Clinical Features of Ocular Disabilities

Myeong Su Kang; Sung Eun Kyung

doi:10.3341/jkos.2010.51.1.95

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Kang and Kyung: Clinical Features of Ocular Disabilities

Original Article

J Korean Ophthalmol Soc 2010;51(1):95-105.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.1.95

Clinical Features of Ocular Disabilities

Myeong Su Kang, MD, Sung Eun Kyung, MD, PhD

Department of Ophthalmology, The Dankook University Medical College, Cheonan, Korea

Address reprint requests to Sung Eun Kyung, MD, PhD Department of Ophthalmology, Dankook University College of Medicine #San 16-5 Anmseo-dong, Cheonan, Chungnam 330-714, Korea Tel: 82-41-550-6377, Fax: 82-41-561-0137, E-mail: kseeye@hanmail.net

Received 18 December 2008 Accepted 13 October 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To describe the characteristics of the disabled patients visiting the eye clinic in our institute.

Methods

We carried out a retrospective analysis of 35 cases in our clinic from April 2004 to June 2008 using the McBride disability evaluation. We investigated the clinical features and the causes of disorders through visual acuity, visual field and ocular motility.

Results

Thirty-three (94.3%) of the 35 patients had disabilities due to trauma; twelve (34.3%) of them were caused by traffic accidents, and 21 (60%) of them were due to blows or lacerations. Other causes of disability were glaucoma and retinal break (5.8%). Nine patients (25.7%) had abnormal findings in the visual field examination, and nine other patients (25.7%) had limitations in ocular motility. Twenty-eight patients (80%) had decreased visual acuity, and nine (25.7%) had multiple symptoms.

Conclusions

Considering the contribution of disability estimation of visual field and ocular motility in McBride disability evaluations, we considered the importance of repetitive examinations and evaluations. When patients complained of unexplained decreased visual acuity with no anatomical abnormalities, multifocal ERG and multifocal VEP should be considered in order to distinguish it from malingering or functional visual loss.

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Keywords: Disability evaluation, Functional visual loss, McBride, Multifocal electroretinography, Occult macular dystrophy

References

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Figure 1.

Fundus findings of case 1. The color fundus photos (A, B) and fluorescein angiographs (C, D) show nonspecific findings.

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Figure 2.

The visual evoked potential findings of case 1. The pattern visual evoked potential of the patient's left eye shows slightly delayed latency compared to that of his right eye.

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Figure 3.

The optical coherent tomography findings of case 1. The patient's retinal nerve fiber layer analysis shows normal findings.

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Figure 4.

The visual field findings of case 2. The visual field shows peripheral constriction and suggestive malingering.

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Figure 5.

The visual evoked potential findings of case 2. The pattern visual evoked potential of the left eye shows slightly decreased amplitude compared to that of his right eye.

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Figure 6.

The optical coherent tomography findings of case 2. The patient's retinal nerve fiber layers analysis shows normal findings.

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Figure 7.

The fundus findings of case 2. The color fundus photos (A, B) and fluorescein angiography (C, D) show nonspecific findings.

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Table 1.

