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The relationship between progression of visual field defects and retrobulbar circulation in patients with glaucoma.

PURPOSE: To investigate whether lower blood flow velocities and higher resistive indices in the retrobulbar arteries are associated with progression of visual field defects in eyes with open-angle glaucoma with or without increased intraocular pressure. METHODS: Color Doppler imaging was performed in 16 eyes with progressive visual field defects in patients with normal-tension glaucoma, 15 eyes with practically stable visual field defects in patients with normal-tension glaucoma, 14 eyes with progressive visual field defects in glaucomatous patients with increased intraocular pressure, and 14 eyes with practically stable visual field defects in glaucomatous patients with increased intraocular pressure. Peak systolic velocity and end-diastolic velocity were measured, and resistive index was calculated in the central retinal artery, short posterior ciliary arteries, and the ophthalmic artery. RESULTS: Eyes with progressive visual field defects in patients with normal-tension glaucoma had statistically significantly lower blood flow velocities and higher resistive index in the central retinal artery and the short posterior ciliary arteries than did those with practically stable visual field defects, whereas, in the glaucomatous patients with increased intraocular pressure, such differences were not found. CONCLUSIONS: Eyes of patients with normal-tension glaucoma and progressive visual field defects have decreased blood flow velocities and increased resistive indices in their retrobulbar arteries, suggesting that these circulatory factors may be associated with the deterioration of visual field defects in patients with normal-tension glaucoma but may be less involved in the deterioration in glaucomatous patients with increased intraocular pressure.

Blood Circulation↗

The effect of pilocarpine on the visual field in normals.

Despite generalized consensus that pilocarpine-induced miosis results in some degree of visual field constriction, studies describing the predictability of this occurrence, as well as the nature of the field defects that may be seen, have not been undertaken. We studied 20 normal subjects, ranging in age from 24 to 57 years. Baseline refraction, pupillary measurements, and visual fields were performed in both eyes on a standardized Goldmann perimeter with the I-2e, I-3e, and I-4e test objects. Pilocarpine 2% was then instilled into the study eye and the field repeated at 30 and 120 minutes. An IBM PC computer program, designed by the authors, was used to calculate the area contained within each isopter. The probability of visual field constriction at 30 and 120 minutes after instillation of pilocarpine was found to be significant, especially with pupillary diameters of 2 mm or less. The I-2e isopter was most sensitive to miosis. Visual field constriction persisted with correction of ciliary spasm induced myopia, suggesting that miosis, especially when marked, can independently alter the visual field. The clinician, then, should make every effort to control visual field testing conditions in glaucoma patients on miotics to allow reliable serial comparisons.

Adult↗

Baseline visual field profile of optic neuritis. The experience of the optic neuritis treatment trial. Optic Neuritis Study Group.

The purpose of the present study was to determine the baseline visual field characteristics in 448 patients with acute optic neuritis who were entered into the Optic Neuritis Treatment Trial. The severity and pattern of visual field loss in both the affected and fellow eyes were classified. For affected eyes, diffuse visual field loss was present in 48.2% of eyes, central or centrocecal scotoma was present in 8.3% of eyes, altitudinal or other nerve-fiber bundle-type defects were present in 20.1% of eyes, and a variety of other defects were present in 23.4% of eyes. Visual field involvement was present in the fellow eye at baseline in 308 (68.8%) of the 448 patients. Evidence of a chiasmal or retrochiasmal visual field defect was present in 2.9% of the patients. Since a wide variety of visual field defects can occur with an acute attack of optic neuritis, the pattern of visual field loss is of limited utility in distinguishing optic neuritis from ischemic optic neuropathy and other optic nerve disorders. Asymptomatic visual field defects in the fellow eye are common.

Acute Disease↗

Infrequent confirmation of visual field progression.

OBJECTIVE: To evaluate the effects of the repeatability criteria on the detection of change in visual fields by six progression algorithms used in standard automated perimetry. DESIGN: Retrospective, observational case series PARTICIPANTS: Fifty-one glaucoma patients, each with multiple visual fields performed between May 1990 and December 1998, were included. METHODS: Each patient's set of visual fields were analyzed using the glaucoma change probability, the Early Manifest Glaucoma Trial (EMGT) algorithm, a modified glaucoma change probability score, a modified EMGT score, the Advanced Glaucoma Intervention Study algorithm, and the Collaborative Initial Glaucoma Treatment Study algorithm. MAIN OUTCOME MEASURES: The effects of repeatability on the detection of field change, the level of agreement among algorithms, as well as the number of eyes identified as changed with each algorithm, were assessed. RESULTS: Mean follow-up was 34 months (range, 12-87 months). The average percentage of eyes with change based on three consecutive follow-up fields was 8.2% (4.0%-12.5%). However, of those showing change on the initial follow-up, this change from baseline was observed in subsequent examinations on average in 23% (18%-33%), depending on the algorithm. When change was based on just one field, four of the six algorithms noted a significantly greater number of eyes with change. The algorithms, however, did not differ significantly when confirmation of field change required two versus three consecutive follow-up visual fields. CONCLUSIONS: Although current algorithms may help identify change, there are inconsistencies among them. We found that requiring repeatable change from baseline significantly reduces the number of changed eyes identified with each subsequent follow-up field. Identification and confirmation of change in visual fields plays an important role in helping to identify true glaucoma progression; however, the specific methods to do so have yet to be determined.

Adult↗

The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators.

PURPOSE: To investigate the association between control of intraocular pressure after surgical intervention for glaucoma and visual field deterioration. METHODS: In the Advanced Glaucoma Intervention Study, eyes were randomly assigned to one of two sequences of glaucoma surgery, one beginning with argon laser trabeculoplasty and the other trabeculectomy. In the present article we examine the relationship between intraocular pressure and progression of visual field damage over 6 or more years of follow-up. In the first analysis, designated Predictive Analysis, we categorize 738 eyes into three groups based on intraocular pressure determinations over the first three 6-month follow-up visits. In the second analysis, designated Associative Analysis, we categorize 586 eyes into four groups based on the percent of 6-month visits over the first 6 follow-up years in which eyes presented with intraocular pressure less than 18 mm Hg. The outcome measure in both analyses is change from baseline in follow-up visual field defect score (range, 0 to 20 units). RESULTS: In the Predictive Analysis, eyes with early average intraocular pressure greater than 17.5 mm Hg had an estimated worsening during subsequent follow-up that was 1 unit of visual field defect score greater than eyes with average intraocular pressure less than 14 mm Hg (P =.002). This amount of worsening was greater at 7 years (1.89 units; P <.001) than at 2 years (0.64 units; P =.071). In the Associative Analysis, eyes with 100% of visits with intraocular pressure less than 18 mm Hg over 6 years had mean changes from baseline in visual field defect score close to zero during follow-up, whereas eyes with less than 50% of visits with intraocular pressure less than 18 mm Hg had an estimated worsening over follow-up of 0.63 units of visual field defect score (P =.083). This amount of worsening was greater at 7 years (1.93 units; P <.001) than at 2 years (0.25 units; P =.572). CONCLUSIONS: In both analyses low intraocular pressure is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low intraocular pressure in visual field deterioration.

Adult↗

Correlation of visual field with quality-of-life measures at diagnosis in the Collaborative Initial Glaucoma Treatment Study (CIGTS).

PURPOSE: To examine the relationship between various clinical measures of visual field and patient-reported measures of symptoms and health status in a large cohort of patients with glaucoma at the time of diagnosis. PATIENTS AND METHODS: The 607 patients in the Collaborative Initial Glaucoma Treatment Study received standardized examinations of visual field at enrollment. In addition, they completed a telephone-administered, health-related quality-of-life questionnaire, which included the Visual Activities Questionnaire (VAQ) and a symptom and health problem checklist. RESULTS: The Visual Activities Questionnaire total and subscale scores, particularly the peripheral vision subscale, correlated weakly but significantly with global visual field scores. Symptoms attributed to glaucoma also correlated weakly but significantly to visual field scores. Correlations with other visual field measures, including only central and pericentral test locations in the scores, did not strengthen the association, and simulating binocular visual field scores produced only slightly stronger correlations. CONCLUSIONS: At diagnosis, most patients were relatively free of glaucoma-related impairments. Various visual field measures derived from clinical visual field test data were only modestly associated with patients' perceptions of health-related quality of life. As the Collaborative Initial Glaucoma Treatment Study population is followed up longitudinally, it will be important to see whether these pertinent associations become stronger.

Disability Evaluation↗

Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling.

