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PubMed1995

Retinal nerve fiber layer changes and visual field loss in idiopathic intracranial hypertension.

PURPOSE: The authors retrospectively analyzed changes in the retinal nerve fiber layer in patients with idiopathic intracranial hypertension and studied their relation to visual field loss to determine the clinical usefulness of retinal nerve fiber analysis in the clinical management of patients with papilledema. METHODS: Retinal nerve fiber layer photographs and visual fields from 36 eyes of 21 patients with papilledema due to idiopathic intracranial hypertension were analyzed for abnormalities in a masked fashion. RESULTS: Nerve fiber layer changes were found in 67% of eyes studied. Superior areas within the nerve fiber layer were affected 5.4 times more frequently than inferior regions. Visual field loss was more prevalent in eyes with diffuse nerve fiber layer loss (89%) than in eyes with slit defects (29%). The location of the nerve fiber layer changes correlated with corresponding areas of visual field loss. Nerve fiber layer changes were as common in mild to moderate as in atrophic papilledema; however, slit defects predominated in patients with mild to moderate papilledema, and diffuse loss predominated in atrophic papilledema. CONCLUSIONS: Changes in the retinal nerve fiber layer observed in patients with idiopathic intracranial hypertension provide objective information regarding the status of their optic nerve and may improve their clinical management.

Adolescent↗

PubMed1991

[Recovery of visual field defects in ischemic optic neuropathy and idiopathic optic neuritis].

Fifty-four eyes of 41 patients with optic nerve disease demonstrating acute visual field defects without any traumatic, compressive, or other known etiology were classified into four categories. Those showing poor recovery of visual field defects were ischemic optic neuropathy which was subclassified into either anterior ischemic optic neuropathy (AION) or posterior ischemic optic neuropathy (PION) according to the ophthalmoscopic changes in the optic nerve head. Those showing good recovery of visual field defects were idiopathic optic neuritis which was subclassified into either papillitis or retrobulbar neuritis according to the ophthalmoscopic pathology of the optic disc. Patients with ischemic optic neuropathy were significantly older than those with optic neuritis. All eyes with optic neuritis showed good recovery of vision, whereas those with ischemic optic neuropathy showed varying outcomes of vision. With regard to the pattern of field defect, central or paracentral scotoma was predominant in all but eyes with AION in which altitude defect predominated. Pale swelling of the optic nerve head and angiographic evidence of circulatory disturbance in the optic disc or adjacent choroid were common findings in eyes with AION, whereas such findings were never observed in eyes with papillitis. The amplitude of pattern visual evoked potential was significantly lower in eyes with PION than in those with retrobulbar optic neuritis. Four patients classified as optic neuritis developed into multiple sclerosis in the follow-up study. It was concluded that poor recovery of visual field defect is one of the most convincing evidences for the diagnosis of ischemic optic neuropathy.

Adult↗

PubMed1978

A new apparatus for visual field testing with binocular fixation.

A new instrument for visual field examination with binocular fixation is described. The binocular vision was dissociated with polarizing plates. Only the point of fixation was visible to both eyes while the testing chart (Amsler chart) was visible to one eye in the use of this apparatus. The examination was done with both the patient's eyes open. With the use of this apparatus, not only was the visual line fixed steadily in order to detect various changes of the central visual field due to maculopathy or optic neuropathy and these changes were detected accurately and quickly, but also suppression scotoma associated with amblyopia or squint could be detected quantitatively.

Adolescent↗

PubMed1997

Influence of axial length on visual field defects in primary open-angle glaucoma.

With the high frequency of myopia in Taiwan, potential complications or associated conditions, such as glaucoma, are of great concern. To investigate the role of axial length in glaucoma, we enrolled 307 primary open-angle glaucoma (POAG) patients from 1986 through 1996. For the control group, 124 persons were recruited from a survey of a non-glaucoma population and the Ophthalmology Out-patient Department of the National Taiwan University Hospital. Routine eye examination, stereophotography of the optic disc, automated visual field tests, and A-scan ultrasonography were performed on each patient. The Glaucoma Hemifield test was used for analysis of visual field results. The mean axial length was longer in the POAG group than in the control group, especially in the younger age groups (40-59 yr). The POAG group was divided into a short-axial-length (SAL, axial length < 26 mm) group and a long-axial-length (LAL, axial length > or = 26 mm) group. Both subgroups had the deepest visual field defects in the upper and lower nasal areas. The LAL group had deeper visual field defects and the defects were more frequently involved in all sectors analyzed than the SAL group defects. The upper visual field had deteriorated more in the SAL group, whereas the depth of scotoma was similar in the upper and lower hemifields in the LAL group. Our results support the idea that glaucoma patients have a longer axial length than people without glaucoma, and that visual field defects are more pronounced in patients with LAL than in those with SAL.

