Early Visual Field Loss Research Articles

Will the PRESERFLO™ MicroShunt impact the future of trabeculectomy practice? A UK and Éire Glaucoma Society National Survey.

To explore the attitudes of UK glaucoma specialists regarding the current and future practice of trabeculectomy and the novel PRESERFLO™ MicroShunt (PF-MS) device, and intentions to adopt the PF-MS into routine glaucoma surgical practice. Online survey of UK and Éire Glaucoma Society members. 43 glaucoma consultants completed the survey. All surgeons performed trabeculectomies (median of 40 annually) and 51% undertook PF-MS procedures (median of 22.5 annually). The mean duration of surgery was reported as 48.9 (SD 13.3) and 31.2 (SD 9.9) min for trabeculectomy and PF-MS respectively (p < 0.0001). For surgeons not currently using the PF-MS, 65% planned to do so. Respondents judged completion of 35 trabeculectomies and 10 PF-MS were required to achieve basic competence. 91% of participants predicted their trabeculectomy volume would decrease and 73% expected PF-MS usage to increase. Respondents reported a median of six and four follow-ups within 3 months post surgery for trabeculectomy and PF-MS respectively (p < 0.0001). Respondents reported trabeculectomy required more post-operative interventions than the PF-MS and 81.8% judged the patient experience to be better with the PF-MS. The PF-MS was deemed suitable for early visual field loss by 72% of respondents, severe visual field loss by 35% and normal tension glaucoma by 21%. The PF-MS has seen rapid adoption in the UK. Respondents predict its usage will significantly increase whilst trabeculectomies will decrease. They report the PF-MS is quicker to learn and perform, and requires less post-operative follow-ups and interventions which may facilitate a more efficient service delivery for patients requiring glaucoma surgery.

What Is the Amount of Visual Field Loss Associated With Disability in Glaucoma?

To propose a new methodology for classifying patient-reported outcomes in glaucoma and for quantifying the amount of visual field damage associated with disability in the disease. Cross-sectional study. A total of 263 patients with glaucoma were included. Vision-related disability was assessed by the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). A latent class analysis (LCA) model was applied to analyze NEI VFQ-25 data and patients were divided into mutually exclusive classes according to their responses to the questionnaires. Differences in standard automated perimetry (SAP) mean deviation (MD) and integrated binocular mean sensitivity (MS) values between classes were investigated. The optimal number of classes was defined based on goodness-of-fit criteria, interpretability, and clinical utility. The model with 2 classes, disabled and nondisabled, had the best fit with an entropy of 0.965, indicating excellent separation of classes. The disabled group had 48 (18%) patients, whereas 215 (82%) patients were classified as nondisabled. The average MD of the better eye in the disabled group was -5.98 dB vs -2.51 dB in the nondisabled group (P < .001). For the worse eye, corresponding values were -13.36 dB and -6.05 dB, respectively (P < .001). Application of an LCA model allowed categorization of patient-reported outcomes and quantification of visual field levels associated with disability in glaucoma. A damage of approximately -6 dB for SAP MD, indicating relatively early visual field loss, may already be associated with significant disability if occurring in the better eye.

Effect of Community Screening on the Demographic Makeup and Clinical Severity of Glaucoma Patients Receiving Care in Urban China

To assess differences in clinical and demographic characteristics between glaucoma patients identified by community screening and those newly diagnosed in hospital in a Chinese setting. Prospective comparative cohort study. A total of 373 patients identified with glaucoma among 27 000 persons undergoing community screening were enrolled as the Screening group. The Clinic group consisted of 119 consecutively presenting, newly diagnosed glaucoma patients in hospital. Primary outcomes were mean deviation (MD), visual field index (VFI) and pattern standard deviation (PSD) on Humphrey Field Analyzer, and intraocular pressure (IOP). Disease severity was categorized into 5 stages based on MD. A total of 89.6% (328/373) of Screening group patients had IOP < 21mm Hg, compared to 48.7% (58/119) in the Clinic group (P < .001). The mean VFI, MD, and PSD were 76.4% ± 23.8%, -9.7 ± 7.3 dB, and 6.4 ± 3.4 dB in the Screening group and significantly worse in the Clinic group: 44.1% ± 32.0%,-19.8 ± 9.5 dB, and 7.6 ± 3.1 dB (P < .001 for MD and VFI, P= .001 for PSD). Nearly three quarters of Screening patients had early or moderate visual field loss (monocular), while nearly half of Clinic patients had severe loss at the time of diagnosis. Screening patients were significantly more likely to be older (P < .001) and female (P < .001) than Clinic patients. Glaucoma patients detected through community screening had significantly milder damage, and were more likely to include underserved groups (women, elderly) than those newly diagnosed in a clinic in this setting. Comparison with population studies suggests that cases of glaucoma with IOP < 21mm Hg are severely underascertained in China, a situation that may be improved by screening.

