Binocular Visual Field Defects Research Articles

Simultaneous bilateral purtscher like retinopathy with systemic lupus erythematosus: a case

BackgroudSystemic lupus erythematosus is an unexplained autoimmune disease involving multiple systems throughout the body, and its ocular changes include dry eye, monocular or binocular visual field defects, vaso-occlusive diseases, or ischemic optic neuropathy.Case presentationThis article reports a patient with SLE complicated with bilateral Purtscher like retinopathy, who had a sudden decrease in ocular vision as the first symptom, the autoantibodies related to phospholipid syndrome showed no abnormality, and both anti-dsDNA antibodies and anti-SM antibodies were significantly positive, indicating that anti-dsDNA antibodies and anti-SM antibodies were also important factors in the pathogenesis of Purtscher like retinopathy.ConclusionThe close relationship between SLE retinopathy and systemic inflammatory activities and emphasize the importance of systemic immunotherapy.

Extraction of three-dimensional shapes in glaucoma patients in response to monocular depth cues.

To assess the impact of glaucoma on perceiving three-dimensional (3D) shapes based on monocular depth cues. Clinical observational study. Twenty glaucoma patients, subjected to binocular visual-field sensitivity (binocular-VFS) tests using a Humphrey Visual Field Analyzer, and 20 age-matched healthy volunteers, underwent two tasks: identifying the nearest vertex of a 3D shape using monocular shading (3D-SfS), texture (3D-SfT), or motion (3D-SfM) cues, and distinguishing elementary one-dimensional (1D) features of these cues. The association of the visual-field index (VFI) of binocular-VFS with 3D shape perception in glaucoma patients was also examined. Glaucoma patients demonstrated reduced accuracy in distinguishing 1D luminance brightness and a larger "error-in-depth" between the perceived and actual depths for 3D-SfM and 3D-SfS compared to healthy volunteers. Six glaucoma patients with a 100% VFI for binocular-VFS exhibited a similar error-in-depth to the other fourteen glaucoma patients; they had a larger error-in-depth for 3D-SfM compared to healthy volunteers. No correlation between the error-in-depth values and the VFI values of binocular-VFS was observed. The 3D shape perception in glaucoma patients varies based on the depth cue's characteristics. Impaired 1D discrimination and larger thresholds for 3D-SfM in glaucoma patients with a 100% VFI for binocular-VFS indicate more pronounced perceptual deficits of lower-level elementary features for 3D-SfS and higher-level visual processing of 3D shapes for 3D-SfM. The effects of the location and degree of binocular visual-field defects on 3D shape perception remain to be elucidated. Our research provides insights into the 3D shape extraction mechanism in glaucoma.

The value of assessing progressive loss of red/green and yellow/blue chromatic sensitivity in glaucoma

*Correspondence: franziska.rauscher@medizin.uni-leipzig.deThe value of assessing progressive loss of red/green and yellow/blue chromatic sensitivity in glaucoma.The study employed visual stimuli designed to isolate and reveal how spatial, temporal and chromatic aspects of visual processing change from normal sensitivity to extreme loss in glaucoma. The experiments carried out examined the fovea and each of four paracentral retinal regions, arranged diagonally away from fixation at an eccentricity of 6°. Spatial vision was investigated by measuring both absolute detection thresholds and functional contrast sensitivity using Landolt ring stimuli (Ophthalmic Physiol Opt 2022;42:1363–1378). These psychophysical tests based on Landolt C optotypes measure both detection thresholds and gap orientation discrimination thresholds in the same experiments using randomly interleaved test locations. First‐order motion perception was examined by using moving stimuli embedded in static luminance contrast noise. Red/green (RG) and yellow/blue (YB) colour thresholds were measured with the Colour Assessment and Diagnosis (CAD) test, which makes use of random, dynamic luminance contrast noise (±45%) to isolate the use of RG and YB colour signals. Subjects were normal controls (n = 65) and glaucoma patients with binocular visual field defects (n = 15) classified based on their Humphrey Field Analyser mean deviation (MD) scores. The impairment of visual function varied depending on the stimulus attribute and location tested. The severity of loss increased monotonically with disease progression. For subjects with mild glaucoma (MD −0.01 to −6.00 dB), significantly more data points exceeded the upper normal threshold limits for the corresponding age for RG colour thresholds than for any other visual test (Br Med Bull 2017;122:51–77), followed by motion thresholds. This was particularly the case for the parafoveal locations when compared with the equivalent thresholds measured at the fovea. The results suggest that a multifaceted measure of binocular visual performance based on foveal and parafoveal tests of RG colour vision and first‐order motion, can best inform on the progression of glaucoma and the overall loss of visual performance for comparison with other measures of changes in the quality of life in patients with glaucoma.Keywords: Glaucoma, Visual function, Colour vision, Motion detection, Contrast, Acuity, Colour Assessment and Diagnosis, CAD.

