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PubMed1982

[Sensitivity of the computer perimeter Competer in early glaucomatous loss of visual field. A controlled study].

Comparative examinations were carried out under controlled conditions in 101 eyes of 66 open-angle glaucoma patients with field defects (Stages I-III according to Aulhorn) with the Octopus and Competer computerized perimeters. The results of the Octopus perimetry were selected as a reference system to evaluate the sensitivity of the Competer in identifying early glaucomatous field defects. The interpretation of qualitative and quantitative discrepancies between the two instruments took into account the different sizes of the test fields. Of the glaucomatous field defects identified with the Octopus perimeter, 84.1% could be recognized with the Competer as well; 4% were questionably pathologic and 11.9% appeared to be false-negative in the Competers. The 11.9% false-negative results of the Competer were all due to the fact that they were scotomas beyond the test eccentricity of this perimeter. In 16.9% of the positive Competer findings the scotomas were outside the Competer test field by more than 50% of their total extent, whereas 83.1% were within the Competer test field by more than 50% of their total extent. In the light of these results it may be concluded that the Competer provides good sensitivity to detect early glaucomatous field defects once these are within 20 degrees eccentricity, while more peripherally situated scotomas will be missed. It would be advisable to enlarge the test field of the Competer to 30 degrees eccentricity. The relation of early glaucomatous field changes to disk morphology revealed that in 42.5% of the eyes definite glaucomatous disk changes were not recognized.

Adult↗

PubMed2005

Menstrual cycle-dependent differences between right and left visual hemifields in perimetry.

PURPOSE: To evaluate the effect of the menstrual cycle and gender on right and left visual hemifields in healthy subjects. METHODS: One randomly selected eye from each of 42 healthy normally menstruating women and of 37 men with no systemic and ocular problems, other than refractive error, were included in the study. Subjects underwent complete ocular examination and standard acromatic perimetric (SAP) and short-wavelength automated perimetric (SWAP) analysis in both follicular (7th to 10th day of the cycle) and luteal phases (days 3 to 7 before the menstrual bleeding) of the menstrual cycle. Visual field analysis was performed using Model 750 Humphrey Field Analyzer II (Carl Zeiss Meditec, Dublin, CA, USA) with full-threshold, central 30-2 program. RESULTS: The mean age of female (n = 42) and the male subjects (n = 37) were 35.2 +/- 3.1 years and 34.8 +/- 2.9 years, respectively (p = 0.58). Neither females nor males showed any statistically significant differences in the right and left hemifield tests with SAP (both p values > 0.05). However, using SWAP, in luteal phase of female subjects, left hemifield sensitivity was significantly less than (with a mean of 0.47 dB) right hemifield. In follicular phase, there was no significant interhemifield difference (p > 0.05). Male subjects did not show any significant differences between the sensitivity of the two hemifields with SWAP tests. CONCLUSIONS: There has been a significant difference between the mean SWAP sensitivity of right and left visual hemifields in luteal phase of the menstrual cycle. In case of a suspected hemifield difference, SAP rather than SWAP may be used to confirm suspected neurological defects as SAP is not affected by the menstrual cycle.

Adult↗

PubMed1992

Visual field loss in primary gaze and reading gaze due to acquired blepharoptosis and visual field improvement following ptosis surgery.

Acquired blepharoptosis has been associated with loss of the superior visual field (SVF) in primary gaze. Because many patients with acquired blepharoptosis complained of difficulty reading or performing other visual functions in reading gaze, a prospective study was undertaken to determine if acquired blepharoptosis was the cause of these visual dysfunctions. Preoperative and postoperative SVFs were tested in primary gaze and reading gaze in 19 patients with unilateral or bilateral acquired blepharoptosis totaling 30 eyes. Preoperative testing revealed a marked loss of the SVF in both primary gaze and reading gaze. All patients underwent levator aponeurosis defect repair. Postoperative results showed a significant improvement in both primary and reading gaze SVFs. Therefore, patients with good visual acuity complaining of difficulty reading or carrying out other visual functions in reading gaze should be examined for the presence of acquired blepharoptosis. Blepharoptosis repair can be expected to improve the SVF in both primary gaze and reading gaze.

