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Kinetics of Visual Field Loss in Usher Syndrome Type II

¹From the Departments of Ophthalmology and ²Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; the ³Division of Ophthalmology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; the ⁴Department of Ophthalmology, Università degli Studi di Parma, Parma, Italy; and the ⁵Boys Town National Research Hospital, Omaha, Nebraska.

PURPOSE. To characterize the kinetics of visual field decay in Usher syndrome type II.

METHODS. The area of 137 Goldmann visual fields (GVFs) delimited with the I4e and V4e targets was measured in each eye of 19 patients with an established diagnosis of Usher syndrome type II, and the average interocular GVF area for each patient at each time point was calculated. The average follow-up was 5.58 years. Symptomatic disease duration was defined as years elapsed after symptoms were first noted. The data set (n = 67 for the I4e target; n = 70 for the V4e target) was analyzed with a random coefficient mixed model to identify the best-fit model describing the decay of visual field size over time. The half-life of the residual visual field area (t_0.5) was also calculated.

RESULTS. The variable that best explained the decay of the GVF area was the duration of symptomatic disease. In an exponential model, the slope estimate for the natural log of the GVF area was -0.172 for the I4e target and -0.136 for the V4e target for each year of symptomatic disease. Accordingly, t_0.5 was approximately 4 years for the I4e target and 5 years for the V4e target. These estimates are very similar to those in previous studies of nonsyndromic retinitis pigmentosa (RP).

CONCLUSIONS. This study suggests that the kinetics of GVF decline in Usher syndrome type II are, on average, very similar to other forms of RP and that, once the disease becomes symptomatic, GVF deterioration follows stereotyped kinetics, even in patients with late-onset retinal disease.

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