PURPOSE: To report visual field defects after vitrectomy for epiretinal membrane with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling. DESIGN: Interventional consecutive case series. METHODS: A retrospective review of 16 eyes of 16 patients who underwent vitrectomy for idiopathic epiretinal membrane. Indocyanine green-assisted ILM peeling was performed in 7 of 16 eyes. The main outcome measure was postoperative visual field. RESULTS: Four of seven eyes (57%) with ICG-assisted ILM peeling had visual field defects postoperatively. The field defects identified were nasal in three eyes; in the fourth eye, the visual field was constricted to approximately 30 degrees. None of the nine eyes without ICG-assisted ILM peeling had a visual field defect. CONCLUSIONS: Peripheral visual field defects may occur after vitrectomy with ICG-assisted ILM peeling. Although the cause of the defects is unclear, the potential role of ICG toxicity requires further investigation.

Aged↗

Concordance of parapapillary chorioretinal atrophy in ocular hypertension with visual field defects that accompany glaucoma development.

OBJECTIVE: To determine whether the extent and location of progressive parapapillary chorioretinal atrophy noted in some patients with ocular hypertension are correlated with the extent and location of visual field defects that occur with progression to glaucoma. STUDY DESIGN: Retrospective cohort study. PARTICIPANTS: Thirty patients with ocular hypertension who had progressive changes of parapapillary atrophy develop before clinically detectable optic disc or visual field damage. MAIN OUTCOME MEASURES: Assessment of changes in the parapapillary atrophy and visual field parameters. METHODS: Baseline and follow-up optic disc photographs and visual field test results were retrospectively analyzed. The relationship between the extent of parapapillary atrophy observed during the ocular hypertension period and initial visual field abnormalities detected after glaucoma development, as well as their spatial relationship, was statistically analyzed. RESULTS: The extent of progressive changes of the parapapillary atrophy detected during the ocular hypertension period was correlated with the extent of changes in the visual field parameters, including corrected pattern standard deviation and mean deviation measured after glaucoma development (Mantel-Haenszel chi-square test, P = 0.026, P = 0.037, respectively). In addition, the visual field abnormalities occurred in the corresponding quadrants of the progressive parapapillary atrophy. Analysis of the spatial relationship revealed that the location of progressive changes of the parapapillary atrophy was concordant with the location of visual field abnormalities in 78% of the quadrants (94 of 120 quadrants) (chi-square test, P = 0.001). CONCLUSIONS: The extent and location of visual field abnormalities that develop in ocular hypertensive eyes with progression to glaucoma exhibit a concordance with the extent and location of progressive parapapillary atrophy noted in the ocular hypertension period. This suggests the importance of detailed examination of the parapapillary area in ocular hypertensive eyes.

Choroid↗

Visual fields of infants assessed with a new perimetric technique.

The visual field of normal infants was assessed using a perimeter with LED stimuli and a forced-choice observation procedure. Central fixation was elicited by four central, pulsing LEDs and maintained with the aid of auditory stimuli. Field extent was derived from the four-alternative, forced-choice judgments of an adult who observed the infant's eye movements to peripherally illuminated LEDs. The binocular visual field of infants, ages 6-7 months, was similar to that of adults tested with the same apparatus. Area of the infants' binocular field was 93% that of the adults'. However, the infants' monocular fields were smaller than those of adults, averaging 74% of the adults' monocular field area. This may have been due to the distracting effect on infant behavior of the adhesive patch used for monocular testing. The visual fields of a young patient with hydrocephalus illustrate the potential clinical utility of this new perimetric technique for infants at risk of field defects.

Adult↗

Glaucoma Hemifield Test. Automated visual field evaluation.

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

Adult↗

Automatic visual field: a software diagnostic procedure.

A recently developed technique for the automatic acquisition of data on visual field losses was tested, with reliable neuro-ophthalmological parameters, on 300 subjects with and without eye disorders. Algorithms for acquisition and processing of the central visual field were implemented on an IBM-AT personal computer with standard peripherals. The contours of scotomata (visual field losses) were best estimated by probabilistic adaptive enhancement of data sampling in those areas with greater visual variability. Image processing tools were specially designed to extract information concerning the size, shape, position and number of scotomata in the visual field. The diagnosis of wider campimetric lesions required parameters such as symmetry or specularity coefficients, obtainable by analysing the visual field of both eyes. Data obtained were correlated to the pathology involved by univariate statistical tools.