Adult↗

PubMed2000

Objective VEP perimetry in glaucoma: asymmetry analysis to identify early deficits.

PURPOSE: The multifocal visual evoked potential (VEP) shows markedly symmetrical responses between the two eyes of control subjects. Patients with glaucoma and patients considered at high risk for glaucoma were examined to determine if VEP asymmetry could be identified and used for diagnosis and detection of early damage. METHODS: Multifocal pattern VEP recordings were performed using a single channel bipolar occipital electrode position and the Visual Evoked Response Imaging System (VERIS). There were 125 subjects: 24 control subjects, 70 patients with glaucoma, and 31 patients considered at high risk for glaucoma. A between-eye relative asymmetry coefficient (RAC) was determined for each of the 60 test points in the VEP field. The RAC for patients with glaucoma and patients considered at risk for glaucoma were compared with values from control subjects. Correlation between Humphrey thresholds and RAC scores was performed. RESULTS: Patients with glaucoma and patients considered at risk for glaucoma both showed significantly larger mean quadrant RAC values. When point by point analysis was performed, 69 out of 70 scotomas were identified with a cluster of at least 3 points of P < 0.05. For those considered at high risk for glaucoma, 10 out of 31 patients had abnormal areas in the VEP field. There was a strong correlation (r = 0.82) between quadrantic RAC mean values and Humphrey quadrant threshold scores in an asymmetric glaucoma subgroup. Abnormal VEP responses were identified in parts of the visual field that were still normal on perimetry. CONCLUSIONS: Asymmetry analysis correctly identifies patients with glaucomatous field loss and shows abnormalities in many patients considered at high risk for glaucoma who still have normal fields. Asymmetry analysis is able to identify objectively the extent of glaucomatous damage and may be able to detect changes before subjective field loss occurs.

Adolescent↗

PubMed1992

Effect of number of test points and size of test field in automated perimetry.

Sensitivity variation in normal subjects was studied, by changing the number of test locations and the size of test fields on automated perimetry. Using the Sargon program, four different programs that differed in the number of test points or in the size of test field were made. Mean sensitivity and short-term fluctuation were calculated from the same test points of each program. The program with the fewest points and the smallest size produced the greatest sensitivity and the least fluctuation. Our results showed that the number of test points and the size of test field affected the sensitivity and its reproducibility in automated perimetry.

Adult↗

PubMed1990

The visual field in chronic open angle glaucoma: the rate of change in different regions of the field.

Using automated perimetry the distribution of visual field loss in 40 chronic open angle glaucoma eyes (40 patients) was found to be predominantly in the nasal, supranasal, and superotemporal regions. The rate of change of visual field threshold values in seven regions of the field was measured by trend analysis over 44.9 +/- 17.9 months. Seventeen eyes had a significant rate of field loss in one or more regions of the field with the remaining eyes either showing improvement or stability. Seven of the 17 eyes with significant regional field loss had stable overall fields. The greatest rate of field loss occurred in the temporal and superotemporal regions. The correlation between the mean threshold value of the initial field test and the rate of change of field over time was significant in the temporal region and of borderline significance in the superotemporal region. The relationship was such that the greater the initial threshold value, the greater the subsequent rate of field loss.

Eye↗

PubMedDate not supplied

Temporal sensitivity deficits in patients with high-risk drusen.

PURPOSE: Data is reported from an ongoing trial considering functional losses in patients with high-risk drusen. We evaluate the temporal processing in 12 subjects: four patients with high-risk drusen, four age-matched controls and four young observers aged 22-30. METHODS: Subjects were tested using frequency-doubling technology, macula static and flicker fields on a Medmont perimeter and foveal temporal contrast sensitivity at 2, 5, 10 and 24 Hz. RESULTS: Eyes with high-risk drusen had good visual acuity (6/9.5(-2) or better). All control eyes had normal fields for static, flicker and frequency-doubling perimetry. All high-risk drusen eyes had normal static perimetry in the presence of abnormal flicker and frequency-doubling perimetry. High-risk drusen eyes showed a generalized loss of temporal sensitivity across all frequencies. CONCLUSIONS: We conclude that eyes with high-risk drusen show losses to temporal stimuli in the presence of near-normal acuity and static thresholds. We suggest that flickering stimuli might be useful for detecting and monitoring such patients.

