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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↗
PubMed1976

Midline tilting between seeing and nonseeing areas in hemianopia.

The line separating the seeing from the nonseeing parts of the visual field was found to be tilted away from the expected vertical position in 24 of 200 patients diagnosed as having various types of hemianopia, including homonymous hemianopia, homonymous quadrant hemianopia, homonymous scotomata, and bitemporal hemianopia. The causes of these defects include vascular accidents, trauma, tumor, and neurosurgery for convulsive disorders. Once discovered by standard monocular field testing methods, the existence of the tilting phenomenon was distinguished from testing artifact by employing binocular fixation and red-green glasses along with red and green test objects. A difference in the overlapping fields of the two eyes was found to exist only in areas where corresponding lines between seeing and nonseeing fields were separated by a tilting away from the vertical in one or both eyes. This can occur superiorly or inferiorly with homonymous scotomata, and in bitemporal hemianopia as well as in homonymous hemianopia or quadrant hemianopia. This incongruity of fields is possibly explained by a variation in anatomic determination of crossing from noncrossing fibers at the level of the retina.

Adult↗
PubMed1992

Photocoagulation with continuous wave ND:YAG laser for neovascular maculopathy.

Twenty-two eyes in 22 cases of neovascular maculopathy were treated with continuous wave (CW) Nd:YAG laser and followed up for 6 to 24 months. The effect of the treatment was evaluated by repeated visual acuity testing, fundus photography, fluorescein angiography and automated static perimetry. In 91% of the patients visual acuity remained unchanged or improved. Fluorescein angiography revealed that the neovascularization disappeared in 91% of the patients. In 40% of the patients the central visual field showed improvement by automated static perimetry. These results indicate that CW Nd:YAG laser photocoagulation is useful for the treatment of neovascular maculopathy.

Aged↗
PubMed1997

Retinal function abnormalities in membranoproliferative glomerulonephritis type II.

PURPOSE: To characterize retinal electrophysiologic and psychophysical abnormalities associated with membranoproliferative glomerulonephritis type II. METHODS: Three adults with membranoproliferative glomerulonephritis type II were studied. Retinal function was measured psychophysically (automated perimetry, Farnsworth D-15 color vision testing, and dark adaptometry) and electrophysiologically (full-field flash electroretinography and electro-oculography). RESULTS: Two symptomatic individuals had prominent drusenlike deposits and retinal pigment epithelial disturbances, findings characteristic of membranoproliferative glomerulonephritis type II retinopathy. These individuals had mild visual field and color vision abnormalities, prolonged dark adaptation, and delayed electroretinographic dark-adapted dim and bright flash responses of normal amplitude. The electro-oculogram of the most severely affected individual was abnormal. The third individual who was asymptomatic had the mildest fundus abnormalities and exhibited normal psychophysical and electrophysiologic responses. CONCLUSIONS: Membranoproliferative glomerulonephritis type II retinopathy may be associated with symptomatic and measurable psychophysical and electrophysiologic abnormalities of retinal function.

Adult↗
PubMed2000

Open-angle glaucoma in an urban population in southern India: the Andhra Pradesh eye disease study.

