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PubMed1993

Quality control functions of the Visual Field Reading Center (VFRC) for the Optic Neuritis Treatment Trial (ONTT).

The Visual Field Reading Center (VFRC) was established to assess visual field testing in the Optic Neuritis Treatment Trial (ONTT), to train and certify ONTT technicians, and to monitor the quality of the visual fields through evaluation of the technical aspects of the visual field testing. We describe the functions of the VFRC personnel and the standardized test protocols developed by the VFRC for Humphrey and Goldmann perimetry. We also describe the VFRC procedures for training and certifying visual field technicians, double-checking the eligibility of ONTT patients, assessing the quality of the visual field data, and processing visual field data. In addition, we describe the principles applied by the director and associate director of the VFRC in their clinical classification of the various localized and diffuse visual field defects observed in the Humphrey and Goldmann visual fields. The VFRC has processed more than 14,000 Humphrey and Goldmann visual field tests. The visual field quality control procedures and visual field defect classification process have been shown to be quite reproducible. Through quality control assessment procedures, we have been able to pinpoint a variety of problems at an early stage and promptly implement corrective measures. The standardized test protocols, technician training and certification procedures, and quality control assessment techniques used by the VFRC for the ONTT may serve as a model for future clinical trials employing visual field data as an outcome measure. These procedures can also be used to enhance visual field reliability in ophthalmological practices.

Education↗
PubMed1998

[The significance of combination of electrophysiology and automated perimetry tests on the early diagnosis of primary open angle glaucoma].

OBJECTIVE: The study was designed to analyze the relationship among the three electrophysiological tests and visual fields in primary open angle glaucoma (POAG) in order to find some more sensitive and specific parameters in earlier and early diagnosis of patients with POAG. METHODS: Thirty-six(70 eyes) patients with POAG, 8(12 eyes) glaucoma suspects and 30 (60 eyes) normal subjects underwent pattern electroretinogram (PERG), oscillatory potentials (OPs), pattern visual evoked potentials (PVEP) and Humphery automated perimetry tests respectively. RESULTS: The abnormal rate of PERG was the highest among the three electrophysiological tests in the glaucoma suspects and those of PERG and automated perimetry results were higher than others after early stage. In the correlation analysis of all objects, the amplitude of PERG had negative correlated with IOP and visual indices, but no correlation with C/D and VA. OPs had negative correlated with C/D, and no correlation with visual fields indices, intraocular pressure (IOP) and visual acuity (VA). The latency of PVEP had positive correlation with visual fields indices and C/D, but no correlation with IOP. CONCLUSION: Statistical result showed that different parameters could be selected according to different appearance of POAG. In the earlier stage before visual field defects could be found, PERG would be a more sensitive indicator if IOP were high; once C/D was abnormal, OPs and PVEP would be the better signs even though IOP was normal. PERG and Humphery automated perimetry were very useful indicators after early stage. It was significant in combination of many visual function tests on earlier or early diagnosis of POAG.

Electrophysiology↗
PubMed2006

Reliability and consistency of dark-adapted psychophysical measures in advanced eye disease.

PURPOSE: To establish reliable vision measures allowing functional monitoring in patients with severe vision loss. METHODS: Legally blind and normally sighted subjects were enrolled in a repeated-measures study to determine the reproducibility of psychophysical vision measures under scotopic conditions. The tests included dark adaptometry, dark-adapted, full-field flash testing, and dark-adapted macular thresholds, obtained by using a perimeter with 500- and 650-nm targets. Two to five test repetitions were performed on the better eye of each subject at monthly intervals. Subject groups included retinitis pigmentosa (RP; n = 33), macular disease (MD; n = 14), optic nerve disease (ON; n = 4), diabetic retinopathy (DR; n = 5), and other retinal diseases (OR; n = 9), and normally sighted control (CTL; n = 12). RESULTS: Dark adaptometry timing yielded mean coefficients of variation for subjects across all groups that averaged approximately 20% throughout the test. For dark-adapted perimetry, the coefficients of repeatability (CR(.95)) were <7 dB (CTL), <8 dB (OR), <6 dB (ON and RP), and <15 dB (MD). Full-field flash test CR(.95) by group varied from 5 to 15 dB, and most low-vision groups performed more reliably than CTL subjects. CONCLUSIONS: Dark-adapted psychophysical tests can provide reproducible vision measures in subjects with severe visual impairments, and these tests would be useful in monitoring outcomes in future clinical trials to reverse, halt, or slow vision loss. The most valuable measure of remaining vision was the dark-adapted, full-field flash test, as it produced repeatable results at all levels of vision loss and for all disease states included in this study.

