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Results for “Visual Field Tests”

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PubMed1996

Early visual disturbances in glaucoma.

Early visual loss in glaucoma may not be detected with conventional perimetry because this technique uses simple spots of light that are perceived by any type of ganglion cells. Visual tests for central or peripheral vision have been designed to more specifically address subsets of cells that are impaired in the early phases of the disease. The rationale for use of these tests and their current clinical evaluation are reviewed in this paper. Many tests assessing different visual pathways give abnormal results in patients with suspected glaucoma and ocular hypertensive patients, favoring the hypothesis that multiple pathomechanisms are involved in the onset of glaucoma.

Animals↗

PubMed1978

Evaluation of the pituitary. Patients with suspected prolactin-producing tumors.

We have reviewed our experience in the radiographic and ophthalmologic evaluation of 1001 patients with symptoms suggesting the presence of a pituitary, prolactin-secreting adenoma. Twenty-seven patients had abnormal or suspicious radiographic examination of the sella turcica. Twenty-two of those had hyperprolactinemia. In only one instance was an abnormality noted on polytomography that was not seen on a conventional four-view study of the skull. Based on these findings, a four-view plain conventional radiographic assessment of the skull suffices as a screening procedure in patients with amenorrhea, galactorrhea, or both. Thin section tomography should be reserved to more thoroughly evaluate those patients with elevated serum prolactin concentrations and/or abnormal conventional radiographs. We found visual field testing to be of little value as an initial screening procedure in these patients.

Adenoma↗

PubMed1989

The effect of perimetric experience in normal subjects.

Two groups of normal subjects were submitted to repeated automated static threshold perimetry. Perimetric results were strongly affected by the level of experience in some subjects; in the majority, however, the effect of experience was small. Initial field tests often showed high numbers of depressed points. Sensitivity increased with perimetric training, particularly between the first sessions. Those subjects who improved most started low, gradually approaching normal levels with experience. Learning effects were more pronounced peripherally than paracentrally and "untrained" fields characteristically showed concentric contraction with numerous points with low sensitivity peripherally. An important practical conclusion is to allow repeated testing of all inexperienced patients in whom initial fields do not agree with clinical findings. A chart showing a concentrically narrowed field should be viewed with particular suspicion. Furthermore, a single initial field may constitute an inadequate baseline for clinical follow-up.

Adult↗

PubMed2002

Can Swedish interactive thresholding algorithm fast perimetry be used as an alternative to goldmann perimetry in neuro-ophthalmic practice?

OBJECTIVE: To assess the potential role of Swedish Interactive Thresholding Algorithm (SITA) Fast computerized static perimetry, compared with that of Goldmann manual kinetic perimetry (GVF), for reliably detecting visual field defects in neuro-ophthalmic practice. BACKGROUND: Automated visual field testing is challenging in patients with poor visual acuity or severe neurological disease. In these patients, GVF is often the preferred visual field technique, but performance of this test requires a skilled technician, and this option may not be readily available. The recent development of the SITA family of perimetry has allowed for shorter automated perimetry testing time in normal subjects and in glaucoma patients. However, its usefulness for detecting visual field defects in patients with poor vision or neurological disease has not been evaluated. DESIGN AND METHODS: We prospectively studied 64 consecutive, neuro-ophthalmologically impaired patients with neurologic disability of 3 or more on the Modified Rankin Scale, or with visual acuity of 20/200 or worse in at least one eye. Goldmann manual kinetic perimetry and SITA Fast results were compared for each eye, with special attention to reliability, test duration, and detection and quantification of neuro-ophthalmic visual field defects. We categorized the results into 1 of 9 groups based on similarities and reliabilities. Patient test preference was also assessed. RESULTS: Patients were separated into 2 groups, those with severe neurologic deficits (n = 50 eyes) and those with severe vision loss but mild neurologic dysfunction or none at all (n = 50 eyes). Overall, GVF and SITA Fast were equally reliable in 77% of eyes. Goldmann manual kinetic perimetry and SITA Fast showed similar visual field results in 75% of all eyes (70% of eyes of patients with severe neurologic deficits and 80% of eyes with poor vision). The mean +/- SD duration per eye was 7.97 +/- 3.2 minutes for GVF and 5.43 +/- 1.41 minutes for SITA Fast (P<.001). Ninety-one percent of patients preferred GVF to SITA Fast. CONCLUSIONS: We found the SITA Fast strategy of automated perimetry to be useful in the detection, and accurate in the quantification of central visual field defects associated with neuro-ophthalmic disorders. Our results suggest that for the general ophthalmologist or neurologist, visual field testing with SITA Fast perimetry might even be preferable to GVF, especially if performed by a marginally trained technician, even in patients with severely decreased vision or who are neurologically disabled.

Adolescent↗

PubMed2005

The psychophysics of glaucoma: improving the structure/function relationship.

Perimetry of some kind remains an important tool in the detection, diagnosis and monitoring of glaucomatous damage to the visual pathway. However, recent studies have served to reinforce the suspicion that conventional perimetry does not possess the sensitivity to detect the earliest signs of functional loss resulting from glaucoma. The relationship between differential light threshold and ganglion cell loss is extremely weak and, in the early stages of glaucoma, non-existent. Alternative, more novel perimetric techniques seem to offer promise of better detectability for early loss by claiming to tap in to one or other of the separate parallel pathways of the visual system. While some of these tests show potential for better detection and monitoring of glaucoma, the reasons why this might be so are not always clearly formulated or represented. This leads to misunderstanding of what the test actually measures and of the glaucomatous disease process itself. This paper seeks to revisit and review the theory underlying psychophysical testing of visual function related to glaucoma and stresses the importance of developing tests that are based on a firm theoretical understanding of visual function and processing in order to both detect glaucoma at an earlier stage and better understand the mechanisms of loss from the disease process.

Glaucoma↗

PubMed1986

[Detectability of glaucomatous visual field defects with the Octopus automatic perimeter. A comparison between program G-1 and programs 31 and 32 and their combinations].

Twenty-three patients between 31 and 76 years of age suffering from either hypertension or glaucoma underwent automatic perimetry with Octopus programs 31 or 32, followed by program G-1. This was done to compare the information content of the latter, new program with that of the former two, long-used in different combinations. Only one eye of any one patient was considered in this study. Using an evaluation program, the G-1 program calculates the so-called "field indices" which help to interpret the results. These field indices are the mean differential light sensitivity threshold (mDLS), the mean defect (MD), the loss variance (LV), and the corrected loss variance (corrected for short-term fluctuations (CLV)). In order to compare programs 31, 32, and their combination 31 + 32, with the field indices of program G-1, the mean DLS was taken from the Delta evaluation program, while the mean defect, the loss variance, and the corrected loss variance were calculated on the basis of programs 31, 32, and the combination of them. The mDLS and mean defect determined with program G-1 were significantly different from those found with programs 31, 32, and the combination of them. On the one hand, this was due to the difference in test patterns, that of G-1 being more centrally weighted; on the other hand, this is indicative of the precision and discrimination capability of Octopus measurements. Calculation of loss variance and corrected loss variance reveals no significant difference between the examination methods as regards these field indices, that is, between G-1 and 31, 32, or 31 + 32.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

Mapping of glaucomatous visual field defects by multifocal VEPs.

PURPOSE: To objectively measure a visual field and to sensitively detect glaucomatous visual field defects by measuring the contrast sensitivity function (CSF), using multifocal visual evoked cortical potentials (MVEPs). METHODS: MVEPs of normal subjects (n = 28) and of patients with glaucoma (n = 12) or ocular hypertension (OH, n = 1) were recorded. A multi-input procedure was used to obtain 37 local VEP responses to each scaled hexagon, composed of 24 triangular patterns, reversing in a counterphase manner. Two pattern contrasts of 32% and 8% were used for measuring the contrast threshold. To improve the signal-to-noise ratio, 37 MVEPs were averaged into 20 groups. The root-mean-square (RMS) measures at both contrasts were calculated. Contrast thresholds were estimated by extrapolating the regression line of the amplitude versus contrast to the mean noise levels. RESULTS: RMS amplitudes of each local MVEP decreased as the eccentricity increased and as the pattern contrast decreased in normal subjects. It was also revealed that the amplitudes were smaller in the upper-half field than those in the lower-half field. Compared with the RMS amplitudes, CSFs estimated by MVEPs were relatively constant without being strongly influenced by retinal eccentricity. In patients with glaucoma, the CSFs, even from the locations where the mean perimetric sensitivities ranged to more than 30 dB, were significantly smaller than those in the normal control subjects (P < 0.001, Mann-Whitney test). CSFs in the 20- to 30-dB and 100 to 20-dB groups were also significantly smaller than those in the more-than-30-dB or 20- to 30-dB groups, respectively (P < 0.001, Mann-Whitney test). A significant correlation was found between the logarithmic function of the CSF and perimetric sensitivity (r = 0.57, P < 0.001, n = 216). The CSFs were evaluated on the basis of normal SD. Mappings of the CSFs agreed well with those of the perimetric sensitivity in all patients with glaucoma and was even more sensitive in detecting slight optic nerve damage by glaucoma than was perimetry. CONCLUSIONS: Local optic nerve damage caused by glaucoma can be sensitively detected by measuring contrast sensitivity using the MVEP.

