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PubMedDate not supplied

The use of the G1 and Octosmart programs in detecting temporal changes in the visual field.

PURPOSE: The Octopus program Octosmart is able to classify visual fields into six classes. In the program a horizontal bar indicates these classes, and an indicator points to the most probable position, related to the measured pathology. The width of this dashed indicator shows the range of possible fluctuations in the measurement and, therefore, its precision. This study sets out to analyse the suitability of this display mode using other visual-field index data. METHODS: The visual fields of 83 glaucomatous eyes of 61 patients of various etiological groups and glaucoma suspects were studied for periods varying from 1 to 5 years in a retrospective study. All examinations were performed with the G1 Octopus program and analyzed with the Octosmart program. The statistical significance of linear trends of the visual-field indices, mean defect (MD) and corrected loss variance (CLV), and the class shown by the indicator (POI = position of indicator) were determined, and their regression coefficients were analyzed by means of a linear trend test as a function of time. RESULTS: Of the sample of 83 tested eyes, a total of 18 significant trends were recorded after five examinations. All visual-field indices showed a trend towards amelioration. CONCLUSIONS: The 18 significant trends observed must be attributed to perturbing long-term fluctuations and, despite their statistical significance, are of little clinical value. It is questionable whether an increased number of examinations per eye would have attenuated the threshold fluctuations sufficiently to make the change in field class more reliable.

Adult↗

PubMed2003

Eccentric correction for off-axis vision in central visual field loss.

BACKGROUND: Subjects with absolute central visual field loss use eccentric fixation and magnifying devices to utilize their residual vision. This preliminary study investigated the importance of an accurate eccentric correction of off-axis refractive errors to optimize the residual visual function for these subjects. METHODS: Photorefraction using the PowerRefractor instrument was used to evaluate the ametropia in eccentric fixation angles. Methods were adapted for measuring visual acuity outside the macula using filtered optotypes from high-pass resolution perimetry. Optical corrections were implemented, and the visual function of subjects with central visual field loss was measured with and without eccentric correction. RESULTS: Of the seven cases reported, five experienced an improvement in visual function in their preferred retinal locus with eccentric refraction. CONCLUSIONS: The main result was that optical correction for better image quality on the peripheral retina is important for the vision of subjects with central visual field loss, objectively as well as subjectively.

Adolescent↗

PubMed1992

[Significance of the peripheral visual field for diagnosis of glaucoma].

Investigated was the significance of semiquantitative tests of the peripheral visual field in glaucoma. For that purpose 793 visual fields of 793 glaucoma patients or glaucoma suspects and 338 visual fields of 338 normal controls (normal central 26 degrees--area) were analysed. Perimetry was performed with an Octopus 201 with the help of program G1, which tests 14 peripheral test locations. In the majority of the 455 glaucoma patients (pathological findings in the central visual field) the periphery was also disturbed. Much to our surprise however, the 338 glaucoma suspects (having normal central visual fields) showed the same frequency of peripheral visual field disturbance as the normals. This holds true for the total peripheral visual field, as well as for the individual test locations. Therefore it makes sense to limit perimetry in glaucoma patients to the central area, provided that the central area is quantitatively measured with an adequate testgrid.

Diagnosis, Differential↗

PubMed1997

Mapping structural damage of the optic disk to visual field defect in glaucoma.

