Visual Field Changes Research Articles

Analysis of Intraoperative Visual Evoked Potentials for Inclusion of Unstable Electroretinograms.

The objectives of the study were to evaluate the validity of intraoperative flash visual evoked potentials (VEPs) when electroretinograms (ERGs) were unstable, to compare white versus red light-emitting diodes, and to assess the impact of luminance on ERG variability. Thirty patients were included (Inomed system; pre- and postoperative visual fields). Possible changes in visual fields were assessed with mean defects in perimetry. The receiver operating characteristic (ROC) curves of normalized VEPs and of normalized and corrected VEPs with ERGs were compared. Thirty-two eyes could be analyzed in 20 patients (mainly gliomas and meningiomas): 2 had a severe defect in their visual field, and 6 had a mild defect. The receiver operating characteristic curve indicated (1) normalized and corrected VEPs with ERGs were more reliable than normalized VEPs only (P < 0.03) and (2) an alarm threshold of 80% of normalized and corrected VEPs. No significant difference in variability of ERGs was found with white or red light-emitting diodes with this system. Increased luminance improved stability of ERGs (P < 0.05). Normalization and correction of VEPs with ERGs improved the validity of VEPs and indicated a 20% decrease as alarm criterion. This normalization and correction with peripheral excitation could be generalized to improve the reliability of neuromonitoring.

Factors associated with vision loss in idiopathic intracranial hypertension patients with severe papilledema.

Our aim was to compare factors associated with poor versus good visual outcomes in idiopathic intracranial hypertension (IIH) patients with severe papilledema at initial presentation. Retrospective review of consecutive IIH patients (1/1/2013-6/10/2023) with severe papilledema (Frisén grade 4-5 and/or atrophy in at least one eye); Patients were divided into "poor visual outcome" (poor visual acuity and constricted visual field in at least one eye) and "good visual outcome" (good visual acuity and only mild visual field changes in both eyes) at >6 months for medically-treated patients and >3 months follow-up for surgically-treated patients. We included 134 IIH patients with severe papilledema (70 had poor and 64 had good visual outcomes). No significant differences existed for age, gender, race, hypertension, haemoglobin, or cerebrospinal fluid opening pressure. The poor-outcome group had significantly greater BMI (mean 39.2 vs 35.1 kg/m2, p = 0.004), and worse initial HVF-MD (-20.04 vs -5.81 dB, p < 0.0001). Poor-outcome patients saw more prior health-care providers (4.7 vs 2.4, p < 0.0001), with delayed neuro-ophthalmology encounters (58.5 vs 15.2 weeks, p = 0.001). 41.4% of poor-outcome patients were initially seen in outside emergency departments (ED) (vs 14.1% of good-outcome patients, p = 0.0005), while only 27.1% were seen by eye-care providers (vs 53.1% of good-outcome patients, p = 0.0027). No poor-outcome patients initially consulted our institution's ED vs 7.8% of good-outcome patients. Although patients with poor visual outcome did not seek medical care later than good outcome patients, they had delayed diagnosis/treatment because of prior outside ED visits andlack of prior eye-care provider evaluations, suggesting that early diagnosis and specialized management of papilledema is essential for patients with symptoms of intracranial hypertension.

Visual field prediction based on temporal-spatial feature learning

Glaucoma stands as the leading irreversible cause of blindness worldwide. Regular visual field examinations play a crucial role in both diagnosing and treating glaucoma. Predicting future visual field changes can assist clinicians in making timely interventions to manage the progression of this disease. To integrate temporal and spatial features from past visual field examination results and enhance visual field prediction, a convolutional long short-term memory (ConvLSTM) network was employed to construct a predictive model. The predictive performance of the ConvLSTM model was validated and compared with other methods using a dataset of perimetry tests from the Humphrey field analyzer at the University of Washington (UWHVF). Compared to traditional methods, the ConvLSTM model demonstrated higher prediction accuracy. Additionally, the relationship between visual field series length and prediction performance was investigated. In predicting the visual field using the previous three visual field results of past 1.5~6.0 years, it was found that the ConvLSTM model performed better, achieving a mean absolute error of 2.255 dB, a root mean squared error of 3.457 dB, and a coefficient of determination of 0.960. The experimental results show that the proposed method effectively utilizes existing visual field examination results to achieve more accurate visual field prediction for the next 0.5~2.0 years. This approach holds promise in assisting clinicians in diagnosing and treating visual field progression in glaucoma patients.