Adult↗

PubMed2006

Intereye concordance in locations of visual field defects in primary open-angle glaucoma: diagnostic innovations in glaucoma study.

PURPOSE: To determine the overlap in defective visual field locations between the right and left eyes of primary open-angle glaucoma patients. DESIGN: Cross-sectional retrospective analysis of data from a prospectively designed longitudinal study. PARTICIPANTS: Patients with glaucomatous optic neuropathy in at least 1 eye and 2 consecutive reliable standard automated perimetry fields within 15 months were included, yielding 468 eyes of 234 patients. METHODS: Concordance in defective visual field locations between right and left eyes were calculated as the number of overlapping locations divided by the total number of defective locations (intereye concordance ratio). Concordance ratios also were calculated within an eye over time (intraeye concordance ratio) and between unmatched pairs of fields (unmatched concordance ratio). RESULTS: Intereye concordance (0.24+/-0.02) was significantly smaller than intraeye concordance (0.37+/-0.02) and significantly larger than unmatched concordance (0.14+/-0.01). There was a significant interaction between concordance type and defect size, such that there was no difference in concordance ratios for defects of fewer than 8 locations, and the difference between intereye concordance versus intraeye concordance and unmatched concordance ratios increased with larger defect sizes. CONCLUSIONS: A spatial relationship exists between defective locations of an individual's eyes. Future studies will show whether information about the spatial relationship is useful to guide the modification of visual field test locations to improve detection of loss and perhaps also progression.

Adult↗

PubMed1994

Sensitivity of the central visual field in 70- to 81-year-old male athletes and in a population sample.

The sensitivity of the central visual field (0 degree-30 degrees) was studied using an automatic Octopus 500E perimeter in elderly male athletes and in a population sample of men of corresponding age. The athletes (N = 96) were endurance and power athletes, who were still active in competitive sports with training histories spanning tens of years. The athletes' results were compared with those of a sample of men of the same age (70-81 years, N = 41) randomly selected from the local population register. The sensitivity values of the athletes, and the endurance athletes in particular, were significantly better than those of the controls, with differences varying from 1 to 2.5 dB in the different areas of the central visual field. Multivariate analyses of the background factors of visual field sensitivity showed that the most important were age, amount of annual training, number of chronic diseases, HDL-cholesterol level, and vital capacity. The results suggest that a long training history, especially of the aerobic type, may be beneficial with respect to the sensitivity of the visual system.

Aged↗

PubMed1998

Visual field defect and perfusion of the juxtapapillary retina and the neuroretinal rim area in primary open-angle glaucoma.

BACKGROUND: At this time little information is available about the relationship between glaucomatous visual field defects and impaired blood flow in the optic nerve head. The purpose of this study was to examine blood flow of the juxtapapillary retina and the rim area of the optic nerve head in primary open-angle glaucoma with a borderline visual defect. METHODS: Juxtapapillary retinal and neuroretinal rim area blood flow was measured by scanning laser Doppler flowmetry (SLDF). The visual field was evaluated by static perimetry (Octopus-G1). The optic nerve head was assessed on 15 degrees color stereo photographs. We examined 116 eyes of 91 patients with POAG with controlled IOP and 66 eyes of 44 healthy individuals. The POAG group was divided into eyes with a mean defect lower than 2 dB (POAG group I) and in eyes with a mean defect equal to or greater than 2 dB (POAG group II). The mean age of POAG group I and POAG group II was 55 +/- 11 years and 57 +/- 10 years, respectively. The mean age of the control group was 45 +/- 15 years. The eyes of POAG group I had an average C/D ratio of 0.71 +/- 0.18 with an average mean defect of the visual field of 0.97 +/- 0.68 dB; the eyes of POAG group II had an average C/D ratio of 0.80 +/- 0.17 with an average mean defect of the visual field of 8.2 +/- 6.0 dB. The intraocular pressure on the day of measurement in POAG group I was 18.2 +/- 3.7 mmHg, in POAG group II 17.6 +/- 4.0 mmHg, and in the control group 15.1 +/- 2.5 mmHg. For statistical analysis, age-matched groups of 32 normal eyes of 32 subjects (mean age 52 +/- 10 years) were compared to 18 glaucomatous eyes of 18 patients (POAG group I, mean age 55 +/- 11 years) and 59 glaucomatous eyes of 59 patients (POAG group II, mean age 55 +/- 10 years). RESULTS: In the eyes of POAG group I and POAG group II, both juxtapapillary retinal blood flow and neuroretinal rim area blood flow were significantly decreased compared to an age-matched control group: neuroretinal rim area "flow" POAG group I -65%, POAG group II -66%; juxtapapillary retina "flow" POAG group I -52%, POAG group II -44%. All eyes of the POAG group I (MD < 2 dB) and 56 of 61 eyes of the POAG group II (MD > = 2 dB) showed a retinal perfusion lower than the 90% percentile of normal blood flow. We found no correlation between reduction of juxtapapillary or papillary blood flow and mean defect in POAG eyes. CONCLUSION: Glaucomatous eyes with no defects or borderline visual field defects as well as glaucomatous eyes in an advanced disease stage show significantly decreased optic nerve head and juxtapapillary retinal capillary blood flow.

