Abnormal Glaucoma Hemifield Test Research Articles

The Trajectory of Glaucoma Progression in 2-Dimensional Structural–Functional Space

To present a method that allows visualization of functional and structural change in 2-dimensional space. Retrospective, longitudinal, observational study. Patients from the Stein Eye Institute, UCLA from 1993 through2017. Patients were arranged into 2 cohorts. Cohort 1 was used to create a structural score for the horizontal axis of the structural-functional (S-F) 2-dimensional space. The visual field (VF) index was used for the vertical axis as the functional score. Cohort 2 was used to apply those scores for analysis of S-F progression with a combined vector. The first cohort included eyes with mild glaucoma (abnormal glaucoma hemifield test results, pattern standard deviation <0.05 on 2 examinations, or mean deviation [MD] >-5 dB) and normal control participants. The second cohort included all stages of open-angle glaucoma with ≥5 OCT retinal nerve fiber layer scans, ≥5 reliable visual field (VF) results, and follow-up of ≥4 years. Vectors were created for each eye to represent the trajectory of glaucoma progression over time. Each vector was defined by structural (x-axis) and functional (y-axis) components. The structural component was calculated with a linear model of Heidelberg Retina Tomograph (Heidelberg Engineering, Heidelberg, Germany) scores over time. The functional component was calculated with a linear model of VF measurements over time. The resultant vector and its confidence interval were plotted in 2-dimensional S-F space. Eyes were divided into severity stages based on baseline MD. A mean vector was calculated for each severity stage. We obtained 290 vectors from 290 eyes of 196 patients. The mean ± standard deviation follow-up period was 14.6±3.1 years. Average age was 58.6±8.8 years. Preperimetric, mild, moderate, and severe categories included 41, 89, 97, and 63 eyes, respectively. Mean baseline MDs were 0.8 dB, -0.95 dB, -3.57 dB, and -11.51 dB, respectively, and mean vector slopes for each severity categories were 0.79, 0.95, 1.95, and 2.08, respectively. Cook's distance removed 131 (7.1%) and 137 (7.4%) outliers from the structure and function regressions, respectively. We report a method to visualize the trajectory of a patient's glaucoma progression in a 2-dimensional S-F space. The slope of the trajectory of glaucoma progression is a function of the severity of the disease.

Association of Systemic Medication Exposure With Glaucoma Progression and Glaucoma Suspect Conversion in the Groningen Longitudinal Glaucoma Study.

To determine the association of statins, five classes of antihypertensive medications, and proton pump inhibitors with (1) primary open-angle glaucoma (POAG) progression and (2) conversion of POAG suspects to POAG. We retrospectively investigated the records of a cohort with POAG cases and suspects from the Groningen Longitudinal Glaucoma Study. To quantify visual field (VF) deterioration in cases, we used the rate of progression of the mean deviation (MD). Suspects were considered to have converted at the time point after which two consecutive VF tests for at least one eye were abnormal (glaucoma hemifield test outside normal limits). Progression and conversion were analyzed with quantile and logistic regression, respectively, with the systemic medications as predictors, controlling for age, sex, body mass index, pretreatment IOP, corneal thickness, and baseline MD. The multivariable models were built with and without IOP intervention. No systemic medications were associated with POAG progression in the final IOP/treatment-adjusted or unadjusted model. However, angiotensin II receptor blockers (ARBs) appeared to slow progression in older patients (b = 0.014, P = 0.0001). Angiotensin-converting enzyme inhibitors (ACEIs) were significantly associated with a decrease in POAG suspect conversion in both the IOP/treatment-adjusted and -unadjusted model (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.79, P = 0.012; OR=0.24, 95% CI 0.07-0.78, P = 0.021, respectively), as were ARBs (OR 0.12, 95% CI 0.01-0.98, P = 0.014; OR 0.11, 95% CI 0.01-0.87, P = 0.005, respectively). No overall association of VF progression with systemic medication was found; ARBs delayed progression in older patients. ACEIs and ARBs were associated with lower risk of suspect conversion. The pathophysiology of this relationship is to be disentangled.

