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PubMed2006

[The interrelationship between the sectorial disc and the visual field changes in patients with normal tension glaucoma].

OBJECTIVE: To investigate the changes of the sectorial discs and visual fields, and their interrelationships in patients with normal tension glaucoma (NTG). METHODS: 26 patients with NTG were undergone the optic nerve and visual field examinations with HRT-II and HFA II in a time interval of less than 5 months. The parameters in the study including cup shape measure (CSM), rim area (RA), rim volume (RV), mean cup depth (MCD) and cup volume index (CVI) were compared between the global discs and the sectorial discs in eyes with the evidences of preperimetric or early visual field defect (MD < or = 4 dB). The CVI was proposed to be equal to CV/(DA x MCD + RA x RNFLT), where DA was disc area and RNFLT was retinal nerve fiber layer thickness. The linear correlations were evaluated between the visual field MD and each of 5 parameters in sectorial discs. RESULTS: The sectorial disc areas were mostly in correspondence to the damaged hemifields (CVI: 92.68%, RA: 87.80%, RV: 82.93%). In addition, a correlation was seen for CSM and MCD (63.41% and 53.66%; chi2 = 23.17, P < 0.05). The comparison between preperimetric and early defects were significantly difference (t = 1.735 approximately 6.536, P < 0.05 approximately P < 0.05, one-sided t test). The correlation between CSM and MD was negative (r = -0.3002, P > 0.05), however the positive correlation was demonstrated in RA versus MD (r = 0.3105, P < 0.05). CONCLUSION: The examination of the 5 parameters of sectorial discs had even closer relationship than those of global discs scanning in the detection of early vision field defect and it is valuable in diagnosis of early glaucoma.

Adult↗

PubMed2001

[Effect of stimulus size on binocular summation within the binocular visual field].

PURPOSE: To study the influence of stimulus sizes on binocular summation using the modified Octopus 201 combined with a space synoptophore. METHODS: Four normal subjects, aged 21 to 26 were tested. Using the SARGON program, we designed a new program to test 37 points in the central 6 degrees visual field. Sensitivity of the central 6 degrees visual field under monocular and binocular conditions was measured while the fusion patterns were displayed on the space synoptophore. The visual fields were measured at stimulus sizes 1, 3, and 5. RESULTS: The visual sensitivity under binocular conditions was higher than under monocular conditions for all the stimulus sizes. Binocular summation for stimulus size 1 was present in a flat form, for stimulus size 3 in a convex form, and for stimulus size 5 in a concave form in the central 6 degrees visual field. CONCLUSION: Binocular summation differed in stimulus size and retinal eccentricity. Binocular summation for stimulus size 3 increased in the fovea and it increased for stimulus size 5 in the peripheral area in the central 6 degrees visual field.

Adult↗

PubMed2006

[Long-term effects of isopropyl unoprostone monotherapy on intraocular pressure and visual field for normal-tension glaucoma and primary open-angle glaucoma patients].

We retrospectively investigated the long-term effects of isopropyl unoprostone monotherapy on intraocular pressure and visual field for normal-tension glaucoma and primary open-angle glaucoma patients. Among 80 eyes of 49 subjects receiving isopropyl unoprostone monotherapy for 2 years or more, 32 eyes of 32 subjects were analyzed because of the good reliability of their visual acuity and visual field (age, 68.1 +/- 10.1 yrs, follow-up period 47.8 +/- 14.7 months). The mean values of intraocular pressure and visual field indices were compared with baseline data before medication. The visual field changes were also analyzed using the Kaplan-Meier life-table method. The mean intraocular pressure decreased for 4 years from 14.7 +/- 4.3 mmHg (mean +/- SD) at baseline, to 12.7 +/- 4.4mmHg at 4 years. The global index of visual field (mean defect, loss variance) did not change significantly during the 4 years. The accumulative probability of survival was 80.7 +/- 8.0% after 4 years when the endpoint was defined as 3dB progression in mean defect. Isopropyl unoprostone might have the possibility of stabilizing the visual field for a long period of time.

Aged↗

PubMed1995

[The relationship between visual field defects and clinical factors in normal-tension glaucoma].