Clinical data of 35 patients diagnosed by McBride disability evaluation

	BCVA^* (far & near)	V/F^†	diplopia	Anatomical finding
1	0.2/0.15 & 0.2/0.15		under at central 20°	L)^‡ esotropia
2	0.8/0.02 & 0.5/0.02	B)^§ peripheral constriction		L)^‡ corneal opacity
				& pseudophakia
3	1.2/1.2		over at superior 20°	R)^∏ superior oblique
				muscle palsy
4	0.8/1.0 & 0.7/1.0	R)^∏ peripheral constriction	at right gaze	
5	LP^＃(−)/0.3 &	L)^‡ sparing under central 5°		R)^∏ optic atrophy & brain
	LP^＃(−)/0.4			parietotemporal area lesion
6	0.1/1.0 & 0.1/1.0			R)^∏ macular hole
7	1.0/1.2 & 1.0/1.0	L)^‡ hemianopsia	under at central 10°	R)^∏ exotropia
		R)^∏ total scotoma		
8	1.5/0.8 & 1.5/1.0	L)^‡ quadrantanopia		L)^‡ pale optic disc
9	LP^＃(−)/0.7			R)^∏ pale optic disc
10	0.8/FC^**5 cm			L)^‡ choroidal rupture
				L)^‡ subfoveal fibrosis
11	1.5/0.6 & 1.0/0.5	L)^‡ superior altitudinal field		L)^‡ pale optic disc
		defect		
12	0.5/LP^＃(−) & 0.5/LP^＃(−)			L)^‡ corneoscleral laceration
				& pale optic disc
13	FC^**5 cm / 0.5			R)^∏ macular hole
14	1.0/HM^††(+)			L)^‡ pale optic disc
15	0.9/0.5 & 0.5/0.5			
16	LP^＃(−)/1.0			R)^∏ band keratopathy
				R)^∏ macular hole, PVR^‡‡
17	1.2/0.01			L)^‡ macular scar
18	1.2/0.01			L)^‡ corneoscleral laceration
19	0.06/1.0 & 0.1/1.0			R)^∏ corneal opacity
20	1.0/0.9 & 1.0/1.0		at 1° gaze	B)^§6th. nerve palsy
21	0.9/LP^＃(+)&0.8/LP^＃(+)			L)^‡ macular hole & scar,
				corneal opacity
22	0.2/1.5 & 0.2/1.5	R)^∏ peripheral constriction		R)^∏ pale optic disc
23	0.6/1.0 & 0.8/1.0	R)^∏ peripheral constriction	at 1° gaze	R)^∏ exotropia
24	0.4/1.2		at 1° gaze	R)^∏ superor oblique muscle palsy
25	1.2/0.9		at 1° gaze	R)^∏ inferior oblique muscle palsy
26	1.0/1.2 & 1.0/1.0		at 1° gaze	R)^∏ superior oblique muscle palsy
27	0.2/1.2 & 0.16/1.2			R)^∏ corneal opacity
28	1.5/0.6 & 1.5/0.1			L)^‡ corneal opacity & optic atrophy
29	1.5/0.2 & 1.5/0.1			L)^‡ corneal opacity
30	0.02/0.9 & 0.02/1.0			R)^∏ corneal opacity
31	1.5/LP^＃(−)			L)^‡ corneal opacity & optic atrophy
32	LP^＃(−)/1.0			R)^∏ pale optic disc
33	1.5/LP^＃(−)			L)^‡ optic atrophy
34	0.5/LP^＃(+)			L)^‡ pale optic disc
35	1.0/1.0	L)^‡ sparing under central 5°		L)^‡ primary open-angle glaucoma

^* BCVA=best corrected visual acuity

^† V/F=visual field

^‡ L)=left eye

^§ B)=both eye

^∏ R)=right eye

^＃ LP=light perception

^** FC=finger count

^†† HM=hand movement

^‡‡ PVR=proliferative vitreoretinopathy.

Table 2.

Data of multifocal electroretinogram of case 1 (right eye)

Ring	Amp.^* P1[nV/deg²]	Amp.^* P1[nV]	Amp.^* N1[nV]	Impl.^† P1[ms]	Impl.^† N1[ms]
1	134.2	1.66	0.62	41.0	18.5
2	82.4	1.45	0.54	40.0	20.5
3	51.4	1.31	0.56	37.1	19.5
4	35.3	1.25	0.51	38.1	18.5
5	25.7	1.21	0.46	37.1	19.5

^* Amp.=amplitude

^† Impl.=implicit time.

Table 3.

Data of multifocal electroretinogram of case 1 (left eye)

Ring	Amp.^* P1[nV/deg²]	Amp.^* P1[nV]	Amp.^* N1[nV]	Impl.^† P1[ms]	Impl.^† N1[ms]
1	100.7	1.24	0.43	41.0	14.6
2	55.7	0.98	0.39	40.0	22.5
3	33.4	0.85	0.43	39.0	19.5
4	18.3	0.65	0.27	39.8	21.5
5	17.6	0.83	0.38	40.0	20.5

^* Amp.=amplitude

^† Impl.=implicit time.