Adult↗

PubMed2003

Bilateral posterior ischemic optic neuropathy after lumbar spine surgery.

PURPOSE: To report a case of bilateral posterior ischemic optic neuropathy (PION) in a healthy young patient after lumbar spine surgery which was initially diagnosed as functional visual loss. DESIGN: Observational case report. PARTICIPANT: A 33-year-old woman who experienced visual loss in the immediate postoperative period after a lumbar spine fusion. TESTING: Serial visual field testing and fundus examinations, ERG. RESULTS: Bilateral PION was confirmed 2 months postoperatively with the development of bilateral optic disc pallor and a normal ERG. CONCLUSION: Young patients without vascular risk factors may develop bilateral PION after otherwise uncomplicated lumbar spine surgery. In subjects complaining of visual loss in the postoperative period who have a normal fundus and normal neuroimaging, a diagnosis of PION should be suspected, and close follow-up is warranted.

Adult↗

PubMed1995

The influence of age-related cataract on blue-on-yellow perimetry.

PURPOSE: The influence of cataract on the blue-on-yellow visual field is unknown. The aim of the study was to compare the effect of age-related cataract on the normal blue-on-yellow (B-Y), yellow-on-yellow (Y-Y) and white-on-white (W-W) visual field. METHODS: Forty normal subjects (age range, 60 to 81 years) randomly performed B-Y, Y-Y, and W-W perimetry using a modified Humphrey Field Analyser 640 (HFA) (Program 24-2). Twenty age-matched patients with cataract underwent the same testing paradigm. Cataract was classified using the LOCS II system. Ocular media absorption was measured with the HFA by determining the difference in scotopic sensitivity to 410-nm and 560-nm stimuli. Forward light scatter was measured by the direct compensation technique of van den Berg. Unweighted mean deviation (MD), short-term fluctuation, and corrected pattern standard derivation indices were calculated for each patient with cataract for each of the three stimulus combinations. RESULTS: Cataract produced an adverse effect on the MD (i.e., a more negative MD) in all patients for each of the three stimulus combinations. The magnitude depended on the degree and type of cataract and was highly correlated with forward light scatter. The attenuation in sensitivity was greatest for the B-Y and W-W stimulus combinations; the B-Y field was preferentially affected by posterior subcapsular cataract and the W-W field by anterior cortical cataract. CONCLUSIONS: Cataract predominantly causes a general reduction in B-Y sensitivity. Caution therefore needs to be exercised in the interpretation of the B-Y visual field in patients in whom glaucoma and cataract coexist.

Aged↗

PubMed1998

Comparison between high-pass resolution perimetry and differential light sensitivity perimetry in patients with glaucoma.

PURPOSE: High-pass resolution perimeters such as the Ophthimus (High Tech Vision, Malmö, Sweden) may provide an easier, faster assessment of the visual field than conventional perimeters such as the Humphrey (Humphrey Instruments Inc., San Leandro, CA, U.S.A.), which is based on differential light sensitivity. The Ophthimus provides global indices and statistical analyses conceptually similar to those produced by the Humphrey. In addition, the Ophthimus provides, as a unique parameter, the estimated neural capacity. PATIENTS AND METHODS: Twenty-one patients with chronic open-angle glaucoma and reliable fields on both Humphrey and Ophthimus testing were evaluated. The results from the two different techniques were compared. RESULTS: The estimated neural capacity was correlated to global deviation and mean deviation at a statistically significant level. There were also correlations between mean deviation and global deviation and between pattern standard deviation and local deviation, but not between retest standard deviation and short-term fluctuation. CONCLUSION: It is not clear at this point if the neural capacity of the Ophthimus provides any clinically useful information over and above global deviation. Mean test time was shorter with the Ophthimus system than the Humphrey. Performance on the reliability indices was better for the Ophthimus. The Ophthimus may prove useful in following patients with glaucoma.