Adult↗
PubMed2000

Optical coherence tomography (OCT) in acute macular neuroretinopathy.

PURPOSE: To evaluate the value of ocular coherence tomography (OCT) concerning diagnosis and pathogenesis of acute macular neuroretinopathy. METHODS: A 33-year old woman complained of sudden onset of central scotomas in her right eye because of acute macular neuroretinopathy. We performed a direct ophthalmoscopy, a visual field testing, a fluorescein angiography (FA) a multifocal ERG (mf-ERG) and an OCT. RESULTS: We found typical paracentral scotoma in visual field testing, a normal FA and mf-ERG in her right eye. In OCT there was a band of higher reflectivity (115 microm) overlying an intact band corresponding to the retinal pigment epithelium (RPE)/ choriocapillaris complex. Retinal thickness was within the normal range. CONCLUSION: OCT can be an additional valuable tool in acute macular neuroretinopathy as it is a disease with discrete pathology and often normal results in other diagnostic tests.

Acute Disease↗
PubMed1983

Perimetry, visual evoked potentials and visual evoked spectrum array in homonymous hemianopsia.

Confrontation field examination, perimetry, visual evoked potentials (VEPs) to pattern hemi-field stimulation and visual evoked spectrum array to flash stimulation were compared in 50 patients with homonymous hemianopsia. Visual field could be examined by confrontation in all patients and demonstrated the field defect in 96% of cases. Goldmann perimetry could only be performed in 60% of patients, but always quantitatively defined the margins of the defect. VEPs could only be tested in 77% of patients and demonstrated an abnormality in 79% of cases. VEPs were absent to stimulation of the affected hemifield in every case of homonymous field defects with macular splitting. Visual evoked spectrum array could be tested in 95% of patients and revealed abnormalities in 67% of cases. The relative value of each test is discussed.

Adult↗
PubMed1989

Visual field versus visual evoked potentials in maculopathies and optic neuropathies.

Both kinetic and static visual fields and visual evoked potential (VEP) were tested in 52 patients with maculopathies and in 29 patients with axial optic neuropathies. The results of central static quantitative perimetry and pattern reversal VEP were compared. The amplitude and latency of P100 were correlated with the total loss of central visual threshold in maculopathies. While the P100 latency was not correlated with the total loss of the central visual threshold in neuropathies, their latency delay was more obvious than that in maculopathies. We arrived at the conclusion that both VEP and visual field are necessary for assessing function loss and reflecting different pathological mechanisms in macular and optic nerve diseases.

Adolescent↗
PubMed2003

Anatomy of a supergroup: does a criterion of normal perimetric performance generate a supernormal population?

PURPOSE: To interpret individual results from automated perimeters, a normative database must be developed. Typically, a set of criteria determines those subjects that may be included in the database. This study examined whether a criterion of normal performance on an established perimeter generates a subgroup with supernormal perimetric performance. METHODS: The right-eye perimetric results of 100 subjects were analyzed. Subjects had visual acuities of 6/12 or better, no history of eye disease, and normal slit lamp biomicroscopic and ophthalmoscopic examinations. Subjects performed test-retest visual field examinations on a Humphrey Field Analyzer (HFA) 24-2 test (Zeiss Humphrey Systems, Dublin, CA), and on a custom frequency-doubling (FD) perimeter with targets spaced in the same 24-2 pattern. RESULTS: Test-retest correlation (Spearman rank correlation coefficients, rs) for mean defect (MD) and pattern SD (PSD) were 0.65 and 0.40 (HFA), and 0.82 and 0.39 (FD perimeter). Three subjects with HFA MDs in the lower 5% had similarly low MDs on retest, whereas no subject was common between the test and retest for the lower 5% of HFA PSD. Correlation between the HFA and FD test results were 0.41 (MD) and 0.05 (PSD). Based on these correlations, the bias introduced into perimetric probability limits were determined, by using Monte Carlo simulations. CONCLUSIONS: Although a criterion of a normal MD may produce a subpopulation with supernormal perimetric performance, a criterion of a normal PSD is less likely to do so. Also, a criterion on one test type is less likely to create a supernormal group on a different test type. The bias introduced into perimetric probability limits is small.

