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PubMed2002

[Comparative investigation of the etiology of visual field defects after epimacular surgery].

BACKGROUND: Sectorial visual field defects after macular hole surgery were described by several authors. The intraocular gas tamponade is discussed to be a possible causative factor for this complication. PATIENTS AND METHODS: Goldmann perimetry and threshold perimetry were performed preoperatively and 6 weeks postoperatively in 48 patients who underwent epimacular surgery because of macular pucker (23 eyes) or macular holes stage II - IV (25 eyes). Laser polarimetry was performed additionally using the Nerve Fiber Analyzer. The results were compared quantitatively. In all cases an epimacular membrane was peeled off. Eyes with macular holes underwent fluid-gas exchange with SF 6 without drying up the retina completely. RESULTS: No patient showed a sectorial visual field defect. The quantitative comparison of visual field examinations did not prove a difference between both groups. CONCLUSIONS: We could not detect any impairing influence of the intraocular gas tamponade in our patients. Without complete desiccation of the vitreous cavity, visual field defects after macular hole surgery are unlikely.

Aged↗
PubMed1980

Visual field abnormalities in multiple sclerosis.

Visual fields were examined with a tangent screen in 54 patients with multiple sclerosis (MS) or optic neuritis (ON). Visual fields were abnormal in all patients with definite MS, 94% with probable MS and 81% with possible MS. Three-quarters of the MS patients with no history of visual symptoms had abnormal fields. The commonest defect found was an arcuate scotoma. As a diagnostic test of visual pathway involvement in MS, tangent screen examination compares favourably with more sophisticated methods.

Adult↗
PubMed2006

Nonarteritic anterior ischemic optic neuropathy and 'visual field defects' following vitrectomy: could they be related?

BACKGROUND: Visual field defects after uncomplicated vitrectomy have been reported but poorly explained. We describe two cases of nonarteritic anterior ischemic optic neuropathy (NAION) observed following vitrectomy. We also reviewed the literature for cases of post-vitrectomy visual field defects for evidence of optic nerve damage. METHODS: Two patients developed optic disc edema and features of an optic neuropathy after uncomplicated vitrectomy for macular hole and epiretinal membrane. A systematic literature search was conducted to obtain prior reports of visual field defects or ischemic optic neuropathy following vitrectomy. Additional studies were identified from the bibliographies of the retrieved articles. RESULTS: The incidence of visual field defects following vitrectomy has varied from 1-71% across all studies. Overall, we found 160 (14.5%) cases of unexplained visual field defects following vitrectomy out of 1,104 patients. Of these, 31 eyes (19.4%) have shown some sign of optic nerve damage following vitrectomy, including pallor in 29 eyes, relative afferent pupillary defect in eight eyes, and intrapapillary hemorrhage in two eyes. CONCLUSIONS: NAION may develop following vitrectomy. "Visual field defects" following vitrectomy are common and many of the involved eyes demonstrate evidence of optic nerve damage, some of which may have represented NAION.

Aged↗
PubMed1982

Subclinical visual field defects in multiple sclerosis. Demonstration and quantification with automated perimetry, and comparison with visually evoked potentials.

Fourteen patients with definite but inactive multiple sclerosis (MS) and 17 normal controls were examined with the automated perimeter octopus. Most of the patients had subclinical visual field defects, typically consisting of patchy, shallow scotomata located mostly in an area of between 15 degrees and 30 degrees eccentricity. In 8 patients, more than 15% of the tested visual field of at least one eye was abnormal. The severity and extent of the defects was unrelated to a history of optic neuritis. When visually evoked potentials (VEPs) of these subjects were examined using a reversing pattern, no correlation was found in the MS patients between prolonged VEP latencies and the location, depth or extent of visual field defects. Since subclinical visual field defects may be found in MS patients with normal VEP latencies, automated perimetry can be helpful in diagnosing some cases.

Adolescent↗
PubMed1999

Blindsight in subjects with homonymous visual field defects.