OBJECTIVE: To assess the prevalence and features of open-angle glaucoma in an urban population in southern India. DESIGN: A population-based cross-sectional study. PARTICIPANTS: A total of 2522 persons (85.4% of those eligible) of all ages, including 1399 persons 30 years of age or older, from 24 clusters representative of the population of Hyderabad city. TESTING: The participants underwent an interview and detailed eye examination that included logarithm of minimum angle of resolution visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, dilatation, cataract grading, and stereoscopic fundus evaluation. Automated Humphrey threshold 24-2 visual fields (Humphrey Instruments Inc., San Leandro, CA) and optic disc photography were performed when indicated by standardized criteria for disc damage or if intraocular pressure (IOP) was 22 mmHg or more. MAIN OUTCOME MEASURES: Definite primary open-angle glaucoma (POAG) was defined as obvious glaucomatous optic disc damage and visual field loss in the presence of an open-angle, and suspected POAG was defined as suspected glaucomatous optic disc damage without definite visual field loss. Ocular hypertension (OHT) was defined as IOP of 22 mmHg or more without glaucomatous optic disc damage or visual field loss in the presence of an open-angle. Glaucomatous optic disc damage or IOP of 22 mmHg or more secondary to an obvious cause and with an open-angle was defined as secondary open-angle glaucoma. RESULTS: Definite POAG, suspected POAG, and OHT were present in 27, 14, and 7 participants, respectively, with age- and gender-adjusted prevalence (95% confidence interval) of 1.62% (0.77%-2.48%), 0.79% (0.39%-1.41%), and 0.32% (0.10%-0.78%) in those 30 years of age or older, and 2.56% (1.22%-3.91%), 1.11% (0.43%-1.78%), and 0.42% (0.11%-1.12%) in those 40 years of age or older, respectively. The prevalence of POAG increased significantly with age using multivariate analysis (P < 0.001). Only two of 27 participants (7.4%) with definite POAG had been previously diagnosed and treated, and 66.7% of the previously undiagnosed had IOP less than 22 mmHg. Fourteen of 27 participants (51.9%) with definite POAG had severe glaucomatous damage based on optic disc and visual field criteria, of which five participants (18.5%) had at least one blind eye as a result of POAG (all with best-corrected distance visual acuity less than 20/400 or central visual field less than 10 degrees); the other 13 participants (48.1%) had moderate glaucomatous damage. Because visual fields and optic disc photography were not performed on all participants, the prevalence of POAG may have been underestimated. Secondary open-angle glaucoma was present in one participant as a result of angle recession. CONCLUSIONS: The prevalence of open-angle glaucoma in this urban population in southern India is at least as much as that reported recently from white populations in developed countries. However, the vast majority of persons with glaucoma were undiagnosed in this population, and a large proportion of those having definite POAG already had severe glaucomatous damage.

Adolescent↗
PubMed1992

[Visual acuity perimetry. Detection of glaucomatous visual field defects].

50 eyes of 50 patients with different types of glaucoma (27 eyes with POAG, 14 eyes with glaucoma due to pseudoexfoliation, 8 eyes with chronic narrow-angle glaucoma, 1 eye with normal-tension glaucoma) were examined with light-sense perimetry (Humphrey-Field-Analyzer, program 30-2) and resolution perimetry according to Frisén [2-7]. As the field area tested by Frisén's ring perimeter is smaller than that of the HFA, the comparison was restricted to the area of the ring perimeter, so that 50 out of 77 test locations of the HFA were included. In addition to a quantitative comparison with statistical criteria based on age-corrected normal values, a subjective qualitative assessment was established. The quantitative comparison of all hemifields showed good agreement in 61% of eyes, the ring perimeter indicating moderately and markedly increased numbers of defects in 13% and 4% of eyes and the HFA in 18% and 4% of eyes, respectively. Qualitative comparison of the entire fields revealed good agreement in 46% of eyes, with moderately and markedly more defects in 18% and 10% for the ring perimeter and 12% and 14% for the HFA, respectively. The average time needed for examination was 6.0 +/- 1.1 min for the ring perimeter and 17.2 +/- 2.7 min for the HFA. The Global Deviation of the ring perimeter correlates linearly with the Mean Deviation of the HFA (r = 0.4824, P < 0.001).

Adult↗
PubMed1995

New approach to estimating variability in visual field data using an image processing technique.

AIMS: A new framework for evaluating pointwise sensitivity variation in computerised visual field data is demonstrated. METHODS: A measure of local spatial variability (LSV) is generated using an image processing technique. Fifty five eyes from a sample of normal and glaucomatous subjects, examined on the Humphrey field analyser (HFA), were used to illustrate the method. RESULTS: Significant correlation between LSV and conventional estimates--namely, HFA pattern standard deviation and short term fluctuation, were found. CONCLUSION: LSV is not dependent on normals' reference data or repeated threshold determinations, thus potentially reducing test time. Also, the illustrated pointwise maps of LSV could provide a method for identifying areas of fluctuation commonly found in early glaucomatous field loss.