Aged↗

PubMedDate not supplied

Influence of blue light spectrum filter on short-wavelength and standard automated perimetries.

PURPOSE: To evaluate the influence of a blue light spectrum filter (BLSF), similar in light spectrum transmittance to the intraocular lens Acrysof Natural, on standard automated perimetry (SAP) and short-wavelength automated perimetry (SWAP). METHODS: Twenty young individuals (< 30 y.o.), without any systemic or ocular alterations (twenty eyes) underwent a random sequence of four Humphrey visual field tests: standard automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) with and without a blue light spectrum filter. All patients had intraocular pressure lower than 21 mmHg, normal fundus biomicroscopy, and no crystalline lens opacity. Foveal threshold (FT), mean deviation (MD), and pattern standard deviation (PSD) indexes obtained from the visual field tests and the difference caused by eccentricity in short-wavelength automated perimetry examinations were analyzed using paired t test. Interindividual variability (standard deviation) was calculated using Pitman's test for correlated samples. RESULTS: Statistically significant reductions in the mean deviation (p < 0.001) and in the foveal threshold (p < 0.001) measured by short-wavelength automated perimetry with the use of the blue light spectrum filter in comparison to short-wavelength automated perimetry without the use of the blue light spectrum filter were observed, but not in standard automated perimetry exams. No other parameters showed statistically significant differences in the short-wavelength automated perimetry and standard automated perimetry tests. Interindividual standard deviation of the test points in the short-wavelength automated perimetry exams increased with eccentricity both with and without the use of the blue light spectrum filter, as sensitivity for inferior and superior hemifields (inferior hemifield minus superior hemifield), but no statistically significant difference in the variability when comparing the use or not of the blue light spectrum filter was noted. When comparing only the four most inferior points and the four most superior points, the inferior-superior difference increases in both situations - without and with the use of the blue light spectrum filter. The difference between without and with the use of the blue light spectrum filter was not statistically significant. CONCLUSION: Statistically significant reductions in mean deviation and foveal threshold in the short-wavelength automated perimetry with the use of the blue light spectrum filter were observed, but not in standard automated perimetry examinations. Additional studies are necessary to determine the influence of intraocular lenses with short-wavelength light filter after cataract extraction on short-wavelength automated perimetry.

Adolescent↗

PubMed1996

A comparative study of Hardy-Rand-Rittler and Ishihara colour plates for the diagnosis of nonglaucomatous optic neuropathy.

OBJECTIVE: To determine the ability of the Hardy-Rand-Rittler (HRR) and Ishihara colour plates to detect acquired colour vision defects in patients with nonglaucomatous optic neuropathy (NGON). DESIGN: Prospective study. SETTING: Neuro-Ophthalmology Unit of the Wilmer Eye Institute, Baltimore. PATIENTS: A total of 178 consecutive patients (349 eyes) referred to the Neuro-Ophthalmology Unit and the General Eye Service of the Wilmer Eye Institute and examined by two of the authors were enrolled from July 1992 to June 1993. OUTCOME MEASURES: Results of testing with HRR and Ishihara plates. RESULTS: Among the 202 eyes that were found to have no ocular disease on neuro-ophthalmologic testing, the HRR plates gave a normal result in 168 (83.2%), compared with 196 (97.0%) with the Ishihara plates (p < 0.0001). The HRR plates detected an acquired colour vision deficit in 48 (87.3%) of the 55 eyes with NGON, compared with 38 (69.1%) for Ishihara plates (p = 0.001). The values for the eyes with NGON with a visual acuity of 20/25 or better were 76.5% (13/17) and 35.3% (6/17) respectively (p = 0.008) and with a visual acuity less than 20/25, 92.1% (35/38) and 84.2% (32/38) respectively. CONCLUSIONS: For patients with unilateral or bilateral NGON, HRR plates are more likely than Ishihara plates to detect a colour vision defect, particularly when the visual acuity is 20/25 or better. However, neither test is sensitive enough to be used as the sole criterion for the diagnosis of NGON. The results of comparison of colour perception of the two eyes may be more useful than absolute colour vision responses, particularly in patients with unilateral disease.

