistance to aminoglycosides.3 Gemella species may emerge as an etiologic agent more commonly seen in ocular disease as automated systems for identifying uncommon bacteria improve and Gemella species are added to databases. Gemella hemolysans should be added to the long list of organisms that may rarely cause keratitis and endophthalmitis. REFERENCES
1. Fresard A, Michel VP, Rueda X, et al. Gemella haemolysans endocarditits. Clin Infect Dis 1993;16:586 –587. 2. Tunicliff R. The cultivation of a micrococcus from blood in pre-eruptive and eruptive stages of measles. JAMA 1917;68: 1028 –1030. 3. Ruoff K. Leuconostoc, pediococcus, stomatococcus, and miscellaneous gram-positive cocci that grow aerobically. In: Murray PR, Baron EJ, et al., editors. Manual of clinical microbiology. Washington, D.C.: ASM Press; 1999:306 –315. 4. Reyn A. Genus Gemella berger. In: Sneath PR, editor. Bergey’s manual of systematic bacteriology. Vol. 2. Baltimore, MD: Williams and Wilkins; 1999:1081–1082. 5. Veziris N, Fuhrman C, Chouaid C, et al. Empyema of the thorax due to Gemella haemolysans. J Infect 1999;39:245–246.
Learning Effect for Frequency Doubling Perimetry in Patients With Glaucoma Naoya Fujimoto, MD, Katsuyuki Minowa, MD, Osamu Miyauchi, MD, Tadao Hanawa, MD, and Emiko Adachi-Usami, MD PURPOSE:
We studied the results obtained by repeated frequency doubling perimetry in patients with glaucoma and demonstrated a learning effect. METHODS: Prospective observational study. Thirty-three patients who had glaucoma and had never experienced frequency doubling perimetry participated in this study. The patients were examined by frequency doubling perimetry three times within 6 months. Mean deviation, pattern standard deviation, and intraocular pressure at examination were compared among three results. RESULTS: On frequency doubling perimetry, the mean deviation results of the first, second, and third tests were ⴚ7.96 dB, ⴚ7.29 dB, and ⴚ7.36 dB, respectively. The first and second results and the first and third results were significantly different (P ⴝ 0.029 and P ⴝ 0.049, Accepted for publication Sep 26, 2001. From the Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan. Supported in part by a Grant-in-Aid 13671822 for Scientific Research, Japan. Inquiries to Naoya Fujimoto, MD, Department of Ophthalmology, Chiba University School of Medicine 1-8-1 Inohana, Chuo-ku, Chiba 260-8760, Japan; Fax: 81-43-224-4162; e-mail: [email protected]. chiba-u.ac.jp
VOL. 133, NO. 2
respectively). No significant differences with regard to pattern standard deviation and intraocular pressure were noted. CONCLUSION: A positive learning effect was found for frequency doubling perimetry in the first and second mean deviation results of patients with glaucoma. (Am J Ophthalmol 2002;133:269 –270. © 2002 by Elsevier Science Inc. All rights reserved.)
F
REQUENCY
DOUBLING
TECHNOLOGY
PERIMETRY
(Welch Allyn, Skaneateles Falls, New York) has been developed to screen patients with glaucoma.1 The stimulus pattern of this perimetry is black and white sinusoidal flickering at 25 Hz. Glaucomatous visual field defects are detected by frequency doubling perimetry.2 Frequency doubling perimetry exhibits less variation than do tests with the Humphrey field analyzer (Humphrey-Zeiss, Dublin, California) in patients with glaucoma.3 For frequency doubling perimetry, a positive learning effect is seen between first and second test results in normal subjects.4 In patients with glaucoma, we wanted to determine the learning effect or long-term variation to estimate for progression or improvement by frequency doubling perimetry prospectively. Thirty-three patients (17 men and 16 women) with glaucoma were studied. Their mean age was 57.1 years (range, 22–75 years). All patients had been evaluated by Humphery field analyzer at least three times before, but never with frequency doubling perimetry. Within 6 months, three tests by frequency doubling perimetry were performed with far correction under the same antiglaucoma eye drops. The interval between the tests was at least 1 month and maximally 3 months. Intraocular pressure was measured by applanation tonometry after visual field testing. One eye of each patient was selected randomly. The results adopted for a reliable test were less than 20% of fixation loss, 20% of false-positive, and 33% of falsenegative. Mean deviation, pattern standard deviation, and intraocular pressure were compared among the three tests (Figure 1). A statistical analysis was done with one-way repeated measure analysis of variance with post hoc correction (Fisher’s method). The research followed institutional guidelines and the tenets of the World Medical Association Declaration of Helsinki. We obtained written informed consent from each patient. On frequency doubling perimetry, the mean deviation was ⫺7.96 ⫾ 0.71 (mean ⫾ standard error) dB at the first test, ⫺7.29 ⫾ 0.67 dB at the second, and ⫺7.36 ⫾ 0.76 dB at the third. A significant difference was noted between first and second (P ⫽ 0.029) and first and third (P ⫽ 0.049) results. No differences between second and third (P ⫽ 0.818) were found. Pattern standard deviation was 8.66 ⫾ 0.44 dB at first, 8.83 ⫾ 0.52 dB at second, and 9.00 ⫾ 0.58 dB at third recordings. Intraocular pressure was 16.7 ⫾ 0.67 mm Hg at first, 16.7 ⫾ 0.52 mm Hg at
