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PubMed1997

Visual function and quality of life among patients with glaucoma.

This study determines the relation between visual field impairment, visual functioning, and global quality of life in patients with glaucoma. Binocular visual field impairment was calculated from simultaneous Esterman visual field testing using the Humphrey automated perimeter. Visual acuity impairment, defined with the American Medical Association's Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the field test version of the National Eye Institute-Visual Functioning Questionnaire; and global quality of life, assessed with the Medical Outcomes Study 36-Item Short Form Health Survey, were determined in 147 consecutive patients with glaucoma. None of the Medical Outcomes Study 36-Item Short Form Health Survey domains demonstrated more than a weak correlation with visual field impairment. The VF-14 scores were moderately correlated (r = -0.58). Of the National Eye Institute-Visual Functioning Questionnaire scales, peripheral vision (r = -0.60), distance activities (r = -0.56), and vision-specific dependency (r = -0.56) were moderately correlated with visual field impairment; vision-specific social functioning, near activities, vision-specific role difficulties, general vision, vision-specific mental health, color vision, and driving were modestly correlated with visual field impairment (r value between -0.32 and -0.55); visual pain was weakly correlated with visual field impairment; and general health and vision-specific expectations were not notably correlated with visual field impairment. Statistically adjusting for visual acuity weakened the correlations. The Medical Outcomes Study 36-Item Short Form Health Survey indicated that our patients with glaucoma were comparable with previously studied patients without severe systemic medical problems. However, the Medical Outcomes Study 36-Item Short Form Health Survey scores did not correlate with visual field impairment in our study. Based on the moderate correlation between binocular visual field impairment with the VF-14 and the National Eye Institute-Visual Functioning Questionnaire, these questionnaires may be useful among patients with glaucoma.

Adolescent↗
PubMedDate not supplied

Newer visual function tests in the evaluation of glaucoma.

Conventional visual field testing, with a uniform white-on-white stimulus, is used routinely to diagnose and follow patients with chronic open-angle glaucoma. Many investigators, however, believe that conventional perimetry may not detect the earliest visual dysfunction in patients with chronic open-angle glaucoma. Consequently, much research has been performed over the past decade to develop a visual function test which might diagnose chronic open-angle glaucoma earlier than conventional perimetry. This review discusses the mechanisms, clinical studies and the current usefulness of the most common new visual function techniques. These tests attempt to detect early glaucomatous visual loss, generally by placing the visual system under stress and by minimizing the influence of extensive functional redundancy in the retinal ganglion cell network due to widely overlapping receptive fields. Success of new visual function tests depends on the specificity and the sensitivity of the instrument, excellent patient acceptance, short test duration, standardization of techniques, and limited expense. In addition to searching for newer visual function tests to evaluate glaucoma, we should continue efforts to improve the diagnostic capability and shorten the test duration of conventional perimetry.

Electroretinography↗
PubMed2002

Visual field assessment and the Austroads driving standard.

PURPOSE: To compare the conventional (Humphrey 24-2) automated visual field testing with the Goldmann standard visual field test for driving, and to predict how many patients with glaucoma may not meet the Australian driving standard with respect to visual fields. METHODS: Four patients (retinitis pigmentosa, glaucoma or vigabatrin treatment) with marked visual field defects as determined by uniocular static computerized perimetry (conventional testing) were re-evaluated with binocular kinetic Goldmann IV4e target field test (Australian driving standard). A series of 48 consecutive patients seen by the Glaucoma Inheritance Study in Tasmania were assessed with both static computerized perimetry and the Goldmann IV4e target test. RESULTS: The four patients with severe visual field defects (on computerized perimetry) were found to meet the driving standard on the binocular Goldmann IV4e target test. On computerized perimetry, 15 of 48 patients from the Glaucoma Inheritance Study in Tasmania were found to have visual field defects of sufficient severity that they may not meet the driving standard. However, only five of these patients failed the driving standard for visual fields, two of whom were still driving. CONCLUSIONS: Patients with severe field defects on conventional uniocular automated perimetry may still meet the Goldmann standard visual field test for driving. Approximately 30% of glaucoma patients would have visual field loss shown on Humphrey 24-2 test of a severity that requires further testing to determine if they meet the driving standard. Ten per cent of glaucoma patients tested did not meet the driving standard for visual fields.