Perimetric and retinal nerve fiber layer findings in patients with Parkinson’s disease

BackgroundVisual dysfunction is common in Parkinson’s disease (PD). It remains, however, unknown whether it is related to structural alterations of the retina. The aim of this study is to compare visual field (VF) findings and circumpapillary retinal nerve fiber layer (RNFL) thickness in a series of PD patients and normal controls, in order to assess possible retinal anatomical changes and/or functional damage associated with PD.MethodsPD patients and controls were recruited and underwent VF testing with static automated perimetry and RNFL examination with optical coherence tomography (OCT). Cognitive performance using Mini Mental State Examination (MMSE), PD staging using modified Hoehn and Yahr (H-Y) scale and duration of the disease was recorded in PD patients.ResultsOne randomly selected eye from each of 24 patients and 24 age-matched controls was included. OCT RNFL thickness analysis revealed no difference in the inferior, superior, nasal or temporal sectors between the groups. The average peripapillary RNFL was also similar in the two groups. However, perimetric indices of generalized sensitivity loss (mean deviation) and localized scotomas (pattern standard deviation) were worse in patients with PD compared to controls (p < 0.01). 73% of eyes of PD patients had glaucomatous-like asymmetrical hemifield defects with abnormal Glaucoma Hemifield Test and various combinations of arcuate defects (n = 12), nasal steps (n = 11) and paracentral scotomas (n = 16). Bilateral defects were found in 14 patients (58%). No correlation was found between VF indices and MMSE or H-Y scores.ConclusionPD patients may demonstrate glaucomatous-like perimetric defects even in the absence of decreased RNFL thickness.

Confirmation of TBK1 duplication in normal tension glaucoma

Confirmation of TBK1 duplication in normal tension glaucoma

The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma

To determine if clinical evaluation of parapapillary atrophy (PPA) significantly improves the ability to distinguish open-angle glaucoma (OAG) patients from glaucoma suspects. Patients in this study were under evaluation for glaucoma and had open angles, at least one reliable 24-2 SITA-standard automatic perimetry, and digital stereophotographs of the optic disc. PPA was identified clinically as a parapapillary region of absent (βPPA) or hyper/hypopigmented (αPPA) retinal pigment epithelium. A single masked observer evaluated photos for: vertical cup-to-disc ratio (CDR), clock hours of total and βPPA, βPPA as percentage width of the optic disc, presence or absence of βPPA at each disc quadrant, and ordinal rating of total PPA. Generalized linear models were used to determine odds of an abnormal or borderline glaucoma hemifield test (GHT) as a function of PPA variables and covariates; model fit was assessed using the log-likelihood ratio test. Of 410 consecutive patients, 540 eyes (of 294 patients) met inclusion criteria. Mean age was greater among patients with abnormal compared with normal GHT (P < 0.001), but sex and race/ethnicity did not differ between groups (P ≥ 0.22). Age, central corneal thickness (CCT) and CDR (P ≤ 0.006), but not intraocular pressure (IOP) (P = 0.71), were significant univariable predictors of the odds of an abnormal GHT. All PPA parameters significantly predicted GHT (P ≤ 0.03), except presence of temporal βPPA (P = 0.25). Adjustment for age, CCT, IOP, and CDR reduced the association between PPA and GHT, and model fit was not greatly improved by addition of PPA variables. Addition of most PPA parameters to a model already containing commonly assessed variables including age, CCT, IOP, and CDR does not significantly improve the ability to distinguish OAG patients from glaucoma suspects.

Association of Visual Field Severity and Parapapillary Retinal Blood Flow in Open-Angle Glaucoma

To examine the association of the parapapillary blood flow parameters with severity of visual field loss (VFL) in open-angle glaucoma (OAG) patients. Observational clinical study. Fifty-two patients with OAG and 30 normal subjects were studied prospectively. Parapapillary blood flow parameters were obtained for superotemporal and inferotemporal quadrants using the scanning laser Doppler flowmeter. Mean deviation score was used to determine the severity of VFL both as continuous variable and stratified by severity: no VFL (OAG A) <or= 2 dB, mild VFL (OAG B) from 2.1 to 6 dB and moderate-severe VFL (OAG C) >6 dB. In the OAG patients with an abnormal Glaucoma Hemifield Test, the hemifield with a predominant VFL was determined. Linear regression analysis and analysis of covariance were used to assess the relationship between the severity of the VFL and the parapapillary blood flow parameters. The variance in mean parapapillary blood flow was assessed using standard deviation (SD) and coefficient of variation (COV). There was no correlation between the severity of VFL and parapapillary blood flow parameters. Variance in the mean parapapillary blood flow was significantly greater in OAG patients with VFL compared with OAG patients without VFL and normal subjects for the superotemporal quadrant (SD, P=0.04; COV, P=0.02) and the inferotemporal quadrant (SD, P<0.02; COV, P=0.02). Results for COV were confirmed for the inferotemporal quadrant in analysis of covariance after adjusting for age and intraocular pressure (F=1.60, P=0.04). The parapapillary blood flow did not correlate with VFL. However, the variance in meanparapapillary blood flow was significantly larger in OAG patients with VFL, thus suggesting vascular abnormality.

African Descent and Glaucoma Evaluation Study (ADAGES)

To investigate differences in visual function between the healthy eyes of people of African (AD) and European descent (ED). Visual function was assessed in 393 AD and 367 ED participants selected from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study. Participants had normal appearance of the optic disc and intraocular pressure of less than 22 mm Hg. Each participant had 2 reliable 24-2 standard automated perimetry tests, and most had short-wavelength automated perimetry and frequency-doubling technology tests. The generalized estimating equation was used to adjust for intereye correlations. Results were adjusted for age, vertical cup-disc ratio, disc size, central corneal thickness, and presence of high blood pressure. The AD participants were younger (mean [SD] age, 46.2 [13.2] years) than the ED participants (age, 49.5 [16.6] years) (P = .003). The AD participants had worse mean deviation and pattern standard deviation and more points triggered as abnormal on the total and pattern deviation plots compared with ED participants on all tests (P < .05). A larger percentage of AD participants had confirmed abnormal glaucoma hemifield test results on standard automated perimetry only. People of AD have significantly worse performance than people of ED on all tests of visual function. Additional research using longitudinal data is needed to determine the cause of these small but significant ancestry differences in visual function.

Análisis de la distribución de anillo neurorretiniano por sectores mediante láser confocal de barrido en el diagnóstico del glaucoma

To evaluate the diagnostic ability of the Moorfields regression analysis (MRA; neuroretinal rim sector-based analysis) by means of confocal scanning laser. 200 eyes were included in this study: 101 normal subjects and 99 glaucoma patients (standard automated perimetry with glaucomatous defects -MD or CPSD with p<0.02 or a cluster of three or more points with p<0.05 or a cluster of two or more points with p<0.01 or abnormal Glaucoma Hemifield Test). All subjects underwent a full ophthalmic evaluation, visual field evaluation by means of a Humphrey Field Analyzer, 24-2 full threshold strategy, and optic disc topography by Heidelberg retina tomograph (HRT-II). The outcome parameters were sensitivity and specificity of the MRA for each sector. The highest sensitivity in detecting structural defects based on MRA (p<0.05) was observed in the nasal-superior sector (48%) and nasal-inferior sector (45%); however the highest specificity was found in the temporal-superior (98%) and inferior (98%) sectors. The highest sensitivity for MRA (p<0.01) was found in the temporal-inferior sector (31%) and nasal-superior sector (30%) while the temporal-superior and inferior-sectors showed the highest specificity (100%). The diagnosis of glaucoma based on the presence of any sector alteration showed sensitivity figures of 67% with p<0.05 and 46% with p<0.01 and specificity values of 84% with p<0.05 and 96% with p<0.01. The analysis of the distribution of the neuroretinal rim by means of HRT-II contributes effectively to the diagnosis of glaucoma based on perimetry in a sample derived from a Spanish population.

Detection of glaucomatous visual field changes using the Moorfields regression analysis of the Heidelberg retina tomograph