BRIEF REPORTS
269
REFERENCES
1. Johnson CA, Samuels SJ. Screening for glaucomatous visual field loss with frequency-doubling perimetry. Invest Ophthalmol Vis Sci 1997;38:413– 425. 2. Sample PA, Bosworth CF, Blumenthal EZ, Girkin C, Weinreb RN. Visual function-specific perimetry for indirect comparison of different ganglion cell populations in glaucoma. Invest Ophthalmol Vis Sci 2000;41:1783–1790. 3. Chauhan BC, Johnson CA. Test-retest variability of frequency-doubling perimetry and conventional perimetry in glaucoma patients and normal subjects. Invest Ophthalmol Vis Sci 1999;40:648 – 656. 4. Iester M, Capris P, Pandolfo A, Zingirian M, Traverso CE. Learning effect, short-term fluctuation, and long-term fluctuation in frequency doubling technique. Am J Ophthalmol 2000;130:160 –164. 5. Heijl A, Bengtsson B. The effect of perimetric experience in patients with glaucoma. Arch Ophthalmol 1996;114:19 –22.
An Apparatus for Color Doppler Imaging in Seated Subjects Miyuki Nagahara, MD, Atsuo Tomidokoro, MD, Sawako Sando, MD, Makoto Araie, MD, and Sumiyoshi Tanaka, MD PURPOSE:
To easily perform reliable color Doppler imaging of the orbital vessels in seated subjects. DESIGN: Experimental study. METHODS: Experimental study. An apparatus mounting the color Doppler imaging probe through a spring plate on a slit-lamp system was devised. In 16 eyes of eight seated subjects, color Doppler imaging assessments of the central retinal artery using the apparatus and by the examiner’s handheld manipulation were repeated with a 10-minute interval. The reproducibility coefficients were calculated regarding the color Doppler imaging indices, including peak systolic velocity, end diastolic velocity, and resistive index. RESULTS: The color Doppler imaging indices obtained with the apparatus showed no significant differences from those obtained by handheld manipulation. The time required for each measurement using the apparatus was shorter than that by handheld manipulation, and reproducibility coefficients were significantly smaller by about 50%.
FIGURE 1. Results of mean deviation and pattern standard deviation are shown among three tests. The differences between first and second, first and third results with regard to mean deviation were significant (P ⴝ 0.029 and P ⴝ 0.049, respectively) by repeated measure analysis of variance. Mean ⴞ SE.
second, and 16.9 ⫾ 0.56 mm Hg at third measurements. No statistically significant differences were noted in terms of pattern standard deviation and intraocular pressure among the three test results. A positive learning effect for mean deviation was found between the first and second results, and no learning effect was found after the second measurement by frequency doubling perimetry in patients with normal healthy subjects.4 Humphery field analyzer shows a positive learning effect between first and second test results in patients with glaucoma.5 Even subjects well trained with conventional automated perimetry showed a learning effect by frequency doubling perimetry. If change of visual field by frequency doubling perimetry was estimated in patients with glaucoma, the results at first examination should be deleted. The change of visual field after the second or later repeats in patients with glaucoma could be estimated with regard to long-term variation.3 270
AMERICAN JOURNAL
Accepted for publication Sep 25, 2001. From the Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan (M.N., A.T., S.S., M.A.), and the Department of Ophthalmology, Teikyo University Ichihara Hospital, Chiba, Japan (S.T.). Supported in part by Grant-in-Aid 01870074 for Developmental Scientific Research (B) from the Ministry of Education, Science, Sports, and Culture of Japan. Inquiries to Makoto Araie, MD, PhD, Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, fax: ⫹81-3-3817-0798; e-mail: [email protected] OF
OPHTHALMOLOGY
FEBRUARY 2002
1. Fresard A, Michel VP, Rueda X, et al. Gemella haemolysans endocarditits. Clin Infect Dis 1993;16:586 –587. 2. Tunicliff R. The cultivation of a micrococcus from blood in pre-eruptive and eruptive stages of measles. JAMA 1917;68: 1028 –1030. 3. Ruoff K. Leuconostoc, pediococcus, stomatococcus, and miscellaneous gram-positive cocci that grow aerobically. In: Murray PR, Baron EJ, et al., editors. Manual of clinical microbiology. Washington, D.C.: ASM Press; 1999:306 –315. 4. Reyn A. Genus Gemella berger. In: Sneath PR, editor. Bergey’s manual of systematic bacteriology. Vol. 2. Baltimore, MD: Williams and Wilkins; 1999:1081–1082. 5. Veziris N, Fuhrman C, Chouaid C, et al. Empyema of the thorax due to Gemella haemolysans. J Infect 1999;39:245–246.
