Visual Field Loss in Patients with Refractory Partial Epilepsy Treated with Vigabatrin Final Results from an Open-Label, Observational, Multicentre Study

Wild, John M.; Chiron, Catherine; Hyosook Ahn; Baulac, Michel; Bursztyn, Joseph; Gandolfo, Enrico; Goldberg, Ivan; Goñi, Francisco Javier; Mercier, Florence; Nordmann, Jean-Philippe; Safran, Avinoam B.; Schiefer, Ulrich; Perucca, Emilio
November 2009
CNS Drugs;2009, Vol. 23 Issue 11, p965
Academic Journal
BACKGROUND: Use of the antiepileptic drug vigabatrin is associated with an elevated risk of visual field loss. OBJECTIVE: To determine the frequency of, and risk factors for, vigabatrin-attributed visual field loss (VAVFL) in the setting of a large-scale, multinational, prospective, observational study. STUDY DESIGN: A comparative, open-label, parallel-group, multicentre study. SETTING: Hospital outpatient clinics at 46 centres in five countries. PATIENTS: 734 patients with refractory partial epilepsy, divided into three groups and stratified by age (8-12 years; >12 years) and exposure to vigabatrin. Group I comprised patients treated with vigabatrin for > or =6 months. Group II comprised patients previously treated with vigabatrin for > or =6 months who had withdrawn from the drug for > or =6 months. Group III comprised patients never treated with vigabatrin. Patients underwent perimetry at either 4- or 6-month intervals, for up to 36 months. Visual field outcome was evaluated masked to drug exposure. INTERVENTION: Perimetry. MAIN OUTCOME MEASURE: The visual field outcome at each of four analysis points: (i) at enrolment (i.e. baseline, all patients); (ii) for patients exhibiting a conclusive outcome at the initial visual field examination; (iii) for patients exhibiting at least one conclusive outcome to the visual field examinations; and (iv) at the last conclusive outcome to the visual field examinations. RESULTS: Of the 734 patients, 524 yielded one or more conclusive visual field examinations. For Group I, the frequency of VAVFL at the last conclusive examination was 10/38 (26.3%) for those aged 8-12 years and 65/150 (43.3%) for those aged >12 years. For Group II, the respective frequencies were 7/47 (14.9%) and 37/151 (24.5%). One case resembling VAVFL was present amongst the 186 patients in Group III at the last conclusive examination. The frequency of VAVFL in Groups I and II combined was 20.0% for those aged 8-12 years and 33.9% for those aged >12 years. VAVFL was associated with duration of vigabatrin therapy (odds ratio [OR] up to 15.2; 95% CI 4.4, 51.7), mean daily dose of vigabatrin (OR up to 26.4; 95% CI 2.4, 291.7) and male gender (OR 2.51; 95% CI 1.5, 4.1). VAVFL was more frequently detected with static than with kinetic perimetry (OR up to 0.43; 95% CI 0.24, 0.75). CONCLUSIONS: Since the probability of VAVFL is positively associated with treatment duration, careful assessment of the risk-benefit ratio of continuing treatment with vigabatrin is recommended in patients currently receiving this drug. All patients continuing to receive vigabatrin should undergo visual field examination at least every 6 months for the duration of treatment. We recommend two-level (three-zone), gradient-adapted, suprathreshold static perimetry of the peripheral field together with threshold perimetry of the central field out to 30 degrees from fixation. The frequency of ophthalmological and perimetric examinations should be increased in the presence of VAVFL.


Related Articles

  • Temporal sensitivity in a hemianopic visual field can be improved by long-term training using flicker stimulation. Raninen, A.; Vanni, S.; Hyvärinen, L.; Näsänen, R. // Journal of Neurology, Neurosurgery & Psychiatry;Jan2007, Vol. 78 Issue 1, p66 

    Background: Blindness of a visual half-field (hemianopia) is a common symptom after postchiasmatic cerebral lesions. Although hemianopia severely limits activities of daily life, current clinical practice comprises no training of visual functions in the blind hemifield. Objective: To find out...