Adult↗
PubMed1987

Orientation-selective visual loss in patients with Parkinson's disease.

Visual contrast sensitivity was measured using 2 cycle/deg sinewave gratings of different orientations in 10 patients with Parkinson's disease and in 15 age-matched controls. Loss of visual contrast sensitivity was found in 6 patients, all of whom had normal visual acuity. Visual loss depended on grating orientation; in all cases the maximum sensitivity loss was for the horizontal. Sensitivity loss was most marked at a temporal frequency of 4 to 8 Hz. Visual fields gave no hint of the orientation selectivity. We conclude that orientation selectivity implicates visual cortical cells in Parkinson's disease. We tentatively suggest that a preferential loss of contrast sensitivity to horizontal gratings might be due to a functional abnormality in the striate cortex that relatively spares the extrastriate cortex. The dependence of visual loss on temporal frequency combined with the sparing of visual acuity might possibly be understood if Parkinson's disease preferentially affects the visual pathway leading from the retina to cortex via the magnocellular layer of the lateral geniculate nucleus. There is an intriguing similarity between the pattern of visual loss in Parkinson's disease and in multiple sclerosis.

Aged↗
PubMed2006

Pediatric homonymous hemianopia.

INTRODUCTION: Homonymous hemianopia is a disabling condition caused by numerous lesions affecting the retrochiasmal visual pathways. Little is known about homonymous hemianopia in childhood. METHODS: All patients seen in the Neuro-Ophthalmology Unit at Emory University with homonymous hemianopia (confirmed by Goldmann, Humphrey, or confrontation visual fields) between 1989 and 2004 were included. Demographic characteristics, clinical features, and evolution of the visual field defects were compared between the pediatric group (18 years of age or younger) and the adult group (older than 18 years). RESULTS: Among 852 patients with homonymous hemianopia, there were 81 children (86 homonymous hemianopias) and 771 adults (818 homonymous hemianopias). Formal visual field testing was obtained in 93% of pediatric cases and 96% of adults; a majority of patients in both groups were evaluated with Goldmann visual field testing. Demographic and visual field characteristics were similar in both groups. Significant differences were noted for the causative lesions and their location. Traumatic brain injury (34%) and tumor (27%) were the most common causes of homonymous hemianopia in the pediatric group, whereas infarction (63%), traumatic brain injury (12%), and hemorrhage (11%) were the most common causes in the adult group. Most lesions involved the optic radiations (37%), followed by the occipital lobes (26%), in the pediatric group, whereas occipital lobes (47%), followed by optic radiations (32%), were most commonly involved in adults. Approximately one third of the pediatric patients were seen in follow-up, and one third of these homonymous hemianopias spontaneously improved over the course of time. Of the 16 pediatric homonymous hemianopias evaluated within 1 month of onset of the cerebral disorder, 8 (50%) improved. CONCLUSION: Trauma and tumors are the most common cause of homonymous hemianopia in childhood. Although spontaneous improvement can be expected in approximately one third to one half of patients within the first few months, the recognition of homonymous hemianopia frequently is delayed in this population.

Adolescent↗
PubMed2000

The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators.

OBJECTIVE: To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery. METHODS: The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures. MAIN OUTCOME MEASURES: Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA). RESULTS: Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively. CONCLUSIONS: On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT-trabeculectomy-trabeculectomy sequence for black patients and of the trabeculectomy-ALT-trabeculectomy sequence for white patients without life-threatening health problems. The choice of treatment should take into account individual patient characteristics and needs.

Adult↗
PubMed2006

Photoreceptor loss overlying congenital hypertrophy of the retinal pigment epithelium by optical coherence tomography.