We investigated the relationship between visual field defects and some clinical factors in 30 eyes of 30 normal-tension glaucoma (NTG) patients. The static central visual field by the Humphrey field analyzer, diurnal variation of intraocular pressure (diurnal IOP), blood flow velocity of the ophthalmic artery by color Doppler imaging, blood flow volume of digital tissue by laser flowmetry, and systemic blood pressure (BP) were measured after rinsing out the anti-glaucoma drug for one month. Mean deviation (MD) calculated by the Humphrey STATPAC program as an index of visual field defect, was correlated to the Pourcelot index (RI) of ophthalmic arterial blood flow and magnitude of diurnal IOP. In multiple regression analysis, the multiple correlation coefficient was 0.79 and the coefficient of determination was 0.62. RI, systolic BP, magnitude of diurnal IOP, and the refraction and mean of diurnal IOP were used in the multiple correlation model as factors significantly related to MD. These results suggest that both IOP and some clinical factors may contribute to the visual field defects of NTG.

Aged↗

PubMed1981

Corticopontine projections of the lateral suprasylvian cortex: de-emphasis of the central visual field.

Layer V pyramidal cells of the cat lateral suprasylvian visual areas project to the pontine nuclei. Although all 6 of the suprasylvian visual areas project to the pons, the densest projections are from 3 areas: anterior medial lateral suprasylvian (AMLS), posterior medial lateral suprasylvian (PMSL) and ventral lateral suprasylvian (VLS). The organization of the corticopontine pathway from one of these areas (PMLS) suggests a disproportionate representation of the peripheral visual fields. This pattern of projection would serve to de-emphasize the central visual field.

Animals↗

PubMed1997

Sector-based analysis of optic nerve head shape parameters and visual field indices in healthy and glaucomatous eyes.

PURPOSE: To evaluate the correlations between the sector optic nerve head parameters measured by Heidelberg Retina Tomograph (HRT, Heidelberg Engineering, Heidelberg, Germany), version 1.11S, and the visual field. METHODS: One eye was randomly chosen from 55 individuals with glaucoma and 50 healthy individuals. Each participant had at last one Humphrey visual field, program 30-2 (Humphrey Instruments, San Leandro, CA, U.S.A.), and three 10 degrees HRT pictures. From the mean of the three HRT pictures, global measurements, superior (45 degrees-135 degrees), nasal (135 degrees-225 degrees), inferior (225 degrees-315 degrees), and temporal (315 degrees-45 degrees) sector measurements were calculated for the following parameters: disc area, effective area, area below reference, mean height of contour, volume below surface, volume above surface, volume below reference, volume above reference, and third moment. From the visual field results, mean deviation (MD), superior MD, and inferior MD were calculated. For each HRT parameter we calculated the "r" Pearson correlation with the corresponding visual field measures. RESULTS: Within the combined healthy and glaucomatous groups we found highly significant (p < 0.001) correlations between the following HRT parameters and the visual field MD: inferior and mean high of contour (r = -0.53), inferior and third moment (r = -0.52), global and third moment (r = -0.49), inferior and volume above reference (r = 0.47), superior and third moment (r = -0.46), and superior and area below reference (r = -0.44). Correlations between global mean deviation and nasal or temporal sector parameters were generally smaller and less significant. CONCLUSIONS: Inferior and superior HRT sector parameters were correlated with the respective visual field indices. In many cases these correlations were as strong or stronger than with the global equivalent shape measures.

Diagnostic Techniques, Ophthalmological↗

PubMedDate not supplied

Visual field testing: pearls and pitfalls.

1. Three major items are needed for a visual field test to take place: a perimetrist, a patient, and a request for a certain type of test. All of these are subject to knowledge of certain information and the ability to perform certain tasks. 2. The purpose of visual field testing is to provide information that will assist in diagnosing ocular diseases, evaluating neurologic diseases, and monitoring progression in ocular diseases. 3. The assessment of the patient's visual field is vital to his or her complete ocular examination. This diagnostic tool is very important and needs to be administered with professional technique and responsibility.

Eye Diseases↗

PubMed1997

[Comparative analysis of changes in the visual field in primary open-angle glaucoma and glaucoma with normal tension].