Blood Flow Velocity↗

PubMed2001

An explicit no response instead of time-out in automated visual-field testing.

BACKGROUND: To evaluate the effect of response-acquisition technique on psychometric performance in visual-field testing, the conventional one-button yes/time-out method was compared with a two-button yes/no method for responding whether or not the stimulus was detected. There are a number of situations in which the single-button technique leads to ambiguous results. In this study, we thus expected the yes/no method to reduce tendencies towards habituation and automatic responding. Our hypothesis was that the two-button technique could reduce the rate of erroneous responses. METHODS: Luminance-difference sensitivity for bright stimuli (32') on a photopic background was evaluated at 26 locations within the central visual field (30 degrees) using a specially equalised video display unit and a modified 4/2-dB staircase strategy (six reversals, maximum-likelihood threshold estimation). Sixty-one ophthalmologically normal subjects (aged 20-30 years) were examined twice with each method. RESULTS: Mean sensitivities with the two-button yes/no method were found to be, on average, 0.13 dB above those measured with the one-button yes/time-out technique--a difference without clinical relevance. Within-subject variability did not differ between the two methods. However, the less intuitive two-button yes/no method had a slightly higher number of false responses in catch trials. CONCLUSION: Compared to the conventional one-button yes/time-out method, the two-button yes/no method in normal young subjects thus showed little difference in mean sensitivities and equivalent within-subject variabilities. Concerning our initial hypothesis, the yes/no method is of somewhat higher complexity and is not able to reduce the rate of erroneous responses. The one-button yes/time-out method fared a little better in error rate. In summary, the yes/no method is an alternative and additional possibility of response acquisition in visual-field testing, which is worthy of being tested in a clinical study with elderly subjects.

Adult↗

PubMed1985

[Perceptual disorders of the peripheral visual field caused by alcohol. Studies with the automatic Octopus perimeter].

The present paper reports on examinations of temporal visual field perimetry with the Octopus computer-controlled automatic perimeter (Program 51). Nine subjects were tested under normal conditions and after consumption of alcohol. The Octopus represents a static examination method employing the grid perimetry principle. Under the influence of alcohol 7 subjects with blood alcohol concentrations of over 1 0/00 had visual fields which were concentrically restricted to various degrees, with relative scotomata centrally to the concentric restriction. In paired comparisons, reductions in sensitivity to light were found which were statistically highly significant. Previous investigations, conducted exclusively with kinetic perimeters, were unable to demonstrate the subjectively perceived concentric restriction of the visual field ("tunnel vision") following consumption of alcohol.

Adult↗

PubMedDate not supplied

[A simple method for automonitoring of the visual fields to be used in screening for glaucoma].

A simple method for automonitoring the visual field nasal border is suggested, fit for screening examinations as well. It consists in successive putting of one, two, or four fingers to the bridge of the nose. In a reference group of normal subjects putting one finger to the bridge of the nose induced narrowing of the nasal border of the visual field by 17 degrees on an average, by 26 degrees with two fingers, and by 34 degrees with four fingers. The method was tried in 27 patients with glaucoma (34 eyes). The detection rate of visual field abnormalities in the patients with Stages II--III condition has made up 92.3%.

Glaucoma↗

PubMed1991

A horizontal stripe of displacement sensitivity in the human visual field.

Displacement thresholds of peripheral sites in monocular human vision were obtained. The average of 12 directional thresholds at different visual field sites was used to define isometric lines of average displacement threshold about central vision. Isometric lines extended further into the temporal visual fields along the horizontal meridian than along other meridians. At any single site in the peripheral visual field the thresholds were not the same in all directions; they were larger toward and away from central vision. These two psychophysical findings vary in a qualitatively similar manner across the retinal field, as does the average size and the collected orientation bias of dendritic fields of retinal ganglion cells.