Contrast Sensitivity↗

PubMed1989

Spatial and spatiotemporal contrast sensitivity of normal and glaucoma eyes.

The spatial contrast sensitivity (CS) to static patterns was tested in the central retina of 156 normal subjects. It showed a decrease above 50 years of age at all spatial frequencies tested which was slightly more pronounced in females than in males. The spatial CS was also studied in 32 glaucoma eyes: Small reductions were found only in the group below 50 but not in eyes of patients above 50. The spatiotemporal CS to phase-reversing patterns was tested in four retinal quadrants of 99 normal subjects. It showed no age dependence in males whereas in females it decreased significantly beyond 50 years at all spatial frequencies tested. The spatiotemporal CS was studied also in 21 glaucoma eyes: Strong losses were again noted only in patients below 50. Spatiotemporal CS losses and perimetric losses were also compared in the four quadrants: For both measures the severest losses were found in the lower nasal and the mildest in the upper temporal quadrant. The spatiotemporal CS test of the peripheral retina seems to be a more powerful tool in glaucoma research than the spatial CS test of the central retina; however, effects of age and gender have to be considered.

Adult↗

PubMed1979

Laser scotometry in drusen and pits of the optic nerve head.

Laser scotometry is an accurate means of detecting dense blind spots. A small low-energy spot is guided across the fundus from nonseeing to seeing areas. Patient responses are recorded on fundus photographys, allowing direct correlation with fundus pathology. Accuracy to less than 1 degree is feasible. All typical optic nerve drusen tested with this technique had field defects. In cases of optic nerve pits, dense scotomas correlated with the shape of visible nerve fiber defects rather than with the shape of serous retinal detachments.

Adult↗

PubMed2003

The effect of cataract on Accumap multifocal objective perimetry.

PURPOSE: To determine the effect of visually significant cataract on Accumap multifocal objective perimetry. DESIGN: Interventional case series. METHODS: Fifteen eyes of 15 adult patients who underwent standard outpatient phacoemulsification cataract surgery with posterior chamber intraocular lens insertion with subsequent improvement of best-corrected visual acuity underwent Accumap testing before and after cataract extraction. Patients had no other ophthalmic disease or other conditions that may have affected visual evoked potentials. Results were analyzed statistically. RESULTS: Visually significant cataract was associated with a statistically significant reduction of mean Accumap amplitudes within the central 107 degrees (zone 1, P =.002; zone 2, P =.003; zone 3, P =.001) but did not affect the outer two zones (zone 4, P =.074; zone 5, P =.931). CONCLUSIONS: Accumap visual fields may be affected by visually significant cataract. Multifocal objective perimetry defects in the central 10 degrees should be interpreted with caution in patients with cataract.

Aged↗

PubMed1994

Clinical heterogeneity of dominant optic atrophy: the contribution of visual function investigations to diagnosis.

BACKGROUND: The variability of the visual function impairment in dominant optic atrophy (DOA) makes it difficult to diagnose the disease within genealogies. Physiologic investigations were conducted on a family with DOA to evaluate methods of detecting clinical and subclinical signs in obligate heterozygotes, in order to identify affected subjects within the genealogy and to formulate the individual and reproductive risks. METHODS: Investigations included tests for color vision, contrast sensitivity function (CSF), kinetic and static computerized perimetry, transient pattern reversal visual evoked potentials (VEPs) and steady-state flash VEPs. RESULTS: Eight subjects from the pedigree were diagnosed as having DOA. Two of them were unaware of their affection, and six showed wide clinical variability. CSF paralleled the central visual impairment, but was also slightly impaired in the two unaware subjects. Static computerized perimetry disclosed mild sensitivity defects in the central visual fields in these two patients. VEPs showed heterogeneous results as well, ranging from normal findings to severely altered tracings. CONCLUSIONS: This investigation suggests that combined clinical and functional evaluation is necessary to diagnose DOA. Particularly, the combined use of computerized perimetry, CSF, and VEPs allowed the identification of cases at a subclinical stage.

