title: Using critical flicker frequency in the evaluation of visual impairment in preeclamptic women.
abstract: OBJECTIVE
  To assess critical flicker frequency (CFF) in normal uneventful pregnancy and preeclampsia.
  
  
  METHODS
  Case-control observational study at the University Hospital Jena and Outpatient Institute for Prenatal Diagnosis and Preventive Medicine. 25 non-pregnant women, 75 uncomplicated pregnant women in first, second and third trimester, and 15 women with overt preeclampsia. For comparison with preeclamptic patients we matched 15 normal pregnant women (mNP) for age, parity, body mass index, current smoking and family history of cardiovascular disease (CVD). We measured CFF using the portable HEPAtonorm Analyzer (nevoLAB GmbH, Germany). This device generates a flickering red light, starting with a frequency of 60Hz, giving the subjective an impression of a steady light. The participant signifies once the impression of a flickering light is recognized, and this CFF is recorded. Mean CFF and standard deviation is automatically calculated. Statistical analysis was performed using SPSS Version 22 for Windows. Following assessment of normal distribution with Kolmogorov-Smirnow test, comparisons were made with univariate and multivariate ANOVA and with unpaired and paired t test for continuous data and with χ2test for categorical data.
  
  
  RESULTS
  Critical flicker frequency in healthy pregnant women does not differ from nonpregnant women. No significant differences in CFF measurements exist in first, second, and third trimester. In preeclampsia, CFF is significantly decreased compared to normal pregnant women (PE 38.80±2.16 vs. mNP 46.23±3.37; p=0.000). This alteration persists even some weeks postpartum (PE 41.17±1.13 vs. mNP 46.45±3.44; p=0.003).
  
  
  CONCLUSIONS
  In preeclamptic women, CFF is decreased indicating an altered endothelial situation. The finding that CFF remains reduced postpartum may be explained by either the effect of preeclampsia on maternal endothelium causing longer lasting damage or indicate a preexisting endothelial disorder. Up to this point, precise responsible mechanisms for altered CFF in preeclampsia are currently unclear and further studies are needed.
authors.affiliation: Department of Obstetrics, Jena University Hospital, Friedrich-Schiller-University, 07744 Jena, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Maier
authors.affiliation: Department of Prenatal Diagnosis and Preventive Medicine, GesaTal Medical Center, 99089 Erfurt, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Brückmann
authors.affiliation: Department of Obstetrics, Jena University Hospital, Friedrich-Schiller-University, 07744 Jena, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Schleußner
authors.affiliation: Department of Obstetrics, Jena University Hospital, Friedrich-Schiller-University, 07744 Jena, Germany; Clinic of Obstetrics, Vivantes Hospital Berlin-Neukoelln, 12351 Berlin, Germany. Electronic address: dietmar.schlembach@vivantes.de.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schlembach
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014787:Vision Tests
keywords: Critical flicker frequency; Hypertension; Preeclampsia; Pregnancy; Visual function