OBJECTIVE: To describe the cross-sectional retinal anatomy overlying congenital hypertrophy of the retinal pigment epithelium (CHRPE) using optical coherence tomography (OCT). DESIGN: Retrospective, observational, noncomparative case series. PARTICIPANTS: Ten consecutive patients with CHRPE. MAIN OUTCOME MEASURES: The main outcome measures were retinal and retinal pigment epithelium (RPE) thickness relative to normal tissue and the status of the retinal layers, in particular the photoreceptor layer. RESULTS: The median patient age was 36 years (mean, 34 years; range, 7-56 years). The CHRPE was within 6 mm of the optic disc or foveola in all patients. All patients showed retinal thinning and complete photoreceptor loss overlying the CHRPE. The sensory retina measured a mean of 68% of normal thickness (range, 47%-87%). Of the 8 patients with pigmented CHRPE, the CHRPE was 52% thicker than adjacent RPE. All 8 patients with pigmented CHRPE showed moderate relative shadowing of the underlying choroid. The 2 patients with nonpigmented CHRPE, presumed to represent large lacunae with thin CHRPE rim, showed absent RPE and increased transmission of light, not shadowing, into the choroid by OCT. Both patients with visual field testing showed a visual field defect corresponding to the photoreceptor loss. CONCLUSIONS: Using OCT, overlying retinal thinning and photoreceptor loss directly over CHRPE was found in 10 consecutive patients. These findings likely account for related visual field loss.

Adolescent↗
PubMed2000

Levodopa may improve vision loss in recent-onset, nonarteritic anterior ischemic optic neuropathy.

OBJECTIVE: To study the effect of levodopa in improving visual function in patients treated within 45 days of onset of nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Nonrandomized, retrospective, comparative trial. PARTICIPANTS: The study involved 37 patients with NAION of less than 45 days duration. METHODS: Eighteen patients who had been treated with levodopa were assigned to the case group, and 19 untreated patients were assigned to the control group. Snellen visual acuity converted to logMAR and mean deviation on Humphrey automated perimetry (Program 24-2, Humphrey Instruments, San Leardro, CA) were evaluated at the initial and 6-month visits. INTERVENTION: The 18 patients in the case group were administered a capsule of 100 mg levodopa/25 mg carbidopa (Sinemet 25-100) three times daily for 3 weeks. MAIN OUTCOME MEASURES: The primary outcome measures were changes in visual acuity and visual field at 6 months from baseline. Improvement in visual acuity was defined as a difference of -0.3 logMAR or less between the 6-month and initial visual acuities, whereas worsened visual acuity was a difference of +0.3 logMAR or more. Each 0.3 LogMar represented a doubling of the visual angle, i.e., a change by three lines on the eye chart. Improvement in visual field was defined as a difference in mean deviation of +3.0 dB or more between the 6-month and initial visual field tests, whereas worsened visual field was a difference in mean deviation of -3.0 dB or less. RESULTS: The proportions of patients with worsened, unchanged, and improved visual acuity at 6 months were compared for the levodopa and control groups. There was a significant difference (P = 0.012) between the groups. Examination of the proportions showed that a higher proportion of patients who received levodopa had improved visual acuity with a corresponding lower proportion having worsened visual acuity as compared with the control patients. Ten of 13 patients (76.9%) in the levodopa group with 20/40 visual acuity or worse at baseline had improved visual acuity at 6 months, and none of the 18 patients had worsened visual acuity. In contrast, 3 of 10 control patients (30%) with 20/40 visual acuity or worse at baseline had improved visual acuity at 6 months, and 3 of 19 control patients (16.3%) had worsened visual acuity. The proportions of patients with worsened, unchanged, and improved visual fields at 6 months were compared for the levodopa and control groups. There was no significant difference between the groups (P = 0.25). CONCLUSIONS: Patients treated with levodopa within 45 days of onset of NAION were more likely to experience improvement and less likely to have worsened visual acuity than untreated patients. Levodopa appears to be beneficial in the treatment of recent-onset NAION.

Aged↗
PubMed1989

Legal aspects of visual field assessment.

Visual field testing can fail to satisfy the standard of care if the optometrist does not test the patient's visual field when it is necessary, and if, even when testing is performed, it is of insufficient sensitivity. In general, the duty to test the visual field arises when examining symptomatic patients and when a suspicious finding is encountered, but "routine" eye health assessments should include a screening visual field test. In some cases the doctrine of informed consent will require the optometrist to inform the patient that testing of the visual field at threshold should be performed. Documentation of both test results and patient communications should be retained in the record.

Documentation↗
PubMed2004

Detection of localized retinal dysfunction in a choroideremia carrier.