Impact of Monocular and Binocular Visual Function Parameters on Vision-Related Quality of Life in Glaucoma.

This study describes the impact of monocular (M/O) and binocular (B/O) visual function decline, primarily the contrast sensitivity (CS) and visual field (VF) defect severity and its location, on the subjective perception of quality of life (QoL) among the Indian glaucoma population with spared central acuity. To investigate the influence of M/O and B/O visual function parameters on vision-related QoL (VRQoL) in glaucoma with spared central visual acuity. Glaucoma subjects underwent M/O and B/O visual acuity, CS assessment, followed by the M/O perimetry from which the integrated VF was estimated (B/O summation method). VRQoL was evaluated using the Glaucoma Quality Of Life-15 (GQL-15) and Visual Function Questionnaire-Utility Index (VFQ-UI) questionnaires. The relationship between CS and VF defect (VFD) with the composite VRQoL scores was analyzed. A total of 154 glaucoma subjects with a median age of 61 (range: 24-83) years were enrolled. Subjects with severe VFD reported poor composite scores for GQL-15 and VFQ-UI when compared with unilateral and mild groups ( P < 0.001, Dunn post hoc). Both the composite scores were negatively correlated with M/O and B/O CS and VF mean deviation ( r range: -0.3 to -0.5, P < 0.001, Spearman rank correlation). B/O VFD in the inferior central zone contributed to poor GQL-15 score [odds ratio: 1.14 (95% CI: 1.10-1.29), P = 0.04] irrespective of sex, whereas females with increasing B/O VFD reported poor QoL score in VFQ-UI [odds ratio: 4.09 (95% CI: 1.77-9.43), p=0.003]. Poor GQL-15 and VFQ-UI scores were reported with increasing disease severity. B/O VFD in the inferior central region was found to contribute predominantly to the poor GQL-15 scores while both disease severity and sex influenced VFQ-UI scores.

Physical Activity Is Associated with Improved Visuomotor Processing in Older Adults with Moderate and Advanced Glaucomatous Visual Field Defect: A Cross-Sectional Study.

Glaucoma affects a wide spectrum of daily essential activities in older adults. This study examined whether older adults with moderate and advanced stages of glaucoma exhibit differences in visuomotor task performance compared with age- and gender-matched ophthalmologically healthy control subjects and estimated the effects of physical activity (PA) levels, age, and severity of visual impairment on patients’ visuomotor task performance. Sixty older adults with moderate glaucoma, advanced glaucoma, and normal sight participated in the study. Visuomotor processing was assessed using laboratory-based simple and complex visuomotor reaction tasks. Monocular Humphrey Visual Field and binocular Humphrey Esterman Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to assess PA levels. Participants with glaucoma had poorer scores in visuomotor tasks compared to participants with normal sight. Glaucoma patients’ PA levels, age, and binocular visual field defect explained 54% of the variation in complex reaction time. Low PA levels were identified as a risk factor for visuomotor processing decline. Compensatory mechanisms to improve the efficiency of visual field scanning in patients with more severe visual field defects may exist.