PURPOSE: To evaluate the relation between the location of focal visual field defects and optic disk damage in eyes with glaucoma by short-wavelength automated perimetery and confocal scanning laser ophthalmoscopy. METHODS: In 14 patients (14 eyes) with open-angle glaucoma, focal optic disk damage, and focal visual field loss, we obtain visual fields with short-wave-length automated perimetry. The short-wavelength automated perimetry visual field was divided into 21 zones, representing retinal nerve fiber layer arcuate bundles. Test points were compared with a normative database. The optic disk was assessed with a confocal scanning laser ophthalmoscope. Optic disk measurements were calculated in 10-degree sectors and compared with a normative database using a new measure, the rim area ratio, which adjusts for individual differences in disk size. RESULTS: The mean number (+/-SD) of damaged visual field zones was 3.9 (+/-1.9), and the mean number of damaged rim sectors was 5.0 (+/-2.9). Focal defects on the optic disk and on short-wavelength automated perimetry were topographically related with specific damaged visual field zones corresponding to specific damaged rim sectors. CONCLUSIONS: In patients with open-angle glaucoma with focal optic disk damage and focal visual field loss, defects in optic disk and short-wavelength automated perimetry are topographically related. The rim area ratio can be used to identify focal optic nerve defects.

Adult↗

PubMed2005

Visual field defects in deformational posterior plagiocephaly.

PURPOSE: We sought to determine whether visual field abnormalities occur in infants with deformational posterior plagiocephaly and to assess whether there is a relationship between the severity and laterality of visual field abnormalities with the severity and laterality of skull deformity. METHODS: A retrospective chart review was performed on 40 consecutive infants with deformational posterior plagiocephaly. Each was tested with standardized binocular arc perimetry in the horizontal plane. Sixteen patients also had 3-dimensional computed tomography of the skull. Hemifield asymmetry of >/=20 degrees and/or a decrease in hemifield values by >/=20 degrees from established normal patients was considered abnormal. Visual field data from study patients was plotted against previously published normative data. Graphs comparing visual field defects and laterality to cranial asymmetry also were generated. RESULTS: Thirty-five percent of infants with deformational posterior plagiocephaly had constriction of one or both hemifields by at least 20 degrees from established normal patients. Hemifield asymmetry of 20 degrees or more was found in 17.5% of infants tested. There was a significant difference in the worse hemifield values measured in each patient and the standard visual fields obtained from normative data ( P = 0.036). There was no correlation between the laterality of the visual fields to the laterality of the defects. A correlation between severity of hemifield constriction and % asymmetry on computed tomography was noted ( P = 0.209). CONCLUSIONS: Deformational posterior plagiocephaly may affect visual field development but neither the laterality nor the severity of skull deformity is predictive of the severity of visual field defects.

Humans↗

PubMed1993

Focal and diffuse visual field defects: their relationship to intraocular pressure.

The view that visual field loss in "low-tension" glaucoma (LTG) is more focal than in ordinary or "high-tension" glaucoma (HTG) is controversial. The basis of the controversy may be the inappropriate presupposition that an arbitrary intraocular pressure (IOP) level effectively differentiates these entities. We attempted to determine whether meaningful differences exist between glaucoma patients classified on the basis of pattern of visual field loss rather than IOP. One hundred consecutive glaucomatous visual fields were classified as focal or diffuse by two independent observers masked to all other clinical information. Several clinical parameters were then evaluated, comparing patients with focal visual field loss, with those with diffuse loss. Maximal pretreatment IOP was significantly lower among the patients with focal visual field loss than it was among those with diffuse loss (21.5 mm Hg +/- 5.7 vs 25.9 mm Hg +/- 4.7; P < .01). There was no difference between the two groups in terms of age, blood pressure, visual acuity, or color vision. We conclude that focal glaucomatous visual field loss occurs at a lower IOP than diffuse loss and, as such, may be a marker by which to identify patients whose optic nerves are abnormally susceptible to glaucomatous injury.

Aged↗

PubMed2000

Component perimetry: a fast method to detect visual field defects caused by brain lesions.

