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. 2001 Mar;85(3):291–296. doi: 10.1136/bjo.85.3.291

Distant cancer effects on standardised testing of peripheral vision

W Dawson 1, B Jordan 1, R Marsh 1, K Hazariwala 1, F Flowers 1, T Fang 1
PMCID: PMC1723897  PMID: 11222333

Abstract

BACKGROUND—Profound central-retinal visual losses have been a major presenting factor reported in cancer and melanoma associated retinopathies (CAR, MAR). However, it is well established that standardised tests of peripheral retinal function are often the most sensitive detectors of early eye disease. This is a preliminary investigation of the responsiveness of the peripheral retina to "distant" (non-eye or CNS) cancers using easily obtained standardised tests.
METHODS—The design is a single blind study where test results are compared with published norms and a small age matched control group. Of 120 ambulatory cancer outpatients who were interviewed at routine follow up examinations, 111 volunteered and admitted a range of mild visual changes. 25 cancer patients completed all tests of peripheral vision function and a clinical screening. There were seven control subjects of the same age range.
RESULTS—98% (49 of 50) of eyes from the patient cohort were judged clinically normal following examinations which emphasised the central retina, fundus appearance, and static fields. On testing which emphasised the visual periphery, 46 (92%) eyes showed one or more quantitative abnormalities >2 SD from the age adjusted norm means. These abnormalities clustered mainly about dark adaptation (rod cell) sensitivity (31, 62% of measured sites), the blue sensitive retinal cells (17, 34% of measured eyes), and the oscillatory component (OP) of the electroretinogram (23, 46% of measured eyes). One control eye (7%) showed a significant dark adaptation abnormality and ERG reduction. There was no identifiable interaction between chemotherapy mode and the cancer associated retinal deficits (CARD). Antiretinal antibodies were found in sera from most patients and controls.
CONCLUSION—CARD is common in the retinal periphery of many cancer patients, and is distinct from rare CAR, MAR central-retinal responses. CARD has numerous potential clinical uses which justify expanded research with more defined large samples.



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Figure 1  .

Figure 1  

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Visual abnormalities in cancer patients. Distribution of patient eyes by diagnosis and visual deficits >2 SD below the norm means. Colour confusion (Colour), electroretinogram high pass signal (OP), final dark adapted sensitivity (dark), deficit bar widths indicate the number of eyes representing a specific diagnostic category. Minor, less numerous deficits are lumped as "other". A variety of small sample cancers are represented under "other". These include lung, testicular, cervical, bladder, renal, and Ewing's sarcoma.

Figure 2  .

Figure 2  

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Common colour sensitivity deficits. Typical distributions of colour confusion in the colour space configured by the FM test and its norm database. (A) Common male protan (white) together with deutan error axes (black). Protan is the distribution with the peak at 67%. (B) Non-axial scatter produced a normal error score (breast cancer patient). (C) Tritanopic defect (testicular cancer patient) with peaks in the blue axis region of colour space loci 34-49. Other errors in (C) show general colour confusion.

Figure 3  .

Figure 3  

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Dark adaptation in cancer patients. Goldmann-Weekers dark adaptation threshold record. Darkness began at 5 minutes after 1000 trolands full field light adaptation. The ordinate is log threshold for light detection. Abcissa is time. The dark band is the means plus or minus 2 SD for two norm groups, one generated internally and one external.11 Points (diamond) at 25, 30, and 35 minutes represent thresholds from the cancer patient sample presented as mean and plus 2 SD.

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