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PubMed1994

Use of visual field tests in glaucoma detection by optometrists in England and Wales.

This paper is based on a survey of 241 optometrists (5% of the national total) in England and Wales, which covered many aspects of glaucoma detection. There were 45 optometrists (19%) who did not use a field screener. Of the 196 who did, 173 reported their criteria for deciding which patients to test: 17 (estimated at 8% of the original sample) used a field screener routinely in patients over 40 years; 40 (19%) selectively tested all patients with intraocular pressure > 20 mmHg, together with most others in whom any glaucoma risk factor was present, (this required a visual field test in only one in five patients aged over 40 years and may be relatively cost-effective); the remaining 116 (55%) on average tested less than one in ten of their patients with a field screener, practice which is shown to contribute little to the number of glaucomas detected. Routine field testers had the highest glaucoma detection rates, and those of the selective testers were not significantly lower.

Age Factors↗
PubMed1982

Programmed visual field testing.

The use of programmed static spot-checking is remarkably accurate in detecting the presence of visual field defects, even the earliest abnormality, provided the correct stimulus (or stimuli) is chosen to check an appropriate number of spots, and the location of each missed response is retested. Automatic quantitation of visual field defects (so it can later be determined if the defects are worsening) can be accomplished automatically with some of the more expensive new instruments. The less elaborate instruments require repetitive testing or manual interaction, achieving accurate results, but typically with a cumbersome record of the results that is difficult to interpret. An efficient plan for the usual office at present is to use an automated spot-checking instrument for screening and diagnosis, but to depend upon the tangent screen or Goldmann perimeter for quantitation unless the most expensive automated instruments can be afforded.

Automation↗
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↗
PubMed1984

[Activity of neurons of the somatosensory and visual cortex in the rabbit during visual field testing and performance of food-getting behavior].

The activity of somatosensory and visual cortex neurons was compared in experiments on freely moving rabbits during testing of their receptive field and during natural "stimulation" of the receptive areas by environmental objects in food-acquisition behaviour. It was found that the neuronal activity during the receptive field testing may correspond completely, partly or not at all to that in food-acquisition behaviour, i.e. units displaying a certain relation to a receptive field area during the testing may keep it unaltered, alter it or lose it in food-acquisition behaviour. The different activity in the behaviour was observed even in neurons having identical receptive fields during testing. A conclusion is made that the picture of unit activity in the active goal-directed behaviour being modelled on the basis of receptive field testing may be rather vague. The results of experiments with the receptive field testing may help to develop the concept of processing of information about environment in the behaviour but with some limitations whose formulation demands special investigations.

Animals↗
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↗
PubMed1996

Analysis of progressive change in automated visual fields in glaucoma.

PURPOSE: To detect and estimate the rate of progression of visual field loss in subjects with glaucoma who undergo long-term automated perimetric visual field testing. METHODS: Automated visual field data were obtained for subjects with glaucomatous visual field loss and a minimum of seven threshold field tests over at least 4.5 years. Univariate linear regression was performed with respect to mean deviation (MD), corrected pattern standard deviation (CPSD), mean thresholds of clusters corresponding to the Glaucoma Hemifield Test (GHT), and thresholds of 52 individual test locations. Subjects were classified as progressive or stable (unchanged or improved) based on the slope and statistical significance of these parameters. Adjusted P values were used to maintain the overall type 1 error at 5%. RESULTS: One hundred ninety-one subjects with a mean follow-up period of 7.1 years (range, 4.5 to 10.5 years) and a mean number of visual field tests of 9.5 (range, 7 to 16) were included. Twenty-four subjects (12.6%) showed progression in MD (mean slope [95% confidence interval], -1.26 [-1.50, -1.01] dB/year), and 27 (14.1%) showed progression in CPSD (mean slope [95% confidence interval], 0.71 [0.58, 0.84] dB/year). Thirty-five subjects (18.3%) had > or = 1 progressive GHT cluster. The mean slope in progressive clusters ranged from -1.51 [-1.82, -1.20] to -2.84 [-3.39, -2.29] dB/year. Thirty-six subjects (18.8%) had > or = 1 progressive individual test locations. Fifty-two subjects (27.2%) were classified as progressive based on progression of CPSD, > or = 1 cluster and/or > or = 1 point. CONCLUSIONS: Fewer than 1 in 3 subjects progressed by any one of the criteria for progression over an average of 7.1 years. Rates of progression that could be statistically confirmed were in the range of approximately 1 to 5 dB/year, depending on the number of fields, the variability over time, and the parameter assessed (global indices, GHT clusters, or individual points). No correlation between initial visual field status and the rate of progression was found. A minimum of approximately 5 years of follow-up with annual perimetry would be required to detect significant changes in the visual field by linear regression.

Adolescent↗
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↗
PubMed1985

Testing of concentric visual field constriction by means of scotopic visually evoked potentials.

Using scotopic visually evoked potentials (VEP), an objective test of concentric absolute field defects is presented. At 0.8 log units above the mean VEP threshold, the full field, the central area of 50 degrees diameter, and the complementary peripheral field were flash stimulated. In 13 normal subjects the peripheral VEP response was larger in amplitude and shorter in latency compared to the central response. In four cases of concentric field restriction due to hysteria and malingering, the same results were found. In three cases of retinitis pigmentosa and advanced glaucoma, the peripheral VEP sensitivity was worse than the central one or no response could be found. The amount of stray light was estimated as the difference of the thresholds for central and peripheral stimulation (1.6 to 1.8 log units) in a patient with a residual central field of 20 degrees.

Adolescent↗
PubMed1995

[The correlation between changes of static central visual fields and posterior polar lesions in high myopia].

The static central visual fields tested by an Octopus Field Analyzer and posterior polar lesions in 53 cases with high myopia were investigated. Cases with low and moderate degrees of myopia were the controls. The results demonstrate that the visual field defects are present in the high myopic eyes and they are related to the degree of high myopia, the age of the patient and the severity of the posterior polar lesion. The visual field defects present multiform and multilevel in character and they do not completely correspond to the fundus lesions. The appearance of central relative scotomata in high myopic eyes detected by a quantified automated perimeter is prior to the appearance of macular lesions seen under an ophthalmoscope. Therefore, the quantified automated central visual field examination is helpful to the early diagnosis of macular disease in high myopia.

Adolescent↗
PubMed1983

Visual field and retinal nerve fibre layer in early glaucoma after optic disc haemorrhage.

Computerized visual field testing with the Competer automatic perimeter including automatic profile perimetry revealed early glaucomatous field loss in 9 of 10 eyes with photographically demonstrable retinal nerve fibre layer (RNFL) defects after optic disc haemorrhages despite the fact than conventional routine perimetry had failed to do so. In 7 of these cases the Competer central pattern test was abnormal; in 2 cases field defects could be shown only when automatic high-resolution static profile perimetry was performed and directed according to the information present in wide-angle RNFL photographs. A field defect was also found in one of five eyes with no photographic RNFL changes. Visual field defects seem to occur in a higher proportion of cases with RNFL defects than was previously thought, but they can be very subtle and hard to find. There are, however, cases where in spite of the presence of an indisputable RNFL defect no visual field defects can be shown even with painstaking technique and conversely field defects may be present without RNFL defects. Automatic perimetry and RNFL photography complement each other in early detection and quantitation of glaucomatous damage.

Aged↗
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↗
PubMed1986

Visual field area response to increased target intensity: a method of detecting ocular disease.

Application of computer digitizing methods to conventional kinetic visual field test data permits mathematical analysis of these data. In some cases this provides more information than is available by a simple inspection of the field charts. This is demonstrated by analysis of multiple isopter data for a patient with open-angle glaucoma and a patient with retinitis pigmentosa.

Adult↗
PubMed1980

Computerized visual field screening in the management of patients with ocular hypertension.

Visual field testing which the Computer fully automatic computerized perimeter (Heijl & Krakau 1975) employing a supra-liminal screening test procedure was used in a material of 1013 eyes with ocular hypertension in which earlier routine perimetry (kinetic and static) on the Goldmann perimeter had yielded a normal result. The automatic screening was repeated if positive, and manual control perimetry was used in order to confirm or reject identified field defects. This procedure revealed field defects that could be confirmed at both automatic and manual perimetry in 3.6% of the eyes. In the control group the incidence of field defects found at manual perimetry during the same time interval was calculated at 0.4%. Thus automatic screening revealed several times more field defects than manual routine perimetry. Eyes in which repeated automatic screening had indicated defects which manual control perimetry failed to confirm, showed a high percentage of field loss at later follow-up. The results are discussed, and the conclusion is drawn that automatic screening is clearly superior to manual routine perimetry used at present. The most practical solution in many eye departments would be to use a computerized perimeter for the visual field screening of glaucoma suspects.

Adult↗