Brain damage in the visual system can lead to apparently blind visual areas. However, more elaborate testing indicates that some visual ability may still exist for specific stimuli in the otherwise blind regions. This phenomenon is called 'blindsight' if subjects report no conscious awareness of visual stimuli but when forced to guess, nevertheless perform better than chance. It has mainly been suggested that secondary visual pathways are responsible for this phenomenon. However, no published study has clearly shown the neural mechanism responsible for blindsight. Furthermore, experimental artifacts may have been responsible for the appearance of the phenomenon in some subjects. In the present study, the visual fields of nine subjects were mapped and residual visual performance was examined in many areas using three different experimental procedures. Artifacts such as stray light or eye movements were well controlled. In addition, confidence ratings were required after each trial in the forced-choice tests. The results show that only one subject with a lesion in the optic radiation had blindsight in two discrete areas of the affected visual field. Spared optic radiation fibers of the main (primary) geniculo-striate visual pathway were most likely to account for this finding.

Adult↗
PubMed1989

Evidence for a neural basis of age-related visual field loss in normal observers.

Many studies have reported a decrease in visual field sensitivity as a function of increasing age in normal individuals. This age-related sensitivity loss has mainly been attributed to reductions in pupil size and transmission losses of the ocular media (particularly the lens), although neural losses in the retina, optic nerve and visual cortex have also been suggested. We evaluated the role of preretinal factors on normal visual field changes associated with aging. The central visual field of both eyes of 62 normal subjects (ages 20 to 72) were evaluated with Program 30-2 of a modified Humphrey Field Analyzer. Three test procedures were employed: (1) a standard visual field evaluation; (2) a yellow target on a yellow background condition (530 nm cutoff filter) to minimize the influence of lens transmission losses with age; and (3) a large target/high background luminance "yellow on yellow" test condition (530 nm cutoff filter, 635 asb background, Size V target) to minimize both pupil size and lens effects on central visual field sensitivity. In addition, relative lens absorption estimates were obtained for each subject. All three test conditions revealed a loss in visual field sensitivity with increasing age (approximately 0.8 dB per decade) but no meaningful differences were found among the three test procedures. Relative lens density increased with age but was not related to visual field sensitivity for any of the three test conditions. These data suggest that normal age-related visual field sensitivity changes are primarily due to neural losses rather than preretinal factors.

Adult↗
PubMed1998

Is visual field evaluation using multiple correlations and linear regressions useful? An evaluation of Delphi perimetry.

BACKGROUND: Delphi perimetry is a method of visual field examination which produces a statistical estimation of the visual field by testing only four critical points of the central visual field. This study was performed to evaluate this technique for the detection of glaucomatous field loss. METHOD: Patients with glaucoma and ocular hypertension underwent Delphi perimetry and Humphrey visual field analysis (HVFA) program 24-2. The visual field results of both examination were compared. RESULTS: Of 262 eyes from 199 patients, 120 eyes showed glaucomatous defects by HVFA and 142 were normal. Delphi perimetry showed abnormal visual fields in 107 eyes, 13 of which were false-positive results as Humphrey visual fields were normal. Delphi classified 155 fields as normal, of which 26 were false negatives as Humphrey visual fields showed glaucomatous defects. Therefore, the sensitivity of Delphi perimetry for the detection of glaucomatous visual field defect was 78% and the specificity was 91%. In the 26 false-negative eyes, the most common defect missed was an isolated paracentral scotoma or an early nasal step. Furthermore, 27 of the 94 glaucomatous eyes classified as abnormal by Delphi had defects estimated by Delphi perimetry that corresponded poorly to the field loss demonstrated by Humphrey visual field analysis. Therefore, qualitative sensitivity and specificity of Delphi perimetry for producing an accurate representation of the location, extent and defect depth of glaucomatous visual field loss would be 48.8% and 72% respectively. CONCLUSION: In this study Delphi perimetry failed to give an accurate statistical estimation of the visual field in an unacceptably high number of cases; therefore, it cannot be recommended for clinical use.

False Positive Reactions↗
PubMed2006

Travoprost versus latanoprost combinations in glaucoma: economic evaluation based on visual field deficit progression.