IMPACTS OF POSTERIOR STAPHYLOMA ON PARAPAPILLARY MICROVASCULATURE AND ATROPHY IN HIGH MYOPIC EYES: A MATCHED COHORT STUDY WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

We aimed to evaluate the impacts of the different types of posterior staphyloma (PS) in high myopia on parapapillary microvasculature and parapapillary atrophy (PPA, i.e., γ-zone and δ-zone) with optical coherence tomography angiography. This cross-sectional study included 152 high myopic eyes (152 participants) with γ-zone. After matching, high myopic eyes were stratified into PS (n = 33) and non-PS (n = 33) groups. PS types, parapapillary microvasculature characteristics, the prevalence of non-juxtapapillary microvasculature dropout (NJ-MvD), the longest radial width from the optic disc edge to retinal pigment epithelium atrophy edge (PPA-w), γ-zone, and δ-zone with changes in visual field and best-corrected visual acuity (BCVA) were evaluated and analyzed. According to Curtin's classification, we identified five types of PS included: primary types I, II, III, and compound types VII, and IX. Eyes with type II showed a higher optic disc tilted ratio and larger PPA-w compared to other primary PS. Subjects with type IX were the oldest. Eyes with types VII and IX had wider γ-zone and δ-zone, worse visual field outcomes, poorer BCVA, and a higher incidence of NJ-MvD compared to primary PS. Choroidal and intrascleral vessels were associated with NJ-MvD and were located near or connected to the circle of Zinn-Haller. Eyes with high myopia and PS show wider PPA, affecting the γ-zone and δ-zone, and are at a higher risk of developing NJ-MvD. Specifically, eyes with PS types VII and IX are more susceptible to visual field damage and decreased BCVA. These results highlight the importance of impact of PS on PPM and PPA in high myopia.

The effect of inner limiting membrane peeling on visual fields: Unravelling a source of bias in glaucoma management

Abstract: Pars plana vitrectomy (PPV) with inner limiting membrane (ILM) peeling aims to improve visual function. Previous studies have focused on visual acuity, often neglecting visual field (VF) changes. This systematic review examines VF changes after PPV with ILM peeling in patients with epiretinal membrane (ERM) or macular hole (MH), including those with glaucoma, who have preexisting VF damage, to identify potential biases in glaucoma management. The inclusion criteria were as follows: (A) Patients undergoing ILM peeling for ERM or MH and (B) VF outcomes assessed through standard automated perimetry (SAP) or Goldmann kinetic perimetry. Exclusions were non-English studies and those with fewer than 30 subjects. Data included retinal disease, demographics, VF outcomes (mean deviation [MD], pattern standard deviation, and central VF sensitivity [CVFS]), study design, and use of stains. Out of 612 studies, 23 met our criteria. Of these, four included glaucoma patients and seven involved concomitant phacoemulsification. In glaucoma patients, two studies showed MD improvement in the central 24°, while one showed deterioration in the central 10°, linked to worse preoperative MD and older age. Among studies without glaucoma patients, three of eight using SAP reported increased VF defects (VFDs); two showed lower outer nasal CVFS postoperatively. Indocyanine green staining was linked to higher VFD incidence while triamcinolone acetonide or tryptane blue staining led to no significant VFDs. The nasal half of the central VF was more affected, possibly due to retinal ganglion cell distribution. Further prospective studies, including randomized controlled trials, are needed to better understand ILM-peeling effects.