PurposeTo evaluate the sensitivity and specificity of optic disk examinations performed using the Moorfields regression analysis (MRA) of the Heidelberg Retina Tomograph (HRT) in differentiating normal from glaucomatous eyes. DesignRetrospective cross-sectional study. MethodsFive hundred and nineteen patients were included in the study for a total of 193 normal eyes, 213 with suspected glaucoma (primary open-angle glaucoma [POAG]), and 113 with POAG. The intervention consisted of optic disk imaging by means of HRT I. A mean of three repeated images was analyzed using version 2.01 software. The optic disk was classified as “normal/outside normal limits” on the basis of the MRA. The visual field was examined using the DS 24 II program (Humphrey perimeter), with a glaucomatous visual field being defined on the basis of an abnormal Glaucoma Hemifield Test and a statistically significant corrected pattern standard deviation greater than 2 dB. The results obtained with MRA were compared with those obtained using the multivariate discriminant analysis (MDA) provided in the HRT I. The main outcome measures were sensitivity, specificity, and positive and negative predictive values of HRT examination. ResultsThe sensitivity and specificity of the HRT-MRA examination were, respectively, 74% and 94% (83% and 75% with MDA) when the patients with suspected POAG were excluded from the analysis; the figures were 74% and 85%, and 41% and 94% (83% and 64%, and 60% and 75% with MDA) when the same patients were included as being normal or having POAG. ConclusionsIn a broad clinical setting including normal subjects, patients with suspected POAG, and POAG patients, the HRT-MRA showed a high degree of diagnostic accuracy. The MRA was less sensitive but more specific than MDA. Greater diagnostic ability may be added by HRT-MRA examinations than by HRT-MDA to standard POAG diagnostic studies.

Clinical ability of Heidelberg retinal tomograph examination to detect glaucomatous visual field changes.

To determine the agreement between Heidelberg Retinal Tomograph (HRT; Heidelberg Instruments, Heidelberg, Germany) and visual field examinations in differentiating normal from glaucomatous eyes and to evaluate the sensitivity and specificity of HRT optic disc examination in detecting eyes with glaucomatous damage. Cross-sectional study. Three hundred fifty-nine patients, for a total of 359 eyes (55 normal, 209 with ocular hypertension [OHT], and 95 with primary open-angle glaucoma). Optic disc imaging by HRT, using a 10 degrees angle view; a mean of three repeated images were analyzed using version 2.01 software. The optic disc was classified as "normal/glaucomatous" on the basis of multivariate discriminant analysis and cumulative frequency distribution (ranked-segment distribution curves). The visual field was examined using the DS 30 II program (Humphrey perimeter, Zeiss Humphrey System, Dublin, CA), with a glaucomatous visual field being defined on the basis of an abnormal glaucoma hemifield test and a statistically significant corrected pattern standard deviation less than 4 dB. Agreement between HRT and visual field examinations calculated by means of the kappa statistic and the sensitivity and specificity of HRT examination. The agreement between the visual field-based and HRT definition of glaucoma was fair to poor, with a kappa statistic of between 0.48 and 0.28. The sensitivity and specificity of the HRT examination were, respectively, 80% and 65%, according to Mikelberg's analysis, and, respectively, 31% to 53% and 90% to 92%, according to the analysis based on cumulative curves of normality. In a broad clinical setting including normal, OHT, and glaucoma patients, the HRT and visual field tests have fair to poor agreement in detecting glaucoma. The HRT demonstrated a lack of specificity when using Mikelberg's multivariate discriminant analysis and a lack of sensitivity when using cumulative frequency distribution (ranked-segment distribution) curves. These values did not change when normal or OHT patients were excluded from the analysis. In the clinical setting, caution should be used when interpreting HRT results on the basis of multivariate discriminant analysis or cumulative frequency distribution curves.

Comparison of frequency doubling perimetry with Humphrey visual field analysis in a glaucoma practice

PURPOSE: To determine the sensitivity and specificity of frequency doubling perimetry with Humphrey visual field testing used as the gold standard. METHODS: Frequency doubling perimetry and Humphrey visual field testing (24-2) were performed on 29 consecutive patients in a glaucoma practice. Data for the right eye were used to calculate sensitivity, specificity, and receiver operating characteristic curves. RESULTS: For the frequency doubling perimetry in screening mode, and with an abnormal glaucoma hemifield test used as the gold standard, the area under the receiver operating characteristic curve was 89.3%, 81.5%, or 75.0% for the presence of mild, moderate, or severe relative defects, respectively. Similar results were found with the use of mean deviation ( P < .05) to define Humphrey visual field defects. For frequency doubling perimetry in threshold mode, the area under the receiver operating characteristic curve was 93.4% with the presence of any defect ( P < .05) used as the criterion for an abnormal case, and an abnormal glaucoma hemifield test as the gold standard. In all cases, the threshold mode detected defects better than the screening mode. CONCLUSIONS: Frequency doubling perimetry showed a high sensitivity and specificity for detecting visual field abnormalities, especially when threshold strategies were used.

Effect of cataract extraction on the results of automated perimetry in glaucoma.

