Carlo 2019. The topographical relationship between visual field loss and peripapillary retinal nerve fibre layer thinning arising from long-term exposure to vigabatrin. CNS Drugs 33 (2) , pp. AbstractBackground The anti-epileptic drug vigabatrin is associated with visual field loss (VAVFL) and thinning of the peripapillary retinal nerve fibre layer (PPRNFL), thereby implicating retinal ganglion cell (RGC) dysfunction.Objective The objective of the study was to determine the relationship between the two outcomes in order to improve the risk/ benefit analysis of vigabatrin, particularly in those unable to undertake perimetry.Methods A retrospective cross-sectional observational design identified 40 adults who had received vigabatrin for refractory seizures and who had undergone a combined protocol of perimetry and optical coherence tomography (OCT) of the PPRNFL. Two established models successfully applied to other optic neuropathies were used to evaluate, topographically, the function-structure relationship for the superior and inferior retinal quadrants. ResultsThe function-structure relationship for each model was consistent with other optic neuropathies. With the first model, PPRNFL thinning, expressed in µm, asymptoted at an equivalent visual field loss of worse than approximately -10.0dB, thereby preventing assessment of more substantial thinning. The second model overcame the asymptote by transforming the outcomes to RGC soma and axon estimates, respectively; the latter were linearly related.Conclusions Concurrent use of perimetry and OCT, enabling reciprocal validation, is essential for the detection and assessment of vigabatrin toxicity. However, OCT affords a limited measurement range compared to perimetry: severity cannot be directly assessed when the PPRNFL quadrant thickness is less than approximately 65µm, depending upon the type of tomographer. This limitation can be overcome by transformation of thickness to remaining axons, an outcome requiring input from perimetry.

BACKGROUND/AIMS:To evaluate the refractive status, axial length, and prevalence of amblyopia among Saudi children with unilateral congenital nasolacrimal duct obstruction (UCNLDO) compared to the unaffected fellow eye.METHODS:A retrospective chart review was performed for children with UCNLDO at two eye institutes in Eastern Saudi Arabia from 2009 to 2015. The outcomes of syringing determined UNCLDO. The risk factors for amblyopia were defined as anisometropia of (spherical equivalent) >1.5 D, hyperopia >3.5 D, myopia >3.0 D, astigmatism >1.5 D at 90° or 180°, >1.0 D, any manifest strabismus, any media opacity >1 mm, or ptosis 1 mm or less margin reflex distance 1 along with blunting of vision in that eye. Matched-pair analysis was performed to correlate variables. P < 0.05 was considered statistically significant.RESULTS:We included 39 children with UNCLDO. The mean axial length was 21.4 ± 1.3 mm for the eyes with UCNLDO and 21.6 ± 1.0 mm for the fellow eye (P = 0.4). Hyperopia >+2 D was present in 17 (44%) eyes with UCNLDO and none of the fellow eyes. None of the participants had strabismus.CONCLUSION:Axial length and risk factors of amblyopia such as anisometropia, hyperopia, and strabismus were not associated with UCNLDO. UCNLDO is likely an isolated defect.

Clinicians and patients, in enabling informed choice, should be alert to the possible substantial increased risk:benefit for VAVFL with increasing long-term exposure to vigabatrin and the ensuing increased cost:benefit resulting from the necessary additional visual assessments.

Background: Menopause is a period where natural cessation of menses occurs, some quality of life characteristics changes with some symptoms associated with this time such as hot flushes and anxiety. Objective: To evaluate and specify the level of impact of these symptoms on the quality of life among women in the Qatif area, Saudi Arabia and to study the factors that may involve in their perception. Methods: A cross-sectional study was conducted of 151 women aged 40 -60 years old interviewed at either hospital or PHCs, a translated and revised questionnaire of other studies with some adoption. Results: 151 women out of 200 participated in questionnaires, majority of them were highly educated having at least a bachelor's degree around 80%, and around 75% of participants were either working or retired, with a moderate level of income and enjoying a good lifestyle 93% in around and 97% in the after menopause. With the majority, were not used hormones 95% or conceptive pills 91%, personal perception of health were high around 93% for around and 97.2% for after menopause with no significant statistical difference between the two groups. Conclusion: Perception and knowledge of menopause were very high, with no differences in the severity of symptoms of the four QOL domains for the around or after menopause among the participants. High level of education and increased level of income and knowledge of the participants may play an important role in the result, so further investigation is advised.

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