Adult↗
PubMed2005

Risk of glaucoma in ocular hypertension with and without pseudoexfoliation.

PURPOSE: To compare glaucoma conversion rates in patients with ocular hypertension (OH) with and without pseudoexfoliation. DESIGN: Cohort study, based on 32,918 screening participants. PARTICIPANTS AND CONTROLS: Ninety-eight patients with OH and pseudoexfoliation and 98 matched controls. MAIN OUTCOME MEASURE: Perimetric glaucoma conversion. METHODS: A population-based glaucoma screening of elderly citizens of Malmö, Sweden, was conducted between 1992 and 1997 to recruit participants for the Early Manifest Glaucoma Trial. Screening participants with intraocular pressure (IOP) between 24 and 32 mmHg and pseudoexfoliation were compared to controls among other screening participants without pseudoexfoliation but matched for baseline IOP, age, and gender, and the 2 groups were invited to a reexamination. Computerized visual field tests were performed to identify persons with manifest glaucoma. Visual acuity, refraction, IOP, and central corneal thickness were also measured. RESULTS: After a mean of 8.7 years (range: 6.3-11.4), 54 of 98 patients (55.1%) with pseudoexfoliation at the baseline examination and 27 of 98 patients (27.6%) without pseudoexfoliation had developed glaucoma. The risk ratio was 2.0 (P<0.0001). CONCLUSION: The glaucoma conversion rate was twice as high in patients with OH and pseudoexfoliation as in control patients matched for IOP, age, and gender. Thus, pseudoexfoliation was a strong independent risk factor for glaucoma in patients with OH.

Aged↗
PubMed1986

Fully automated screening procedure for early detection of visual field defects.

A major problem in mass screening for glaucoma is the substantial time required to detect areas of depressed visual sensitivity, scotoma. We have developed a novel instrument for testing rapidly and automatically the sensitivity of the visual field. The patient views a large CRT screen on which up to four luminous points are presented in a prearranged pattern. The patient's vocal response is a number from zero to four, the number of stimulus points that he has observed, which is recognized by the controller and recorded. A series of 90 such patterns is presented sequentially, giving a 288 points visual field test, at the conclusion of which a hard copy probabilistic map of the retinal location of scotoma is drawn. The examination procedure is much faster than that using conventional 'automatic' tests and its results are almost identical with those from two commercial instruments with which our experimental 'perimeter' has been compared. Initial clinical trials are very encouraging.

Glaucoma↗
PubMed1994

Visual field interpretation with a personal computer based neural network.

The Computer Assisted Touch Screen (CATS) and Computer Assisted Moving Eye Campimeter (CAMEC) are personal computer (PC)-based video-campimeters which employ multiple and single static stimuli on a cathode ray tube respectively. Clinical studies show that CATS and CAMEC provide comparable results to more expensive conventional visual field test devices. A neural network has been designed to classify visual field data from PC-based video-campimeters to facilitate diagnostic interpretation of visual field test results by non-experts. A three-layer back propagation network was designed, with 110 units in the input layer (each unit corresponding to a test point on the visual field test grid), a hidden layer of 40 processing units, and an output layer of 27 units (each one corresponding to a particular type of visual field pattern). The network was trained by a training set of 540 simulated visual field test result patterns, including normal, glaucomatous and neuro-ophthalmic defects, for up to 20,000 cycles. The classification accuracy of the network was initially measured with a previously unseen test set of 135 simulated fields and further tested with a genuine test result set of 100 neurological and 200 glaucomatous fields. A classification accuracy of 91-97% with simulated field results and 65-100% with genuine field results were achieved. This suggests that neural networks incorporated into PC-based video-campimeters may enable correct interpretation of results in non-specialist clinics or in the community.