Adolescent↗

PubMed1993

Pointwise topographical and longitudinal modeling of the visual field in glaucoma.

PURPOSE: To develop a suitable mathematical model for the description of the pointwise distribution of sensitivity across the visual field in glaucoma. METHODS: The pointwise distribution of sensitivity at any given stimulus location for any given examination was described by a joint topographical and longitudinal model. The topographical element modeled the pointwise distribution of sensitivity using a second-order polynomial function in terms of the respective stimulus coordinates whereas the longitudinal element modeled the pointwise distribution of sensitivity using multiple linear regression in terms of the sensitivity at the given location determined at one or more previous examinations. The sample comprised Humphrey Field Analyser (Humphrey Instruments, San Leandro, CA) Program 30-2 and 24-2 fields from 49 patients attending a glaucoma clinic for an average of 3 years. RESULTS: The constant term of the polynomial correlated highly with the mean deviation and moderately with the pattern standard deviation. The goodness-of-fit between the modeled and the measured field increased as an exponential function of the number of previous examinations. The median R2 was 19.6% for the first examination and 83.6% for the sixth examination. The group median optimum percentage of error between the measured and modeled sensitivity at each test location was below 10% (i.e., less than 3 dB), increased with increase in eccentricity, was greater at the extremities of the superior field and varied as a function of the severity of the field loss. CONCLUSION: The model seems to be a promising way to evaluate visual field progression.

Glaucoma↗

PubMed1975

The screening of the central visual field.

The Armaly technique, a method of screening for glaucomatous field defects was evaluated in 100 normal eyes and 38 selected central field defects using the Goldmann perimeter and the Auto-Plot tangent screen. The screening results obtained from the Goldmann perimeter and the tangent screen using the selective perimetry of Armaly were compared with the results obtained from the Friedmann central field analyser. Testing normal eyes we found the highest initial false positive rate with the Friedmann analyser and the lowest initial false positive rate with the Auto-Plot tangent screen. The specificity of the Friedmann analyser for detecting early central field changes is less than the Goldmann perimeter or the Auto-Plot tangent screen when using Armaly's technique. On the other hand, the Friedmann analyser turned out to be the easiest instrument to handle and requires least experiences for the observer. Some problems of mass screening perimetry are discussed.

Glaucoma↗

PubMedDate not supplied

Visual field damage in normal-tension glaucoma patients with or without ischemic changes in cerebral magnetic resonance imaging.

PURPOSE: To compare the pattern of visual field damage between normal-tension glaucoma (NTG) patients with signs indicative of ischemic changes and those NTG patients without signs of ischemic changes, using brain magnetic resonance imaging (MRI), in a single center, cross-sectional study. METHODS: In 94 consecutive NTG patients who were younger than 61 years old, brain MRI images were obtained using fluid-attenuated inversion recovery pulse sequences. The presence of signs indicative of ischemic changes in brain MRI images was decided separately by two neuroradiologists masked to the diagnosis and stage of glaucoma. Visual field testing was performed using the 30-2 program of the Humphrey Visual Field Analyzer. Between the patients with signs indicative of ischemic changes in brain MRI (ischemic group) and those without MRI signs (nonischemic group), total deviation (TD) at each test point less the average of TDs of the 30-2 program ([TD - TD(mean)])--was compared at each test point. RESULTS: Signs indicative of ischemic changes in brain MRI were found in 32 of the 94 patients (34.0%). Age, blood pressure, refraction, intraocular pressure, the average of TDs, mean deviation, and corrected pattern standard deviation were not significantly different between the ischemic (N = 32) and nonischemic (N = 62) groups (P > 0.2). [TD - TD(mean)] in the ischemic group was significantly smaller than that in the nonischemic group at 6 nonedge contiguous test points in the inferior pericentral to nasal field (P = 0.005-0.047). CONCLUSION: NTG patients with signs indicative of ischemic changes in brain MRI had a relatively deeper depression in the inferior pericentral visual field.