Bilateral superficial optic disc drusen: A case report and literature review

We herein report a relatively rare case of bilateral superficial optic disc drusen in 50-year-old woman who complained of binocular visual field defects. She did not have any loss of vision, photophobia, tears, ophthalmodynia, headache, or other symptoms of discomfort.

Impact of binocular integrated visual field defects on healthy related quality of life in glaucoma.

To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients’ quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.

Prognostic value of optical coherence tomography in chronic chiasmal compression

Introduction. Sellar and parasellar region lesions, such as pituitary adenoma, often lead to the compression of the optic chiasm. Consequentialy, visual field (VF) defects and loss of visual acuity are common complaints in these patients. The aim of this report is to evaluate if optical coherence tomography, measuring retinal nerve fibre layer (RNFL) and ganglion cell complex thickness (GCC), offers a reliable prediction of visual outcome in patients with chronic chiasmal compression from a pituitary macroadenoma. Case outline. We present a case of chronic chiasmal compression from a pituitary macroadenoma with an initial binocular VF defect and low values of optical coherence tomography parameters binocularly. The average value of RNFL on the right eye pre/postoperatively was 48/79 ?m, while on the left eye it was 56/63 ?m. The average value of GCC pre/postoperatively was 47/46 microns on the right and 45/46 microns on the left eye. Six weeks after surgical optochiasmal decompression, macular GCC on both eyes and RNFL on the left eye remained largely unchanged, while RNFL of the right eye exhibited increases in thickness, as the postoperative consequence of the removal of the conduction block. Neither VF nor visual acuity showed postoperative improvement. Conclusion. Irreversible damage to the GCC and RNFL by longstanding compression results in poor visual outcome after surgery. Ganglion cell layer of the macula is a more accurate and reliable indicator of postoperative visual outcome.

Eye-Hand Coordination Impairment in Glaucoma Patients.

This study examined whether patients with glaucoma exhibit differences in eye–hand coordination tasks compared to age-matched normal-sighted control subjects. Twenty-eight patients with moderate-to-advanced stages of glaucoma and 28 subjects with no ocular disease participated in the study. The Motor Performance Series (MLS) of the Vienna Test System including aiming, linear tracking, tremor, and tapping tests were used to assess eye–hand coordination. Monocular Humphrey Visual Field and binocular Humphrey Esterman Visual Field tests were used to estimate visual field (VF) defect severity. Correlation between MLS scores and VF defects, visual acuity, and patient age were assessed. Glaucoma patients performed slower aiming at targets, committed more errors, and took longer to complete linear tracking and tremor tasks compared to the normal-sighted control group. Furthermore, tapping test scores indicated reduced hand movements at maximum frequency. The presence of asymmetrical monocular VF defects were associated with longer error durations in linear tracking tasks. Furthermore, MLS scores decline with advancing age and reduced visual acuity. Glaucoma patients had lower values for most MLS parameters compared to controls. However, monocular and binocular VF defects cannot fully explain the impartments in eye–hand coordination associated with glaucoma.

Toward Improving the Mobility of Patients with Peripheral Visual Field Defects with Novel Digital Spectacles

To assess the efficacy of novel Digital spectacles (DSpecs) to improve mobility of patients with peripheral visual field (VF) loss. Prospective case series. Binocular VF defects were quantified with the DSpecs testing strategy. An algorithm was implemented that generated personalized visual augmentation profiles based on the measured VF. These profiles were achieved by relocating and resizing video signals to fit within the remaining VF in real time. Twenty patients with known binocular VF defects were tested using static test images, followed by dynamic walking simulations to determine if they could identify objects and avoid obstacles in an environment mimicking a real-life situation. The effect of the DSpecs were assessed for visual/hand coordination with object-grasping tests. Patients performed these tests with and without the DSpecs correction profile. The diagnostic binocular VF testing with the DSpecs was comparable to the integrated monocular standard automated perimetry based on point-by-point assessment with a mismatch error of 7.0%. Eighteen of 20 patients (90%) could identify peripheral objects in test images with the DSpecs that they could not previously. Visual/hand coordination was successful for 17 patients (85%) from the first trial. The object-grasping performance improved to 100% by the third trial. Patient performance, judged by finding and identifying objects in the periphery in a simulated walking environment, was significantly better with the DSpecs (P= 0.02, Wilcoxon rank sum test). DSpecs may improve mobility by facilitating the ability of patients to better identify moving peripheral hazardous objects.

Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss.

On-road testing is considered the standard for assessment of driving performance; however, it lacks standardization. In contrast, driving simulators provide controlled experimental settings in a virtual reality environment. This study compares both testing conditions in patients with binocular visual field defects due to bilateral glaucomatous optic neuropathy or due to retro-chiasmal visual pathway lesions. Ten glaucoma patients (PG), ten patients with homonymous visual field defects (PH), and 20 age- and gender-matched ophthalmologically normal control subjects (CG and CH, respectively) participated in a 40-min on-road driving task using a dual brake vehicle. A subset of this sample (8 PG, 8 PH, 8 CG, and 7 CH) underwent a subsequent driving simulator test of similar duration. For both settings, pass/fail rates were assessed by a masked driving instructor. For on-road driving, hemianopia patients (PH) and glaucoma patients (PG) showed worse performance than their controls (CH and CG groups): PH 40%, CH 30%, PG 60%, CG 0%, failure rate. Similar results were obtained for the driving simulator test: PH 50%, CH 29%, PG 38%, CG 0%, failure rate. Twenty-four out of 31 participants (77%) showed concordant results with regard to pass/fail under both test conditions (p > 0.05; McNemar test). Driving simulator testing leads to results comparable to on-road driving, in terms of pass/fail rates in subjects with binocular (glaucomatous or retro-chiasmal lesion-induced) visual field defects. Driving simulator testing seems to be a well-standardized method, appropriate for assessment of driving performance in individuals with binocular visual field loss.

‘I didn't see that coming’: simulated visual fields and driving hazard perception test performance

BackgroundEvidence is limited regarding specific types of visual field loss associated with unsafe driving. We use novel gaze‐contingent software to examine the effect of simulated visual field loss on computer‐based driving hazard detection with the specific aim of testing the impact of scotomata located to the right and left of fixation.MethodsThe ‘hazard perception test’ is a component of the UK driving licence examination, which measures speed of detecting 15 different hazards in a series of real‐life driving films. We have developed a novel eye‐tracking and computer set up capable of generating a realistic gaze‐contingent scotoma simulation (GazeSS) overlaid on film content. Thirty drivers with healthy vision completed three versions of the hazard perception test in a repeated measures experiment. In two versions, GazeSS simulated a scotoma in the binocular field of view to the left or right of fixation. A third version was unmodified to establish baseline performance.ResultsParticipants' mean baseline hazard perception test score was 51 ± 7 (out of 75). This reduced to 46 ± 9 and 46 ± 11 when completing the task with a binocular visual field defect located to the left and right of fixation, respectively. While the main effect of simulated visual field loss on performance was statistically significant (p = 0.007), there were no average differences in the experimental conditions where a scotoma was located in the binocular visual field to the right or left of fixation.ConclusionSimulated visual field loss impairs driving hazard detection on a computer‐based test. There was no statistically significant difference in average performance when the simulated scotoma was located to the right or left of fixation of the binocular visual field, but certain types of hazard caused more difficulties than others.

Traffic Aspects in Glaucoma Patients

Glaucomatous damage may lead to morphological and functional deficits. If these deficits affect both eyes, binocular visual field defects may result. If these field defects are in the areas which are most important for the car driver (centre and horizontal meridian) then the driver may no longer be able to participate actively in road traffic. Mesopic vision and sensitivity to glare may also be affected by glaucomatous damage. The most important point is that the patient is alert to problems in this area and he must be directed to possible ways of compensation, especially for mesopic vision and sensitivity to glare. Binocular visual field defects in the relevant areas, however, cannot be compensated for.