Diagnosis, Computer-Assisted↗
PubMed2004

Peripheral cone dystrophy: a variant of cone dystrophy with predominant dysfunction in the peripheral cone system.

PURPOSE: To determine the phenotype of 3 patients from 2 pedigrees with an unusual form of cone dystrophy in which the peripheral cone system is more affected than the central cone system, and whose rod system is relatively normal. DESIGN: Three observational case reports with electrophysiologic and psychophysical studies. METHODS: Three patients underwent fundus photography, fluorescein angiography, color vision testing, Goldmann visual field testing, full-field electroretinograms (ERGs), focal macular cone ERGs, and rod-cone perimetry, in addition to routine ophthalmologic examinations. Multifocal ERGs also were recorded from 2 patients. RESULTS: The fundus examination and fluorescein angiogram results essentially were normal except for a mild temporal pallor of the optic disc in 2 patients. The corrected visual acuity ranged from 20/16 to 20/100. Color vision was normal in 1 patient, but was abnormal in 2 patients. A relative paracentral scotoma was detected in 2 patients. Full-field ERG cone responses were reduced significantly, but rod responses were normal in all patients, as in patients with typical cone dystrophy. However, the focal macular cone ERGs were well preserved in all patients. Psychophysical rod-cone perimetry demonstrated that the peripheral cone system was impaired, whereas the rod sensitivity was completely normal. The results of the multifocal ERG in 2 patients supported the findings made by the full-field and focal macular ERGs. CONCLUSIONS: These findings demonstrate that there is a subgroup of patients with cone dystrophy where the peripheral cone system is more affected than the central cone system.

Adult↗
PubMed1994

Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak.

BACKGROUND: Spontaneous intracranial hypotension has been considered a rare clinical entity, with less than 75 cases reported in the medical literature. With the advent of magnetic resonance imaging (MRI), spontaneous intracranial hypotension currently is being recognized more frequently. The authors report the neurovisual manifestations of this disorder in a consecutive series of three patients. METHODS: Each patient underwent clinical examination, computerized visual field testing, and MRI. After treatment, each patient was re-examined, and MRI was repeated. RESULTS: Two patients had transient visual obscurations and unusual binasal visual field defects on automated perimetry. A third patient had diplopia from an abducens nerve paresis. After treatment of spontaneous intracranial hypotension, these findings improved or resolved. CONCLUSIONS: This case series, and a review of previously reported cases, indicates that neurovisual problems are common in patients with spontaneous intracranial hypotension. Findings may include diplopia from sixth nerve paresis, transient visual obscurations, blurred vision, visual field defects, photophobia, and nystagmus.

Adult↗
PubMed2005

Visual fields correlate better than visual acuity to severity of diabetic retinopathy.

AIMS/HYPOTHESIS: We compared the outcomes of perimetric and visual acuity tests in patients with diabetic retinopathy. METHODS: We examined 59 diabetic patients with different degrees of retinopathy using stereo fundus photography in accordance with the Early Treatment of Diabetic Retinopathy Study (ETDRS) and fluorescein angiography. Conventional white-on-white perimetry (WWP) and short wavelength automated perimetry (SWAP) were performed and analysed with reference to normal values. Visual acuity was measured with ETDRS charts. RESULTS: Regression analysis revealed that visual acuity was significantly associated with increasing severity of retinopathy according to the ETDRS scale when visual acuity was estimated by counting logarithm of minimum angle of resolution (LogMar) scores, but not when visual acuity was measured by the conventional reading of the smallest line that could be seen. Visual acuity decreased by 0.02 LogMar per ETDRS step (p=0.03). The degree of visual field loss was significantly associated with increasing severity of retinopathy according to the ETDRS scale, perimetric sensitivity decreasing by 0.44 dB per ETDRS step (p=0.0001) using WWP, and by 0.40 dB per ETDRS step (p=0.04) with SWAP. The size of the area of the foveal avascular zone and adjacent perifoveal intercapillary areas (PIAs) also affected the central visual field as obtained both by WWP (-2.6 dB/mm2, p=0.03), and by SWAP (-7.9 dB/mm2, p=0.002), but did not affect visual acuity. The regression model fit for peripheral retinopathy according to the ETDRS scale was better using WWP than SWAP or visual acuity, while SWAP testing was superior to both WWP and visual acuity when measuring effects caused by enlarged foveal avascular zones and PIAs. CONCLUSIONS/INTERPRETATION: Perimetry can provide more useful information than visual acuity on functional loss in diabetic retinopathy, particularly when the perifoveal capillary network is damaged.