PURPOSE: To compare the pattern and the depth of visual field defects of POAG and NTG patients. MATERIALS AND METHODS: The visual fields in two groups of POAG and NTG patients, each counting 25 eyes, were analysed statistically. All eyes were tested at least twice, employing full threshold G2 test of Octopus 101 (Interzeag) automatic perimeter. The tests with the highest reliability level were included. The analysis was performed using Peridata (Interzeag) statistical package. Mean values of mean defect (MD), corrected loss variance (CLV) and compound index (CI) for each group were acquired. Furthermore, main values of MD for upper and lower hemifield, quadrants and 10 degrees concentric rings, were obtained. The differences between the two groups were tested for the statistical significance. RESULTS: Values of all three above parameters (MD, CLV i CI) were significantly lower in the group of eyes with POAG as compared with those with NTG. In both groups mean MD was higher in the upper hemifield, but the upper/lower hemifield ratio was significantly higher in the POAG group (1.50) as compared with NTG group (1.05). In POAG group the highest mean MD was found in the upper-temporal quadrant whereas in NTG group the lower-nasal quadrant was the most affected. In both groups the highest values of mean MD were found in the outer ring between 20 degrees and 30 degrees of visual field but the difference between the centre and periphery was considerably lower in NTG group. CONCLUSIONS: The results support the opinion that there exist differences between the patterns of visual field changes in POAG and NTG. The loss tends to be more diffuse in POAG, showing deeper defects in the periphery and stronger tendency to affect the upper hemifield.

Adult↗

PubMed1997

How often do patients need visual field tests?

BACKGROUND: This study was undertaken to determine whether the interval between visual field tests affects the ability to detect progressive glaucomatous field loss. METHODS: One hundred and nineteen retinal locations which were deteriorating significantly by > or = 1 dB/ year (untreated normal tension glaucoma patients: 6 eyes) were studied. Analysis was repeated using 'thinned' visual field tests: one test per year instead of the complete three per year over a period of 4 years. RESULTS: The 'thinned' tests identified only 45.4% of the deteriorating points over the 4-year period. Furthermore, there was a mean delay of 1.10 years in detection (P < 0.01). CONCLUSIONS: Less frequent visual field testing detects fewer progressing locations and detects them later.

Adult↗

PubMed1982

Visual masking with presentations in same and opposite visual fields: evidence for contralateral masking.

Three experiments were conducted in a preliminary attempt to study the effects of presentations of an informational target stimulus to the right or left visual fields when the target was either preceded or followed by a noninformational masking stimulus and when the mask was presented to the same or opposite visual field of the target. Results indicated that masking was more effective in the same than in the opposite visual field but that masking of the opposite visual field was feasible for both forward and backward masking. Laterality effects were also found for forward and backward masking, with a modest advantage of the right visual field (left hemisphere) in both cases. Limitations of the data and directions for future research were discussed.

Discrimination Learning↗

PubMed2000

Visual field defects and normal nerve fiber layer: may they coexist in primary open-angle glaucoma?

The retinal nerve fiber layer (RNFL) is the anatomical structure most sensitive to glaucoma injury. Before a functional loss such as a visual field defect is displayed, a large number of nerve fibers can be damaged. However, there are glaucoma patients in which an apparently normal RNFL coexists with evident visual field defects. A total of 54 eyes affected with primary open-angle glaucoma were studied. Visual field was examined with the Humphrey Field Analyzer (Zeiss) using program 30-2. The Nerve Fiber Analyzer II (Laser Diagnostic Technologies) was used to study the RNFL of these patients. Mean deviation of the visual field ranged from 6 to 31 dB in all eyes that were examined. The average thickness of the RNFL ranged from 20 to 90 microm. According to our previous experience 75 microm was fixed as the cutoff between normal and pathological values of RNFL thickness. We identified 5 eyes with a RNFL thickness over 75 microm and a visual field with a mean deviation over 6 dB; 9% of the studied eyes were found to have a visual field defect with no changes in RNFL. We conclude that not all subjects have the same number of fibers at birth and that it is therefore possible to underestimate the RNFL changes. Our study illustrates that the concept of normal and altered has to be considered as a relative one for all the aspects characterizing the glaucomatous disease.

Aged↗

PubMed2003

Patterns of visual field defects in chronic angle-closure glaucoma with different disease severity.