PURPOSE: Noise field campimetry, performed according to Aulhorn and Köst, confronts patients with a large field of irregularly flickering dots, and many patients immediately perceive their visual field defects. The original method had a somewhat low specificity and sensitivity, especially for patients with visual field defects caused by cortical lesions. METHODS: The method was improved in two ways. First, the grain of the visual noise was increased toward the periphery of the visual field to accommodate the peripheral decrease in visual acuity. Second, the type of stimulus pattern was varied to include separate investigations of different visual components or functions (color, motion, temporal resolution, line orientation, stereoscopic depth, acuity, and figure-ground segmentation). To evaluate the reliability of the method, the visual fields were compared, as assessed by the new method, with those of conventional perimetry in 41 patients with neurologic disorders and 22 normal control subjects. RESULTS: The results were encouraging. All patients with suprageniculate lesions subjectively experienced visual field defects in component perimetry. Sizes of visual field defects obtained with both methods corresponded qualitatively with each other, with a highly significant correlation. The specificity of component perimetry was higher than that of the original noise field campimetry. CONCLUSIONS: This pilot study indicates that component perimetry is a subjective but relatively reliable method for detecting disorders of visual perception caused by lesions at different stages along the visual pathway, permitting fast screening of the visual field. In addition, this method seems to allow examination of the visual field, not only for defects in contrast sensitivity, as does conventional light perimetry, but also for the status of other components of vision such as color or motion perception. Further evaluation with larger patient cohorts is needed to allow exact assessment of the clinical usefulness of the method.

Adolescent↗

PubMed2000

Correlation of automated visual field parameters and peripapillary nerve fiber layer thickness as measured by scanning laser polarimetry.

PURPOSE: To correlate Humphrey visual field mean sensitivity and peripapillary nerve fiber layer thickness as measured by scanning laser polarimetry. METHODS: The authors studied 54 eyes of 34 patients who visited a university-based glaucoma clinic and had undergone scanning laser polarimetry and Humphrey perimetry within 6 months. The study population included normal patients and those with glaucoma, ocular hypertension, and glaucoma suspect. The authors correlated visual field sensitivity with peripapillary nerve fiber thickness, and visual field mean deviation with the average deviation from the normal nerve fiber layer thickness. They also correlated the visual field mean deviation with all available GDx Nerve Fiber Analyzer parameters. RESULTS: The visual field mean sensitivity and deviation showed a bilinear correlation to peripapillary nerve fiber layer thickness. The visual field mean sensitivity changed little when the nerve fiber layer thickness was greater than 70 microm. The nerve fiber layer thickness below this level was associated with a rapid decrease in the visual field sensitivity. Similarly, the visual field mean deviation was close to 0 dB when the nerve fiber layer was within -10 microm of the normal value; below this thickness, the mean deviation became substantially more negative. There was a large individual variability around the bilinear fit. Of the scanning laser polarimetry parameters, a calculated index, referred to as the number, had the highest correlation with the Humphrey mean deviation. CONCLUSION: The bilinear correlation and its variability between the scanning laser polarimetry and visual field parameters make it difficult to predict the result of one from the other. In general, the correlation between the two is better when there is a significant visual field defect than when the visual field is close to normal.

Adult↗

PubMed2002

Baseline visual field characteristics in the ocular hypertension treatment study.