  • Optimizing Contrast Sensitivity Perimetry for Clinical Use. Dul, Mitchell W. // Journal of Ophthalmic & Vision Research;Jan2013, Vol. 8 Issue 1, p74 

    The article presents information on the clinical use of perimetric testing for examining visual field abnormalities. It states that high test-retest variability affects conventional automated perimetry (CAP), which is inversely connected with retinal sensitivity. Images displaying contrast...

  • Two types of acute zonal occult outer retinopathy differentiated by dark- and light-adapted perimetry. Kuniyoshi, Kazuki; Sakuramoto, Hiroyuki; Nakao, Yuzo; Matsumoto, Chota; Shimomura, Yoshikazu // Japanese Journal of Ophthalmology;Mar2014, Vol. 58 Issue 2, p177 

    Purpose: To assess the results of perimetry recorded under dark- and light-adapted (DA and LA) conditions in patients with acute zonal occult outer retinopathy (AZOOR) and to compare the results of electroretinography (ERG) and spectral-domain optical coherence tomography (SD-OCT) in two groups...

  • Matrix 24-2 Compares Favorably with SITA-Standard. Shaikh, Adam; Semes, Leo; Bartlett, Jimmy D.; Aiyuan Xie // Review of Optometry;3/15/2005 Supplement, Vol. 142, p3 

    Discusses the efficacy of the Humphrey Matrix 24-2 Standard Perimetry. Comparison with the Humphrey Field Analyzer 24-2 SITA-Standard Perimetry; Role of frequency doubling technology as a tool in visual field evaluation; Instruments' use of a different stimulus to measure retinal sensitivity;...

  • Prediction of future scotoma on conventional automated static perimetry using frequency doubling technology perimetry. Kogure, S.; Toda, Y.; Tsukahara, S. // British Journal of Ophthalmology;Mar2006, Vol. 90 Issue 3, p347 

    Aim: To see if scotoma detected with frequency doubling technology (FDT) is confirmed by Humphrey field analyser (HFA) 3 years later. Methods: Subjects were first examined with the screening C-20-1 program of FDT. The visual field was examined annually for 4 years using HFA program C30-2. The...

  • Perimetric and retinal nerve fiber layer findings in patients with Parkinson's disease. Tsironi, Evangelia E.; Dastiridou, Anna; Katsanos, Andreas; Dardiotis, Efthymios; Veliki, Stella; Patramani, Gianna; Zacharaki, Fani; Ralli, Stella; Hadjigeorgiou, Georgios M. // BMC Ophthalmology;2012, Vol. 12 Issue 1, p54 

    Background: Visual dysfunction is common in Parkinson's disease (PD). It remains, however, unknown whether it is related to structural alterations of the retina. The aim of this study is to compare visual field (VF) findings and circumpapillary retinal nerve fiber layer (RNFL) thickness in a...

  • Loss of vision. Vafidis, Ms Gilli // GP: General Practitioner;11/30/2007, p28 

    The article presents detailed information on various aspects of loss of vision. Loss of vision is caused by opacity preventing light reaching the photo-receptors or by an interrupted nervous connection between photoreceptor and brain. The most common cause of blindness is cataract. Without...

  • Electroretinographic Responses in Epileptic Children Treated With Vigabatrin. Bali, MohammadKazem Bakhshandeh; Otaghsara, Seyedeh Mohadeseh Taheri; Soltansanjari, Mostafa; Sadighi, Nadia; Nasehi, Mohammad Mahdi; Ashrafi, Mahmoud Reza; Karimzadeh, Parvaneh; Taghdiri, Mohammad Mahdi; Ghofrani, Mohammad // Journal of Child Neurology;Jun2014, Vol. 29 Issue 6, p765 

    Vigabatrin is an antiepileptic drug that results in higher gamma-aminobutyrate levels in the brain and retina. Vigabatrin-induced visual field defects are usually asymptomatic and only detectable by perimetry. Further, perimetry requires good cooperation, and children aged under 10 years cannot...

  • Defining low vision.  // Mayo Clinic Guide to Better Vision;2007, p186 

    A chapter from the book "Mayo Clinic Guide to Better Vision" is presented. It focuses on the different levels of low vision, from mild to more severe loss of sight. It is stated that any person with vision that cannot be corrected to better than 20/200 in the best eye, or who has 20 degrees or...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics