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Inter-observer and intra-observer agreement in the interpretation of visual fields in glaucoma.

Visual field changes are one of the main parameters used to monitor progression of glaucoma. This study assesses the degree of intra-observer and inter-observer agreement among nine observers in grading visual fields in glaucoma patients using a visual field system previously described by Jay. The results show a median inter-observer agreement of 61% (median kappa = 0.52) and a median intra-observer agreement of 72% (median kappa = 0.65). This system for grading fields in glaucoma has a high degree of intra-observer agreement, suggesting it is a useful system for longitudinal follow-up of patients by a single observer. The higher degree of disagreement between observers points to the need for careful pretraining of observers in clinical management and research where the results from visual field examinations are to be graded by more than one clinician.

Cohort Studies↗

[Effect of systolic blood pressure on the location of visual field defects in upper and lower visual half-fields in patients with chronic simple glaucoma].

In earlier studies we found that visual field defects occur more frequently in the lower half of the visual field and that low systolic blood pressure occurs more frequently in low-tension glaucoma (stage II) compared to primary open-angle glaucoma (POAG) (stage II). We wanted to find out whether visual field defects in the lower half of the visual field point to insufficient perfusion of the optic nerve head due to low blood pressure. We therefore examined the visual fields of 153 eyes of 153 patients with POAG and regulated IOP with program 31 or 33 of the Octopus perimeter 201. With program Delta the loss per test point in the upper and lower hemifield was calculated. The mean systolic blood pressure was calculated for each patient from the blood pressure recordings during the observation time and over a long-term follow-up period (3-19 visual field examinations during a period of 1-8 years). With the Delta program we decided case by case whether the visual field showed a tendency to deteriorate or not. An asymmetry in the mean loss per test point between the two visual hemifields in a relation of 2:1 or more was found in 71 eyes out of 153. In the upper hemifield 50 out of 71 patients had two times greater loss per test point than in the lower hemifield. These patients showed a mean systolic blood pressure of 158 +/- 37 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The glaucoma suspect: differentiation of the future glaucoma eye from the non-glaucomatous suspect eye. 2. Visual field decay.

Visual-field areas to a I2e stimulus were measured planimetrically using an X-Y digitizer and a computer program. Sampling of normal subjects and patients suspected of having glaucoma was done at two points in time. Calculations of eye-wall stress were done using ultrasonic data and intra-ocular pressure (IOP) measurements from patient records. For those suspected of having glaucoma who developed chronic open-angle glaucoma (COAG), the time of transition was the second point in time. The visual field area was regressed against patient age at the two points in time. No difference in the regression slopes was found for the normal subjects and unchanged patients. The patients who did develop glaucoma were significantly different. The mean annual rate of visual-field change (rate of decay) was calculated and found to be 28.5 mm2/year for the normals, 153.5 mm2/year for the suspects, and 376.4 mm2/year for those patients who developed glaucoma. The rate of visual-field decay only correlated with patient age (P = 0.03) and eye-wall stress (P less than 0.01) in the patients who developed glaucoma.

Age Factors↗

Functional properties of parietal visual neurons: radial organization of directionalities within the visual field.

Parietal visual neurons (PVNs) were studied in waking monkeys as they executed a simple fixation-detection task. Test visual stimuli of varied direction, speed, and extent were presented during the fixation period; these stimuli did not control behavior. Most PVNs subtend large, bilateral receptive fields and are exquisitely sensitive to stimulus motion and direction but insensitive to stimulus speed. The directional preferences of PVNs along meridians are opponently organized, with the preferred directions pointing either inward toward or outward away from the fixation point. Evidence presented in the preceding paper (Motter et al., 1987) indicates that opponent directionality along a single meridian is produced by a feed-forward inhibition of 20 degrees-30 degrees spatial extent. The observations fit a double-Gaussian model of superimposed but unequal excitatory and inhibitory receptive fields: When the former is larger, inward directionality results; when smaller, outward directionality results. We examine here the distribution of the meridional directional preferences in the visual field. Tests showed that opponent organization is not produced by differences in local directional properties in different parts of the receptive field. The distribution of response intensities from one meridian to another is adequately described by a sine wave function. These data indicate a best radial direction for each neuron with a broad distribution of response intensities over successive meridians. Thus, any single PVN, with rare exceptions, cannot signal radial stimulus direction precisely. We then determined how accurately the population response predicted radial stimulus direction by the application of a linear vector summation model. The resulting population vector varied from stimulus direction by an average of 9 degrees. Whether or not the perception of the direction of motion depends upon a population vector remains uncertain. PVNs are especially sensitive to object movement in the visual surround, particularly in the periphery of the visual field. This, combined with their large receptive fields and their wide but flat sensitivity to stimulus speed, makes them especially sensitive to optic flow. This is discussed in relation to the role of the parietal visual system in the visual guidance of projected movements of the arm and hand, in the guidance of locomotion, and in evoking the illusion of vection.

