Automated Perimetry Testing Research Articles

Association of Quality of Life and Visual Function in Glaucoma with Tests of Structure and Function.

In addition to standard automated perimetry tests, contrast sensitivity testing and macular analyses may predict changes in the quality of life in patients at different stages of glaucoma. To examine the relationship between functional and structural tests of visual function and the 25-item National Eye Institute-Visual Function Questionnaire (NEI-VFQ-25) and the 36-item Short Form Health Survey (SF-36) in patients with different stages of glaucoma. Standard automated perimetry tests, optical coherence tomography scans, and contrast sensitivity (CS) testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related quality of life questionnaires (NEI-VFQ-25, SF-36) were also administered to all patients. The study group comprised 29 patients with suspected glaucoma, 104 with mild glaucoma, 15 with moderate glaucoma, and 12 with severe glaucoma. The mean total score of the NEI-VFQ-25 was 88.8±8.2. The SF-36 did not show a significant correlation with the data on functional and structural tests of visual function, whereas the NEI-VFQ-25 showed a low to moderate correlation (r=0.212--0.492). Vision parameters can explain up to 18.6% of the total score of the NEI-VFQ-25. CS was the only function significantly correlated with glaucoma suspects, while in the early stages, VA was the strongest correlated function with the NEI-VFQ-25 total score (P=0.003 and r=0.551; P=0.001 and r=0.343, respectively). The impact of the visual field on vision-related quality of life increased in the advanced stages (P=0.013, r=0.688). The macular retinal ganglion cell plus inner plexiform layer thickness remained associated with NEI-VFQ-25 at all stages of glaucoma (r=0.335-0.802). The NEI-VFQ-25 total score and most of the subscales were correlated with the physical and mental component summary scores of the SF-36 (r=0.159-0.587). VA correlated the most with quality of life in glaucoma patients, as measured with the NEI-VFQ-25 to assess quality of life in glaucoma. The impact of visual functions on quality of life varies at different stages of glaucoma.

Reference Database for a Novel Binocular Visual Function Perimeter: A Randomized Clinical Trial

PurposeTo construct a comprehensive reference database for a novel binocular automated perimeter. DesignA four-site prospective randomized clinical trial. Subjects and controls356 healthy subjects without ocular conditions that might affect visual function were categorized into 7 age groups. MethodsSubjects underwent comprehensive ocular examination of both eyes before enrollment. Using the TEMPO/IMOvifa automated perimeter (Topcon Healthcare/CREWT Medical Systems, Tokyo, Japan), each subject completed four binocular threshold visual field (VF) tests during a single visit: First, practice 24-2 and 10-2 tests were obtained from both eyes. Next, study 24-2 and 10-2 tests were obtained from both eyes. Test order of each sequence was randomized, and the tests were conducted under Standard Automated Perimetry testing conditions (SAP): Goldmann stimulus size III, 3183 cd/m2 maximum stimulus intensity, and background intensity of 10 cd/m2, using AIZE-Rapid test strategy. Standard VF reliability indices were assessed. For each subject, 24-2 and 10-2 test results from one randomly selected eye were analyzed. Main Outcome MeasuresPerimetric threshold sensitivity and reference limits for each test analysis parameter. ResultsThe ages of the study cohort were widely distributed, with a mean age (SD) of 52.3 (18.5) years. Sex assignment was 44.0% male and 56.0% female. The majority of subjects self-identified as White (67.4%), followed by Black or African American (13.5%) and Asian (8.7%), with 14.6% self-identified as Hispanic or Latino ethnicity. Mean sensitivity (MS) (SD) was 29.1 (1.3) decibels (dB) for the 24-2 and 32.4 (1.0) dB for the 10-2 test. For the 24-2 and 10-2, MS (SD) age-related changes averaged -0.06 (0.01) dB and -0.05 (0.01) dB per year, respectively. The normal range of pointwise threshold sensitivity increased with eccentricity and showed asymmetry around the mean, particularly notable in the 24-2 test. Mean (SD) binocular test duration was 3.18 (0.38) minutes (1 minute 35 seconds per eye) for the 24-2 test and 3.58 (0.43) minutes (1minute 47 seconds per eye) for the 10-2 test. ConclusionsA reference database for the TEMPO/IMOvifa perimeter was established, highlighting the significance of considering both age and stimulus eccentricity in interpreting threshold visual field test results.

Accuracy and Reproducibility of Virtual Reality Perimetry in Children.

To determine normal threshold values for the 24-2 program of the VisuALL-K (Olleyes, Inc), a portable static automated virtual reality perimeter that uses a video game-based testing modality on an updated version of the algorithm and to repeat the test to assess retest variability. This prospective cohort study included 19 participants (aged 8 to 17 years) with healthy afferent systems. Participants performed two 24-2 automated perimetry tests on the virtual reality perimeter device. Mean age was 12.7 ± 2.5 years; 53% were boys and 47% were girls. Mean test location threshold was 30.5 ± 4.0 dB for test 1 and 31.3 ± 2.8 dB for test 2. Sensitivity decreased with eccentricity as expected (-0.17 dB per degree). Bland-Altman analysis showed a repeatability coefficient of ±5.1 dB for mean deviation, meaning that 95% of retest values were within ±5 dB of the threshold value for the first test. Higher thresholds for the first test regressed toward the mean values in the second test, indicating a learning effect. Intraclass correlation coefficient for mean deviation between test 1 and test 2 was 0.70 (0.55 to 0.80, P < .0001). Mean time to completion for the virtual reality perimeter was 5.1 ± 1.5 min/eye. The VisuALL-K virtual reality perimeter provided an assessment of the visual field in normal children aged 8 to 17 years. A shallow hill of vision was demonstrated. A notable learning effect was demonstrated, with repeatability difference wider than other published head-mounted display perimeters. [J Pediatr Ophthalmol Strabismus. 2024:61(4):262-266.].

Visual Function Tests: Visual Fields.

Visual field tests, also known as perimetry tests, are used to assess progression of ophthalmic diseases such as retinitis pigmentosa (RP) by monitoring changes in a patient's visual field (VF). VF loss corresponds to damage at any point in the visual pathway, including the retina, such as in RP. Damage to different parts of this pathway corresponds to characteristic VF defects. Perimetry tests are subjective, as they are functional tests that help physicians identify abnormal fields as well as quantitatively assess VF sensitivity. The results may also be informative of a patient's visual function crucial for performing day-to-day activities. Automated perimetry tests are among the most commonly used, with the most common being automated static perimetry.

The Open Perimetry Initiative: A framework for cross-platform development for the new generation of portable perimeters.

The Open Perimetry Initiative was formed in 2010 with the aim of reducing barriers to clinical research with visual fields and perimetry. Our two principal tools are the Open Perimetry Interface (OPI) and the visualFields package with analytical tools. Both are fully open source. The OPI package contains a growing number of drivers for commercially available perimeters, head-mounted devices, and virtual reality headsets. The visualFields package contains tools for the analysis and visualization of visual field data, including methods to compute deviation values and probability maps. We introduce a new frontend, the opiApp, that provides tools for customization for visual field testing and can be used as a frontend to run the OPI. The app can be used on the Octopus 900 (Haag-Streit), the Compass (iCare), the AP 7000 (Kowa), and the IMO (CREWT) perimeters, with permission from the device manufacturers. The app can also be used on Android phones with virtual reality headsets via a new driver interface, the PhoneHMD, implemented on the OPI. The use of the tools provided by the OPI library is showcased with a custom static automated perimetry test for the full visual field (up to 50 degrees nasally and 80 degrees temporally) developed with the OPI driver for the Octopus 900 and using visualFields for statistical analysis. With more than 60 citations in clinical and translational science journals, this initiative has contributed significantly to expand research in perimetry. The continued support of researchers, clinicians, and industry are key in transforming perimetry research into an open science.