Blood Pressure↗

PubMed2003

Chiasmal syndromes.

PURPOSE OF REVIEW: This review of the more recent literature and testing strategies in patients with chiasmal syndromes focuses on the clinical evaluation and management of these patients. Visual loss is often the initial manifestation of disorders involving the optic chiasm. Hemianopic defects and preferential involvement of the temporal visual field are the earliest and most common visual deficits. Progression of the lesion may cause compression of adjacent structures, including the optic nerves and cavernous sinuses, and may result in more profound visual loss, ocular motor deficits, and hypopituitarism. RECENT FINDINGS: Although a number of modalities have been used to assess visual function in patients with chiasmal disorders, perimetry remains the most effective means of detecting and following the visual deficit. SUMMARY: Most chiasmal syndromes can be categorized as intrinsic (thickening of the chiasm itself) or extrinsic (compression of the chiasm from an adjacent structure). Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome.

Hemianopsia↗

PubMed2006

Alterations in multifocal visual evoked potentials during the acute phase of Leber's hereditary optic neuropathy.

PURPOSE: This report aimed to investigate alterations in multifocal visual evoked potentials (mfVEPs) during the acute stage of Leber's hereditary optic neuropathy (LHON). METHODS: A 27-year-old woman with a point mutation at nucleotide 11778 in the mitochondrial DNA was examined during the acute phase of LHON, which is generally investigated only rarely because of its rapid progress. She was examined repeatedly, with testing of best corrected visual acuity, pupil function, Goldmann perimetry, ophthalmoscopy and frequent assessment of mfVEPs. RESULTS: Multifocal VEPs, which reveal topographical information about different parts of the visual pathways, demonstrated reduced responses in all parts of the central visual field. The mean amplitude (summarized amplitude of the first two components) in the mfVEPs in the previously described sector C, which has been identified as a hallmark of other optic nerve disorders, was evaluated. This amplitude demonstrated a correlation with the progression of the disease during the acute period of LHON, which also correlated with the VA, pupil function and Goldmann perimetry. CONCLUSIONS: These alterations in the components of mfVEPs reflect the reduction in the function of the visual pathways in different parts of the central field; the drop in amplitude in a localized area (sector C), not previously described, demonstrates the acute course of this disorder. Multifocal VEPs may be of further interest in evaluating the pathogenesis of this disorder and of clinical value in representing an objective method for monitoring the course of this disease.

Acute Disease↗

PubMed2004

Integrated visual fields: a new approach to measuring the binocular field of view and visual disability.

BACKGROUND: We have developed a method of quantifying the central binocular visual field by merging results from monocular fields (Integrated visual field). This study aims to compare the new measure with the binocular Esterman visual field test in identifying patients with self-reported visual disability. METHODS: Forty-eight patients with glaucoma each recorded Humphrey 24-2 fields for both eyes and an Esterman on the same day, and each completed a binary forced-choice questionnaire relating to perceived visual disability. Computer software merged sensitivity values from monocular fields to generate an integrated visual field and a related score of the number of defects at the <10 dB and <20 dB level. Receiver operating characteristic (ROC) analysis was used to compare the integrated visual field score and the Esterman disability score with individual responses to the questions on perceived difficulty with visual tasks. RESULTS: Comparison of areas under ROC curves revealed that a score based on the integrated visual field was generally better (median area: 0.79) than Esterman scores (median area: 0.70) in classifying patients with or without a self-reported perceived difficulty with visual tasks. CONCLUSIONS: The integrated visual field offers a rapid assessment of a glaucoma patient's binocular visual field without extra perimetric testing. As compared to an actual binocular field test (Esterman), the integrated visual field provides a better prediction of a glaucoma patient's perceived inability to perform certain visual tasks.

Adult↗