Action Potentials↗

Visual field examination during transient migrainous visual loss.

A transient episode of bilateral amaurosis fugax, or transient visual loss, occurred in a patient with ophthalmic migraine associated with mitral valve prolapse while computerized visual field testing was performed. This fortunate finding illustrated characteristic defects which are compared with the patient's visual field tested 24 hours later. Statistical analysis of both examinations is stressed here.

Adult↗

Pseudopapilloedema with and without verified optic disc drusen. A clinical analysis II: visual fields.

An analysis of visual field findings in the material of 200 patients with pseudopapilloedema with and without verified optic disc drusen was performed. Goldmann and/or Friedmann visual fields were examined in 383 eyes. Visual field defects were found in 38.9% of the pseudopapilloedema eyes without verified drusen, but in 73.4% of the drusen eyes. The strongest field defects were found only in the eyes with drusen seen by oblique illumination or with superficial drusen. The eyes with superficial drusen showed visual field defects in 85.8%. Only 7 patients complained of visual field defects. A progression of visual field defects could be documented in 22% of 118 patients with visual field examinations 2 or more times.

Adult↗

The effect of protective sports eyewear on peripheral visual field and a peripheral visual performance task.

Seven different types of protective sports eyewear were tested to determine whether peripheral awareness as measured with a visual performance task were affected. Goldmann perimetry and the Wayne Saccadic Fixator with Stik-Up attachments were utilized in a repeated measures research design. The sports glasses did restrict visual field, but no one pair of glasses were least restrictive. The restrictions did not translate into significant differences on the performance task. Peripheral visual factors should be taken into account when prescribing protective sports eyewear. The importance of proper eye protection in sports is also discussed.

Adult↗

Localization of objects in the peripheral visual field.

We investigated visual localization by asking humans to point at visual objects without vision of their hand. The objects were luminous discs, presented stereoscopically at different distances, eccentricities and meridians with respect to the subjects' straight-ahead. Final pointing position was recorded by an electromagnetic search-coil technique. We found that the eccentricity of pointing responses towards peripheral targets was larger when subjects fixated straight-ahead rather than looked at the targets. This outcome confirmed our previous finding that target eccentricity in the peripheral visual field is overestimated. We further found that overestimation increased less than proportionally with target eccentricity, which suggests that the local magnification factor gradually declines in the visual periphery. A quantitative analysis indicated that the magnification factor is about 1.5 at the fovea, and approaches 1.0 at 10 degrees visual angle. Thus, our data support the hypothesis of a peri-foveal magnification effect which gradually subsides with increasing eccentricity. The observed magnification was similar for the horizontal and the vertical meridian. We found that the egocentric distance of pointing responses depends not only on the distance of the object pointed at, but also on the distance of a second object in the visual field. This outcome was in quantitative agreement with the predictions of Foley's model of interactive distance evaluation. Response depth, i.e. the difference in the response distances towards the two objects, was larger if both objects appeared near the center of the visual field rather than if one object appeared in the visual periphery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Relationship cataract density and visual field damage.

In interpreting visual field results, two questions arise: a) what type of visual field damage is produced by cataract, and b) can the influence on the visual field somehow be predicted? To answer these questions, cataract density was quantified with the Opacity Lens Meter (OLM) 701, and visual field tests were done before and after IOL-implantation surgery with Octopus Program G1 in 58 eyes of 58 patients (mean age 71 +/- 8 years) with cataract but with no other detectable ocular diseases. The average improvement of mean damage (MD) after surgery was 5.4 dB, and that of D (20) (defect 20 on the Bebie Curve) was 5.7 dB. The improvement of the visual fields was, as expected, statistically highly significant (p < 0.0001). The corrected loss variance (CLV), however, increased on the average only by 2.5 dB2, which was not significant. The predictive value of the OLM reading for opacity-induced MD depends on the type of cataract. It is good for cortical and nuclear cataracts but poor for posterior subcapsular opacifications. The overall predictive value (R = 0.66) is, nevertheless, better than for preoperative visual acuity (R = -0.54). If OLM and visual acuity (VA) are considered together, the predictive value is slightly higher (R = 0.72). Thus, optical density influences on visual field performance can be subtracted from general visual field results.

Adult↗

The effects of visual field changes and ocular hypertension on the visual evoked potential.