Agreement between Compass Fundus Perimeter New Grid and 10-2 Testing Protocols for Detecting Central Visual Field Defects

To evaluate the agreement between Compass New Grid (NG) and 10-2 test protocols for detecting early glaucomatous defects in the central 10 degrees of the visual field (CVFD). Cross-sectional study. A total of 123 eyes of 14 healthy individuals, 17 glaucoma suspects, and 32 glaucoma patients were enrolled. Subjects performed NG and 10-2 Compass automated perimetry testing within 1 week. For both test protocols, total deviation (TD) and pattern deviation (PD) plot CVFDs were defined by 3 contiguous points with probabilities of <5%, <2%, <2% or <5%, <1%, <1%. Cohen's Kappa statistic was used to assess agreement between NG and 10-2 for identifying CVFDs. The Spectralis GMPE Hood Glaucoma Report (investigational software version) macula deviation analysis obtained within 1 year was used for calculating sensitivities and specificities of test protocols. Protocols' agreement, sensitivity, and specificity. Fair to moderate agreement was observed between NG and 10-2 protocols for detecting presence of superior CVFDs on TD (k= 0.57) and PD (k= 0.26) plots and for detecting inferior CVFDs on TD (0.49) and PD (0.27) plots. With the use of OCT macula deviation maps, specificity for detecting CVFD was consistently higher with NG than 10-2 tests for TD plots of the superior hemifield (0.82 and 0.65), inferior hemifield (0.92 and 0.84), and PD plots of the superior hemifield (0.81 and 0.36) and inferior hemifield (0.86 and 0.52). Sensitivity of NG was consistently lower than TD plots of the superior hemifield (0.48 and 0.72), inferior hemifield (0.28 and 0.46), and PD plots of the superior hemifield (0.48 and 0.78) and inferior hemifield (0.20 and 0.52). By using pattern standard deviation (PSD) criterion, the mean PSD values for 10-2 and NG VF tests were 1.61 (95% confidence interval [CI], 1.26-1.96) and 1.81 (95% CI, 1.45-2.17) (P < 0.001), respectively. Although the Compass NG detected fewer CVFDs than the 10-2 test protocol, it did detect CVFDs that were not observed in the Compass 24-2 test in patients with early glaucoma. Therefore, NG may be particularly useful in clinical situations when higher specificity is desired or PSD criterion is used.

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months

PurposeTo assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma.DesignProspective longitudinal feasibility and reliability study.MethodsTwenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye).ResultsAll 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320).ConclusionsHome monitoring of VFs is viable for some patients and may provide clinically useful data.

Temporal Wedge Defects in Glaucoma: Structure/Function Correlation With Threshold Automated Perimetry of the Full Visual Field.

We used the Open Perimetry Interface (OPI) to design a static automated perimetry test of the full visual field. About half of our glaucoma cohort had defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. To test the hypothesis that in glaucoma patients with mild visual loss, perimetric nerve fiber bundle defects present outside 30 degrees will correlate well with areas of Cirrus ocular coherence tomography (OCT) retinal nerve fiber layer thinning. We tested 27 consecutive glaucoma subjects with mild vision loss (mean deviation better than -4 dB) with a SITA standard test, 2 size V custom OPI tests (OPI 30-2 and OPI Peripheral) and Cirrus OCT. Two observers assigned qualitative grades to each type of visual field test based on their level of correlation with OCT retinal nerve fiber layer and ganglion cell thickness. Discrete temporal wedge defects were found on the OPI peripheral V test in 26% of cases whereas more extensive inferior temporal loss (including inferior temporal wedge defect region) was present in 22% of other cases. OCT data correlated best with the OPI peripheral test for 8 glaucoma subjects. The OPI central 30-2 test correlated best for 9 glaucoma subjects; the remainder of subjects had equal central/peripheral correlations. About half of our glaucoma cohort have defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. Adding a threshold automated perimetry test of the far periphery improves structure/function correlations and adds useful clinical information.