Adolescent↗

PubMed2004

Macular perimetry in low vision.

BACKGROUND: Detection of residual visual function is critical for vision rehabilitation. Macular perimetry may provide essential information in this regard. In the presence of reduced vision, fixation maintenance is paramount for perimetric test validation. We performed a study to determine the validity of perimetric test results in the presence of low vision, as expressed by the relation between scotoma location, acceptable fixation maintenance and visual acuity. METHODS: The study was a prospective observational case series. Macular perimetry testing was performed with the Humphrey Automated Perimeter in eyes of consecutive patients attending our low-vision clinic between July and December 1999. The main outcome measures referred to scotoma location, acceptable fixation maintenance and visual acuity. RESULTS: We tested 46 eyes of 46 patients, 24 men and 22 women aged 33 to 88 years (mean 69.0 [standard deviation 15.41] years). Of the 35 eyes with best corrected visual acuity of 20/200 or better, 18 (51.4%) had acceptable fixation maintenance (p = 0.052), and 31 (88.6%) had scotoma patterns displaced eccentrically (p < 0.001). INTERPRETATION: We conclude that in the presence of residual vision of 20/200 or better, acceptable fixation maintenance is possible, probably with a new preferred retinal locus, and, as a result, scotoma patterns are recorded eccentrically. Therefore, perimetric results in such cases should be viewed as valid, and interpretation should always account for eccentric fixation. Concomitant testing with scanning laser ophthalmoscopy or eye tracking equipment could further clarify this issue.

Adult↗

PubMed2005

Detection of narrow bars when presented in the right and left visual hemifields.

Three series of psychophysical experiments were performed to study the effects of additional images on the contrast thresholds for detection of narrow bars of width 1 arc min and length 1 arc degree presented randomly to the left and right sides of the fixation point with an eccentricity of 4 degrees. The additional images were bars of the same size but with lower contrast, presented to the right and left of the test bar at varying distances, i.e., 1-2 degrees. Different series used different contrast ratios for the test and additional bars. The first series revealed significant predominance of one visual hemifield over the other in performing the bar detection task, though the predominant side varied in different subjects. This predominance disappeared or changed to the opposite side in the second or third series. There was a tendency for the additional images to have asymmetrical influences on the detection threshold for the test bar: additional bars had more extensive inhibitory influences when they were on the peripheral side of the test bar. These data provide evidence for the absence of specificity in hemisphere operation in the detection task. The mechanism of description of peripheral images is discussed.

Contrast Sensitivity↗

PubMed2006

Frequency doubling technology perimetry after clear and yellow intraocular lens implantation.

PURPOSE: To evaluate the effect of intraocular lens (IOL) color on frequency doubling technology (FDT). DESIGN: Randomized clinical trial. METHODS: For 26 eyes of 26 patients, FDT perimetry (24-2-threshold test) was measured three months after cataract surgery. An acrylic IOL was randomly selected from clear (VA60BB, HOYA) and yellow-tinted lenses (YA60BB, HOYA), which only differed by color. As a control, a further 14 cataractous eyes with visual acuity > or =20/30 were examined. We analyzed mean deviation (MD) and pattern standard deviation (PSD) among the three groups. RESULTS: After cataract surgery, MD significantly improved (Fisher protected least significant difference (PLSD): P < .05), but PSD did not change (analysis of variance (ANOVA): P = .94) compared with control values. There was no significant difference between the two IOLs for either MD (Mann-Whitney test; P = .15) or PSD (Mann-Whitney test; P = .84). CONCLUSIONS: When interpreting the results of FDT, the effect of cataract should be considered but that of IOL color does not need consideration.

Color↗

PubMed2006

Structural and functional assessment of the macular region in patients with glaucoma.