Quality of Life and Primary Open-Angle Glaucoma in the Ocular Hypertension Treatment Study

If preperimetric glaucoma reduces patient-reported vision-related quality of life (VRQoL), clinicians might consider earlier and more aggressive treatment of some patients with ocular hypertension and early glaucoma. To determine the impact of preperimetric glaucoma and early glaucomatous visual field (VF) loss on participants' VRQoL compared with participants who did not develop glaucoma in the Ocular Hypertension Treatment Study (OHTS). This cross-sectional study used data from participants enrolled in the OHTS from 1994 to 1996 who completed 20-year examination follow-up and VRQoL surveys from January 7, 2016, to November 19, 2019. Diagnosis of primary open-angle glaucoma (POAG) required reproducible changes in VFs or optic discs as determined by reading centers and attributed to glaucoma by a masked end point committee. Data analysis was performed from June 27, 2023 to March 7, 2024. Ocular hypertension and glaucoma. Cross-sectional analysis of Rasch-calibrated total scores of the National Eye Institute Visual Function Questionnaire (VFQ) and the Glaucoma Quality of Life (GQL) survey was performed. Total scores were standardized from 0 (poor) to 100 (good). The main outcomes were differences in total VRQoL scores between participants who did not develop POAG (control) and 4 mutually exclusive POAG groups: unilateral or bilateral disc POAG with no glaucomatous VF loss in either eye and unilateral or bilateral VF POAG with or without disc changes. Differences in total VRQoL scores were analyzed using univariate and multivariate linear regression models. Of 1636 participants originally enrolled in the OHTS, 679 (42%) completed the 20-year examination and VRQoL surveys. Of those participants completing 20-year follow-up, mean (SD) participant age at follow-up was 73.8 (7.7) years, and 412 of 679 participants (60.7%) self-reported as female. The mean (SD) Rasch-calibrated total VFQ scores were 72.5 (13.4) in the no POAG group (control) vs 72.7 (13.8) in the unilateral disc POAG group (difference, 0.17; 95% CI, -3.17 to 3.41; P = .92), 73.4 (14.0) in the bilateral disc POAG group (difference, 0.92; 95% CI, -2.93 to 4.77; P = .64), 69.2 (14.5) in the unilateral VF POAG group (difference, 3.33; 95% CI, -6.38 to -0.27; P = .03), and 58.5 (16.9) in the bilateral VF POAG group (difference, -13.96; 95% CI, -17.73 to -10.19; P<.001). Similar results were found for the GQL questionnaire. In this cross-sectional study, among the surviving participants of OHTS who completed the 20-year follow-up examination, those participants who developed preperimetric POAG but no glaucomatous VF loss did not report lower VFQoL compared with participants who did not develop POAG. This finding should allow clinicians and patients the time to determine the frequency of examinations and whether the initiation of treatment is appropriate.

Does the Visual Field Improve After Initiation of Intraocular Pressure Lowering in the United Kingdom Glaucoma Treatment Study?

PurposeEvidence to support the hypothesis that visual field (VF) status can improve after initiation of intraocular pressure (IOP) reducing treatment is controversial. We take advantage of participant eligibility data from the United Kingdom Glaucoma Treatment Study (UKGTS) to test this hypothesis in newly diagnosed glaucomatous patients randomised to IOP lowering therapy or placebo. DesignMulticentre, randomised, triple-masked, placebo-controlled trial. ParticipantsNewly diagnosed open-angle glaucoma patients in the UKGTS with eligibility and baseline data (n = 202 and n = 205 participants from the treatment and placebo groups, respectively). MethodsUKGTS eligibility data, including two reliable VFs (Humphrey 24-2 SITA Standard) and IOP measurements were compared to UKGTS trial baseline data acquired after allocation to treatment (topical prostaglandin analog) or placebo eye drops. Mean change in VF mean deviation (MD) and proportion of eyes that improved MD by more than different thresholds were compared across this interval in the treatment and placebo groups. Secondary analyses included stratifying the groups by level of IOP, level of VF loss and age along with pointwise analyses including change in subsets of VF locations. Main outcome measureMean change in VF MD. ResultsMean (standard deviation [SD]) time between eligibility/baseline visits and reduction in IOP was 12 (3) weeks and 4.8 (4.2) and 1.0 (3.6) mmHg for the treated and placebo eyes, respectively. Mean (SD) change in MD was almost the same for the treated (-0.03 (1.45) dB) and placebo groups (+0.08 (1.72) dB) (P=0.47). Proportion of participants with an MD improvement of 1 dB or more were similar for both groups (P=0.25). No association was found between MD improvement and magnitude of IOP lowering. Stratifying data by IOP, level of VF loss and age did not reveal any differences between the treated and placebo groups and neither did any of the pointwise VF analyses. ConclusionInitial short-term VF changes in the treatment and placebo arms of UKGTS were the same. In these newly diagnosed patients (non-advanced glaucoma) we found no evidence to support the hypothesis that VF status improves after initial lowering of IOP by medical therapy.

Visual Field Defects and Retinal Nerve Fiber Layer Thickness in Migraine Patients: A Study From a Tertiary Care Center in India.

Background This study aimed to analyze the visual field changes and retinal nerve fiber layer (RNFL) thickness during the headache phase of migraine attacks among migraine patients compared with controls. Methodology A prospective, case-control study was conducted at a tertiary care center in Palakkad, Kerala from January 2022 to August 2023. This study included 50 migraine patients and 50 age/gender-matched controls. Adults aged 20-40 years with a more than three-year history of migraine were included in this study and those who had systemic or ocular pathologies were excluded. All 100 subjects underwent complete ocular examination, including full threshold 24-2 automated perimetry for visual field analysis and optical coherence tomography for analyzing RNFL thickness. Statistical analysis was done using SPSS Statistics Version 25 (IBM Corp., Armonk, NY, USA). Results In this study, the average age for cases was 29.24 ± 5.10 years, and for controls was 30.12 ± 6.20 years. Gender distribution was identical between cases and controls with 29 (58%) females and 21 (42%) males. Among the 50 migraine patients, 22 (44%) had generalized, while 28 (56%) had localized field defects during the headache phase of migraine attacks. There was a statistically significant (p < 0.001) difference in superior quadrant RNFL thickness between cases (114.08 ± 12.25) and controls. Conclusions We found that RNFL thinning in the superior quadrant and non-specific localized visual field changes occur during migraine attacks. We conducted this study in a tertiary care center as very few studies in our country have revealed visual field changes during migraine headache attacks.

Evaluation of a Normal Tension Glaucoma Suspect with Visual Field Changes

Evaluation of a Normal Tension Glaucoma Suspect with Visual Field Changes

Visual field changes in patients receiving antitubercular therapy: A prospective cross-sectional study from South India

Objective Tuberculosis is a global health challenge with one-third of the world’s population infected by it. Although ocular side effects of Anti-tubercular drugs are well known, the patients generally report late in the course which can result in irreversible vision loss. The purpose of this study was to study the visual field changes during the time course of anti-tubercular therapy (ATT). Methods A total of 48 patients were studied in this prospective type of study. All patients newly diagnosed with TB and started on treatment were included in the study. Baseline examination which included visual acuity, color vision, anterior segment, IOP, Amsler grid, fundus, and visual field test were performed before starting ATT and at 6-month follow-up. Results The mean age of the study population was 35.90 ± 10.2 years. 35 (72.9%) were males and 13 (27.1%) females. 32(66.6%) had pulmonary TB and the rest 16 (33.3%) had extrapulmonary TB. MDR TB was diagnosed in 27 (56.3%) of the patients with the rest 21 (43.8%) being drug sensitive. The baseline examination was normal in all 48 patients. 3(6.3%) out of 45 patients presented with visual complaints after the treatment initiation. Altogether 7 patients out of 48, had visual field defects at the 6-month follow-up. The incidence of visual field defects in our study was 14.6% with the value being significant (0.016). 8.3% had peripheral constriction of visual fields, 2.1% with Severe generalized depression of visual fields and 2.1% with central scotoma. Out of the 45 patients with no visual complaints at 6-month follow-up, 4 (8.33%) showed peripheral field constriction. Conclusion Visual field defects caused by ATT can precede clinical symptoms. Visual field evaluation can be an important tool for the early detection of optic neuropathy in patients receiving ATT in clinical settings where Visual evoked potential testing and RNFL-OCT are not available.