Adult↗
PubMed1997

The ability of Medmont M600 automated perimetry to detect threats to fixation.

PURPOSE: The authors studied the sensitivity and specificity of the Medmont M600 central 10 degrees program (Medmont PTY Ltd., Camberwell, Victoria, Australia) in identifying paracentral threats to fixation mapped on the Humphrey program 10-2 (Humphrey Inst. Inc., San Leandro, CA, U.S.A.). METHODS: Humphrey automated threshold perimetry (program 10-2) and Medmont M600 automated threshold perimetry (central 10 degrees program) were performed on 62 eyes of 62 patients with glaucoma, and their paracentral point defects on the field were investigated. The sensitivity and specificity of Medmont central 10 degrees program were analyzed. RESULTS: The sensitivity and specificity of Medmont M600 central 10 degrees field was 78% and 81% within 1 degree, and 95% and 83% within 3 degrees in detecting the field defects on the Humphrey program 10-2. The Medmont M600 central 10 degrees threshold visual field test took 36% of the testing time required for the Humphrey threshold 10-2 visual field examination. CONCLUSION: The Medmont perimeter seems to be efficient in its performance of central threshold testing and significantly cuts down the test time.

Fixation, Ocular↗
PubMed2000

Entoptic perimetry screening for central diabetic scotomas and macular edema.

OBJECTIVE: The aim of this study was to compare entoptic perimetry, using conventional television, to Amsler grid and patient-reported visual loss for the detection of functional diabetic maculopathy and macular edema. DESIGN: Observational case series. PARTICIPANTS: A single eye from each of 104 consecutive patients with diabetes in an academic retina clinic. INTERVENTION: Each eye was screened by Amsler grid, entoptic perimetry, and Humphrey 10-2 threshold visual field testing (HVF 10-2; Humphrey Instruments Inc., San Leandro, CA) in random order. Eyes were then examined clinically. MAIN OUTCOME MEASURES: The presence or absence of new visual decline since the patient's last clinical examination, the presence or absence of central visual field abnormalities using an Amsler grid, entoptic perimetry, HVF 10-2, and the presence or absence of clinically significant macular edema (CSME). RESULTS: The sensitivities and specificities for the detection of central diabetic scotomas as evidenced by HVF 10-2 abnormalities were: subjective impression, 31 of 90 eyes (34.4%) and 11 of 14 eyes (78.6%); Amsler grid, 29 of 90 eyes (32.2%) and 13 of 14 eyes (92.9%); and entoptic perimetry, 58 of 90 eyes (64.4%) and 11 of 14 eyes (78.6%). Entoptic perimetry was statistically more sensitive than both subjective impression (P < 0.001) and Amsler grid (P < 0.001), but the specificities were statistically indistinguishable. The sensitivities and specificities for the detection of CSME were: subjective impression, 6 of 24 eyes (25.0%) and 52 of 80 eyes (65.0%); Amsler grid, 9 of 24 eyes (37.5%) and 59 of 80 eyes (73.8%); and entoptic perimetry, 17 of 24 eyes (70.8%) and 44 of 80 (55.0%) eyes. These results are also statistically significant, with entoptic perimetry being more sensitive and less specific than both subjective impression (P = 0.007 and P = 0.011, respectively) and Amsler grid (P = 0.008 and P < 0.001, respectively) in this subset of patients. CONCLUSIONS: Entoptic perimetry is 87% more sensitive than the subjective impression of visual decline (P < 0.001) and 100% more sensitive than Amsler grid (P < 0.001) for the detection of central scotomas in diabetic patients. For the detection of CSME, entoptic perimetry is 183% more sensitive than subjective impression (P = 0.007) and 89% more sensitive than Amsler grid (P = 0.008). Hence, entoptic perimetry, performed using conventional television, has the potential to be an effective, inexpensive, and widespread adjunct to surveillance examinations for the early detection of diabetic maculopathy.