PURPOSE: The Ocular Hypertension Treatment Study (OHTS) seeks to evaluate the safety and efficacy of topical ocular hypotensive medication in preventing or delaying the onset of visual field loss and/or optic nerve damage in ocular hypertensive subjects at risk for developing primary open-angle glaucoma. This study evaluates the baseline visual field test characteristics (visual field status, reliability properties, etc.) of patients who underwent eligibility visual field testing for entry to the OHTS. DESIGN: Cross-sectional study of baseline data as part of a longitudinal randomized clinical trial. PARTICIPANTS: Two thousand eight hundred nineteen ocular hypertensive individuals, aged 40 to 80 (mean age, 55). METHODS: Subjects underwent at least two Humphrey Field Analyzer Program 30-2 Full Threshold visual field examinations in both eyes for study eligibility. A third examination was performed if a prior test was abnormal, questionable, or unreliable. For final eligibility, two sets of visual field examinations had to meet OHTS criteria for reliability and had to be classified as "normal." All OHTS visual field tests of potential subjects were submitted for eligibility assessment to the OHTS Visual Field Reading Center. MAIN OUTCOME MEASURES: The percentage of visual fields that were normal and reliable according to OHTS criteria. RESULTS: Of the subset of 2304 subjects who completed the eligibility assessments, 1828 (79%) were OHTS-eligible based on visual field test requirements. A third eligibility test was required for 11% of all eyes because of unreliable, questionable, or abnormal test results. With the 33% fixation loss cutoff in the OHTS, 97% of all eligibility visual field examinations were reliable and 3% were unreliable. The most frequent cause (69.5%) of unreliability was excessive fixation losses. CONCLUSIONS: Permitting one repeat test after an abnormal or unreliable test allowed an extra 560 patients to be "eligible" for the study based on visual field tests. A clinical screening review of otherwise normal and reliable tests was not restrictive. The adoption of a 33% fixation loss cutoff significantly reduced the number of required retests and prevented study rejection of 89 patients.

Adult↗

PubMed1989

Visual field development in infants with stage 3 retinopathy of prematurity.

Binocular visual field development was measured in 11 infants who had stage 3 ROP in early infancy and in 11 infants without ROP, matched for birthweight and gestational age. Kinetic perimetry was used to measure visual fields along the 45 degree, 135 degree, 225 degree and 315 degree half-meridia. Infants were tested at 4, 9, and 18 months from due date. Analyses of variance were used to compare results of the two groups for each age tested. Results at the 4-month test age indicated that both groups had visual fields within the normal range for their age. However, at the 9-month test age the ROP group showed a significantly (P less than 0.05) smaller visual field than the control group. At 18 months, the ROP group still showed smaller visual fields than the control group, but the difference was not significant. The results suggest that dysfunction of the peripheral retina associated with ROP may produce a constriction of the visual field or a delay in visual field development.

Aging↗

PubMedDate not supplied

Normative values for visual fields in 4- to 12-year-old children using kinetic perimetry.

We report normative data for 4- to 12-year-old children using a kinetic perimetry technique that employs a double arc perimeter with a 6-degree target designed for use with infants and children. The subject population consisted of 84 children in four age groups (4, 5, 7, and 10 yrs) and 21 adults as comparison subjects. Individuals had eye examinations to rule out causes of abnormal visual fields. Mean visual field size was determined separately for the right and left eyes in each age group. In the 4-year-old group, the mean extent of visual field along each of the four meridians for the right eye was 59, 48, 52, and 85 degrees of arc for radial meridians orientation set at 45, 135, 225, and 315 meridians, respectively. The visual field extent in each quadrant generally increased with age. The overall extent of field as measured along the four meridians for all subject groups increased significantly with the age, indicating a continued growth of visual field size in older children. These data suggest that adult visual field size is achieved at about 11.6 years of age.

Adult↗

PubMed2000

Quantitative analysis of visual field and optic disk in glaucoma: retinal nerve fiber bundle-associated analysis.

BACKGROUND: A study was performed to evaluate whether visual field analysis using a perimetric nerve fiber bundle map gives information additional to global visual field indices and cumulative defect curves for early glaucoma diagnosis. METHODS: One hundred and four control subjects, 124 patients with ocular hypertension (OHT), 97 patients with high-tension glaucoma without visual field defects (preHTG) and 91 patients with open-angle glaucoma with visual field defects [30 low-tension glaucoma (LTG), 61 high-tension glaucoma (HTG)] were included in this study. Correlation analyses were performed between (a) global visual field indices and total neuroretinal rim (NRR) area; (b) local mean values of four visual field areas and the NRR area of the corresponding four optic disk sectors; and (c) local mean values of 10 perimetric nerve fiber bundles (PNFB 1-10) according to Weber and Ulrich (1991) and the four optic disk sectors. The correlations were adjusted for global mean defect and total NRR. RESULTS: There were no significant correlations between NRR area and visual field in control subjects or in patients with OHT or preHTG for all three analyses. Significant correlations were found between the global visual field indices and the total NRR area for LTG and HTG. Significant correlations between local mean defects and NRR area of corresponding optic disk sectors were found only in LTG for the superior and inferior visual field area and the PNFB covering these areas. CONCLUSION: The method used for visual field analysis and sectorization of the optic disk does not give additional information on visual field defects in patients with normal global visual field indices and a normal cumulative defect curve. The nerve fiber bundle-related visual field analysis allows the topographical determination and quantification of glaucomatous damage.