OBJECTIVE: Changes in intraocular pressure (IOP) are known to be related to visual field deficit progression, although multiple models of this relationship exist. In addition, visual functioning is known to affect medical costs. The objective of this study was to project visual field deficit progression and subsequent costs based on clinical trial data. RESEARCH DESIGN AND METHODS: Using data from a randomized, 12-month, double-masked study, we compared the use of a fixed combination of travoprost 0.004%/timolol 0.5% (T/T) versus a fixed combination of latanoprost 0.005%/timolol 0.5% (L/T) on visual field deficit progression and associated costs. We applied published algorithms linking IOP to visual field changes to calculate the likelihood of visual field deterioration by treatment group. Differences in medical care costs were estimated using guideline-recommended practice patterns, Medicare hospital costs, and published estimates of differences in hospitalization by visual functioning. MAIN OUTCOME MEASURES: Increase in visual field deficit progression rates, increase in annual hospital days per subject, and increase in annual hospital, outpatient, and total costs per subject. RESULTS: Predicted visual field deficit progression for T/T patients was less than that for L/T patients (not statistically significant). Projected annual medical care costs were 43 dollars lower for T/T vs. L/T patients. CONCLUSIONS: By applying published algorithms linking IOP to visual field changes, this study projected long-term visual field deficit and associated costs. Use of a fixed travoprost/timolol solution may lead to less long-term visual field deficit progression and lower annual medical care costs than a fixed latanoprost/timolol solution. DISCUSSION: The use of clinical trial data may limit the applicability of these findings. However, this analysis of direct medical costs only is likely a conservative estimate of the costs associated with visual field deficits.

Adult↗
PubMed2003

Magnetic field visualization in applications to pulsed electromagnetic field stimulation of tissues.

Electromagnetic field visualization is important in multidisciplinary research on the molecular basis of therapeutic effects of pulsed electromagnetic fields (PEMF). We have compared classic PEMF representations by two-dimensional field lines and field magnitude contour plots with a field representation using three-dimensional field isosurfaces. Field simulations were performed for a clinically approved Spinal-Stim Lite system (Orthofix Inc., McKinney, TX). The relatively simple coil system geometry and the predominantly dielectric properties of the surrounding medium (air and human connective tissue) allowed us to develop analytical expressions for the field. The field model was validated by comparison with experimentally measured field values, and with values calculated using a commercial finite-element analysis software package. Two-dimensional field representations by field lines and field contour plots were less intuitive than three-dimensional field isosurface representations to members of the group without an engineering background. Field isosurfaces, represented as three-dimensional solids, allowed for direct visualization of PEMF targeting of individual organs (lumbar spine), the extent of the therapeutic field value, and the directional field characteristics. The dynamic characteristic of the field was well illustrated by a sequence of field isosurfaces corresponding to the evolution with time of the electric current waveform (sawtooth) powering the coils. The isosurface representation of the field can be extended to any three-dimensional coil system geometry using plotting capabilities of current computer algebra software packages.

Computer Simulation↗
PubMed1999

Vigabatrin, a gabaergic antiepileptic drug, causes concentric visual field defects.

OBJECTIVE: To determine whether there is a causal link between vigabatrin treatment and concentric visual field defects and to evaluate the prevalence of these visual field constrictions. BACKGROUND: While the GABAergic antiepileptic drug (AED) vigabatrin was being clinically developed, only rare cases (less than 1:1000) of symptomatic visual field constriction and retinal disorders were reported. During 1997 to 1998, concentric visual field constrictions were described in case reports of mostly drug-resistant epilepsy patients receiving vigabatrin concurrently with other AEDs. METHODS: Ophthalmologic tests including Goldmann perimetry were performed on 32 adult patients on long-term successful vigabatrin monotherapy (treatment duration 29 to 119 months) and on 18 patients on carbamazepine monotherapy (treatment duration 32 to 108 months). Eighteen healthy adults served as controls. RESULTS: None of the patients complained about vision problems when asked to participate into the study. Thirteen out of the 32 (40%) epilepsy patients treated with vigabatrin monotherapy had concentrically constricted visual fields (9% severely, 31% mildly constricted), whereas none of the carbamazepine monotherapy patients or normal controls presented with a visual field defect (chi-square test, p = 0.0001). The extents of the visual fields were significantly constricted in vigabatrin group as compared with the visual fields of the patients in carbamazepine group or healthy controls (analysis of variance, Scheffe F-test, significant at 99%). CONCLUSIONS: The use of vigabatrin seems to increase the risk of a unique and specific pattern of bilateral, mainly asymptomatic visual field constriction. This risk should be considered when using vigabatrin. Visual field testing should also be performed before treatment and during routine follow-up for patients on vigabatrin.