The Correlation between Body Mass Index and Intraocular pressure, Retinal Nerve Fiber Layer Thickness and Visual Field

Abstract Background Obesity has become a world-wide medical epidemic. it constitutes an important risk for several eye diseases like cataract, diabetic retinopathy, age related macular degeneration (AMD) and glaucoma.Body mass index (BMI) is one of the most specific and objective measurement to define obesity. Obesity has recently been reported to be negatively associated with visual acuity, but the ocular conditions underlying this association and the potential implications are unclear. Amongst different eye diseases, obesity has been associated with cataract, age-related maculopathy, diabetic retinopathy, and glaucoma. Purpose To investigate the relationship between BMI and IOP and correlate it with changes in RNFL thickness and visual field. Materials and Methods 60 participants divided into three groups (normal, overweight, and obese) according to BMI, were included in this Cross-Sectional Study (pilot study). Participants underwent a complete ophthalmologic assessment, measurement of RNFL thickness and ganglion cell complex (GCC) thickness using SD-OCT, IOP with Goldmann applanation tonometry (GAT) and visual field analysis using Humphrey field analyser. Results IOP was significantly higher in obese group than those in healthy weight and overweight group. Also, IOP was statistically significant higher in overweight group compared with those healthy weight group. There were no significant differences between the three groups in average, superior, inferior, nasal, and temporal RNFL thicknesses or in GCC thickness. Yet, GCC thickness in the obese group showed significant negative correlation with BMI.There were no significant differences between the three groups in MD, and VFI. Conclusion IOP was variable according to the degree of obesity with incremental pattern with advance of BMI. BMI of overweight group had no correlation with IOP, average, superior, inferior, nasal, and temporal RNFL thicknesses. While BMI of obese group showed a significant positive correlation with IOP and negative correlation with GCC thickness.

Visual field changes in patients receiving antitubercular therapy: A prospective cross-sectional study from South India

Visual field changes in patients receiving antitubercular therapy: A prospective cross-sectional study from South India

CORRELATION OF VISUAL FIELD CHANGES WITH OPTICAL COHERENCE TOMOGRAPHY IN PRIMARY OPEN ANGLE GLAUCOMA

PURPOSE: To detect morphological changes in Optic Nerve Head (ONH), macula and Retinal nerve fibre layer (RNFL) using spectral domain optical coherence tomography (SDOCT) and to correlate them with functional loss (Visual field changes) using 24-2 and 10-2 standard automated perimetry in Primary open angle glaucoma patients. RESULTS: Mean value of 90D cup to disc ratio (CDR) of study subjects was 0.64 ± 0.13 with median (25th-75th percentile) of 0.7(0.6-0.7). Mean value of average RNFL thickness(microns), superior quadrant thickness (micron), inferior quadrant thickness (micron), nasal quadrant thickness (micron) and temporal quadrant thickness (micron) of study subjects was 62.35 ± 14.43, 77.96 ± 14.29, 81.41 ± 22.84, 51.33 ± 21.14 and 50.71 ± 17.71 with median(25th-75th percentile) of 63(52-75), 78(66.25-89), 81.5(64.25-93.75), 54(46-63) and 50.5(39-57.75) respectively. Mean value of average macular thickness (micron), macular GCL-IPL thickness -Superior quadrant (micron) and macular GCL-IPL thickness -Inferior quadrant (micron) of study subjects was 65.6 ± 11.7, 76.49 ± 11.63 and 76.76 ± 16.86 with median (25th-75th percentile) of 64(56-75), 75(67-87.75) and 75.5(65.25-93) respectively. Mean value of MD and PSD of study subjects was -7.34 ± 4.47 and 6.8 ± 3.11 with median (25th-75th percentile) of -7.65(-11--3.1) and 6.9(3.9-9.1) respectively. 57(41.3%) eyes had early glaucoma, 51(37%) eyes had moderate glaucoma and 30(21.7%) eyes had advanced glaucoma. CONCLUSION: In present study, ONH parameters (rim area), RNFL parameter (inferior quadrant thickness) and macula parameters (average macular GCLIPL thickness) showed statistically significant correlation with VF MD. Correlation between VF parameters i.e. MD and PSD with OCT parameters shown that there was a relation between Macular GCLIPL thickness ,RNFL thickness and ONH with the changes in the results of VF.