Seeing is believing: a demonstration of critical fusion frequency and its multidimensional nature.

critical fusion frequency (CFF), or the flicker fusion threshold, is defined as the critical frequency above which a flickering light source appears steady to the observer (see [Fig. 1][1]). It is known to depend on a number of parameters, namely, intensity of the light source ([5][2], [15][3]),

Detection of glaucoma progression by perimetry and optic disc photography at different stages of the disease: results from the Early Manifest Glaucoma Trial.

PurposeTo compare the earliest detection of progression in visual fields and monoscopic optic disc photographs at different stages of manifest glaucoma.MethodsThis study evaluated 306 eyes in 249 patients with manifest open‐angle glaucoma included in the Early Manifest Glaucoma Trial (EMGT). All patients in the trial were followed up regularly by standard automated perimetry and monoscopic optic disc photography, and the median follow‐up time was 8 years. Progression was assessed in series of optic disc photographs and in series of visual fields using glaucoma change probability maps and the predefined EMGT progression criterion. The proportion of progressions detected first in visual fields and the proportion detected first in optic disc photographs were compared at different stages of glaucoma severity defined by the perimetric mean deviation (MD) of the baseline visual field.ResultsAssessment of 210 eyes with early visual field loss, 83 eyes with moderate field loss, and 13 eyes with advanced field loss showed that, among the eyes exhibiting progression, the progression was detected first in the visual field in 80%, 79% and 100%, respectively. The predominance of visual field progressions at all stages was still apparent when using narrower (3‐dB) MD intervals for staging.ConclusionIn the EMGT material on eyes with manifest open‐angle glaucoma, the initial progression was detected much more often in the visual field series than in the optic disc photographs at all stages of disease.

Heidelberg Edge Perimeter: The New Method of Perimetry.

Glaucoma is an optic nerve neuropathy associated with progressive visual field loss. One of the most frequent eye diseases these days, it is believed to have affected 60 million people worldwide in 2014. Various visual field examination methods are known, from the confrontational test to kinetic and static perimetry. The latest device to access the visual field is the Heidelberg Edge Perimeter (HEP). It is a flicker perimeter, but, unlike others of its kind, it uses a unique stimulus called FDF (Flicker Defined Form). A 5-grade round stimulus is created by reversing the phase of flickering black and white dots, thereby forming illusory outlines. The test uses randomly flickering points in medium illumination (50 cd/m²). The background remains the same during the whole test. Background luminance is 50 cd/m2, the marker showing time is 400 ms, and the frequency is 15 Hz. Current studies show that HEP can detect early visual field loss which remains invisible during a standard visual field test with standard automated perimetry. HEP might also prove useful in the early detection of other diseases connected with visual field loss, for example in neurology.

Spatial Changes of Central Field Loss in Diabetic Retinopathy After Laser

To explore the spatial distribution of central visual field loss in untreated proliferative diabetic retinopathy (PDR) and to quantify the effect of medium-pulse Optos-guided 20-millisecond Pascal laser treatment on the central field. Visual field data (Swedish Interactive Threshold Algorithm 24-2) from 99 eyes (66 patients) with treatment-naive PDR were used to train a self-organizing map (SOM) that classified the defects into nine patterns. Twenty-eight eyes of 23 patients treated with 20-millisecond Pascal retinal laser photocoagulation underwent Optos widefield fundus fluorescein angiography (WF-FFA) at baseline and 3 months after treatment. Postlaser changes in SOM patterns and global indices were analyzed. Visual field defect changes (Total Deviation [TD]) with eccentricity and extent of initial loss were analyzed. Grading of WF-FFA after laser was undertaken by two masked retina specialists. At baseline, 44.4% of PDR eyes showed early visual field loss patterns (1 to 3), with 23.2% classified into the advanced patterns (7 to 9). Mild SOM patterns had more superior hemifield field defects, whereas advanced patterns involved both superior and inferior hemifield field loss. After laser, a significant shift to early SOM patterns were observed (p = 0.02), as well as improvement of Mean Deviation and Pattern Standard Deviation (p = 0.003 and p = 0.06, respectively). Improvement of TD was commonly observed in test locations of 0 to 10, 10 to 20, and 20 to 30 degrees. Greater improvement was observed with deeper baseline TD (p < 0.001). Masked WF-FFA image grading showed 78.6% PDR regression. The SOM method is a promising technique to classify and monitor over time PDR-associated visual field defects. Medium-pulse Optos-guided 20-millisecond Pascal laser treatment improved the spatial patterns and global parameters of central field defects.