Quality of Life According to Location of Integrated Binocular Visual Field Defect in Normal-Tension-Glaucoma Patients

Purpose: To investigate the relationship between vision-related quality of life (QOL) and integrated binocular visual field (IVF) defect and the difference in QOL based on the location of visual field defects in Korean normal tension glaucoma (NTG) patients. Methods: Two hundred monocular visual fields from 100 patients diagnosed with normal tension glaucoma in at least one eye were integrated using the best location method, and the mean deviation (MD) of whole, superior, and inferior IVF was calculated. We analyzed the correlations between subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) and each calculated MD using Spearman correlation. After adjusting for confounding factors of age, visual acuity of the better eye, number of medications, and education level, the impact of IVF loss on the composite score of the NEI VFQ-25 was evaluated using multivariate linear regression analysis. Results: The MDs of whole and inferior IVF were significantly associated with 7 of 12 NEI VFQ-25 subscales, and the superior IVF was associated with 3 subscales (p < 0.05). After adjusting confounding variables, the composite score of the NEI VFQ-25 showed significant correlation with whole, superior, and inferior IVF. The adjusted R and β coefficient of the regression line were highest in the whole IVF (Adjusted R = 0.451, β = 1.12), followed by the inferior and superior IVF (Adjusted R = 0.438, 0.395, β = 0.95, 0.85). Conclusions: The IVF of Korean NTG patients can effectively reflect patient QOL, and the inferior IVF was significantly associated with more subscales of NEI VFQ-25 than was the superior IVF. However, overall QOL of patients is thought to be determined by severity of visual field loss rather than its location. J Korean Ophthalmol Soc 2016;57(1):86-97

Patterns of Binocular Visual Field Loss Derived from Large-Scale Patient Data from Glaucoma Clinics

To estimate prevalence of visual field (VF) loss in superior and inferior hemifields in binocular VFs in a large sample of patients with bilateral glaucoma. Retrospective cohort study. Glaucoma patients and suspects attending 4 regionally different secondary-care eye clinics in the United Kingdom. Binocular integrated visual fields (IVFs) using a best location method were constructed for 16 642 patients with bilateral VF loss. A significant VF defect was defined as 3 or more VF locations less than a certain sensitivity threshold, such as 20 dB. Patients were classified as having a VF defect in the inferior hemifield, superior hemifield, both hemifields, or neither hemifield. The criteria for number of locations and sensitivity threshold (in decibels) were varied across a large range of values. In addition, factor analysis was applied to the sensitivity values (in decibels) of the IVFs to determine common defect patterns in an automated fashion. Ratio of patients with binocular VF defects in the superior compared with the inferior areas of the IVF. Estimates of the ratio of patients having binocular VF defects in the superior compared with the inferior region of the IVF ranged from 2.1 (95% confidence interval, 2.1-2.4) to as high as 5.1 (95% confidence interval, 4.7-5.5), depending on the defect criteria used. Fewer than 10% of those patients exhibiting relatively early binocular VF loss had a defect confined to the inferior region only. Common patterns of binocular VF loss were dominated chiefly by superior hemifield defects. In a clinical population of patients with measurable VF loss in both eyes, superior-only binocular VF loss is more common than inferior-only loss. These estimates, derived from large collections of electronic medical records, are useful for interpreting findings about location of binocular VF loss impacting everyday activities and examining visual disability in glaucoma.

Binocular Visual Field Impairment in Glaucoma and At-Fault Motor Vehicle Collisions