Adolescent↗
PubMed2004

Association of visual field loss and mobility performance in older adults: Salisbury Eye Evaluation Study.

PURPOSE: To determine the association between visual field loss and orientation and mobility (O&M) performance in a population-based sample of older adults and to identify the specific regions of the visual field that are most strongly associated with O&M performance. METHODS: A population-based sample of 1504 persons between the ages of 72 to 92 was enrolled in the third round of Salisbury Eye Evaluation. Monocular visual fields (60 degrees radius) were tested with the 81-point, single intensity (24 dB) screening test strategy on the Humphrey Field Analyzer. Binocular visual fields were estimated from a combination of the monocular fields. The number of points missed was calculated for the overall visual field and for 3 non-overlapping regions: central (< or = 20 degrees radius), upper- and lower-peripheral visual fields. Orientation and mobility performance was evaluated by walking speed, number of bumps, and number of orientation errors on a circuitous, 32.8-m course seeded with obstacles. Log-linear regressions and linear regressions, adjusting for age, gender, body mass, height, cognitive and general health status, were performed. RESULTS: Loss in the overall visual field was associated with an increase in the number of bumps and decrease in walking speed. Visual field loss was not associated with the number of orientation errors. Out of the three visual field sub-regions that we tested, in terms of percentage of loss, the central and lower peripheral regions showed comparable decrements in walking speed and the central region was most strongly associated with number of bumps. CONCLUSIONS: The loss in visual field, which occurs with aging, is associated with a decline in mobility performance. Walking speed decreases, and the number of bumps into obstacles increases, with decreases in the visual field. The number of orientation errors is not associated with the loss in visual field that occurs with aging.

Aged↗
PubMed2004

A visual field abnormality: ocular or cerebral cause?

The visual field can be affected by disorders involving any part of the visual pathway, from the retina to the striate cortex. The pattern of visual field damage can indicate the location of the disorder. The case is presented here of an 8-year-old girl with congenital glaucoma. Initial perimetry appeared consistent with glaucomatous field loss; however, this evolved into a homonymous quadrantanopia, indicating the presence of a cerebral lesion as the cause. Computed tomography and magnetic resonance imaging scans detected a large middle cranial fossa arachnoid cyst. Postoperatively there was resolution of the visual field defects secondary to the arachnoid cyst. The pattern of field loss was pivotal in this patient's management. Attention must be paid when caring for the patient with a chronic disease to ensure that concurrent conditions are diagnosed.

Arachnoid Cysts↗
PubMed2002

Visual field asymmetries for motion processing in deaf and hearing signers.

Recently, we reported a strong right visual field/left hemisphere advantage for motion processing in deaf signers and a slight reverse asymmetry in hearing nonsigners (Bosworth & Dobkins, 1999). This visual field asymmetry in deaf signers may be due to auditory deprivation or to experience with a visual-manual language, American Sign Language (ASL). In order to separate these two possible sources, in this study we added a third group, hearing native signers, who have normal hearing and have learned ASL from their deaf parents. As in our previous study, subjects performed a direction-of-motion discrimination task at different locations across the visual field. In addition to investigating differences in left vs right visual field asymmetries across subject groups, we also asked whether performance differences exist for superior vs inferior visual fields and peripheral vs central visual fields. Replicating our previous study, a robust right visual field advantage was observed in deaf signers, but not in hearing nonsigners. Like deaf signers, hearing signers also exhibited a strong right visual field advantage, suggesting that this effect is related to experience with sign language. These results suggest that perceptual processes required for the acquisition and comprehension of language (motion processing in the case of ASL) are recruited by the left, language-dominant, hemisphere. Deaf subjects also exhibited an inferior visual field advantage that was significantly larger than that observed in either hearing group. In addition, there was a trend for deaf subjects to perform relatively better on peripheral than on central stimuli, while both hearing groups showed the reverse pattern. Because deaf signers differed from hearing signers and nonsigners along these domains, the inferior and peripheral visual field advantages observed in deaf subjects is presumably related to auditory deprivation. Finally, these visual field asymmetries were not modulated by attention for any subject group, suggesting they are a result of sensory, and not attentional, factors.