Combining Spectral Domain Optical Coherence Tomography Structural Parameters for the Diagnosis of Glaucoma With Early Visual Field Loss

To create a multivariable predictive model for glaucoma with early visual field loss using a combination of spectral-domain optical coherence tomography (SD-OCT) parameters, and to compare the results with single variable models. Two hundred fifty-three subjects (149 healthy controls and 104 with early glaucoma) underwent optic disc and macular scanning using SD-OCT in one randomly selected eye per subject. Sixteen parameters (rim area, cup-to-disc area ratio, vertical cup-to-disc diameter ratio, average and quadrant RNFL thicknesses, average, minimum, and sectoral ganglion cell inner-plexiform layer [GCIPL] thicknesses) were collected and submitted to an exploratory factor analysis (EFA) followed by logistic regression with the backward elimination variable selection technique. Area under the curve (AUC) of the receiver operating characteristic (ROC), sensitivity, specificity, Akaike's information criterion (AIC), predicted probability, prediction interval length (PIL), and classification rates were used to determine the performances of the univariable and multivariable models. The multivariable model had an AUC of 0.995 with 98.6% sensitivity, 96.0% specificity, and an AIC value of 43.29. Single variable models yielded AUCs of 0.943 to 0.987, sensitivities of 82.6% to 95.7%, specificities of 88.0% to 94.0%, and AICs of 113.16 to 59.64 (smaller is preferred). The EFA logistic regression model correctly classified 91.67% of cases with a median PIL of 0.050 in the validation set. Univariable models correctly classified 80.62% to 90.48% of cases with median PILs 1.9 to 3.0 times larger. The multivariable model was successful in predicting glaucoma with early visual field loss and outperformed univariable models in terms of AUC, AIC, PILs, and classification rates.

Sensitivity and Specificity of Short-Duration Transient Visual Evoked Potentials (SD-tVEP) in Discriminating Normal From Glaucomatous Eyes

To evaluate the ability of the short-duration transient visual evoked potential (SD-tVEP) to discriminate between healthy eyes and eyes with early to advanced glaucomatous visual field loss. We tested 30 eyes of 30 healthy controls and 45 eyes of 35 glaucoma patients. Normal eyes had 20/30 or better visual acuity and normal 24-2 Swedish interactive thresholding algorithm (SITA) Standard visual fields. Glaucoma was staged as mild (mean deviation, MD > -6.0 dB), moderate (MD between -6.0 and -12.0 dB), and severe (MD < -12.0 dB). There were 15 eyes in each group. SD-tVEPs were recorded using the Diopsys NOVA-LX System. Each eye was stimulated with a low (Lc) and a high (Hc) Michelson contrast checkerboard pattern. Each test resulted in an Lc and an Hc SD-tVEP response. Each response was evaluated for overall waveform quality, P100 latency, and P100 amplitude referenced to the N75. The sensitivity, specificity, negative predictor value (NPV), and positive predictor value (PPV) were calculated. Lc latency showed the highest accuracy for discrimination using receiver operating characteristic curves for high and low contrast parameters. The analysis for all subjects resulted in a 91.1% sensitivity, 93.3% specificity, 95.3% PPV, and an 87.5% NPV. Evaluating the mean Lc latency of the mild, moderate, and severe glaucoma patients against controls showed discrimination consistent with the glaucoma severity. Short-duration transient VEP objectively identified decreased visual function and discriminated between healthy and glaucomatous eyes, and also showed good differentiation between healthy eyes and those with early visual field loss. VEP may be useful for early diagnosis of glaucoma.

Retinal functional changes measured by frequency-doubling technology in patients treated with hydroxychloroquine

Antimalarial drugs such as chloroquine (CQ) and hydroxychloroquine (HCQ) are mainly used in the treatment of rheumatologic diseases, and their use may be associated with irreversible retinal toxicity. Previous studies indicate early paracentral visual field loss (Humphrey 10-2) in patients taking HCQ". These paracentral defects appear before changes in other clinical parameters as visual acuity and fundoscopy. The mechanism of CQ toxicity remains unclear. It was reported that toxic doses of CQ administered for as long as 4.5 years to Rhesus monkeys caused an initial dramatic effect on ganglion cells, followed later by photoreceptors and RPE degeneration. The purpose of this study is to explore early retinal functional changes measured by frequency-doubling technology (FDT) in patients treated with hydroxychloroquine (HCQ). Forty-eight eyes of 48 subjects treated with hydroxychloroquine (HCQ), with no signs of retinal toxicity, and 36 eyes of 36 age and sex-matched healthy subjects were enrolled in this cross-sectional, prospective, observational, case control study. Functional testing included frequency-doubling Humphrey-matrix perimetry (FDP), white-on-white Humphrey visual field perimetry (HFA), using the 24-2 and 10-2 threshold programs, multifocal electroretinogram (mfERG, Veris 4.9) and low contrast sensitivity (CS) measurement. FDP mean deviation (MD) was found to be significantly reduced in HCQ-treated patients compared to controls both in the 24-2 (-1.38 ± 2.41 dB vs 0.21 ± 1.83 dB, p < 0.01) and in the 10-2 program (-0.97 ± 2.88 dB vs 0.15 ± 1.72 dB, p < 0.01). FDP pattern standard deviation (PSD) was found to be significantly worse in HCQ-treated patients compared to controls both in the 24-2 (2.70 ± 0.65 dB vs 2.41 ± 0.31 dB, p < 0.01 and in the 10-2 program (2.86 ± 0.48 dB vs 2.48 ± 0.39 dB, p < 0.01). HFA PSD and CS was also significantly reduced in HCQ patients, while response amplitude densities (RAD) were similar between patients and controls. A statistically significant difference in the ratio of the 5°-10° RAD and the 0°-2.5° RAD (0.31 ± 0.08 vs 0.36 ± 0.07 respectively, p < 0.05) was found between groups. Frequency doubling perimetry could be useful to detect early retinal impairment in patients treated with hydroxychloroquine.

