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Nerve fibre bundle visual field defects are the hallmark of pathology at the optic nerve head or retina. In the present series, six eyes of four patients with large intracranial mass lesions demonstrated such field defects with visual acuity spared in three of the involved eyes. In no cases did visual function in the opposite eye offer a clue to the localization of the lesion.
A rare case which showed scotomatous defects in the left central visual field was presented. A 51 year-old man was admitted to our clinic because of the visual deterioration. In neuroradiological examinations the left carotid angiography showed elevation of both A1 portions and CT suggested pituitary tumor. On February 5, 1980 radical operation was carried out, in which it was confirmed that part of the optic nerve was concave and split longitudinally with a compression of the pituitary adenoma. Postoperative course was uneventful and recovery from the defects in the central visual field was quickly. In this case longitudinal splitting of unilateral optic nerve, caused by gradual compression of supra- or parasellar tumor, was considered as one cause of scotomatous defects in the central visual field. In addition, visual status of forty six cases of pituitary adenoma which had been operated at our clinic during the past fourteen years was analysed both pre- and post-operatively, compared with the case described above.
Fifty advanced glaucoma patients with central visual field islands were evaluated before and after intra-ocular surgery with respect to visual acuity and visual field behavior. Thirteen patients underwent a cataract extraction, and 37 a filtering procedure. Visual acuity generally improved to a certain extent after lens extraction, and deteriorated after filtering surgery. For both groups the visual field island became somewhat larger with respect to the surface area, but the foveal value was usually lower after the operation. There was no clear relationship between visual acuity and foveal values or the surface area of the central island. One patient suffered unexplained loss of central vision.
PURPOSE: To determine the progression of defects in the central 10-degree visual field in patients with retinitis pigmentosa and choroideremia by means of univariate linear regression with respect to the mean deviation. METHODS: In a retrospective study, results of automated static perimetry in the central 10-degree visual field were reviewed for patients with retinitis pigmentosa and choroideremia. Univariate linear regression of mean deviation was undertaken for each eye that had field data from at least five tests in addition to the prior static perimetric experience during a period of 3.5 years or more. Data from 30 eyes of 16 patients fulfilled eligibility requirements; the mean number of fields was 5.8 (range, five to 10) and the mean follow-up period was 64 months (range, 42 to 97 months). Eyes were classified as progressive if the regression coefficient was negative and significantly different from zero, with a P value of less than .05. RESULTS: Among 14 patients in whom both eyes were eligible for univariate linear regression analysis, a statistically significant progression was demonstrated in both eyes in four patients, only in one eye in five patients, and in neither eye in five patients. One of two patients, in whom only one eye was eligible for the study, showed significant progression in the eye. Overall, 14 (47%) of 30 eyes showed statistically significant progression with respect to the mean deviation. No eye showed significant improvement. CONCLUSIONS: Automated static perimetry of the central 10-degree visual field measured approximately once or twice a year demonstrated the progressive nature of the disease with the use of univariate linear regression of mean deviation in 47% of eyes with retinitis pigmentosa and choroideremia during the follow-up period of 3.5 years or more. These results may be useful in understanding the clinical course of the diseases and counseling patients.
Purpose: We investigated the relationship between the progression of visual field defect and clinical factors in patients with normal-tension glaucoma (NTG).Subjects and Methods: Forty-eight eyes of 48 NTG patients undergoing more than 5-year follow-up were enrolled in this study. Their visual field defects ranged between Aulhorn's classification stage 2 and 4, and mean deviation (MD) more than -10 dB measured by Humphrey Field Analyzer (HFA). End points of this follow-up study were defined as follows: in HFA STATPAC 2 glaucoma change probability analysis, more than 5 points which significantly deteriorated at P <.05 were found at 2 consecutive examinations (Criterion 1) or a significant decrease in MD value at P <.025 was encountered at one examination or in MD value at P <.05 at consecutive examinations (Criterion 2).Results: During the follow-up period, 18 eyes of 48 patients satisfied Criterion 1 and 21 eyes Criterion 2. There were no significant differences in clinical factors between patients with progression and without progression. By multiple logistic regression analysis, minimum flow velocity of central retinal artery (CRA) showed significant relation (odds ratio for a 1 cm/sec rise = 0.2215; 95% confidence interval: 0.0530-0.9253) to progression of visual field defect in Criterion 1, and minimum flow velocity of CRA (odds ratio for a 1 cm/sec rise = 0.2099; 95% confidence interval: 0.0506-0.8712) and cholesterol (odds ratio for a 1 cm/dl rise = 1.0332; 95% confidence interval: 0.4096-2.6064) showed significant relation in Criterion 2.Conclusion: These results suggests that vascular risk factors of ocular blood flow may play a role in the progression of visual field defects in NTG patients.