To evaluate the association between the binocular visual field defects in drivers with glaucoma and the risk of motor vehicle collision (MVC) involvement. A retrospective cohort study was conducted on 438 drivers with glaucoma aged 55 years or older using data from 1994 through 2000. Demographic, clinical, and driving characteristics were obtained from chart abstractions and patient survey. Binocular field measures were generated by combining data from the monocular (central 24-degree radius) fields whereby the binocular field measure was defined as the more sensitive point at each monocular field location. Measures included threshold (TH), total deviation (TD), and pattern deviation (PD); severe impairment in these measures was defined as falling into the worst quartile. MVC data were obtained from police records. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Drivers with severely impaired PD measures were twice as likely to have an at-fault MVC compared with those not severely impaired (RR, 2.13; 95% CI, 1.21-3.75); those with severely impaired TH (RR, 1.49; 95% CI, 0.81-2.74) and TD (RR, 1.50; 95% CI, 0.82-2.74) also had an increased rate of at-fault MVCs, although these were not significant. When the binocular central visual field was stratified into 9 regions, drivers with impaired TH, TD, or PD had similarly elevated MVC rates in all regions compared with those not severely impaired, though not all reached statistical significance. On the basis of clinical measures of visual field routinely used in the management of glaucoma, drivers with glaucoma with severe PD field defects in the binocular field have a higher rate of at-fault MVC compared with those with less impaired or unimpaired binocular visual fields.

Driving with Binocular Visual Field Loss? A Study on a Supervised On-Road Parcours with Simultaneous Eye and Head Tracking

Post-chiasmal visual pathway lesions and glaucomatous optic neuropathy cause binocular visual field defects (VFDs) that may critically interfere with quality of life and driving licensure. The aims of this study were (i) to assess the on-road driving performance of patients suffering from binocular visual field loss using a dual-brake vehicle, and (ii) to investigate the related compensatory mechanisms. A driving instructor, blinded to the participants' diagnosis, rated the driving performance (passed/failed) of ten patients with homonymous visual field defects (HP), including four patients with right (HR) and six patients with left homonymous visual field defects (HL), ten glaucoma patients (GP), and twenty age and gender-related ophthalmologically healthy control subjects (C) during a 40-minute driving task on a pre-specified public on-road parcours. In order to investigate the subjects' visual exploration ability, eye movements were recorded by means of a mobile eye tracker. Two additional cameras were used to monitor the driving scene and record head and shoulder movements. Thus this study is novel as a quantitative assessment of eye movements and an additional evaluation of head and shoulder was performed. Six out of ten HP and four out of ten GP were rated as fit to drive by the driving instructor, despite their binocular visual field loss. Three out of 20 control subjects failed the on-road assessment. The extent of the visual field defect was of minor importance with regard to the driving performance. The site of the homonymous visual field defect (HVFD) critically interfered with the driving ability: all failed HP subjects suffered from left homonymous visual field loss (HL) due to right hemispheric lesions. Patients who failed the driving assessment had mainly difficulties with lane keeping and gap judgment ability. Patients who passed the test displayed different exploration patterns than those who failed. Patients who passed focused longer on the central area of the visual field than patients who failed the test. In addition, patients who passed the test performed more glances towards the area of their visual field defect. In conclusion, our findings support the hypothesis that the extent of visual field per se cannot predict driving fitness, because some patients with HVFDs and advanced glaucoma can compensate for their deficit by effective visual scanning. Head movements appeared to be superior to eye and shoulder movements in predicting the outcome of the driving test under the present study scenario.

Assessment of novel binocular colour, motion and contrast tests in glaucoma

The effects of glaucoma on binocular visual sensitivity for the detection of various stimulus attributes are investigated at the fovea and in four paracentral retinal regions. The study employed a number of visual stimuli designed to isolate the processing of various stimulus attributes. We measured absolute contrast detection thresholds and functional contrast sensitivity by using Landolt ring stimuli. This psychophysical Landolt C-based contrast test of detection and gap discrimination allowed us to test parafoveally at 6 ° from fixation and foveally by employing interleaved testing locations. First-order motion perception was examined by using moving stimuli embedded in static luminance contrast noise. Red/green (RG) and yellow/blue (YB) colour thresholds were measured with the Colour Assessment and Diagnosis (CAD) test, which utilises random dynamic luminance contrast noise (± 45 %) to ensure that only colour and not luminance signals are available for target detection. Subjects were normal controls (n = 65) and glaucoma patients with binocular visual field defects (n = 15) classified based on their Humphrey Field Analyzer mean deviation (MD) scores. The impairment of visual function varied depending on the stimulus attribute and location tested. Progression of loss was noted for all tests as the degree of glaucoma increased. For subjects with mild glaucoma (MD -0.01 dB to -6.00 dB) significantly more data points fell outside the normal age-representative range for RG colour thresholds than for any other visual test, followed by motion thresholds. This was particularly the case for the parafoveal data compared with the foveal data. Thus, a multifaceted measure of binocular visual performance, incorporating RG colour and motion test at multiple locations, might provide a better index for comparison with quality of life measures in glaucoma.