PURPOSE: To investigate severe unilateral vision loss in a choroideremia carrier. DESIGN: Case report. METHODS: Ocular examination, genetic testing, Humphrey visual fields, full-field and multifocal (mf) electroretinogram (ERG) tests were used to study a family with choroideremia. RESULTS: In a carrier with unilateral central vision loss, mfERG showed severely reduced amplitudes which correlated with a band of retinal pigment epithelial and choroidal atrophy in the macula, a dense central scotoma on Humphrey visual fields testing, and decreased ERG amplitudes. CONCLUSIONS: Multifocal ERG may be a sensitive tool to measure functional abnormalities in choroideremia carriers. Mosaic inactivation of the normal gene may cause expression of the mutation with severe vision loss in choroideremia carriers.

Aged↗
PubMed1992

High-pass resolution perimetry in neuro-ophthalmology. Clinical impressions.

High-pass resolution perimetry is a new technique for visual field testing that determines extrafoveal resolution thresholds. The authors used this method in a neuro-ophthalmology clinic and compared it with other visual field tests. The main advantages of the technique were the short test time and the strong preference by patients for this technique over conventional automated perimetry. The sensitivity and specificity of the test seemed to be as good as or better than conventional perimetry. A minor disadvantage was its slightly less precise spatial definition of field defects. In this report, the authors present their experiences with this new perimetric technique.

Adult↗
PubMed1998

Evaluation of a new perimetric threshold strategy, SITA, in patients with manifest and suspect glaucoma.

PURPOSE: To evaluate the performance of the new perimetric threshold strategy SITA relative to older methods. METHOD: Thirty-two patients with either glaucoma or ocular hypertension performed two threshold visual field tests with each of three threshold strategies, SITA, Humphrey Full Threshold, and Fastpac. Testing was distributed over three visits, and testing order was balanced between strategies to control for order effects. RESULTS: SITA tests consumed 54% of the time taken by Full Threshold tests on average, and 85% of Fastpac tests; SITA's test times were significantly shorter than those of Full Threshold (p<0.0001) and Fastpac (p=0.0008). Test-retest threshold variability did not differ significantly between strategies. Intertest variability of the pattern deviation analysis was lowest in SITA (p<0.01) relative to both Full Threshold and Fastpac. Both SITA and Fastpac showed higher than expected average sensitivities relative to Full Threshold. SITA and Fastpac showed approximately the same amount of visual field loss. There was a significant relationship between Mean Deviation and the SITA function used to shorten stimulus sequences at points where measurement errors are small (p<0.0001). CONCLUSION: Our results suggest that SITA matches the precision of older thresholding methods, consuming considerably and significantly less test time. This indicates that SITA could replace Full Threshold as the standard clinical test used in glaucoma management, without decreasing the quality of test results.

Aged↗
PubMed2005

Risk of sudden visual loss following filtration surgery in end-stage glaucoma.

PURPOSE: To evaluate the effect of filtration surgery on visual acuity and visual fields in patients with end-stage glaucoma during the immediate postoperative period and to assess the risk of sudden visual loss. DESIGN: Prospective interventional, consecutive case-series. METHODS: The study prospectively included consecutive patients with end-stage glaucoma who underwent trabeculectomy with mitomycin-C. The inclusion criterion was a preoperative visual field with Advanced Glaucoma Intervention Study score over 16. Main outcome measures included change in best corrected logMAR visual acuity, in mean deviation (MD) of visual field test, in number of points among the four central visual field points with a sensitivity less than 5 dB and in mean sensitivity of the four central visual field points after surgery. The incidence of intraoperative and postoperative complications was also recorded. RESULTS: Twenty-one patients (21 eyes) were enrolled. Mean age was 64 years (range 31 to 78). Surgery resulted in a reduction of preoperative intraocular pressure (IOP) by 14.1 +/- 9.2 mm Hg (P < .001) and a decrease in postoperative antiglaucoma medication use (P < .001). Preoperatively the mean visual acuity was 0.77 +/- 0.78, and the mean value of the mean deviation at the visual field test was -27.94 +/- 2.7 dB. Three months after surgery, there was no significant difference in visual acuity (0.74 +/- 0.79, P = .73) and mean deviation (-27.50 +/- 2.6 dB, P = .1). Similarly there was no significant change in the visual field parameters tested to assess central visual field sensitivity. There were no intraoperative complications. Transient hypotony occurred in three eyes while one eye presented more extended hypotony. Three of these eyes experienced bleb leak (seidel). CONCLUSIONS: In our case-series of consecutive patients with end-stage glaucoma, followed for 3 months after filtration surgery IOP was reduced effectively and vision was preserved with no occurrences of "wipe-out" phenomenon.

Adult↗