Learning Effect for Frequency Doubling Perimetry in Patients With Glaucoma Naoya Fujimoto, MD, Katsuyuki Minowa, MD, Osamu Miyauchi, MD, Tadao Hanawa, MD, and Emiko Adachi-Usami, MD PURPOSE:
We studied the results obtained by repeated frequency doubling perimetry in patients with glaucoma and demonstrated a learning effect. METHODS: Prospective observational study. Thirty-three patients who had glaucoma and had never experienced frequency doubling perimetry participated in this study. The patients were examined by frequency doubling perimetry three times within 6 months. Mean deviation, pattern standard deviation, and intraocular pressure at examination were compared among three results. RESULTS: On frequency doubling perimetry, the mean deviation results of the first, second, and third tests were ⴚ7.96 dB, ⴚ7.29 dB, and ⴚ7.36 dB, respectively. The first and second results and the first and third results were significantly different (P ⴝ 0.029 and P ⴝ 0.049, Accepted for publication Sep 26, 2001. From the Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan. Supported in part by a Grant-in-Aid 13671822 for Scientific Research, Japan. Inquiries to Naoya Fujimoto, MD, Department of Ophthalmology, Chiba University School of Medicine 1-8-1 Inohana, Chuo-ku, Chiba 260-8760, Japan; Fax: 81-43-224-4162; e-mail: [email protected]. chiba-u.ac.jp
VOL. 133, NO. 2
respectively). No significant differences with regard to pattern standard deviation and intraocular pressure were noted. CONCLUSION: A positive learning effect was found for frequency doubling perimetry in the first and second mean deviation results of patients with glaucoma. (Am J Ophthalmol 2002;133:269 –270. © 2002 by Elsevier Science Inc. All rights reserved.)
F
REQUENCY
DOUBLING
TECHNOLOGY
PERIMETRY
(Welch Allyn, Skaneateles Falls, New York) has been developed to screen patients with glaucoma.1 The stimulus pattern of this perimetry is black and white sinusoidal flickering at 25 Hz. Glaucomatous visual field defects are detected by frequency doubling perimetry.2 Frequency doubling perimetry exhibits less variation than do tests with the Humphrey field analyzer (Humphrey-Zeiss, Dublin, California) in patients with glaucoma.3 For frequency doubling perimetry, a positive learning effect is seen between first and second test results in normal subjects.4 In patients with glaucoma, we wanted to determine the learning effect or long-term variation to estimate for progression or improvement by frequency doubling perimetry prospectively. Thirty-three patients (17 men and 16 women) with glaucoma were studied. Their mean age was 57.1 years (range, 22–75 years). All patients had been evaluated by Humphery field analyzer at least three times before, but never with frequency doubling perimetry. Within 6 months, three tests by frequency doubling perimetry were performed with far correction under the same antiglaucoma eye drops. The interval between the tests was at least 1 month and maximally 3 months. Intraocular pressure was measured by applanation tonometry after visual field testing. One eye of each patient was selected randomly. The results adopted for a reliable test were less than 20% of fixation loss, 20% of false-positive, and 33% of falsenegative. Mean deviation, pattern standard deviation, and intraocular pressure were compared among the three tests (Figure 1). A statistical analysis was done with one-way repeated measure analysis of variance with post hoc correction (Fisher’s method). The research followed institutional guidelines and the tenets of the World Medical Association Declaration of Helsinki. We obtained written informed consent from each patient. On frequency doubling perimetry, the mean deviation was ⫺7.96 ⫾ 0.71 (mean ⫾ standard error) dB at the first test, ⫺7.29 ⫾ 0.67 dB at the second, and ⫺7.36 ⫾ 0.76 dB at the third. A significant difference was noted between first and second (P ⫽ 0.029) and first and third (P ⫽ 0.049) results. No differences between second and third (P ⫽ 0.818) were found. Pattern standard deviation was 8.66 ⫾ 0.44 dB at first, 8.83 ⫾ 0.52 dB at second, and 9.00 ⫾ 0.58 dB at third recordings. Intraocular pressure was 16.7 ⫾ 0.67 mm Hg at first, 16.7 ⫾ 0.52 mm Hg at