PURPOSE: To evaluate the patterns of visual field defects in patients with chronic angle-closure glaucoma (CACG) with varying extent of optic nerve damage. DESIGN: Prospective, consecutive, observational case series. PARTICIPANTS: One hundred forty-six Asian patients with well-controlled CACG. METHODS: Visual field tests were performed using program 24-2 of the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA) with the Swedish interactive thresholding algorithm standard. One hundred ten eligible visual fields were scored with the system adopted by the Advanced Glaucoma Intervention Study and were categorized into 4 groups accordingly: mild, moderate, severe, and end-stage. Each hemifield was divided into the nasal, paracentral, and arcuate areas, and field loss that involved respective areas was defined as nasal step, paracentral scotoma, and arcuate scotoma. MAIN OUTCOME MEASURES: The distribution of field defect patterns in each group was evaluated. The mean deviation (MD) was compared among the 3 areas within one hemifield and between each pair of corresponding areas across the median raphe. RESULTS: The nasal area was the most commonly damaged area in the mild group, being noted in 52% of eyes in the superior hemifield and 58% of eyes in the inferior hemifield. In the moderate group, field loss involving both the nasal and arcuate areas dominated the superior hemifield, whereas field loss involving all three areas dominated the inferior hemifield. The MD of the nasal area was the worst among the three areas in each hemifield of the mild and moderate groups, as well as in the inferior hemifield of the severe group (all P < 0.001). There were no significant differences in the MD of each area between the superior hemifield and their inferior counterparts. However, the superior hemifield as a whole showed a better MD than the inferior hemifield (P=0.034) in the mild group. CONCLUSIONS: Visual field loss that involved the nasal area was the most common pattern in the early stage of CACG. The MD of the nasal area was worse than those of the arcuate and the paracentral areas within the same hemifield in the mild, moderate, and severe groups of CACG patients.

Aged↗

PubMed1999

Visual field constriction is not limited to children treated with vigabatrin.

Vigabatrin (GVG) is widely used in the treatment of complex partial seizures and infantile spasms. Persistent visual field constriction associated with GVG therapy in adults was reported as a rare but serious side-effect. Visual field examination in children is more difficult because of a lack of cooperation among very young or mentally handicapped patients. We performed Goldmann perimetry in 12 of 153 patients treated with GVG as mono- or as add-on therapy. The others would not cooperate, and two adolescents refused the examination. For comparison, we examined 12 age-matched patients with complex partial or generalized epilepsy who had never taken GVG. In five of 12 GVG-treated patients, and in one of the control group, we found a concentric visual field constriction. All patients were subjectively asymptomatic. The GVG-treated patients had taken the drug in combination with valproic acid (VPA) or oxcarbazepine (OCB). In four patients, GVG treatment was already stopped at the time of the ophthalmologic examination. Three patients had intracerebral lesions that could not account for the pathologic perimetric findings. The single patient from the control group with concentric visual field constriction had an absence epilepsy, treatment being performed with VPA and lamotrigine (LTG). In conclusion, GVG has a causal but not unique connection with visual field constriction in pediatric patients.

Adolescent↗

PubMed1992

[Frequency distribution of earliest glaucomatous visual field defects].

42 eyes with established early glaucoma and normal visual field were followed-up with Goldmann perimetry for 2.5 years, during which time 24 eyes manifested reproducible glaucomatous visual field defects. The initial defects were characteristically shallow and located mostly in the superior Bjerrum region adjacent to the blind spot. This finding may be useful in designing protocols for the detection of early glaucomatous field defects.

Adult↗

PubMed1997

Visual field loss after vitrectomy for full-thickness macular holes.

PURPOSE: To report the results of a prospective study of the incidence of peripheral visual field loss after macular hole surgery. METHODS: Prospectively, 30 eyes of 30 consecutive patients with full-thickness macular holes operated on between December 1995 and April 1996 had preoperative and postoperative Goldmann visual field tests. The surgical procedure consisted of three-port pars plana vitrectomy, posterior hyaloid removal, nonexpansile fluid-hexafluoroethane (C2F6) exchange, and, in 19 of 30 patients, autologous platelet injection, followed by face-down positioning. RESULTS: Twenty-nine of these 30 cases were considered to be anatomic successes. Comparison of preoperative and postoperative visual fields disclosed that four patients (13%) had a peripheral scotoma, including one patient with stage 4 macular hole. Three other patients (10%) had a postoperative relative arcuate defect. Mean postoperative intraocular pressure was higher in the latter group. None of the patients complained of peripheral scotoma. CONCLUSIONS: Overall, seven of 30 patients (23%) had a postoperative visual field defect. Two categories of scotomas were observed: peripheral and relative arcuate. The cause of peripheral visual field loss is unclear. Increased intraocular pressure may be the cause of relative arcuate scotomas.