Phacoemulsification in angle-closure glaucoma: A 360° evaluation.

To evaluate the effect of phacoemulsification on intraocular pressure (IOP) and anterior chamber angle (ACA) morphology in primary angle-closure glaucoma (PACG). A hospital-based, prospective pre- and post-interventional study was carried out in 40 PAC and PACG eyes post patent PI with visually significant cataracts. All patients underwent phacoemulsification and were evaluated for IOP control, ACA widening, and disease progression for a minimum of 6 months. Failure was defined as an IOP of >21 mmHg necessitating another intervention, including trabeculectomy and/or an increase in the required number of antiglaucoma medications (AGMs) by >1. A highly statistically significant reduction of IOP ( P < 0.0001) was seen with an overall reduction of 42.2% over 6 months and a mean reduction of 8.9 ± 3.59 mmHg, with the requirement of AGMs reducing from 39/40 patients preoperatively to 1/38 postoperatively. Success was seen in 95% of cases, with two patients not achieving target IOP and requiring trabeculectomy. Angle widening was documented in all cases by both gonioscopy and AS-OCT, and none of the patients showed any progression in disc damage and visual field changes. Early cataract surgery in ACG not only helps to control IOP and disease progression by widening angles and improving aqueous outflow but also improves visual acuity and reduces the economic burden of AGMs. It also helps in better evaluation of disease progression by both structural and functional analysis, as was documented by the improved and more reliable visual field indices.

Electrophysiological Evidence for a Whorfian Double Dissociation of Categorical Perception Across Two Languages

AbstractTaza in Spanish refers to cups and mugs in English, whereas glass refers to different glass types in Spanish: copa and vaso. It is still unclear whether such categorical distinctions induce early perceptual differences in speakers of different languages. In this study, for the first time, we report symmetrical effects of terminology on preattentive indices of categorical perception across languages. Native speakers of English or Spanish saw arrays of cups, mugs, copas, and vasos flashed in streams. Visual mismatch negativity, an implicit electrophysiological correlate of perceptual change in the peripheral visual field, was modulated for categorical contrasts marked in the participants’ native language but not for objects designated by the same label. Conversely, P3a, an index of attentional orienting, was modulated only for missing contrasts in the participants’ native language. Thus, whereas native labels influenced participants’ preattentive perceptual encoding of objects, nonverbally encoded dissociations reoriented their attention at a later processing stage.

Observation on the changes of visual field and optic nerve fiber layer thickness in patients with early diabetic retinopathy

BackgroundDiabetic retinopathy (DR) is a common complication of diabetes mellitus (DM) and is a leading cause of vision loss. Early detection of DR-related neurodegenerative changes is crucial for effective management and prevention of vision loss in diabetic patients. MethodsIn this study, we employed spectral-domain polarization-sensitive optical coherence tomography (SD PS-OCT) to assess retinal nerve fiber layer (RNFL) changes in 120 eyes from 60 types 1 DM patients without clinical DR and 60 age-matched healthy controls. Visual field testing was performed to evaluate mean sensitivity (MS) and mean defect (MD) as indicators of visual function. ResultsSD PS-OCT measurements revealed significant reductions in RNFL birefringence, retardation, and thickness in type 1 DM patients compared to healthy controls. Visual field testing showed decreased MS and increased MD in DM patients, indicating functional impairment correlated with RNFL alterations. ConclusionOur findings demonstrate early neurodegenerative changes in the RNFL of type 1 DM patients without clinical DR, highlighting the potential of SD PS-OCT as a sensitive tool for early detection of subclinical DR-related neurodegeneration. These results underscore the importance of regular ophthalmic screenings in diabetic patients to enable timely intervention and prevent vision-threatening complications.