Adult↗
PubMed1994

[Effect of artificial media opacities on Frisén ring perimetry and conventional light sense perimetry. A comparative study].

In this study we compare the influence of blurring by diffusor foils (Bangerter) on visual acuity and on the thresholds of ring and light sense perimetry. Light sense perimetry was performed using the G1 program of the Octopus 1-2-3 perimeter [1], and ring perimetry with the "ring" test, version 2.20 (High-Tech-Vision) designed by Frisén [4]. Ten eyes of ten healthy persons with a visual acuity of 1.25 or better were examined at six different levels corresponding to visual acuities between 1.6 and hand movements. With both perimeters sensitivity decreased with decreasing visual acuity. At good visual acuities (1.2-1.6) no changes were found in either ring perimetry or light sense perimetry. At acuity levels of 0.8 and below a more pronounced decrease in sensitivity was found with the ring perimeter than with the light sense perimeter. At the level of hand movements there were only absolute scotomas in the ring perimeter, while the Octopus 1-2-3 still detected a baseline sensitivity. Sensitivity was correlated with the logarithm of the visual acuity with both perimeters (Octopus 1-2-3: r = 0.99, P < 0.001; ring perimeter: r = 0.98, P < 0.001). The decrease in sensitivity per log-unit of visual acuity was 9.43 dB (Octopus 1-2-3) or 5.19 dB (ring perimeter). The ring perimeter, at least in its currently available version giving an absolute scotoma at mean scores > 14 dB, is obviously more sensitive to media opacities than the Octopus 1-2-3. This may be of importance in the clinical evaluation of the test results.

Adult↗
PubMed1984

Neuropathies of the optic nerve and visual evoked potentials with special reference to color vision and differential light threshold measured with the computer perimeter OCTOPUS.

The contrast evoked potentials (VEPs) to different check sizes were recorded in about 200 cases of discrete optic neuropathies (ON) of different origin. Differential light threshold (DLT) was tested with the computer perimeter OCTOPUS. Saturated and desaturated tests were applied to evaluate the degree of acquired color vision deficiency. Delayed VEP responses are not confined to optic neuritis (RBN) alone and the different latency times obtained from other ON are confluent. The delay may be due to demyelination, to an increasing dominance of paramacular VEP subcomponents or to an increasing dominance of the upper half-field responses. Recording with smaller check sizes has the advantage that discrete dysfunctions in the visual field (VF) center are more easily detected: a correlation between amplitudes and visual acuity is best in strabismic amblyopias, is less expressed in maculopathies of the retina and weak in ON. The absence or reduction of amplitudes to smaller check sizes, however, is an important indication of a disorder in the VF center of ON in an early or recovered stage. Acquired color vision defects of the tritan-like type are more confined to discrete ON, whereas the red/green type is reserved to more severe ON. The DLT of the VF center is reduced in a different, significant and non significant extent in discrete optic neuropathies and the correlation between DLT and visual acuity is weak. A careful numerical analysis is needed in types of discrete ON where the central DLT lies within normal statistical limits: a side difference of the DLT between the affected and the normal fellow eye is always present. Evaluation of visual fatigue effects and of the relative sensitivity loss of VF center and VF periphery may provide further diagnostic information.

Adolescent↗
PubMed1999

Comparison of central and peripheral visual field properties in the optic neuritis treatment trial.