Algorithms↗

Patterns of glaucomatous visual field progression identified by three progression criteria.

PURPOSE: To determine typical patterns of repeatable glaucomatous visual field progression. DESIGN: Retrospective analysis of data obtained from two prospective studies. METHODS: Included were 72 eyes of 72 patients tested up to six times over 2 years, and 40 eyes of 40 patients followed annually for up to 12 years. Each patient had two abnormal baseline visual fields, abnormal optic nerves, and serial fields. Progression was identified using three methods: by glaucoma change probability using total deviation (GCP-TD) and pattern deviation (GCP-PD) plots and by a clinical criteria. Progression was categorized as deepening or expansion of an existing scotoma, or a new scotoma. RESULTS: The percentage of eyes repeatably progressed ranged from 17% to 27%. The most common pattern of progression was a deepening of an existing scotoma in the annual group, followed by expansion. With two follow-ups required, percentages for deepening only were 20% (clinical classifier). A combination of expansion and deepening was most common for the GCP criteria: 15% (GCP-TD classifier), and 10% (GCP-PD classifier) for the annual group. For the semiannual group, deepening was most common with the clinical criteria (11% of eyes), and deepening with expansion was most common by GCP criteria (14%, GCP-TD and GCP-PD). No eyes showed repeatable new scotomas. CONCLUSIONS: Glaucomatous visual fields progress in the area of the visual field where baseline testing showed an existing scotoma. Follow-up testing might be improved by concentrating on already defective locations and using sparser test patterns or screening algorithms in normal areas of the visual field.

Diagnostic Techniques, Ophthalmological↗

Assessment of visual-field changes before and after focal photocoagulation for clinically significant diabetic macular edema.

Visual fields were compared before and after focal photocoagulation for eyes with nonproliferative diabetic retinopathy and clinically significant diabetic macular edema. A total of 8 eyes was tested before treatment and 6-8 weeks after treatment using static automated visual fields (Octopus). The visual-field indices, mean defect (MD) and corrected loss variance, were employed as measures of retinal sensitivity. Our results show that focal photocoagulation (CLV) generally depressed sensitivity (increased MD) in the treated central 10 degrees field, whereas in the untreated control region (10-30 degrees) sensitivity generally remained stable. However, the whole-field indices indicated that overall the fields remained stable following focal photocoagulation treatment. These results suggest that although focal treatment produces local absolute visual-field defects, the effects are small relative to the global indices.

Adult↗

Comparison of contrast sensitivity, visual acuity, and Humphrey visual field testing in patients with glaucoma.

PURPOSE: To investigate the relationship between large-letter contrast sensitivity, high-contrast visual acuity, and visual field defects in patients with glaucoma. METHODS: Patients with a diagnosis of glaucoma, glaucoma suspect, or ocular hypertension whose visual acuity was 20/40 (logMAR = 0.3) on better were included in the study. Visual acuity was measured using the Lighthouse visual acuity charts. Contrast sensitivity was measured using the Pell-Robson (PR) chart. The mean depression (MD) score from the most recent Humphrey visual field was used to quantify the visual field defect. RESULTS: A total of 120 eyes were studied. The PR contrast sensitivity score correlated more strongly with the MD of the visual field (r = .589, P < .001) than did the logMAR visual acuity (r = .193, P = .035). When just the eyes with open-angle glaucoma were considered (N = 54), the correlation was even greater for the PR score (r = .638). In ocular hypertensive eyes (N = 25), the correlations to PR and logMAR were not that different (r = .394 for PR, r = .303 for logMAR). Pseudophakic eyes did not show as strong a correlation (r = .335) as did phakic eyes (r = .591). CONCLUSION: For glaucomatous eyes with visual acuity of 20/40 or better, a decrease in the contrast sensitivity correlates with increased visual field loss. We speculate that this decrease in contrast sensitivity in glaucoma patients may account for their complaints of poor vision despite normal or near normal visual acuity.

Contrast Sensitivity↗

Prognostic factors in glaucomatous visual field loss.

A retrospective review was conducted of 31 patients with bilateral elevations of intraocular pressure and unilateral glaucomatous visual field loss. Nine (29%) of the fellow eyes developed visual field loss during a three- to seven-year follow-up period. Of the 13 fellow eyes that had an initial intraocular pressure greater than 26 mm Hg, eight (62%) developed visual field loss, as opposed to one (6%) of the 18 eyes that had lower intraocular pressures. Of the 11 fellow eyes whose intraocular pressures exceeded 24 mm Hg, either treated or untreated, on more than 50% of the measurements, seven (64%) lost visual field, whereas in the 20 eyes whose intraocular pressures were lower, only two )10%) lost visual field.