The structure-function relationship between multifocal pupil perimetry and retinal nerve fibre layer in glaucoma.

Multifocal pupillographic objective perimetry (mfPOP) is a novel method for assessing functional change in diseases like glaucoma. Previous research has suggested that, in contrast to the pretectally-mediated melanopsin response of intrinsically photosensitive retinal ganglion cells, mfPOP responses to transient onset stimuli involve the extrastriate cortex, and thus the main visual pathway. We therefore investigate the correlation between peripapillary retinal nerve fibre layer (pRNFL) thickness and glaucomatous visual field changes detected using mfPOP. Parallel analyses are undertaken using white on white standard automated perimetry (SAP) for comparison. Twenty-five glaucoma patients and 24 normal subjects were tested using SAP, 3 mfPOP variants, and optical coherence tomography (OCT). Arcuate clusters of the SAP and mfPOP deviations were weighted according to their contribution to published arcuate divisions of the retinal nerve fibre layer. Structure-function correlation coefficients (r) were computed between pRNFL clock-hour sector thickness measurements, and the local visual field sensitivities from both SAP and mfPOP. The strongest correlation was observed in the superior-superotemporal disc sector in patients with worst eye SAP MD < -12dB: r = 0.93 for the mfPOP LumBal test (p < 0.001). Correlations across all disc-sectors were strongest in these same patients in both SAP and mfPOP: SAP r = 0.54, mfPOP LumBal r = 0.55 (p < 0.001). In patients with SAP MD ≥ -6dB in both eyes, SAP correlations across all sectors were higher than mfPOP; mfPOP correlations however, were higher than SAP in more advanced disease, and in normal subjects. For both methods the largest correlations with pRNFL thickness corresponded to the inferior nasal field of more severely damaged eyes. Head-to-head comparison of mfPOP and SAP showed similar structure-function relationships. This agrees with our recent reports that mfPOP primarily stimulates the cortical drive to the pupils.

Visual Field Outcomes in the Primary Tube Versus Trabeculectomy Study

PurposeTo describe visual field outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. DesignCohort analysis of a prospective multicenter randomized clinical trial. SubjectsA total of 155 eyes from 155 subjects randomly assigned to treatment with tube shunt surgery (n=84) or trabeculectomy with mitomycin C (n=71). MethodsThe PTVT Study was a multicenter randomized clinical trial comparing the safety and efficacy of trabeculectomy and tube shunt surgery in eyes without prior intraocular surgery. Subjects underwent standard automated perimetry (SAP) at baseline and annually for five years. SAP tests were deemed reliable if the false positive rate was ≤15%. Tests were excluded if visual acuity was ≤20/400 or loss of ≥2 Snellen lines from baseline were attributed to a non-glaucomatous etiology. Linear mixed-effects models were used to compare rates of change in SAP mean deviation (MD) between the two treatment groups. Intraocular pressure (IOP) control was assessed by percentage of visits with IOP <18 mmHg and mean IOP. Outcome MeasuresRate of change in SAP MD during follow-up. ResultsA total of 730 SAP tests were evaluated, with an average of 4.7 tests per eye. The average SAP MD at baseline was -12.8±8.3 dB in the tube group and -12.0±8.4 dB in the trabeculectomy group (p=0.57). The mean rate of change in SAP MD was -0.32±0.39 dB/year in the trabeculectomy group and -0.47±0.43 dB/year in the tube group (p=0.23). Eyes with mean IOP 14-17.5 mmHg had significantly faster rates of SAP MD loss compared to eyes with mean IOP <14 mmHg (-0.59±0.13 vs. -0.27±0.08 dB/year, p=0.012) and eyes with only 50-75% of visits with IOP <18 mmHg had faster rates than those with 100% of visits with IOP <18 mmHg (-0.90±0.16 vs. -0.29±0.08 dB/year, p<0.001). Multivariable analysis identified older age and worse IOP control as risk factors for faster progression in both treatment groups. ConclusionsNo statistically significant difference in mean rates of visual field change was observed between trabeculectomy and tube shunt surgery in the PTVT Study. Worse IOP control was significantly associated with faster rates of SAP MD loss during follow-up. Older patients were also at risk for faster progression.