PURPOSE: To investigate the correlation of a structural measure of the macular area (optical coherence tomography (OCT)) with two functional measures (10-2 Humphrey visual field (HVF) and multifocal visual evoked potential (mfVEP)) of macular function. METHODS: 55 eyes with open-angle glaucoma were enrolled. The 10-2 HVF was defined as abnormal if clusters of > or =3 points with p<5%, one of which had p<1%, were present. The mfVEP was abnormal if probability plots had > or =2 adjacent points with p<1%, or > or =3 adjacent points with p<5% and at least one of these points with p<1%. Two criteria were used for the macular OCT: (I) > or =2 sectors with p<5% or 1 sector with p<1% and (II) 1 sector with p<5%. RESULTS: 54 of the 55 eyes showed an abnormal 10-2 HVF and 50 had central mfVEP defects. The two OCT criteria resulted in sensitivities of 85% and 91%. When both functional tests showed a defect (in 49 eyes), the OCT was abnormal in 45. For the OCT the outer and inner inferior regions were the most likely to be abnormal, and both functional techniques were most abnormal in the superior hemifield. CONCLUSIONS: Good agreement exists between macular thickness and functional defects in patients with glaucoma. Study of the macular region may provide a quantitative measure for disease staging and monitoring.

Adult↗

PubMed2003

[Contrast detection thresholds during their presentation in right and left hemifields of vision].

We measured contrast detection thresholds for thin black vertical bars (1 min of arc wide, 1 deg long) against a bright background, which were presented eccentrically at 4 deg to the left or right of fixation and flanked on one side by a subthreshold bar having the same dimensions. On each presentation, the stimulus randomly appeared in the left or right visual hemifield. The separation between the test and the flanks varied from 1 to 60-120 min of arc. Different subjects showed better performance in different hemifields. This preference was lost or changed to opposite in the course of training. The central excitatory areas are more or less symmetrical, but inhibitory areas reveal asymmetrical tendency: when flanked bars were more peripheral than the test line, the inhibitory areas were larger. Our results show absence of hemispheric specificity in the line detection task. We discuss the ways of stimulus description in fovea and periphery.

Fovea Centralis↗

PubMed1995

Landmark-driven fundus perimetry using the scanning laser ophthalmoscope.

PURPOSE: To present a new method of performing scanning laser ophthalmoscope perimetry that compensates for eye movements so that the correct retinal location is tested even if fixation changes. This allows for accurate testing of patients with central scotomas and for repeating testing longitudinally at the same retinal locations even if central fixation is lost. METHODS: The operator views the retina and selects a retinal landmark, such as a vessel bifurcation, that can be identified easily. A testing strategy is preselected, and the computer saves the landmark and stimulus coordinates. To present each stimulus, the operator positions a cursor over the retinal landmark, and the computer adjusts the site of presentation of the stimulus for any change in landmark position caused by an eye movement. At the conclusion of the testing, the results are displayed in the proper retinal location on a fundus image. RESULTS: Sixty-seven eyes with macular disease were tested with the landmark-driven method, using the same preplanned strategy for each eye for both a bright and a dim stimulus. There was a low rate of inconsistent points (seen with dim but not bright stimuli), and virtually all of these bordered a dense scotoma. Those eyes with more inconsistent points had a significantly greater percentage of dense scotoma points and significantly lower visual acuity. The technique significantly corrected error in retinal localization resulting from large eye movement. There is no significant rotation or magnification change during the procedure, so specifying the change in location of one landmark is sufficient to describe movement of the retina. The technique is rapid and easy to administer to elderly patients and to children. CONCLUSIONS: This technique allows for accurate and repeatable measures of retinal sensitivity in specific locations. It is useful in following change over time. It can be developed further to allow for fully automated, retinally correct testing.

Adolescent↗

PubMedDate not supplied

Optic disc pallor: a false localizing sign.

A 20-year-old pregnant woman was referred with bilateral mild visual acuity loss and optic disc pallor. Because of profound color vision deficits out of proportion to her acuity loss, an abnormality of the cone photoreceptors was suspected. An electroretinogram confirmed the diagnosis of a cone dystrophy and precluded further costly and invasive testing. Cone dystrophy should be considered in the differential diagnosis of any patient with bilateral, nonrefractive visual loss, especially if color vision is disproportionately affected, even with a normal retinal appearance and no significant family history.

Adult↗