Threshold Automated Perimetry of the Full Visual Field in Patients With Glaucoma With Mild Visual Loss.

The authors used the Open Perimetry Interface to design a static automated perimetry test of the full field. Abnormal test locations in the nasal midperiphery and temporal inferior sector area best separated glaucomas from normals. The peripheral visual field in glaucoma outside 30 degrees is largely unexplored with static perimetry. Their goal was to use threshold static automated perimetry to characterize the visual loss in glaucoma of the central 30 degrees and the far periphery. The authors administered the 30-2 perimetric test to 27 patients with early stage glaucoma (with mean deviation better than -4 dB) with the Goldmann III and V stimulus sizes and a custom test from 30 to up to 87 degrees with the size V stimulus twice within a month. The authors quantified (1) the retest variability, (2) the proportion of patients flagged as abnormal (at level 0.05) on the basis of pointwise probability distributions obtained from 63 ocular healthy observers, (3) the pointwise statistical distance using the Kullback-Leibler divergence between normal and glaucoma eyes, and (4) the effect of eccentricity on visual loss. Size V 30-2 testing identified significantly more abnormal test locations (36%) than size III 30-2 (30%; P=0.004). Kullback-Leibler divergence between healthy and glaucoma distributions was greatest for the nasal midperipheral test locations and the inferior temporal sector area. A more pronounced decrease was found in visual sensitivity with eccentricity in the patients with glaucoma compared with the ocular healthy participants across the full visual field (P<0.001). Patients with glaucoma demonstrate a systematic decrease in sensitivity with eccentricity across the full visual field. Goldmann size V stimuli better detected visual loss in patients with glaucoma with mild loss than size III.

Atypical Optic Nerve Sheath Menengioma Mimics Like Optic Neuritis; A case report

A 40-years old female patient applied with complaining of a progressive vision loss for 3 months. Systemic symptoms were; headache, tingling in her hands and feet and pain during eye movements. Visual acuity was hand motion on the right eye, 20/20 on the Snellen chart on the left. There was relative afferent pupillary defect on the right eye. In fundoscopic examination, disc edema was met on the right eye and left eye’s fundus examination was normal. A prolongation of p100 wave latency in the Visual Evoked Potentials examination and total visual field defect on automated perimetry test were seen on the right eye. The patient was hospitalized with a pre-diagnosis of optic neuritis. Orbita Magnetic Rezonans was reported the optic nerve sheath menengioma (ONSM). Atypical clinical presentation of an ONSM case that mimiced as optic neuritis, extended to the optic chiasm and lead to a progressive visual loss in a period of 3 months is presented. It is crucial to recognize atypical ONSM cases by the guidence of imaging techniques.

Predicting the early visual outcomes in sellar-suprasellar lesions compressing the chiasm: the role of SD-OCT series of 20 patients operated via endoscopic endonasal approach

Tumors involving the sellar area often cause visual disorders due to optic nerves/chiasm compression, so that surgery is required. However, the likelihood of visual improvement/restoration is variable. Optical coherence tomography (OCT) is a valid diagnostic tool for defining pathological conditions of the optic apparatus. We herein investigated the role of the SD-OCT and the best corrected visual acuity in predicting postoperative visual recovery, in patients complaining of chiasm compression due to sellar-suprasellar lesions. We retrospectively analyzed 20 patients (7 females and 13 males; mean age 50.8±17.87 years, range 11-83), with optic chiasm/nerve compression that underwent endoscopic endonasal approach at the Division of Neurosurgery of the University of Naples Federico II, Naples, Italy, between June 2014 and February 2015. Preoperative ophthalmological assessment focused on BCVA Snellen charts, standard automated perimetry test and SD-OCT. Test were repeated at two weeks, one and three months after surgery. A significant thickness reduction in all the patients, as compared to the control group was noted: GCC thickness reduction remained mostly unchanged postoperatively: 42.9% of the patients had altered visual acuity (VA), while the Perimetry revealed 90% of altered preoperative MD values (MD>-2.00): perimetry improvement was noted in 93% of cases and visual acuity in 91.3% of cases. A direct correlation between preoperative retinal status and functional recovery was identified considering the values of pRNFL and GCC. OCT provides valuable information regarding the entity of compression also in patients without any visual field defects. Although several factors should be taken into consideration, we retain that preoperative RNFL and GCC thickness values can be claimed as a reliable predictor of visual recovery in those patients presenting chiasm compression.

