The SCHEIE Visual Field Grading System

OBJECTIVE

No method of grading visual field (VF) defects has been widely accepted throughout the glaucoma community. The SCHEIE (Systematic Classification of Humphrey visual fields-Easy Interpretation and Evaluation) grading system for glaucomatous visual fields was created to convey qualitative and quantitative information regarding visual field defects in an objective, reproducible, and easily applicable manner for research purposes.

METHODS

The SCHEIE grading system is composed of a qualitative and quantitative score. The qualitative score consists of designation in one or more of the following categories: normal, central scotoma, paracentral scotoma, paracentral crescent, temporal quadrant, nasal quadrant, peripheral arcuate defect, expansive arcuate, or altitudinal defect. The quantitative component incorporates the Humphrey visual field index (VFI), location of visual defects for superior and inferior hemifields, and blind spot involvement. Accuracy and speed at grading using the qualitative and quantitative components was calculated for non-physician graders.

RESULTS

Graders had a median accuracy of 96.67% for their qualitative scores and a median accuracy of 98.75% for their quantitative scores. Graders took a mean of 56 seconds per visual field to assign a qualitative score and 20 seconds per visual field to assign a quantitative score.

CONCLUSION

The SCHEIE grading system is a reproducible tool that combines qualitative and quantitative measurements to grade glaucomatous visual field defects. The system aims to standardize clinical staging and to make specific visual field defects more easily identifiable. Specific patterns of visual field loss may also be associated with genetic variants in future genetic analysis.

Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population

PURPOSE

To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population.

METHODS

This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors.

RESULTS

Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pre-treatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP ≥21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups.

CONCLUSION

Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.

A single blind controlled study comparing bipolar elecrocautery tonsillectomy to cold dissection method in pediatric age groups

Background: Tonsillectomy is one of the most commonly performed operations in otolaryngology. There are many proven methods of tonsillectomy, including cold dissection and bipolar electrocautery. Objective: To compare bipolar elecrocautery tonsillectomy with cold dissection method in pediatric age groups. Methods: Single blind controlled study to compare bipolar technique against the conventional dissection/snare technique. Results: The average amount of bleeding on electrocautery side was 4.07ml and on the cold dissection side was 14.58 ml. The mean time of operation for electrocautery and cold dissection was 12.04 and 16.57 minutes respectively. On the second post operative day, 35% of the patients complained of pain on the cauterized side, 30% complained of more pain on the dissection side while 35 % experienced equal pain on both sides. Post-operative complication such as hemorrhage was not seen in both the techniques employed. Conclusion: In the present study, bipolar diathermy tonsillectomy had advantages in having less post-operative time and blood loss intraoperatively but patients experience slightly more pain than cold dissection. DOI: http://dx.doi.org/10.3126/hren.v11i3.9651 Health Renaissance 2013;11(3):270-272

Thyroid abscess: A report of six cases

Thyroid abscess is a rare clinical entity and infrequently encountered. We hereby present a review of six cases-four in the paedriatic and two in the adult age group who presented to our hospital which is a Tertiary care referral centre with thyroid abscess and the management varying from serial aspiration to incision and drainage of abscess. A brief review of literature is also included. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12019 Bangladesh J Otorhinolaryngol 2012; 18(2): 207-211

Schwannoma of the palatine tonsil

Schwannomas can originate in any peripheral, autonomic, or cranial nerve except the olfactory and optic nerves. Between 25 and 48% of all schwannomas have been reported to arise in the head and neck, with the acoustic nerve being the most common site of origin there. Schwannomas of the palatine tonsil are rare; as far as we know, only 6 such cases have been previously reported in the literature; 5 of these 6 occurred in adults and the other in an adolescent. We report a new case in a 42-year-old woman, which was diagnosed on the basis of histopathology.

Role of mitomycin-C in prevention of post operative adhesions after endoscopic sinus surgery--a prospective study

To evaluate the role of Mitomycin-C in preventing synaechiae formation and ostial stenosis following endoscopic sinus surgery. This prospective study was conducted in VMMC and Safdarjung hospital from November 2007 to August 2008. 30 subjects aged between 16 and 60 of either sex in two groups were included in the study. All these patients with bilateral nasal polyposis underwent endoscopic sinus surgery with topical application of Mitomycin-C and were subjectively and objectively assessed for improvement of symptoms and post operative synaechiae formation. Patients showed improvement in subjective symptoms mainly nasal obstruction and hyposmia as well as decreased incidence of synaechiae formation and ostial stenosis post surgery following Mitomycin-C application. After doing this study we could conclude that Mitomycin-C applied topically following endoscopic sinus surgery was helpful in improvement of symptoms like nasal obstruction and hyposmia as well as decreased adhesion rate and middle meatal antrostomy closure rate. Topical application of Motomycin-C was safe in a dose of 0.4-0.8 mg/ml applied over 5 min and offered significant improvement both subjectively and objectively.