PURPOSE: To compare the results of peripheral kinetic visual field testing and central static perimetry for patients enrolled in the Optic Neuritis Treatment Trial to determine (1) whether loss and recovery of visual field sensitivity in the far periphery was different from that observed in the central visual field and (2) whether the far peripheral visual field provided additional useful information that was not available in the central visual field results. METHODS: Both affected and fellow eyes of 448 patients with optic neuritis in the Optic Neuritis Treatment Trial were evaluated according to the trial protocol during the patients' first 3 years in the study. Central static visual field tests were performed with program 30-2 on the Humphrey Field Analyzer, and peripheral kinetic testing consisted of plotting the I3e and II4e isopters on the Goldmann perimeter. Both test procedures were conducted according to the trial protocols, and quality control assessments and clinical evaluations were performed on all the visual fields. RESULTS: For both affected and fellow eyes at all 11 visits, there was a greater number of abnormal visual fields in the central static perimetry results than in the peripheral kinetic data. Only 2.9% of affected eyes had an abnormal peripheral visual field with a normal Humphrey mean deviation during year 1. At baseline, 97.1% of affected eyes had an abnormal Humphrey mean deviation on central static testing, whereas only 69.9% had abnormal peripheral kinetic visual fields. Approximately 80% of the I3e and II4e isopters for affected eyes that were abnormal at baseline were within normal limits at 30 days, but it took until week 19 for even 70% of the Humphrey mean deviations to return to normal. In addition, the II4e isopters (more peripheral than the I3e isopters) that were abnormal at baseline showed a somewhat greater percentage of improvement from baseline through day 30 than the abnormal I3e isopters. Although this difference is statistically significant, it is probably not clinically significant. For visits after week 19, approximately 25% to 30% of affected eyes had an abnormal Humphrey mean deviation, whereas only 10% to 15% of peripheral kinetic fields were abnormal. CONCLUSIONS: For the affected eye in optic neuritis, the central visual field shows greater abnormalities than the far peripheral visual field. When the results obtained through Humphrey automated central static visual fields and Goldmann peripheral kinetic isopters are compared, the far periphery appears to recover more rapidly and more completely than the central field, at least in more severe cases of optic neuritis. In most cases, recovery in optic neuritis can probably be monitored effectively with automated perimetry of the central visual field alone. However, in cases of severe loss of the central visual field, a peripheral kinetic visual field obtained with a Goldmann perimeter may provide additional information about the patient's vision in the far periphery.

Adolescent↗
PubMed1993

Role of automation in new instrumentation.

In recent years there has been an unprecedented increase in the development of automated instrumentation for ophthalmic diagnostic and assessment purposes. An important part of this growth in automated clinical ophthalmic instrumentation has been directed to perimetry and visual field testing. In less than 15 years automated perimetry has advanced from a laboratory curiosity to become the standard for clinical visual field testing. This paper will provide a brief overview of the impact that automated perimetry has had on current clinical ophthalmic practice and patient management. It is presented as a general example of the influence that automated instrumentation has exerted on the clinical environment.

Automation↗
PubMed1998

Effects of migraine on visual function.

BACKGROUND: Data is reported from an ongoing trial considering whether visual loss associated with migraine is consistent with a selective deficit in M- or P-cell functioning. METHODS: The psychophysical tests used include spatio-temporal contrast thresholds and luminance increment thresholds for a spot drifting across a spatially or temporally modulated background. A migraineur and 15 non-headache controls participated in the present study. Measurements were made foveally and at 10 degrees in the superior field. Static and flicker perimetry were conducted. RESULT/CONCLUSION: Regionalized losses occurred for stimuli with moderate temporal frequencies (16 Hz), which is consistent with M-cell dysfunction.

Adult↗
PubMed2001

Optic disc and visual field changes in a prospective longitudinal study of patients with glaucoma: comparison of scanning laser tomography with conventional perimetry and optic disc photography.

OBJECTIVE: To investigate the relationship between optic disc changes measured with scanning laser tomography and those measured with conventional perimetry and optic disc photography. METHODS: In a prospective longitudinal study, we followed up 77 patients with early glaucomatous visual field damage. Scanning laser tomography (using the Heidelberg Retina Tomograph) and conventional perimetry (using the Humphrey Field Analyzer) were carried out every 6 months. Disc progression was determined by a procedure recently described by us for scanning laser tomography, with confirmed progression requiring repeatable changes based on probability limits for both the depth (using individual test-retest variability values) and size of change (determined in a group of 37 healthy individuals also followed up prospectively). Field progression was determined with the Statpac Glaucoma Change Probability Analysis. The agreement between scanning laser tomography and conventional disc photography was determined in a subgroup of patients. RESULTS: Patients were followed up for a median of 5.5 years, with a median of 12 sets of examinations with scanning laser tomography and conventional perimetry. Twenty-one patients (27%) showed no progression with either technique. Thirty-one patients (40%) progressed with scanning laser tomography only, while 3 (4%) progressed with conventional perimetry only. Of the 22 patients (29%) who progressed with both techniques, 10 (45%) progressed with scanning laser tomography first (median, 18 month earlier) and 9 (41%) with conventional perimetry first (median, 12 months earlier), while 3 (14%) progressed at the same time. Of the 16 patients with disc photographs that closely overlapped the follow-up, there was concordance between scanning laser tomography and disc photography in 13 patients (81%). CONCLUSIONS: Glaucomatous disc changes determined with scanning laser tomography occur more frequently than field changes. Most patients with field changes also had disc changes; however, less than half of those with disc changes had field changes.