Influence of learning effect on reliability parameters and global indices of standard automated perimetry in cases of primary open angle glaucoma

Aim. To find out the influence of learning effect on various reliability parameters and global indices of standard automated perimetry in cases of primary open angle glaucoma. Method. Thirty eyes of 30 patients of Primary Open Angle Glaucoma constituted material for this prospective observational study. All the patients underwent standard automated perimetry three times on three different days within one week on G program of Octopus Visual Field Analyzer. The details of reliability indices, global indices, and test duration were compiled and analyzed. Result. A male preponderance was observed with a mean age of 53.43 years. The mean false positive was found to be 11.13, 6.07, and 2.40 on visit 1, visit 2, and visit 3, respectively. The mean false negative was found to be 13.73, 9.33, and 6.30 on visit 1, visit 2, and visit 3, respectively. The mean fixation loss was found to be 7.53, 3.83, and 1.60 on visit 1, visit 2, and visit 3, respectively. The mean deviation was found to be -10.14, -5.75, and -3.11 on visit 1, visit 2, and visit 3, respectively. The pattern standard deviation was found to be 5.58, 4.63, and 4.35 on visit 1, visit 2, and visit 3, respectively. The mean test duration was found to be 7.68, 6.21, & 5.51 minutes for visit 1, visit 2 and visit 3, respectively. All the values were statistically highly significant except for the pattern standard deviation. Conclusion. At least three standard automated perimetry tests should be performed for all glaucoma patients in order to obtain a base line perimetry chart.

Is vision-related quality of life impaired in patients with preperimetric glaucoma?

Background/aimsTo investigate whether subjects with preperimetric glaucoma exhibit decline in patient-reported vision-related quality of life (QoL) compared with healthy individuals.MethodsThis cross-sectional study included 45 patients with preperimetric glaucoma, 102 patients...

Baseline Lamina Cribrosa Curvature and Subsequent Visual Field Progression Rate in Primary Open-Angle Glaucoma

To investigate the relationship between the degree of posterior bowing of the lamina cribrosa (LC) at baseline and the rate of subsequent visual field (VF) progression in eyes with primary open-angle glaucoma (POAG). Prospective, observational study. One hundred one early-stage (VF mean deviation [MD], -5.0 to -0.01 dB) POAG eyes that met the following conditions: (1) follow-up longer than 3.5 years, (2) more than 5 reliable standard automated perimetry tests, and (3) medically well-controlled intraocular pressure during follow-up. All participants underwent swept-source OCT scanning of the LC at baseline. The area enclosed by a vertical line at the anterior laminar insertion, anterior LC plane, and reference plane of Bruch's membrane opening (BMO) was divided by D (distance between the 2 cross-points made by vertical lines drawn from the anterior laminar insertion to the reference plane of BMO) to approximate the LC depth (LCD). The difference between the LCD and mean anterior laminar insertion depth was defined as the LC curvature index (LCCI). To consider the steepness of the LC curve, the adjusted LCCI (aLCCI) was calculated as LCCI divided by D and multiplied by 100. The mean LCD (mLCD), mean LCCI (mLCCI), and mean aLCCI (maLCCI) were computed by averaging the measurements on 12 radial scans. The subsequent MD slope and associated factors were analyzed. Lamina cribrosa parameters and subsequent MD slope. The participants' mean baseline MD was -3.8 ± 3.4 dB. The mean baseline mLCD, mLCCI, and maLCCI were 419.0 ± 111.2 μm, 76.4 ± 29.0 μm, and 4.8 ± 1.9, respectively. A greater MD slope was associated with a greater baseline maLCCI (P < 0.001). We found a statistically significant breakpoint for the maLCCI (4.12) above which a larger maLCCI showed a steeper MD slope (P < 0.001). Analysis by age revealed that significantly more VF progression with maLCCI changes occurred in the relatively younger group (≤69 years; P= 0.043). The baseline maLCCI showed a significant correlation with the rate of subsequent VF deterioration. This suggests that, in POAG eyes with greater posterior bowing of the LC, the axons of retinal ganglion cells may be more vulnerable to further glaucomatous injury.