Female↗

[Computerized and manual perimetry in patients with severe temporal visual field defects due to suprasellar tumors].

PURPOSE: To study, on Goldmann perimetry, a group of patients with complete temporal hemianopia on Humphrey perimetry (24-2 full threshold test) and to evaluate the percentage of eyes in which computerized perimetry failed to identify a temporal visual field remnants. METHODS: Nineteen patients with visual field defect by chiasmal compression were prospectively studied with manual and automated perimetry. Twenty-five eyes with complete temporal hemianopia on Humphrey Field Analyzer, 24-2 threshold test were selected and studied with Goldmann perimeter, in order to evaluate the presence of a temporal visual field remnants. According to the result of Goldmann perimetry the eyes were divided into two groups: group 1, with complete temporal hemianopia; group 2, with residual temporal visual field remnants in the periphery. The mean number of mean deviation in the 2 groups was calculated and compared using Student's t test. RESULTS: Automated perimetry failed to identify a temporal residual visual field in 17 of 25 eyes studied (68%). Mean values of the mean deviation in groups 1 and 2 were respectively -15.43 and -15.93. Statistical analysis did not indicate a significant difference between them. CONCLUSIONS: Computerized automated Humphrey perimetry using 24-2 threshold test fails to identify temporal visual field remnants in a great percentage of patients with severe chiasmal compression. Analysis of the mean deviation is not helpful in identifying such cases. Patients evaluated on automated perimetry and presenting with a complete temporal hemianopia should be checked for temporal visual field remnants.

Adenoma↗

Long term changes in the visual fields of patients with temporal lobe epilepsy using vigabatrin.

AIM: To study the long term changes in the concentric contraction of the visual field in patients with temporal lobe epilepsy on vigabatrin medication. METHODS: Repeated Goldmann visual field examinations were compared in 27 patients with drug resistant temporal lobe epilepsy and concentric contraction of the visual field. Two groups were studied: 16 patients who had already stopped vigabatrin medication before surgery and 11 patients who continued vigabatrin medication. RESULTS: Concentric contraction of the visual field did not change in 16 patients who stopped vigabatrin before the first examination; there was slight but significant progress in visual field loss in 11 patients who continued the use of vigabatrin. CONCLUSION: Long term follow up of concentric contraction in this selected group of patients indicates that vigabatrin associated visual field loss is not reversible and that progression is possible when vigabatrin is continued.

Anticonvulsants↗

Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma.

OBJECTIVE: To evaluate the effect of Ginkgo biloba extract (GBE) on preexisting visual field damage in patients with normal tension glaucoma (NTG). DESIGN: Prospective, randomized, placebo-controlled, double-masked cross-over trial. PARTICIPANTS: Twenty-seven patients with bilateral visual field damage resulting from NTG. INTERVENTION: Patients received 40 mg GBE, administered orally, three times daily for 4 weeks, followed by a wash-out period of 8 weeks, then 4 weeks of placebo treatment (identical capsules filled with 40 mg fructose). Other patients underwent the same regimen, but took the placebo first and the GBE last. Visual field tests, performed at baseline and at the end of each phase of the study, were evaluated for changes. MAIN OUTCOME MEASURES: Change in visual field and any ocular or systemic complications. RESULTS: After GBE treatment, a significant improvement in visual fields indices was recorded: mean deviation (MD) at baseline versus MD after GBE treatment, 11.40 +/- 3.27 dB versus 8.78 +/- 2.56 dB (t = 8.86, P = 0.0001, chi-square test); corrected pattern standard deviation (CPSD) at baseline versus CPSD after GBE treatment, 10.93 +/- 2.12 dB versus 8.13 +/- 2.12 dB (t = 9.89, P = 0.0001, chi-square test). No significant changes were found in intraocular pressure, blood pressure, or heart rate after placebo or GBE treatment. Any ocular and systemic side effects were recorded for the duration of the trial. CONCLUSIONS: Ginkgo biloba extract administration appears to improve preexisting visual field damage in some patients with NTG.

Administration, Oral↗