The effects of visual field changes and ocular hypertension on visual evoked potentials were investigated by photopic ERG and by luminance and pattern-reversal EPs on 116 glaucomatous and on 7 normal eyes. The problem was approached by way of four investigations: Firstly, which nerve structures are affected by glaucoma and how do visual field defects caused by glaucoma influence the EP? The results show a functional diminution of all intraocular nerve structures in which the prelaminary part of the optic nerve is most affected. The EPs, especially the pattern-reversal EPs, are markedly diminished if the visual field defects extend inside the 10 degree boundary. Differences in the visual field defects of both eyes and the course of the sickness can be well observed by the EPs. Secondly, which preoperative prognosis for visual acuity produced by the EP can be given to patients who have a dense cataract in addition to glaucoma? A postoperative improvement of the visual acuity can be expected if the L-EPs are within the standard deviation. If the EP is distinctly diminished and does not increase with increasing stimulus intensity, then there is no hope for an improvement of the visual acuity after the operation. Thirdly, does a decrease of intraocular pressure in chronic and acute glaucoma influence the EP? In acute glaucoma with pressure levels of 50 mmHg or more, and sometimes in chronic glaucoma with pressure levels of about 30 mmHg, an increase of the amplitude of the EP and an improvement of the visual field could be noticed after pressure regulation. Fourthly, what is the behaviour of the EP in normal and glaucomatous eyes at experimentally elevated intraocular pressure? The amplitudes of the ERG components show a gradual decrease in normal as well as in glaucomatous eyes when intraocular pressure is increased and are maintained when intraocular pressure reaches systolic ophthalmic blood pressure. On the other hand, the EPs show a strong decrease in amplitude when intraocular pressure exceeds the mean ophthalmic blood pressure, particularly in the case of glaucomatous eyes.

Evoked Potentials, Visual↗

[Central visual fields in pure alexia "without hemianopsia"--visual dysfunction in the right hemifield, and alexia for "kana" words in the left].

Following a left occipito-temporal subcortical hematoma, a 57-year-old, right-handed man developed pure alexia that was more prominent in kana words, especially in kana nonwords, than in kanji letters. Although a kinetic perimetry with a Goldmann perimeter showed his visual fields to be full, a static perimetry with a Humphrey visual field analyzer disclosed decreased visual sensitivity in the right visual field in its central 30 degrees. In addition, a tachnistoscopic examination with Landolt rings revealed his visual acuity (the ability of two points discrimination) to have decreased in the right half of his central visual filed in its 3 degrees. In the right central vision, he was unable to recognize the letters, pictures or colors presented by the tachistoscope. Concerning the reading, the more letters in kana words or the higher the number of strokes in kanji letters, the more difficulty he experienced in orally reading both kana and kanji. On the contrary, in the left central vision, kanji reading was not so affected by an increased number of strokes as the kana-word reading which became difficult when the number of the letters increased. CT scan showed subcortical hematoma in the left occipitotemporal region. Magnetic resonance imaging 3 months after onset revealed a localized injury in the region between the left postero-inferior temporal lobe and the infero-lateral occipital lobe, including the fusiform gyrus. None of the splenium, the lingual gyrus or the optic area were affected. The spared structures also included the angular gyrus, the Wernicke area and their subcortical white matter.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗

Multifocal pupillary light response fields in normal subjects and patients with visual field defects.

The optimal conditions for recording focal pupillary light responses with a multifocal stimulation technique were determined, and the technique was applied to normal subjects and patients with visual field defects. Thirty-seven hexagonal stimuli were presented on a TV monitor with a visual field of 40 degrees diameter under a constant background illumination. Using a slow (4.7 Hz) m-sequence, reliable focal responses were obtained in both normal subjects and patients. The pupillary field and visual field were well correlated in patients with retinal diseases, but the correlation was not strong in patients with optic-nerve diseases. Pupillary light responses were reduced in the blind hemifield in patients with post-geniculate lesions. These results indicate that the multifocal stimulation technique can be used clinically to obtain a pupillary field for objective visual field testing.

Adult↗

Disc and field damage in patients with unilateral visual field loss from primary open-angle glaucoma.

To assess the temporal relationship between field and disc change in early glaucoma, 24 patients with unilateral visual field loss from primary open angle glaucoma were identified for planimetric optic disc measurements. Cross-sectional analysis of disc rim area was performed and compared to 25 age-matched normal controls. The mean (+/- SD) disc rim area in eyes with normal visual fields (1.10 +/- 0.31 mm2) was slightly larger than that of eyes with visual field loss (0.90 +/- 0.33 mm2). The mean disc rim area in the control group (1.49 +/- 0.19 mm2) was significantly different from both sets of eyes in the asymmetric primary open angle glaucoma patients (p = 0.000). These findings support the hypothesis that loss of the optic disc rim can be detected before perimetric abnormalities develop in patients with glaucoma.

Aged↗