A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor for Predicting Development of Glaucoma

To investigate the role of corneal hysteresis (CH) as a risk factor for development of glaucoma. Prospective observational cohort study. Two hundred and eighty-seven eyes of 199 patients suspected of having glaucoma were followed for an average of 3.9 ± 1.8 years. All eyes had normal visual fields at baseline. Development of glaucoma was defined as occurrence of 3 consecutive abnormal standard automated perimetry tests during follow-up, defined as pattern standard deviation (PSD) < 5%, and/or Glaucoma Hemifield Test outside normal limits. Measurements of CH were acquired at baseline using the Ocular Response Analyzer (ORA). Univariable and multivariable Cox regression models were used to investigate baseline factors associated with development of visual field loss over time. Fifty-four (19%) eyes developed repeatable visual field defects during follow-up. Measurements of CH at baseline were significantly lower in patients who developed glaucoma vs those who did not (9.5 ± 1.5mm Hg vs 10.2 ± 2.0mm Hg; P= .012). Each 1-mm Hg lower CH was associated with an increase of 21% in the risk of developing glaucoma during follow-up (95% confidence interval [CI]: 1.04-1.41; P= .013). In a multivariable model adjusting for age, intraocular pressure, central corneal thickness, PSD, and treatment, CH was still predictive of development of glaucoma (hazard ratio= 1.20; 95% CI: 1.01-1.42; P= .040). Baseline lower CH measurements were significantly associated with increased risk of developing glaucomatous visual field defects over time. The prospective longitudinal design of this study supports a role of CH as a risk factor for developing glaucoma.

M&S Smart System Contrast Sensitivity Measurements Compared With Standard Visual Function Measurements in Primary Open-Angle Glaucoma Patients.

To evaluate the nature and extent of letter contrast sensitivity (CS) deficits in glaucoma patients using a commercially available computer-based system (M&S Smart System II) and to compare the letter CS measurements to standard clinical measures of visual function. Ninety-four subjects with primary open-angle glaucoma participated. Each subject underwent visual acuity, letter CS, and standard automated perimetry testing (Humphrey SITA 24-2). All subjects had a best-corrected visual acuity (BCVA) of 0.3 log MAR (20/40 Snellen equivalent) or better and reliable standard automated perimetry (fixation losses, false positives, and false negatives <33%). CS functions were estimated from the letter CS and BCVA measurements. The area under the CS function (AUCSF), which is a combined index of CS and BCVA, was derived and analyzed. The mean (± SD) BCVA was 0.08±0.10 log MAR (∼20/25 Snellen equivalent), the mean CS was 1.38±0.17, and the mean Humphrey Visual Field mean deviation (HVF MD) was -7.22±8.10 dB. Letter CS and HVF MD correlated significantly (r=0.51, P<0.001). BCVA correlated significantly with letter CS (r=-0.22, P=0.03), but not with HVF MD (r=-0.12, P=0.26). A subset of the subject sample (∼20%) had moderate to no field loss (≤-6 dB MD) and minimal to no BCVA loss (≤0.3 log MAR), but had poor letter CS. AUCSF was correlated significantly with HVF MD (r=0.46, P<0.001). The present study is the first to evaluate letter CS in glaucoma using the digital M&S Smart System II display. Letter CS correlated significantly with standard HVF MD measurements, suggesting that letter CS may provide a useful adjunct test of visual function for glaucoma patients. In addition, the significant correlation between HVF MD and the combined index of CS and BCVA (AUCSF) suggests that this measure may also be useful for quantifying visual dysfunction in glaucoma patients.