Adult↗

PubMed2000

A comparison of short wavelength automated perimetry with frequency doubling perimetry for the early detection of visual field loss in ocular hypertension.

BACKGROUND: Achromatic automated perimetry (AAP) is limited in its ability to detect very early visual field loss in ocular hypertensive patients. Tests targeting axons that are selectively damaged, or have low redundancy, may detect visual field losses before they are seen on AAP. It has been claimed that short wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP) are two tests that provide early detection. METHODS: Patients (n = 62) were selected on the basis that they had raised intraocular pressure but normal visual fields detected by AAP. A SWAP and an FDP was performed on each of the patients and the results compared. Fields were scored as either normal or abnormal based on criteria used in previous studies. RESULTS: On comparing FDP with SWAP as the 'gold standard', a sensitivity of 88.9% and a specificity of 96.2% was found, showing a high concordance between the two tests. CONCLUSION: These results suggest that as SWAP may be predictive of AAP visual field loss, FDP may be similarly predictive.

Adult↗

PubMed1996

Prevention of visual field defect progression with brovincamine in eyes with normal-tension glaucoma.

PURPOSE: A prospective investigation of the effect of brovincamine fumarate, a Ca2+-channel blocker, on visual field changes in normal-tension glaucoma (NTG). METHODS: A total of 28, age- and field-matched, patients with NTG were allocated randomly to either brovincamine fumarate (20 mg 3 times daily) or placebo (3 times daily). The patients were followed at least every 4 months for a minimum of 2.5 years, and visual field examinations were carried out at least every 6 months. The mean follow-up periods (+/-standard deviation) were 39.1 +/- 8.7 months in the brovincamine-treated group and 37.9 +/- 10.1 months in the placebo group. Stepwise discriminant analyses were performed to separate the patients who showed improvement of their visual fields from those who failed to improve in the brovincamine-treated group, and to identify factors that may determine the visual field prognosis of all patients with NTG enrolled in the study. RESULTS: In the brovincamine-treated group, six patients showed visual field improvement, whereas none showed improvement in the placebo group using the Statpac 2 linear regression analysis. Discriminant analyses identified better cold recovery rate and higher initial systolic blood pressure to be significantly contributory to a favorable outcome in the brovincamine-treated group, and the use of brovincamine, better cold recovery rate, and higher initial systolic blood pressure were identified to be significantly contributory to a favorable prognosis in all subjects. CONCLUSION: Brovincamine seems to have a favorable effect on visual field in at least some patients with NTG.

Administration, Oral↗

PubMed2002

The structure-function relationship in eyes with glaucomatous visual field loss that crosses the horizontal meridian.

OBJECTIVE: To evaluate the relationship between visual field loss and glaucomatous optic discs in eyes in which field loss spreads across the horizontal meridian. SUBJECTS AND METHODS: Ninety-six patients with glaucoma (9 advanced, 60 moderate, and 27 early) with 2 successive abnormal fields were included. Standard achromatic automated perimetry defects were identified with a nerve fiber bundle map to identify abnormal sectors. Crossover was present if the superior and inferior sectors at the horizontal meridian (nasal, central, or temporal) were both abnormal. Optic disc damage was assessed by masked grading of simultaneous stereophotographs. RESULTS: Only 30% (29) of glaucomatous eyes showed crossover, and only 2 of those eyes had early loss. The most frequent pattern of visual field loss (41% of eyes) was single hemifield damage with defects in contiguous sectors. Regardless of the pattern or severity of visual loss, most eyes (66 [69%] of 96) had both superior and inferior optic disc damage. CONCLUSIONS: Early glaucomatous visual field loss rarely crosses the horizontal meridian, but defects in both hemifields at the horizontal meridian are more common in more advanced field loss. In 26 (90%) of 29 eyes with crossover, it could be explained by changes at the optic nerve head.

Adult↗