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PubMed1991

A clinical comparison of visual field testing between Goldmann-type manual perimetry and the Marco MT-336 automated perimeter.

A randomized, prospective clinical trial was performed to compare the Marco MT-336 automated perimeter with Goldmann-type manual kinetic perimetry. The number of true and false, positive and negative scotomas were counted, as determined by the findings on the Marco perimeter, assuming that the Goldmann perimeter was the "gold standard." For eight of the available programs, the accuracy specificity, sensitivity, positive predictive value and negative predictive value were determined. Chi-squared testing across and within programs was performed to determine the degree of agreement between the tests as to the presence or absence of scotomas. Additionally, McNemar's test was used to determine the amount of random disagreement between the two methods of testing. Although there are inherent difficulties in the analysis, the authors conclude that the Marco MT-336 perimeter is an accurate instrument for both detecting and ruling out the presence of visual field defects.

Adolescent↗
PubMed1988

Monocular visual-field testing under binocular conditions.

Spectacles with plastic polarizers in front of each eye, with the polarizing axis at right angles to each other, permit monocular visual-field tangent screen testing under binocular conditions, provided a rotatable polarizer is attached in front of the standard ophthalmic slide projector which generates the test light.

Eyeglasses↗
PubMed1976

The influence of visual field testing procedure on blind spot size.

Blind spots as measured by three different testing instruments were shown to be significantly different. These size variations seem to be related to the target contrast provided by the instrumentation. The need for instrument standardization in perimetry is discussed.

Adult↗
PubMed1992

A comparison of the OKP visual field screening test with the Humphrey field analyser.

In order to determine the loss of retinal sensitivity detectable by oculokinetic perimetry (OKP), we tested 27 eyes of 27 persons with glaucoma and 32 eyes of 32 patients with ocular hypertension with the OKP screener and with a central threshold test on the Humphrey analyser. The threshold at eight locations on the OKP chart between 12.5 degrees and 15 degrees from fixation was compared with the corresponding Humphrey perimetric thresholds. Seventeen eyes from 17 patients with glaucoma failed the OKP screening test by not seeing the target at one or more locations. The mean light sensitivity threshold at points seen on OKP screening was -5.8 dB (SD 4.6 dB) from aged-matched normals (AMN), whereas points missed had a mean threshold -16.1 dB (SD 9.3 dB) from AMN. The sensitivity and specificity with which OKP testing differentiated normal points from abnormal ones in Humphrey testing was 82.5% and 80% respectively, with a threshold criterion of -12 dB from AMN. Ten eyes from 10 patients with glaucomatous defects and all of the ocular hypertensive eyes gave normal responses on the OKP screening test. The glaucomatous eyes that passed were characterized by less severe defects on the Humphrey than those who failed in terms of mean deviation (0.02 < p < 0.05) or corrected pattern standard deviation (0.01 < p < 0.02). Four of the glaucomatous eyes to pass had a nasal step as the primary field defect. None of those to fail failed only on points within 10 degrees of fixation. We suggest further modification of the OKP screening chart to improve its efficiency.

Fixation, Ocular↗
PubMed1992

Static versus kinetic testing in the nasal peripheral field in patients with glaucoma.

One-hundred and seventy-seven subjects (207 eyes) were tested on the Humphrey Field Analyzer to evaluate the usefulness of static and kinetic peripheral nasal visual field testing in identifying glaucomatous defects. In 20 of the 187 glaucomatous or ocular hypertensive eyes glaucomatous defects were found in the peripheral nasal field while the central 30 degrees remained normal or showed non-specific diffuse depression. Kinetic peripheral nasal field testing identified 17 of these eyes while the static testing identified eleven. This difference was not statistically significant (P greater than 0.05, Stuart-Maxwell test). Twenty control eyes showed one glaucomatous peripheral nasal defect on static testing, and none with kinetic testing. These results differed statistically from the diagnoses in the diseased population (P less than 0.005, chi 2-test). This study suggests the potential value of nasal peripheral field testing in selected glaucoma patients for which static testing has no apparent diagnostic advantage over kinetic techniques.

Adolescent↗
PubMed1992

Blue versus white stimuli in ocular hypertension with the Friedmann Mark 1 Visual Field Analyser.

Fifty eyes of fifty patients with ocular hypertension had their visual fields tested on a Friedmann Mark 1 field analyser whilst wearing a Wratten 47B blue filter in a spectacle frame. All had normal visual fields to a white stimulus. Use of a scoring system with the blue field identified 11 patients (22%) with ocular hypertension as abnormal. The scores from this subgroup were indistinguishable from a group of subjects with early glaucomatous field loss, whilst the remaining scores were similar to normal subjects. These two subgroups of ocular hypertensive patients were similar in age and intraocular pressure. The use of a blue filter in front of the eye may offer a simple test to identify a subgroup of patients with ocular hypertension who are at increased risk of developing field loss.

Color↗
PubMed1991

The learning and fatigue effect in automated perimetry.

A visual field test was performed on 100 volunteers to study learning or fatigue effects during one session. The test was carried out with the help of the Octopus program J1, which measures the threshold 12 times at 3 test locations. In the majority of cases the sensitivity was quite stable during the session. We noted no difference between trained and untrained subjects or between normal and pathological eyes. However, patients with refractive errors, especially myopes, revealed a larger learning effect than did emmetropes.

Adolescent↗
PubMed1989

Static threshold asymmetry in early glaucomatous visual field loss.