Adult↗

PubMed2005

The rate of visual field loss in optic nerve head drusen.

PURPOSE: To define the rate of visual field loss in patients with optic nerve head drusen (ONHD). DESIGN: Retrospective chart review. METHODS: Goldmann visual field (GVF) testing from initial visit and last follow-up examination were quantified using the modified Esterman grid technique. The rate of visual field loss was calculated by comparing the initial GVF to the last follow-up GVF. A comparative analysis of GVF and age at initial evaluation was performed on all patients with an initial GVF only. SETTING: Tertiary academic care center. PARTICIPANTS: Inclusion criteria for the rate analysis: (1) diagnosis of ONHD and (2) at least 36 months of follow-up with serial GVF testing. EXCLUSION CRITERIA: (1) patients with glaucoma or glaucoma-suspect; (2) history or examination evidence for other ocular disease; and (3) drusen-related macular causes of visual loss. RESULTS: Thirty-two of 292 charts were included in the rate analysis. The rate of visual field loss was 1.58%. There was no statistically significant difference between men and women (P = .74). One hundred eighty patients were included in the initial visual field analysis. There was a significant negative correlation between age and GVF, with older patients having lower GVF scores with a Spearman correlation of -0.42 (P < 0.0001); 73% of these 180 patients had mild, minimal, or no visual field loss. CONCLUSIONS: The rate of visual field loss for ONHD over a 36-month interval of time was 1.6% per year. Patients with minimal or no visual field loss were younger, and patients with moderate or severe visual loss were older.

Adult↗

PubMed1994

Detection sensitivity to light offsets is abnormal in glaucomatous visual field.

The detection thresholds in the central visual fields of glaucomatous (n = 21), ocular hypertensive (n = 21) and normal (n = 13) individuals were tested with both light decrements (offsets = dark spots) on a cathode ray tube (CRT) and light increments (onsets = bright spots) on a bowl projection perimeter. Both types of stimuli were of equal surface area (Goldmann size IV = 16 mm2) and duration (200 milliseconds) on a 10 cd/m2 background intensity. Computerized threshold testing with light offsets on CRT could document the glaucomatous visual field loss with high accuracy and might indicate early glaucomatous visual field loss missed by the conventional light onset stimuli.

Adult↗

PubMed1998

Visual field defect after pars plana vitrectomy.

OBJECTIVE: This study aimed to report the occurrence of visual field defects after pars plana vitrectomy (PPV) for the treatment of each of the following conditions: macular hole (MH), subretinal neovascular membrane (SRNVM), and epiretinal membrane proliferation (EMP). This study also aimed to speculate on the pathogenic mechanisms for the observed field defects. DESIGN: Noncomparative case series. PARTICIPANTS: The study included 48 subjects (50 eyes). Twenty-one of the 50 eyes had stage III MH, 13 eyes had SRNVM, and 16 eyes had EMP. TESTING: Goldmann kinetic perimetry was performed postoperatively. MAIN OUTCOME MEASURE: Visual field defects. RESULTS: Nine (18%) of the 50 eyes had visual field defects. Four (19%) of the 21 eyes with MH and 5 (38%) of the 13 eyes with SRNVM had visual field defects. Of the 16 patients who had epiretinal membrane peeling, none had a visual field defect. An air-fluid exchange had been performed in all patients found to have a postvitrectomy field defect. The difference in rate of visual field defects in eyes that had air-fluid exchange (EMP group) was statistically significant (P < 0.05, chi-square). No significant correlation was found between visual field defect and preoperative intraocular pressure, postoperative intraocular pressure, patient's age, and iatrogenic detachment of the vitreous cortex. The field defects identified were altitudinal (2 eyes), baring of the blind spot (1 eye), inferotemporal (3 eyes), inferonasal (2 eyes), and superonasal (1 eye). CONCLUSIONS: Central and peripheral visual field defects may occur after PPV for the treatment of MHs or SRNVMs. Air-fluid exchange procedure was the common denominator in all of the patients found to have visual field deficit. The etiology is likely to be trauma to the optic nerve region during the air-fluid exchange procedure.