Effect of treatment with carteolol and latanoprost in newly diagnosed primary open-angle glaucoma on peripapillary vessel density.

In a previous follow-up of glaucoma patients taking carteolol or latanoprost, we found a greater progression of visual field changes with the prostaglandin than the betablocker. In the present study we compared the impact of carteolol and latanoprost on peripapillary vessel density in newly diagnosed primary open-angle glaucoma (POAG) patients. The study consisted of two groups of POAG patients. There were 46 patient eyes treated with carteolol (Carteol LP 2%) in the first group and 52 eyes treated with latanoprost (Xalatan 0.005%) in the second. Intraocular pressure (IOP), vessel density (VD) and visual field were assessed in all patients. VD was measured peripapillary by optical coherence tomography angiography (OCTA) with the Avanti RTVue XR in eight segments: Inferior Temporal - IT (1); Temporal Inferior -TI (2); Temporal Superior - TS (3); Superior Temporal - ST (4); Superior Nasal - SN (5); Nasal Superior - NS (6); Nasal Inferior - NI (7) and Inferior Nasal - IN (8). The measurements were compared before and after three months of treatment. The visual field was examined with a fast threshold glaucoma program using a Medmont M 700 instrument from Medmont International Pty Ltd. and only when a diagnosis of POAG was done. The overall defect (OD) was assessed. Before treatment, there was no difference between groups in either OD or VD. After treatment, there was a decrease in IOP in both groups. In the carteolol-treated group, the mean decrease was 5.8 mmHg and in the latanoprost-treated eyes, the mean decrease was 7 mmHg. The difference was not statistically significant (P=0.133). After treatment with carteolol, there was a statistically significant increase in VD in segments 4, 5 and 6. After latanoprost treatment, VD was statistically significantly improved only in segment 5. A greater increase in VD values was found in eyes treated with carteolol than in eyes treated with latanoprost. Carteolol had a better effect on vessel density than latanoprost.

Changes in the Visual Field Test after Descemet Stripping Automated Endothelial Keratoplasty in Advanced Glaucoma.

Background: To evaluate changes in the visual field (VF) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with advanced glaucoma and previous trabeculectomy. Methods: Changes in VF, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications were analyzed before and after DSAEK in 19 eyes. The VFs were evaluated using the 10-2 program of the Humphrey Field Analyzer (HFA) and/or Goldmann perimetry (GP). Results: In nine eyes, the MD improved from -22.24 ± 6.5 dB to -18.36 ± 5.1 dB in HFA. In five out of nine eyes, postoperative MD improved >1 dB compared to preoperative MD. In GP testing, 10 out of 15 eyes showed an improvement, that is, greater than 20° in VF enlargement by the isopter of I-4e and/or new detection of a smaller or darker isopter. Overall, improvement in VF with the HFA and/or GP test was observed in 12/19 (63.2%) eyes after DSAEK. Postoperative BCVA improved by more than two lines in logMAR VA in 18 of 19 (94.7%) eyes. There were no significant differences between the preoperative and postoperative IOP and the number of glaucoma medications. Conclusions: DSAEK may produce subjective improvement in the visual field as well as improved visual acuity, even in advanced glaucomatous eyes.