Table 4.

The difference of average amplitude P1 of both eyes (case 1)

Ring	Diff.^* of Both Ave.^† Amp.^‡ P1[nV/deg²]	p-value
1	33.5	
2	21.1±28.2	0.127
3	11.3±13.5	0.014
4	10.8±9.9	0.000
5	3.6±9.7	0.086

^* Diff.=difference

^† Ave.=average

^‡ Amp.=amplitude.

Table 5.

The difference of average implicit P1 of both eyes (case 1)

Ring	Diff.^* of Both Ave.^† Impl.^‡ P1[ms]	p-value
1	0.0	
2	2.0±3.9	0.270
3	2.4±4.3	0.074
4	4.7±4.6	0.000
5	5.6±4.2	0.000

^* Diff.=difference

^† Ave.=Average

^‡ Impl.=implicit time.

Table 6.

Data of multifocal electroretinogram of case 2 (right eye)

Ring	Amp.^* P1[nV/deg²]	Amp.^* P1[nV]	Amp.^* N1[nV]	Impl.^† P1[ms]	Impl.^† N1[ms]
1	107.7	1.33	0.42	39.0	19.5
2	67.7	1.19	0.53	36.1	20.5
3	41.1	1.05	0.48	34.2	18.5
4	30.1	1.07	0.50	35.1	18.5
5	25.1	1.18	0.56	36.1	19.5

^* Amp.=amplitude

^† Impl.=implicit time.

Table 7.

Data of multifocal electroretinogram of case 2 (left eye)

Ring	Amp.^* P1[nV/deg²]	Amp.^* P1[nV]	Amp.^* N1[nV]	Impl.^† P1[ms]	Impl.^† N1[ms]
1	136.2	1.68	0.21	40.0	11.7
2	86.5	1.52	0.69	37.1	21.5
3	51.8	1.32	0.52	35.1	17.6
4	39.2	1.39	0.56	36.1	19.5
5	28.6	1.35	0.65	36.1	20.5

^* Amp.=amplitude

^† Impl.=implicit time.

Table 8.

The difference of average amplitude P1 of both eyes (case 2)

Ring	Diff.^* of Both Ave.^† Amp.^‡ P1[nV/deg²]	p-value
1	28.5	
2	26.5±32.3	0.101
3	18.0±15.4	0.002
4	11.3±11.1	0.000
5	8.4±8.2	0.000

^* Diff.=difference

^† Ave.=average

^‡ Amp.=amplitude.

Table 9.

The difference of average implicit P1 of both eyes (case 2)

Ring	Diff.^* of Both Ave.^† Impl.^‡ P1[ms]	p-value
1	1.0	
2	0.5±3.0	0.711
3	0.1±2.9	0.874
4	0.9±2.7	0.157
5	2.0±3.7	0.014

^* Diff.=difference

^† Ave.=average

^‡ Impl.=implicit time.

Table 10.

The amplitude of multifocal electroretinogram of control group

Ring	Average of Amp.^* P1[nV/deg²]	Stdev^† of Amp.^* P1	95% Confidence Range
1	172.63	49.44	134.62∼210.63
2	97.17	34.51	70.64∼123.71
3	59.01	16.88	46.03∼71.99
4	41.93	10.27	34.03∼49.83
5	32.70	10.96	24.27∼41.12

^* Amp.=amplitude

^† Stdev=standard deviation.

Table 11.

The implicit time of multifocal electroretinogram of control group

Ring	Average of Impl.^* P1[ms]	Stdev^† of Impl.^* P1[ms]	95% Confidence Range
1	39.90	2.79	37.75∼42.04
2	37.42	0.97	36.66∼38.17
3	36.43	2.30	34.66∼38.20
4	35.55	1.61	34.31∼36.79
5	38.37	5.96	33.79∼42.96

^* Impl.=implicit time

^† Stdev=standard deviation.

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