Adult↗
PubMed2000

Confirmation of visual field abnormalities in the Ocular Hypertension Treatment Study. Ocular Hypertension Treatment Study Group.

OBJECTIVE: To determine the frequency with which visual field abnormalities observed on follow-up visual fields for patients in the Ocular Hypertension Treatment Study were confirmed on retest. METHODS: Between April 1, 1994, and March 1, 1999, 21,603 visual fields were obtained from 1637 patients in the Ocular Hypertension Treatment Study. When follow-up visual fields are outside the normal limits on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation (P<.05), or both, subsequent follow-up visual fields are monitored to confirm the abnormality. Abnormalities are confirmed if they are again abnormal on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation, or both; if the defect is not artifactual; and if the same index and location are involved. Reliability criteria used by the study consisted of a limit of 33% for false positives, false negatives, and fixation losses. RESULTS: Of the 21,603 regular follow-up visual fields, 1006 were follow-up retests performed because of an abnormality (n = 748) or unreliability (n = 258). We found that 703 (94%) of the 748 visual fields were abnormal and reliable, and 45 (6%) were abnormal and unreliable. On retesting, abnormalities were not confirmed for 604 (85.9%) of the 703 originally abnormal and reliable visual fields. CONCLUSIONS: Most visual field abnormalities in patients in the Ocular Hypertension Treatment Study were not verified on retest. Confirmation of visual field abnormalities is essential for distinguishing reproducible visual field loss from long-term variability. Arch Ophthalmol. 2000;118:1187-1194

False Positive Reactions↗
PubMed2000

Prevention of visual field defects after macular hole surgery.

BACKGROUND/AIM: The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula. METHODS: 102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey's perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week. RESULTS: In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The difference in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups. CONCLUSION: The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is confined to the area of the macula so that the hyaloid remains attached at the optic nerve head. The postoperative clinical course does not appear to differ from eyes in which a complete posterior vitreous detachment has been effected during surgery.

Adult↗
PubMed2003

Effect of a patient training video on visual field test reliability.

AIMS: To evaluate the effect of a visual field test educational video on the reliability of the first automated visual field test of new patients. METHODS: A prospective, randomised, controlled trial of an educational video on visual field test reliability of patients referred to the hospital eye service for suspected glaucoma was undertaken. Patients were randomised to either watch an educational video or a control group with no video. The video group was shown a 4.5 minute audiovisual presentation to familiarize them with the various aspects of visual field examination with particular emphasis on sources of unreliability. Reliability was determined using standard criteria of fixation loss rate less than 20%, false positive responses less than 33%, and false negative responses less than 33%. RESULTS: 244 patients were recruited; 112 in the video group and 132 in the control group with no significant between group difference in age, sex, and density of field defects. A significant improvement in reliability (p=0.015) was observed in the group exposed to the video with 85 (75.9%) patients having reliable results compared to 81 (61.4%) in the control group. The difference was not significant for the right (first tested) eye with 93 (83.0%) of the visual fields reliable in the video group compared to 106 (80.0%) in the control group (p = 0.583), but was significant for the left (second tested) eye with 97 (86.6 %) of the video group reliable versus 97 (73.5%) of the control group (p = 0.011). CONCLUSIONS: The use of a brief, audiovisual patient information guide on taking the visual field test produced an improvement in patient reliability for individuals tested for the first time. In this trial the use of the video had most of its impact by reducing the number of unreliable fields from the second tested eye.

Aged↗
PubMed2001

Effectiveness of testing visual fields by confrontation.

Many tests are used to examine visual fields by confrontation, but such methods have not been thoroughly compared with an accepted reference standard. The choice of test might affect the identification of subtle defects in the visual field. We prospectively compared seven confrontation field tests with full-threshold automated static perimetry among 138 outpatients in an eye clinic. Our primary outcome was detection of a defect in the visual field. With automated perimetry, most field defects were small or shallow. Most confrontation field tests were insensitive in the identification of field loss. The most sensitive method was examination of the central 20 degrees visual field with a small red target (73% [95% CI 63-82]). Assessment of the visual field should thus include such a test.

Adolescent↗