Visual Field Outcomes and refractive status for Retinopathy of Prematurity After Laser Treatment

Objective To analyze visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation. Method The data of 39 patients (73 eyes) with ROP had been received laser treatment were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex are matched with ROP group. The data of patients and controls were retrospectively analysed including best corrected visual acuity, refractive examination, automated perimetry test. There were 24 males (45 eyes)and 15 females (28 eyes) in ROP group, with average age of (7.0±1.28) years, first laser treatment at postnatal age (PA) of (38.74±3.82) weeks, birth weight (BW) of (1 402.33±369.61) g and number of laser burns (517.86±277.40). The control group included 7 females (13 eyes) and 6 males (12 eyes), with average age of (7.17±0.96) years. The age and sex are comparable between 2 groups (t=0.691、χ2=1.425,P=0.491、0.233). Results The mean deviation (MD) of visual field (VF) test in ROP group and control group were 4.87±5.12 dB and 1.27±3.34 dB respectively and the difference between 2 groups were statistically significant (t=–4.01,P 2 dB) group (t=2.074, –1.996, –2.162,P=0.042, 0.026, 0.034 respectively). The GA was approximately significantly different between 2 groups (t=1.973,P=0.052). The difference of PA was approximately statistical significant between mild VF loss group (MD≤6 dB) and moderate VF loss group (MD>6 dB) (t=2.03,P=0.051) and SE was significantly different between above 2 groups. For refractive outcomes, the BW and ROP stage correlated with SE significantly (r=–0.304, –0.387,P=0.015, 0.002 respectively). The prevalence of myopia was 18.8% and no hyper myopia patients was found in ROP group. The mean BCVA in ROP group was 0.84±0.23, and 59 eyes (91.2%) with BCVA better than 0.5. Conclusion Patients with laser treatment for ROP tended to have less effect on long term refractive status and VF loss as we imagined, thus laser treatment can be viewed as an economical, safe and effective treatment for ROP. Key words: Retinopathy of prematurity/ therapy; Laser coagulation/adverse effects; Visual fields; Refractive errors

Microstructure of Peripapillary Atrophy and Subsequent Visual Field Progression in Treated Primary Open-Angle Glaucoma

To investigate the relationship between the microstructure of β-zone peripapillary atrophy (PPA) and the subsequent visual field (VF) progression in eyes with primary open-angle glaucoma (POAG), including highly myopic eyes. Retrospective cohort study. A total of 129 patients with POAG who had been followed up for a minimum of 2 years and had undergone at least 5 reliable standard automated perimetry tests after spectral-domain (SD) optical coherence tomography (OCT) examination. β-Zone PPA was evaluated from 3 SD OCT scans centered on the optic disc. Upper and lower scans were defined as scans at 30° above and below the horizontal scan, respectively. From 3 scans of each eye, β-zone PPA was classified as PPA(+BM) or PPA(-BM) on the basis of the presence or absence of Bruch's membrane (BM), respectively. Eyes were classified into 3 groups according to the horizontal scan images: group A (only PPA(+BM)), group B (both PPA(+BM) and PPA(-BM)), and group C (only PPA(-BM)). Factors associated with the subsequent mean deviation (MD) slope after OCT examination were analyzed, and the hemifield total deviation (TD) slope was assessed in eyes with unilateral hemifield VF defects in the corresponding direction. Subsequent MD slope after OCT examination. The VF progression in group A was faster than in group C (P = 0.004). A larger PPA(+BM) width was associated with a faster MD slope in all eyes (P < 0.001) and highly myopic eyes (P < 0.001) and with a faster TD slope in eyes with superior or inferior hemifield VF defects in the corresponding direction (P = 0.002 and P = 0.035, respectively). A larger PPA(-BM) was correlated with a slower MD slope in all eyes (P = 0.030 and P = 0.034) but not in highly myopic eyes. There were significant differences in VF progression according to the microstructure of the β-zone PPA in eyes with POAG. The PPA(+BM) width may be an important risk factor for VF progression in POAG, including high myopia, and the PPA(-BM) width may have a protective effect for VF progression in this subtype of POAG.