Determinants of severity at presentation among young patients with early onset glaucoma

Aim:The aim of this study was to evaluate the clinical, socio-economic, and demographic factors associated with the severity at presentation among juvenile primary open angle glaucoma (JOAG) patients.Materials and Methods:Age at diagnosis, family history, baseline intraocular pressure (IOP), access to health-care, socio-economic status, and glaucoma awareness among 80 unrelated JOAG patients presenting between 10 years and 40 years of age were analyzed for their association with the severity at presentation. Severity at presentation was graded based on worse eye visual field using the advanced glaucoma intervention study score and on binocular visual field defects at presentation.Results:Patients with a positive family history presented 4 years earlier (P = 0.045, confidence interval [CI]: 0.09-8.8) compared to those without a family history. Lower socio-economic status (Odds ratio [OR] 5.7, P = 0.01, CI: 1.5-22), and higher baseline IOP (OR 7, P = 0.003, CI: 1.9-26) were associated with severe glaucomatous visual field defect at presentation. A negative family history was associated with a 10 times likelihood of presenting with a severe glaucomatous field defect (OR 0.1, P = 0.007, CI: 0-0.5).Conclusions:Clinical, socio-economic, and demographic factors are contributory to the severity at presentation among young patients with early onset glaucoma. Presence of a family history is associated with an earlier presentation among these patients and a reduced risk of the severe presentation.

Patient reported outcomes in glaucoma: associations between the NEI VFQ‐25 and the GQL‐15 and clinical measures of visual function

Abstract Purpose To examine associations between visual function measurements and patient‐reported outcomes as assessed by vision‐specific National Eye Institute Visual Function Questionnaire(NEI‐VFQ25) and glaucoma‐specific Glaucoma Quality of Life 15(GQL‐15) Methods NEI‐VFQ25 &amp; GQL‐15 were self administered. LogMAR visual acuity (VA), contrast sensitivity (CS), stereoacuity and visual field (VF) testing with Humphrey Field Analyzer were performed. To estimate the binocular VF defect severity, 2 scores were generated: the average Visual Field Index (mVFI) and the binocular integrated visual field (IVF). Correlations were examined using Spearman’s correlation coefficient. Results To date, 54 glaucoma patients were included(mean age 65.1±12.9 yrs). The group mean mVFI index was 79.6 ±26 % and IVF score was 9 ±19.5. NEI VFQ composite scores were strongly associated with VF defect severity (mVFI rho = 0.61, p &lt; 0.001; IVF rho = ‐ 0.55, p &lt; 0.001), worse VA and CS (VA worse eye rho = ‐0.44, p = 0.01; CS worse eye rho = 0.55, p &lt; 0.001) and poorer stereoacuity (rho = ‐0.35, p = 0.01). GQL scores were also associated with VF defect severity, worse eye VA, worse eye CS and stereoacuity, but to a lesser extent (mVFI: rho = ‐0.47, p &lt; 0.01; IVF: rho = 0.38, p &lt; 0.01; VA worse eye = 0.37, p = 0.05; CS worse eye rho = ‐0.43, p&lt;0.01; stereoacuity rho = 0.31, p &lt; 0.05). Conclusion The perceived difficulties experienced by glaucoma patients appear to be related to many aspects of visual function. This interim analysis shows that clinical measures of visual ability are better correlated with the NEI VFQ than the GQL‐15. This suggests the former maybe more sensitive to the experiences reported by glaucoma patients.