Adult↗
PubMed2004

Amiodarone and optic neuropathy.

PURPOSE: To investigate the clinical, perimetric, contrast sensitivity and visual evoked potentials findings in patients on longterm treatment with amiodarone. METHODS: We enrolled 14 patients (age range 47-78 years, mean age 62.7 years) on chronic amiodarone therapy (mean cumulative dose of 519 g), and 14 age-matched control subjects. Participants were submitted to ophthalmological examination, kinetic visual field testing (Goldmann), standard achromatic automated perimetry (central 30-2, Humphrey), computerized isoluminant chromatic contrast sensitivity (CCS) and pattern visual evoked potentials evaluation (VEP). Data from baseline, 6-month and 1-year follow-up examinations were analysed. The main outcome measures were: initial and final corrected visual acuity; corneal, optic disc and fundus abnormalities; mean deviation (MD) and pattern standard deviation (PSD) central 30-2 perimetry parameters; visual field loss on kinetic perimetry; indices of CCS (tritan, protan and deutan axes), and pattern VEP latency (L-VEP) and VEP amplitude (a-VEP). RESULTS: We found a statistically significant difference between the patients and controls' baseline L-VEP and a-VEP measurements (p < 0.001). We found no significant correlation between prolonged L-VEP and duration of amiodarone use (r = 0.07). After a 1-year follow-up, we evidenced an average increment in L-VEP of 1.96 ms and a-VEP measurements showed a decline of 0.69 micro V. In cumulative dose-specific analyses, mean differences between baseline and 12-month L-VEP measurements were more evident in those taking higher than 200 g cumulative amiodarone doses (p = 0.03). We found abnormal tritan CCS results in 19 eyes (68%). Of these, four eyes belonged to patients with no ocular disease (diabetes, cataracts). No significant differences were observed between the baseline and 12-month clinical eye examinations, central 30-2 perimetry and CCS results. CONCLUSION: We found a significant prolongation in pattern L-VEP and a significant reduction in pattern a-VEP in patients on longterm treatment with amiodarone compared to control subjects. Nevertheless, current data are insufficient to recommend appropriate methods of visual screening.

Aged↗
PubMed2002

Learning effects among perimetric novices in frequency doubling technology perimetry.

PURPOSE: To investigate learning effects, including improvements in reliability indices, in frequency doubling technology (FDT) perimetry in subjects without glaucoma who have not undergone previous automated perimetry. DESIGN: Prospective consecutive case series. PARTICIPANTS: Eighty-one normal subjects. METHODS: Normal subjects were recruited from the University of Washington Eye Clinic who had no history of automated visual field testing. All eyes underwent complete ophthalmic examination. The C-20-5 screening mode of FDT perimetry (Zeiss-Humphrey, San Leandro, CA) was performed after appropriate instruction, including a demonstration of the frequency doubling phenomenon. If any abnormal areas were identified or there were greater than 33% fixation losses or false-positive results, then the test was readministered up to three times or until a normal result was returned. MAIN OUTCOME MEASURES: Normal FDT test. RESULTS: The mean age was 54.8 years (range, 19-94). Sixty-nine subjects (85.2%) returned a normal test after a single test administration. Nine subjects (11.1%) required two administrations, and two subjects (2.5%) required three or more administrations to return a normal test. One subject still tested unreliably after four tests. The number or severity of abnormal locations did not predict the number of trials necessary to overcome learning effects. Fixation loss was the most common reliability problem. Subjects who demonstrated learning effects did not differ significantly in age, visual acuity, refraction, or test time from those who did not. CONCLUSIONS: Some perimetric novices demonstrate learning effects in C-20-5 screening-mode FDT perimetry. Learning effects in FDT perimetry must be considered during screening for glaucoma or other ocular disease.