Adult↗
PubMed1975

A erimetric technique believed to test receptive field properties: sequential evaluation glaucoma and other conditions.

We used a technique to simplify and speed up a perimetric test (Westheimer function). Through sequential testing, the technique was successfully used to evaluate pathologic findings and partially to evaluate treatment regimens in three subjects. One patient had an onset of kinetic field changes and Westheimer function alteration with primary open-angle glaucoma. Temporary remissions of alterations in the Westheimer function and kinetic visual field loss occurred in patients with glaucoma and tobacco-alcohol (complicated) amblyopia. Using these techniques it is possible to localize an anomaly in the outer retinal layer, the inner retinal layer, and central to the optic nerve head. We divided the inner and outer retinal layers on a vascular support basis.

Aged↗
PubMed1980

[Visual perception under the influence of a tranquilizer (author's transl)].

In a double blind study, the influence of the tranquilizer Camazepam on different ophthalmological parameters was examined. The 12 test persons were between 20 and 30 years of age and had entirely normal ocular findings. Visual acuity was uninfluenced by a single dose of 40 mg of Camazepam, reflecting the very slightly hypnotic effect of the drug. Roughly half of the patients showed a considerable widening of the visual field, thought to be related to the stimulation of attention caused by Camazepam. Finally the lack of muscle relaxing properties of Camazepam was confirmed as regards the extraocular muscles, since their balance remained uninfluenced as well.

Accommodation, Ocular↗
PubMed2002

Dark adaptation in age-related macular degeneration: relationship to the fellow eye.

BACKGROUND: Abnormalities of dark adaptation have been documented in patients with age-related macular degeneration (AMD), but the relationship with the various forms of this disorder has not been studied systematically. METHODS: Dark-adapted retinal sensitivities and kinetics of dark adaptation were studied using a Humphrey visual field analyzer adapted for these purposes in patients over 64 years of age. One eye per patient was studied. Study eyes had a normal visual acuity and macular drusen only. The fellow eye was categorized as follows: group I, pigment epithelial detachments and tears of the retinal pigment epithelium (RPE); group II, choroidal neovascularization; and group III, drusen only. The results of psychophysical tests of the study eyes (group I and II and one eye of group III patients) were compared with one another and with older patients without evidence of AMD (group IV). RESULTS: Retinal sensitivity was found to be most consistently abnormal nearest the fovea. The time course of dark adaptation was prolonged beyond 45 min in 10/11 patients (91%) in group I, 6/10 patients (60%) in group II, and 6/10 (60%) in group III and 1/11 (9%) in group IV. CONCLUSION: In a high proportion of patients with visual loss from AMD in one eye, the fellow eye shows abnormal dark adaptation. These changes appear to be most pronounced in patients with detachments of the RPE in the fellow eye.

Aged↗
PubMed1991

Rod thresholds in dominantly inherited juvenile optic atrophy.

Three members of a family with dominantly inherited juvenile optic atrophy with tritan type of colour vision deficiency all showed dysfunction of the rod mechanism tested with green light after 30 min of dark adaptation. Two subjects had typical optic atrophy, centrocaecal scotoma and lower than normal visual acuity. In 1 subject with good visual acuity of both eyes, no optic atrophy was observed, but there were, in this case, reduced peripheral parts of the standard visual fields.

Adult↗