BACKGROUND: Conventional kinetic perimetry is of especial use in case of advanced scotoma. However, examiner dependency is a major drawback. Purpose of this study was to evaluate the clinical feasibility and intraindividual scatter of computer-assisted kinetic perimetry in monitoring advanced visual field defects of various origins. METHODS: Examinations were carried out with the Tuebingen Computer Campimeter (background lumincance 10 cd/m2). In an initial session, the localization of the scotoma border is estimated with conventional manual kinetic perimetry. In the subsequent computer assisted kinetic mode, an individually adjusted set of vectors is designed. Each vector crosses the manually assessed visual field defect border almost perpendicularly, starting approximately 3 degrees within the scotoma. Each individual set of vectors can be stored and recalled for follow-up. Stimuli move along these vectors with identical characteristics as in manual kinetic perimetry. Stimulus presentations are repeated six times in a randomized order. Patients' responses are recorded and additionally corrected for mean individual reaction time. A "local kinetic threshold" (mean) and a related parameter for dispersion (standard deviation) are assessed. RESULTS: Four subjects with advanced visual field loss of various origin (retinitis pigmentosa, vigabatrin-associated visual field defect, glaucomatous nerve fibre layer defect, and postgeniculate visual pathway defect) participated in this study. Maximal difference between manual-kinetic and automated kinetic thresholds reaches from 1.7 degrees to 5 degrees. Local scatter (standard deviation) of kinetic threshold, assessed by computer-assisted perimetry, varies between 0.1 degree and 3.0 degrees. CONCLUSION: Computer assisted kinetic perimetry is a new, useful, examiner-independent, reliable method for effective evaluation and monitoring of advanced visual field loss.
We assessed 81 patients in four groups (normal, low- and high-risk ocular hypertension, and early glaucoma) with the standard Octopus G1 central visual field program in addition to two quantitative programs, PFN (peripheral field-nasal) and PFT (peripheral field-temporal), designed for this study to test the nasal and temporal periphery, respectively. Indices were calculated for each program for each subject in all groups. We then examined the behavior of the indices across the separate visual field areas within each group as well as the behavior of the indices of each field area among the different groups. We found that quantitative testing of the peripheral nasal visual field provided valuable information in the detection of glaucomatous visual dysfunction additional to that provided by quantitative testing of the central visual field. Quantitative testing of the temporal periphery was less valuable.
The visual field defects in 20 consecutive patients who had branch retinal "vein" occlusions included arcuate nerve fiber bundle scotomas, central scotomas, paracentral scotomas, and segmental peripheral constriction. The role of retinal arteriolar insufficiency in the production of these field defects is discussed. The available evidence suggests that the term "branch retinal vascular occlusion" is a preferable term to describe such clinical findings.
OBJECTIVE: To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation. CLINICAL FEATURES: A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony. INTERVENTION AND OUTCOME: It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results. CONCLUSION: Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.
BACKGROUND: The aim of this study was to investigate the quantitative changes of visual field in patients with arterial hypertension using standard white-on-white perimetry. MATERIALS AND METHODS: Sixty-two patients (f : m = 33 : 29) with arterial hypertension without damage in end-organs were included and divided into three groups: Group 1: systolic/diastolic blood pressure: 120 - 139/80 - 89 mm Hg (n = 18, f : m = 14 : 4, mean age 55 +/- 13 years), group 2: systolic/diastolic blood pressure: 140 - 159/90 - 99 mm Hg (n = 24; f : m = 9 : 15, mean age 55 +/- 12 years), group 3: systolic/diastolic blood pressure: 160 - 179/100 - 109 mm Hg (n = 20; f : m = 10 : 10, mean age 55 +/- 12 years). We compared these patients with an ophthalmological and healthy control group (systolic/diastolic blood pressure < 120/80 mm Hg, n = 20, f:m = 12 : 8, mean age 55 +/- 9 years). Beside the ophthalmological examinations (visual acuity, refraction, intraocular pressure, slit lamp and fundus examination) quantitative analysis of visual field by Octopus 1-2-3 perimeter was performed. Different parameters (mean deviation (MD), mean sensitivity (MS), loss variance (LV), pattern standard deviation (PSD) and the test-duration) were statistically compared using the Mann-Whitney-U test and the Wilcoxon test. RESULTS: Hypertensive retinopathy grade I - II was found in 10 patients with arterial hypertension. Statistic analysis showed no significant difference of MD, MS, LV, PSD and test duration between the patients with arterial hypertension and the control group (Mann-Whitney-U test: p > 0.05). There was also no significant difference between the three hypertonic groups (Mann-Whitney-U test: p > 0.05). CONCLUSIONS: The examination of visual field using standard achromatic automated perimetry based on investigation of the parvocellular system. Arterial hypertension, however, does not damage this parvocellular system enough to assess disturbances in the white-on-white perimetry. Further studies are necessary to clarify the value of Frequency Doubling Perimetry, which is based on the detection of early damage of the magnocellular system.