Pupillary Responses to High-Irradiance Blue Light Correlate with Glaucoma Severity

To evaluate whether a chromatic pupillometry test can be used to detect impaired function of intrinsically photosensitive retinal ganglion cells (ipRGCs) in patients with primary open-angle glaucoma (POAG) and to determine if pupillary responses correlate with optic nerve damage and visual loss. Cross-sectional study. One hundred sixty-one healthy controls recruited from a community polyclinic (55 men; 151 ethnic Chinese) and 40 POAG patients recruited from a glaucoma clinic (22 men; 35 ethnic Chinese) 50 years of age or older. Subjects underwent monocular exposure to narrowband blue light (469 nm) or red light (631 nm) using a modified Ganzfeld dome. Each light stimulus was increased gradually over 2 minutes to activate sequentially the rods, cones, and ipRGCs that mediate the pupillary light reflex. Pupil diameter was recorded using an infrared pupillography system. Pupillary responses to blue light and red light were compared between control subjects and those with POAG by constructing dose-response curves across a wide range of corneal irradiances (7-14 log photons/cm(2) per second). In patients with POAG, pupillary responses were evaluated relative to standard automated perimetry testing (Humphrey Visual Field [HVF]; Carl Zeiss Meditec, Dublin, CA) and scanning laser ophthalmoscopy parameters (Heidelberg Retinal Tomography [HRT]; Heidelberg Engineering, Heidelberg, Germany). The pupillary light reflex was reduced in patients with POAG only at higher irradiance levels, corresponding to the range of activation of ipRGCs. Pupillary responses to high-irradiance blue light associated more strongly with disease severity compared with responses to red light, with a significant linear correlation observed between pupil diameter and HVF mean deviation (r=-0.44; P= 0.005) as well as HRT linear cup-to-disc ratio (r= 0.61; P < 0.001) and several other optic nerve head parameters. In glaucomatous eyes, reduced pupillary responses to high-irradiance blue light were associated with greater visual field loss and optic disc cupping. In POAG, a short chromatic pupillometry test that evaluates the function of ipRGCs can be used to estimate the degree of damage to retinal ganglion cells that mediate image-forming vision. This approach could prove useful in detecting glaucoma.

Glaucoma Progression Detection Using Structural Retinal Nerve Fiber Layer Measurements and Functional Visual Field Points

Machine learning classifiers were employed to detect glaucomatous progression using longitudinal series of structural data extracted from retinal nerve fiber layer thickness measurements and visual functional data recorded from standard automated perimetry tests. Using the collected data, a longitudinal feature vector was created for each patient's eye by computing the norm 1 difference vector of the data at the baseline and at each follow-up visit. The longitudinal features from each patient's eye were then fed to the machine learning classifier to classify each eye as stable or progressed over time. This study was performed using several machine learning classifiers including Bayesian, Lazy, Meta, and Tree, composing different families. Combinations of structural and functional features were selected and ranked to determine the relative effectiveness of each feature. Finally, the outcomes of the classifiers were assessed by several performance metrics and the effectiveness of structural and functional features were analyzed.