Ten normal subjects underwent static threshold visual field testing of both eyes with the Humphrey perimeter, with one eye tested twice. The mean sensitivity of the field seemed virtually identical in the two eyes, with the average difference between the right and left eyes (0.65 decibels [dB]) being no greater than the testing error as reflected in the difference between the same eye tested twice (0.7 dB). The authors provide the mathematical basis for recognizing that a right eye-left eye difference in mean sensitivity might be abnormal. Additional information is needed about the variance of the right eye-left eye difference in the population at large, but present information suggests that a 2-dB difference may be meaningful on a single examination. A 1.5-dB difference is statistically significant if confirmed on a second test, and a difference as small as 1 dB may be meaningful if shown consistently in a series of four examinations. In all cases, nonglaucomatous causes of field abnormality needs to be ruled out, and the generalized asymmetry is most meaningful if it is consistent with asymmetry of cupping or intraocular pressure. Several cases are reported in which a mild (1 dB) generalized depression of the visual field is the only recognizable abnormality in the visual field in eyes with early glaucoma.

Adult↗
PubMed1992

Glaucoma Hemifield Test. Automated visual field evaluation.

We have developed an algorithm, the Glaucoma Hemifield Test (GHT), for automated evaluation of single static threshold visual field test results in glaucoma. The GHT uses empirically determined limits of normality for up-down differences in the Statpac probability maps of the Humphrey Field Analyzer to detect localized visual field loss. It is also constructed to detect field loss that is symmetric around the horizontal meridian. Analysis is done in five corresponding pairs of sectors that are based on the normal anatomy of the retinal nerve fiber layer. Deviations from the age-corrected normal threshold in the most sensitive portions of the visual field are used to detect general reductions of sensitivity or abnormally high sensitivities. The GHT provides brief visual field evaluations printed on the field chart as plain text. The aim of this article is to describe the fundamentals of the analysis program and to provide clinical examples.

Adult↗
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↗
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↗
PubMed1991

Adding automated perimetry to glaucoma evaluation and treatment.

Tangent-screen visual fields were compared with the fields determined by a newly acquired automated perimeter in 100 eyes of consecutive patients with glaucoma or suspected glaucoma. The tangent screen found defects in 12 eyes, and the automated perimeter found defects in 34 eyes. Because the automated perimeter found new defects or defects much worse than were found by the tangent-screen examinations, three patients received timolol, and a laser iridotomy, two laser trabeculoplasties, and three filtering operations were done on other patients. The major benefit in switching from tangent screen to automated perimetry was increased confidence in the visual fields tested as an indicator for treating patients with glaucoma. A minor problem in using the automated perimeter was that the testing was slightly longer and more tiring. This problem was reduced by using a translucent occluder, rather than the universally used opaque one.

Glaucoma↗
PubMed1990

Effects of pupillary dilation on automated perimetry in normal patients.

The effects of pupillary dilation (tropicamide 1%) on automated static threshold perimetry were studied in 18 normal subjects using the Humphrey field analyzer 30-2 and STATPAC programs. The mean defect worsened by 0.83 decibels (standard deviation, 0.92 decibels) in dilated fields as compared with baseline visual fields (P = 0.001). These findings indicate that pupillary dilation in healthy subjects who are not receiving ocular medications produces statistically significant declines in threshold sensitivities. Valid comparison of results from serial visual field testing, therefore, depends on control of or adjustment for the effect of pupillary dilation.

Adult↗
PubMed1991

Visual field examination during transient migrainous visual loss.

A transient episode of bilateral amaurosis fugax, or transient visual loss, occurred in a patient with ophthalmic migraine associated with mitral valve prolapse while computerized visual field testing was performed. This fortunate finding illustrated characteristic defects which are compared with the patient's visual field tested 24 hours later. Statistical analysis of both examinations is stressed here.

Adult↗
PubMed1989

Pattern electroretinogram recorded by skin electrodes in early ocular hypertension and glaucoma.

Diagnostic value of transient pattern electroretinogram (PERG), recorded by skin electrodes, was compared with Goldmann perimetry in cases of ocular hypertension and glaucoma. According to the assumption that the PERG mostly reflects activity of the retinal ganglion cells, and histological evidence that 30-50% atrophy of the retinal ganglion cells is necessary to cause defects in visual field, we wanted to assess if i) this method could be more sensitive in detecting early glaucomatous damage than routine Goldmann perimetry in eyes with normal or only borderline elevated intraocular pressure in the time of PERG recording (first group of patients), and ii) how the PERG amplitude corresponds to ganglion cell loss, expected in the eyes with already detectable initial glaucomatous visual field defects, according to Goldmann II/2 isopter, with normal or borderline elevated intraocular pressure in the time of PERG recording (second group). In the group with no visual field defects subnormal amplitude of the major positive component of the PERG, N1-P1, was detected in three of 30 eyes (10%), while in the group with initial visual field defects N1-P1 amplitude was subnormal in 6 of 11 eyes (54%). The amplitude of the major negative PERG component, P1-N2, was found normal in all eyes of the first group and subnormal in 5 eyes (45%) of the second group.

Adult↗
PubMed1987

High-pass resolution targets in peripheral vision.

Visual acuity was measured at 10 degree intervals on the horizontal meridian in two normal subjects, using high-pass spatial frequency filtered test targets in a computer graphics display. The close similarity between detection and recognition thresholds resulted in quick and reliable measurements. Peripheral acuity was proportional to local retinal ganglion cell separation. High-pass targets appear to be nearly ideal for clinical perimetry because of the easy test task and the possibility of interpreting results in terms of numbers of functional neuroretinal channels. The major limitation appears to be a somewhat fuzzy definition of small, circumscribed defects.

Adult↗