53 eyes of 53 advanced open angle glaucoma (stage 5 of Aulhorn-Greve's classification) were studied regarding the risk factors for central visual field loss by the Cox proportional hazards model. The cases of foveal threshold under 20 dB were defined as central visual field loss group (9 eyes), and the cases over 20 dB were defined as no visual field loss group (44 eyes). The following clinical factors were statistically analyzed between the two groups: gender, age, family history of glaucoma, refraction, intraocular pressure, blood pressure, visual field measured by static perimetry, optic disc, retinal nerve fiber layer, treatment, and systemic disease. Foveal threshold, mean deviation, pattern standard deviation, corrected pattern standard deviation, and retinal nerve fiber layer defect showed significant difference between the two groups, and diastolic blood pressure and diastolic blood pressure minus intraocular pressure showed a tendency to be related. From the results obtained, intraocular pressure and these other clinical factors should be considered for the management of advanced open angle glaucoma patients.
This study examined whether differential word length effects in the two visual fields imply hemisphere-dependent modes of word recognition. Length was defined as the number of constituent characters of Chinese foreign names (Experiments 1 and 2), as the number of constituent morphemes of three-character words (Experiments 3 and 4), and as that of constituent words of phrases (Experiments 5 and 6). Two types of experimental tasks were adopted, one required linguistic judgments on overall items (Experiments 1, 3, and 5) and the other was target detection tasks performed on the same set of stimuli (Experiments 2, 4, and 6). Five of the six experiments failed to find any kind of interaction between length and visual field. An interaction was observed only for the detection of characters embedded in foreign names, that is, when lexical access is least involved in the task, suggesting that word recognition plays a minimum role in the phenomenon. Other observations suggested that modes of word recognition are more frequency-dependent than hemisphere-dependent, and that Chinese compound words and phrases, although hardly distinguishable, do behave differently.
Many drugs used in the treatment of systemic pathologies may cause retinal or neurotoxic side effects which effect visual fields. This paper discusses the role of the drug history, personal health history, and testing procedures in evaluating these toxic visual fields. Specific drugs are cited which may cause toxic visual field defects.
The scanning speed of focal visual attention was measured directly by flashing a sequence of two, three, or four numerals one by one at random retinal positions and at a distance from each other to avoid interference between the numerals. Each numeral was followed by a mask pattern so the observers had to move their focal attention in the visual field in synchrony and at the same speed as the presentation rate of the numerals in order to recognize every numeral in the stimulus sequence. Observers could recognize the numerals orders of magnitude above the theoretical chance level of performance even when the presentation rate was as fast as 33 ms per numeral. However, the temporal order of the numerals was perceived rather poorly at the fast presentation rates and for the sequences of four numerals.
We studied the relationship between intraocular pressure (IOP) and progression of visual filed loss in 83 eyes of 83 patients with advanced primary open-angle glaucoma (loss of at least one quarter of the visual field on Goldmann perimetry). During the 15-year follow-up study, 71 eyes (86%) showed progression of visual field loss. The mean IOP was significantly lower in eyes that remained stable (13.4 +/- 1.3 mm Hg) than in those that showed progression of visual field loss (19.4 +/- 2.6 mm Hg). These results suggest that it is necessary to reduce IOP to below 15 mm Hg to prevent further progression of visual filed loss in advanced glaucoma.
Eighty-eight glaucoma patients and 252 normal subjects underwent C-30-2 testing on the Humphrey Field Analyzer. The effect of fixation losses, high false-positive and false-negative response rates on visual field test results was assessed using the mirror image method of detecting asymmetry across the horizontal meridian, and the Humphrey STATPAC pattern standard deviation (PSD) and mean deviation (MD). Glaucoma patients with poor fixation (greater than or equal to 20%) had less depressed fields and fewer localized defects than those with good fixation. Fixation loss did not affect measures of localized defects or generalized depression among normal subjects. High false-positive rates (greater than or equal to 10%) were associated with less-depressed visual fields among glaucoma patients and normal subjects. Visual fields were depressed by an average of 9 dB for glaucoma patients and 7 dB for normal subjects with high false-negative rates (greater than or equal to 33%), when compared with those with low false-negative rates. Apparent localized defects were observed among normal subjects with high false-negative rates. Most of these defects were located in the superior nasal and adjacent arcuate area.
Orientation sensitivity in the peripheral visual field has been tested in two tasks: (a) setting horizontal the orientation of a grating at various retinal eccentricities, and (b) matching the orientation of a peripherally viewed grating as close as possible to an oblique reference viewed foveally. Both performances fall off with increasing retinal eccentricity. Magnification of the stimulus optimizes peripheral performance. Peripheral performance, optimized by magnification, varies with retinal eccentricity. It approaches, but does not reach, the foveal value (tested by the same method) at 10 deg of eccentricity, and is much lower at 20 and 30 deg of eccentricity.
The examination of the central visual field with the help of automatic or semi-automatic field analyser leads to a great number of false negative or false positive results. Therefore, we tried to develop two modified perimetric techniques: they allow a continuous variation of light intensity and a quantitative recording of relative scotomas. For the investigation we can use a well-known card-grid. By a new arrangement of the gitter lines, it is possible to analyse nerve fiber scotomas. The results of these new perimetric techniques distinguish themselves by the fact that they can be swiftly executed and are helpful for detecting small central and paracentral scotomas.