BRIEF REPORTS
269
REFERENCES
1. Johnson CA, Samuels SJ. Screening for glaucomatous visual field loss with frequency-doubling perimetry. Invest Ophthalmol Vis Sci 1997;38:413– 425. 2. Sample PA, Bosworth CF, Blumenthal EZ, Girkin C, Weinreb RN. Visual function-specific perimetry for indirect comparison of different ganglion cell populations in glaucoma. Invest Ophthalmol Vis Sci 2000;41:1783–1790. 3. Chauhan BC, Johnson CA. Test-retest variability of frequency-doubling perimetry and conventional perimetry in glaucoma patients and normal subjects. Invest Ophthalmol Vis Sci 1999;40:648 – 656. 4. Iester M, Capris P, Pandolfo A, Zingirian M, Traverso CE. Learning effect, short-term fluctuation, and long-term fluctuation in frequency doubling technique. Am J Ophthalmol 2000;130:160 –164. 5. Heijl A, Bengtsson B. The effect of perimetric experience in patients with glaucoma. Arch Ophthalmol 1996;114:19 –22.
An Apparatus for Color Doppler Imaging in Seated Subjects Miyuki Nagahara, MD, Atsuo Tomidokoro, MD, Sawako Sando, MD, Makoto Araie, MD, and Sumiyoshi Tanaka, MD PURPOSE:
To easily perform reliable color Doppler imaging of the orbital vessels in seated subjects. DESIGN: Experimental study. METHODS: Experimental study. An apparatus mounting the color Doppler imaging probe through a spring plate on a slit-lamp system was devised. In 16 eyes of eight seated subjects, color Doppler imaging assessments of the central retinal artery using the apparatus and by the examiner’s handheld manipulation were repeated with a 10-minute interval. The reproducibility coefficients were calculated regarding the color Doppler imaging indices, including peak systolic velocity, end diastolic velocity, and resistive index. RESULTS: The color Doppler imaging indices obtained with the apparatus showed no significant differences from those obtained by handheld manipulation. The time required for each measurement using the apparatus was shorter than that by handheld manipulation, and reproducibility coefficients were significantly smaller by about 50%.
FIGURE 1. Results of mean deviation and pattern standard deviation are shown among three tests. The differences between first and second, first and third results with regard to mean deviation were significant (P ⴝ 0.029 and P ⴝ 0.049, respectively) by repeated measure analysis of variance. Mean ⴞ SE.
second, and 16.9 ⫾ 0.56 mm Hg at third measurements. No statistically significant differences were noted in terms of pattern standard deviation and intraocular pressure among the three test results. A positive learning effect for mean deviation was found between the first and second results, and no learning effect was found after the second measurement by frequency doubling perimetry in patients with normal healthy subjects.4 Humphery field analyzer shows a positive learning effect between first and second test results in patients with glaucoma.5 Even subjects well trained with conventional automated perimetry showed a learning effect by frequency doubling perimetry. If change of visual field by frequency doubling perimetry was estimated in patients with glaucoma, the results at first examination should be deleted. The change of visual field after the second or later repeats in patients with glaucoma could be estimated with regard to long-term variation.3 270
AMERICAN JOURNAL
Accepted for publication Sep 25, 2001. From the Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan (M.N., A.T., S.S., M.A.), and the Department of Ophthalmology, Teikyo University Ichihara Hospital, Chiba, Japan (S.T.). Supported in part by Grant-in-Aid 01870074 for Developmental Scientific Research (B) from the Ministry of Education, Science, Sports, and Culture of Japan. Inquiries to Makoto Araie, MD, PhD, Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, fax: ⫹81-3-3817-0798; e-mail: [email protected] OF
OPHTHALMOLOGY
FEBRUARY 2002