Adult↗
PubMedDate not supplied

Visual field defects after radial optic neurotomy for central retinal vein occlusion.

PURPOSE: Surgical decompression of the vein in central retinal vein occlusion (CRVO) by radial optic neurotomy (RON) was recently proposed as being surgically feasible, safe, and beneficial. The effect of RON on the visual field has not been systematically reported, although possible visual field defects are expected due to iatrogenic cutting of the optic nerve fibers. The authors report the results of visual field testing in patients who underwent RON at the Tel Aviv Medical Center. METHODS: Twelve consecutive patients (8 men, mean age of all patients 68 years) with nonperfused or indeterminate CRVO whose initial visual acuity (VA) was < or =20/400 underwent RON. Nine of these patients were able to perform visual field tests at 6 months post-RON and their visual field results are presented. RESULTS: : VA improved by > or =3 lines in 5 patients (42%). Three (25%) patients had a final VA of > or =20/200 and another had a final VA > or =20/50. Fundus and VA improvement were relatively slow. Two patients had clearing of the intraretinal blood, resolution of the venous dilation, and improved VA at the 2-month follow-up visit. Temporal visual field defects consisting of temporal ones that could be correlated to the site of the RON incision were detected in five out of the nine patients who were able to perform visual field tests. No temporal visual field defects were found in the remaining four patients, and three other patients were unable to perform visual field tests due to inability to identify the largest target size. CONCLUSION: VA improvement in 5 of 12 patients with ischemic or indeterminate CRVO following RON may be better than the natural history of CRVO. The risk of visual field defects may, however, be heightened by possibly cutting off blood supply to the optic nerve head and possible damage to nerve fibers in the optic nerve head, both inherent to the surgical procedure and both likely to produce visual loss.

Adult↗
PubMed2001

Homonymous defect of macular vision in ischemic stroke.

It is generally believed that a homonymous defect of macular vision (HMV) is caused by a small lesion restricted to the occipital lobe tip and rarely results from ischemic stroke. The incidence of HMV was studied retrospectively in 54 patients with infarction of the posterior cerebral artery territory who underwent Goldmann's visual field test. HMV was found in 6 patients (11%). In all of them, HMV was first dismissed due to a confrontation test of visual fields at the bedside and later detected by Goldmann's visual field test. All had a relatively large infarction extending from the occipital lobe tip to the posterior part of the calcarine cortex and/or the neighboring subcortical regions. Stroke-induced HMV can be caused by a large lesion involving the occipital pole and may not be so rare as generally considered.

Aged↗
PubMed1986

The normal visual field on the Humphrey field analyzer.

To provide a bank of normal perimetric data, we tested the central and peripheral visual fields of 102 novice normal subjects using the Humphrey automated perimeter. All eyes used for visual field testing were first carefully examined to be sure that they were, indeed, normal. We calculated population means and standard deviations of each test location and for each decade for age. Average differential light sensitivity decreased with advancing age: -0.5 dB/decade at fixation, -0.6 dB/decade in the central (30-2) field, and -06. dB/decade in the peripheral (30/60-2) field. However, neither the slope nor the shape of the hill of vision changed with aging. Short-term fluctuation was not constant throughout the visual field, but instead was greater in the periphery than the center.

Adult↗
PubMed1992

Permanent homonymous hemianopias following migraine.

Two patients with migraine and repetitive visual field defects of homonymous hemianopic type are reported. The visual field defects were confirmed by Goldmann perimetry and automated static perimetry. Neither computed tomography nor magnetic resonance imaging showed abnormal findings. Decreased cerebral blood flow at the left basal ganglion area was the only abnormal finding detected in one patient by 123I-IMP (iodoamphetamine)-SPECT (single photon emission computed tomography), which is applicable to right homonymous hemianopia. A visual field test that includes the current automated static perimetry is important to the diagnosis and the subsequent treatment of patients with migraine, particularly those who have experienced visual negative phenomena.

Adult↗