To investigate the effect of cataract extraction on the results of automated perimetry in persons with glaucomatous visual field loss. Subjects from a retrospective study of visual field progression who underwent cataract extraction during follow-up were identified. Subjects came from the glaucoma service of a hospital-based tertiary referral center. Subjects had at least 7 Humphrey 24-2 or 30-2 visual fields over 5 years or more, with an abnormal glaucoma hemifield test result on the first 2 examinations. Visual field data were transferred to a microcomputer and comparison of the visual fields immediately before and after cataract extraction was performed. Sixty-five eyes of 50 subjects (mean age, 71.8 years) were included in the analysis. A mean improvement in mean deviation (MD) of 1.68 dB (P<.001), and a mean worsening in corrected pattern SD (CPSD) of 0.54 dB (P=.09) was observed. The mean unweighted change in threshold in the 52 points of program 24-2 was 1.58 dB, corresponding to a 43.9% increase in sensitivity. A significant correlation between improvement in visual acuity and improvement in MD was also found. A mean increase in CPSD of 1.61 dB (P=.005) occurred in subjects with dense scotomas (minimum threshold value < or = 5 dB) and preoperative CPSD of 8 dB or less. In persons with glaucomatous visual field defects, cataract extraction produces only a modest improvement in MD. After cataract surgery, the CPSD index worsened in many subjects with dense scotomas. This suggests that the development of cataract can mask progressive glaucomatous visual field loss in such persons.

Motion perimetry identifies nerve fiber bundlelike defects in ocular hypertension.

To determine whether patients with ocular hypertension (OHT) have elevated motion perimetry thresholds. Motion perimetry uses a customized computer graphics program to detect the ability to identify a coherent shift in position of 50% of dots in a defined circular area against a background of fixed dots. Motion size threshold is defined as the smallest circular area in which dot motion is detected. Subjects respond by touching the area of the computer monitor with a light pen where motion stimuli are perceived. Reaction times (milliseconds) to stimuli and localization error (number of pixels from target center) are also obtained for each trial. University hospital ophthalmology clinic. Twenty-seven patients with OHT and 27 age-matched normal subjects. One eye was tested in each subject. Random dot motion stimuli size thresholds and total deviation probability plot data, reaction times, and spatial localization errors. The patients with OHT had more abnormal test points in the total deviation probability plot analysis compared with the controls (P < .001, chi 2). The abnormal test points were concentrated in the superior and inferior nasal regions. Six subjects had nerve fiber bundlelike defects to motion stimuli. Six subjects (5 overlapping with the probability plot analysis) had abnormal glaucoma hemifield test results. The patients with OHT also had significantly greater localization errors. Motion threshold perimetry may be a more sensitive method to detect visual field abnormalities in OHT than conventional automated perimetry.

Detection of Incident Field Loss Using the Glaucoma Henaifield Test

To examine different definitions of incident visual field loss among patients with elevated intraocular pressure and varying numbers of abnormal glaucoma hemifield test results over an average of 6 years of follow-up. A cohort of patients with annual C-30-2 Humphrey visual fields were followed for a minimum of 5 years. Three different definitions of field loss were compared: 1, 2, or 3 consecutive annual abnormal glaucoma hemifield test results. Of 253 subjects, 506 eyes were followed for 5 to 9 years. If incident field loss was defined as one or more normal fields followed by one abnormal glaucoma hemifield test result, the incidence of field loss was 63.6 per 1000 person-years of follow-up. For two or three consecutive abnormal glaucoma hemifield test results, the rates were 27.6 and 19.2 per 1000 person-years of follow-up, respectively. Among patients with field loss in one eye at the start of the study, the incidence of field loss in the fellow eye using 1, 2, or 3 consecutive abnormal fields as the definition of incident field loss was 60.9, 55.5, and 25.5 per 1000 person-years of follow-up, respectively. Three years after incident field loss, 31.9% (1 abnormal test result), 76.5% (2 abnormal test results), and 88.5% (3 abnormal test results) of eyes with incident field loss had an abnormal hemifield test result. For eyes with one, two, and three consecutive abnormal glaucoma hemifield test results at the start of the study, 59.2%, 83.6%, and 89.1%, respectively, had an abnormal field 3 years later. One abnormal glaucoma hemifield test result is not a consistent criterion for defining incident field loss. The use of two or three consecutive abnormal fields to define incident field loss makes it more likely that subsequent test results will be abnormal.