Fixation, Ocular↗

PubMed2002

The relationship of visual threshold and reaction time to visual field eccentricity with conventional automated perimetry.

To investigate the relationship between reaction time (RT), stimulus intensity and visual field eccentricity. We generated frequency of seeing (FOS) curves and measured RTs by testing 10 perimetrically experienced normal subjects with a Humphrey perimeter controlled by a custom program. Subjects were tested from 10 degrees to 50 degrees eccentricity along the nasal horizontal meridian in 10 degrees increments. A range of 20 dB, centered on threshold, was tested in 1 dB steps along with 60 and 0 dB intensities as catch trials. Twenty repetitions for each intensity at each location were used. Linear regression showed a significant increase in suprathreshold RT (to the 0 dB stimulus) with increasing eccentricity. The RT at the calculated FOS 50% threshold was prolonged by about 200 ms compared with the RT using the 0 dB target at the equivalent eccentricities. Also, when the difference between the RT at 0 dB stimulus and the RT at threshold was regressed against visual field eccentricity there was a significant decrease with eccentricity. When the RT(pi) (RT prolongation from threshold relative to the 0 dB stimulus) was plotted as a function of decreasing stimulus attenuation, the results fit the function RT(pi)=a+bi(3) (i=stimulus intensity) with r(2)>0.94 at all eccentricities. However, the slope of the function flattened with increasing eccentricity. Using conventional automated perimetry stimuli in perimetrically experienced young subjects, suprathreshold RT increases but threshold RT prolongation decreases with increasing visual field eccentricity. RT fits a power function with decreasing stimulus attenuation but the slope flattens with eccentricity. This relationship found along the nasal horizontal meridian may allow use of RT to cross-check threshold results or to define response windows for reliability indices of conventional automated perimetry.

Adult↗

PubMed1994

Visual field analysis using artificial neural networks.

There have been several reports on the application of artificial neural networks (ANNs) to visual field classification. While these have demonstrated that neural networks can be used with good results they have not explored the effects that the training set can have upon network performance nor emphasized the unique value of ANNs in visual field analysis. This paper considers the problem of differentiating normal and glaucomatous visual fields and explores different training set characteristics using field data collected from a Henson CFS2000 perimeter. Training set properties including size, balance between normals and glaucomas, extent of field loss and the spatial location of glaucomatous defects are explored. A multilayer network with 132 input nodes, 20 hidden layer nodes and 2 output nodes in trained using an error backpropagation algorithm. Both sensitivity and specificity are measured during testing. The results demonstrate that large random sets are better than small random sets since sensitivity improves with size and specificity is not adversely affected. The variability in performance also reduces as training set size increases. In addition, sets that are biased towards glaucoma examples are more sensitive and less specific, while sets biased with normal examples are more specific and less sensitive than balanced sets. Thus large training sets with class balance are generally desirable for good sensitivities and specificities. The actual glaucoma examples contained in the set are also important. A training set deficient in examples has no detrimental effect on sensitivity or specificity. The spatial distribution of defects is also crucial. Spatially biased sets are unable to recognize defects that occur in locations where no previous defect has been presented while more balanced sets lead to better performance. In conclusion the 'ideal' training set should contain many examples of early defects that represent the full range of locations where these defects may occur.

Algorithms↗

PubMed1990

[Amblyopia and the visual field].

The author examined 20 hypermetropic eyes with functional amblyopia with application of the objectively sciascopically determined diopters and, separately, without such correction, during the investigation of the visual field using Goldmann kinetic light perimetry in photopia. The starting hypothesis was statistically tested by means of differences of the two arithmetic mean values. Based on the obtained results, the author has found that the values denoting the degree of visual field damage are in correlation with the degree of visual acuity decrease. He also observed that the application of the objectively determined dioptric value leads to the normalization of the visual field in amblyopic persons, although it does not improve visual acuity. This is an important observation, since extensive visual field failings without the introduction of the objectively determined correction may raise suspicion of a retrobulbar inflammation or atrophy of the optic nerve.

Adolescent↗

PubMed2002

Transsaccadic perception of translating objects: effects of landmark objects and visual field position.