Adult↗

PubMed1992

Effect of restriction of the binocular visual field on driving performance.

The importance of the visual field on driving performance was investigated. This was undertaken by simulating binocular visual field defects for a group of young normal subjects and assessing the impact of these defects on performance on a driving course. Constriction of the binocular visual field to 40 or less, significantly increased time taken to complete the course, reduced the ability to detect and correctly identify road signs, avoid obstacles and to manoeuvre through limited spaces. Accuracy of road positioning and reversing were also impaired. Constriction of the binocular visual field did not significantly affect speed estimation, stopping distance, or the time taken for the reversing and manoeuvring tasks. The monocular condition did not significantly affect performance for any of the driving tasks assessed.

Adult↗

PubMed1985

Quantification of glaucomatous visual field defects with automated perimetry.

A method to quantify different glaucomatous visual field defects is presented. Three visual field indices are calculated: the short-term fluctuation, the mean defect, and the corrected loss variation. The method was applied to visual fields tested with program JO on the Octopus automated perimeter. The indices of 130 glaucoma suspects and 50 glaucoma patients were compared with 100 normal controls. The indices provide good detectability of visual field defects and easy follow-up.

Adult↗

PubMed2000

Fellow eye prognosis in patients with severe visual field loss in 1 eye from chronic open-angle glaucoma.

OBJECTIVES: To examine the prognosis for the fellow eye of patients with severe visual field loss in 1 eye from chronic forms of open-angle glaucoma, and to identify risk factors for visual field progression in such eyes. METHODS: Review of 36 patients followed in an academic medical center with monocular severe visual field loss (Advanced Glaucoma Intervention Study score > or =12) from open-angle glaucoma either at initial Humphrey visual field testing or during follow-up. Change in Advanced Glaucoma Intervention Study visual field score and clinical evaluation were used to determine visual field progression. Kaplan-Meier survival analysis and Cox proportional hazards survival regression were used to estimate visual field progression in fellow eyes and assess possible risk factors. RESULTS: During 67+/-32 months (mean +/- SD), 12 of 36 first-affected eyes (33%) and 6 fellow eyes (17%) had significant visual field progression. The Kaplan-Meier estimate of visual field progression in the fellow eye was 12.4% at 5 years after severe visual field loss in the first eye. Compared with stable fellow eyes, fellow eyes with visual field progression had significantly larger initial cupdisc ratio, smaller between-eyes difference in the initial Advanced Glaucoma Intervention Study score, and lower calculated ocular perfusion pressure. Ocular perfusion pressure was the only variable significantly associated with visual field progression by Cox proportional hazards survival regression (P = .019). During an average of 10.2 years of disease, 2 patients (6%) became bilaterally blind from glaucoma. CONCLUSIONS: In this predominantly white population, fellow eyes of patients with severe visual field loss in 1 eye from open-angle glaucoma were not at particularly high risk for further visual field progression, and few patients became bilaterally blind. Fellow eye visual field progression was associated with lower calculated ocular perfusion pressure.

Adult↗