Previously Gysen, De Graef, and Verfaillie [Vision Research 42 (2002) 379] showed that, with stimulus displays presenting one stationary and one translating object, sensitivity for intrasaccadic displacements was higher for translating than for stationary objects. In the present paper the importance of the relative encoding of the path of the translating object towards the stationary object is investigated. In three experiments we compared detection of intrasaccadic displacements of translating objects in relative motion (moving towards the landmark object) and translating objects moving in isolation. No 'facilitatory' effect of relative motion was found. However a visual field effect was present. Performance was always better for the translating object presented in the lower part in comparison to the upper part of the visual field. A fourth experiment investigated the sensitivity for intrasaccadic displacements of stationary and translating objects presented in the upper as well as in the lower visual field. A lower visual field advantage was observed. The superior performance for translating objects, as was found previously, was confirmed in the lower and upper visual field.

Adult↗

PubMed2006

Central corneal thickness and visual field loss in fellow eyes of patients with open-angle glaucoma.

PURPOSE: To determine the relationship of central corneal thickness (CCT) and visual field loss between fellow eyes in primary open-angle glaucoma. DESIGN: Retrospective, observational case series. METHODS: Records review of glaucoma patients seen at local Veterans Administration eye clinic. Those with CCT measurements performed within one month of visual field testing were included. Patients were excluded with vision below 20/40 or disease that would affect visual fields. Intrasubject (between fellow eyes) differences in CCT, mean deviation (MD), and pattern standard deviation (PSD) were calculated by subtracting left eye value from right eye value. RESULTS: Of the 100 subjects (94 males), the Spearman correlation coefficient between intrasubject differences in CCT vs intrasubject differences in MD was 0.36 (P = .0003). The Spearman correlation for differences in CCT vs differences in PSD was -0.31 (P = .0019). CONCLUSIONS: Our study suggests that worse visual field changes tend to occur in the eye with the thinner cornea.

Adult↗

PubMed1998

Clinical classification of glaucomatous visual field loss by frequency doubling perimetry.

PURPOSE: To determine whether the frequency doubling perimeter (FDP) can grade glaucomatous visual function loss in a clinically relevant manner. Sinusoidal gratings < 1 cpd that undergo counterphase flicker > 15 Hz appear to have twice as many bands of light, a phenomenon referred to as the "frequency doubling illusion." Evidence suggests that this psychophysical effect is mediated in part by large-diameter ganglion cells, which are reported to be lost early in the glaucomatous disease process. A portable, commercially available FDP has already demonstrated high diagnostic potential for glaucoma screening. METHODS: Sixty-four eyes of 42 glaucomatous patients and 22 eyes of 14 normal subjects were evaluated by means of both frequency doubling perimetry and Humphrey perimetry. A clinical scoring algorithm modeled after the Hodapp-Parrish-Anderson criteria for scoring Humphrey visual field defects was derived for the FDP at the halfway point of the study, and all participants were reassessed with this algorithm upon its completion. RESULTS: FDP mean and pattern deviation showed strong linear correlations with Humphrey 30-2 mean deviation (R = 0.75; P < .0001) and corrected pattern standard deviation values (R = 0.64; P < .0001). Despite this, neither global index could consistently categorize the graded glaucomatous visual fields in a manner consistent with the Hodapp-Parrish-Anderson criteria. The new FDP scoring algorithm did provide good segregation (73% precise parity, 93% parity within one Humphrey grade). CONCLUSIONS: Sixteen-zone frequency doubling perimetry can segregate glaucomatous visual field loss into pathologic categories approximating those obtained with Humphrey 30-2 perimetry by means of a formula modeled after the Hodapp-Parrish-Anderson criteria.

Algorithms↗

PubMed1991

Characteristics of the normal central visual field measured with resolution perimetry.

The ring perimeter is an innovative device that measures the resolution threshold at 50 locations in the central visual field in approximately 6 min. This study was undertaken to define the characteristics of the resolution visual field in normal eyes using this instrument and to check the repeatability of the measurement. A total of 114 perimetrically naive, normal subjects aged from 20 to 79 years were prospectively enrolled; 55 randomly chosen subjects were tested twice, with a rest period of less than or equal to 60 s elapsing between examinations. The resolution threshold increased towards the periphery in all subjects. A small but significant decline in sensitivity occurred with age; this loss was greatest in the inner part of the field. Variability in threshold between subjects was not found to increase towards the periphery or in the upper field as compared with the lower. The field was highly repeatable when reexamined in the same subject. This study defines the resolution visual field in normal subjects, along with its inter- and intra-observer variability, and gives age-corrected predictive confidence intervals for each location of the field using the ring perimeter.

Adult↗