Visual field loss in patients with normal-tension glaucoma under topical nipradilol or timolol: Subgroup and subfield analyses of the nipradilol-timolol study

To estimate the deterioration rates of visual field loss in Japanese normal-tension glaucoma (NTG) patients under either topical nipradilol or timolol, and to explore intergroup differences in the treatment results. A total of 146 NTG patients with mild to moderate damage were randomized to either nipradilol or timolol and followed for 3 years with a periodic comprehensive ophthalmological visual field examination (30-2 Humphrey perimeter program) every 6 months (the Nipradilol-Timolol Study). The time course of mean deviation (MD), the average total deviation (TD(mean)) in four subfields, and the corrected pattern standard deviation (CPSD) were compared between the two groups using regression analysis with a linear mixed effect model. The estimated slope for MD (dB/year) was -0.03 in the nipradilol and -0.05 in the timolol group (P > 0.4). In both groups, TD(mean) in the superior-central subfield and CPSD showed significant changes (-0.3 and 0.2-0.3, P <or= 0.001). In the patients with early visual field loss or those younger than 40 years, deterioration of some visual field parameters tended to be slower in the nipradilol group than in the timolol group. During 3 years of monotherapy with either nipradilol or timolol in NTG patients, only TD(mean) in the superior-central subfield and the CPSD changed significantly without any intergroup differences.

Glaucoma With Early Visual Field Loss Affecting Both Hemifields and the Risk of Disease Progression

Glaucoma With Early Visual Field Loss Affecting Both Hemifields and the Risk of Disease Progression

Glaucoma With Early Visual Field Loss Affecting Both Hemifields and the Risk of Disease Progression

To evaluate whether damage to both hemifields in glaucomatous eyes predicts more rapid disease progression than does single-hemifield involvement. We reviewed the medical records of 43 660 consecutive patients. Eyes with glaucomatous optic neuropathy, 10 or more Swedish Interactive Threshold Algorithm standard 24-2 visual fields in at least 5 years, and mean deviation (MD) smaller than -6.0 dB were included. Pointwise linear regression was used to determine progression. Cox proportional hazards analysis was used to calculate risk of progression based on different baseline covariates. We enrolled 205 eyes (205 patients; mean [SD] age, 64.2 [11.0] years; follow-up, 6.5 [1.8] years; number of visual fields, 12.3 [2.9]). Patients were divided into 3 groups: initial superior defect (group A; n = 79; MD, -3.4 [1.9] dB), initial inferior defect (group B; n = 61; MD, -3.4 [1.8] dB), and both hemifields affected (group C; n = 65; MD, -4.2 [1.5] dB). Group C progressed faster than did groups A and B (P < .02). Multivariate analysis showed significant effect of higher baseline intraocular pressure, thinner central corneal thickness, and initial damage to both hemifields. Initial damage to both hemifields increases the risk of glaucoma progression. More aggressive therapy should be considered for these eyes.

Spatial Summation Properties for Magnocellular and Parvocellular Pathways in Glaucoma

To examine the spatial summation properties for the magnocellular (M) and parvocellular (P) visual pathways in participants with glaucoma and approximately age-matched controls in central and midperipheral retinal eccentricities. Contrast discrimination thresholds were measured for six different stimulus array sizes, using steady- and pulsed-pedestal paradigms designed to measure function of the M and P pathways, respectively. This study involved 15 participants with glaucoma and 17 approximately age-matched controls. All participants completed trials foveally and at 12.5 degrees eccentricity. The peripheral stimulus location for each glaucoma participant was within a quadrant of early visual field loss, and locations were matched for the control group. The glaucoma group demonstrated significantly elevated thresholds compared with the control group (F((1,30)) = 16.29; P < 0.001). Thresholds were also significantly dependent on the stimulus sizes, testing location, and pedestal condition. Data obtained for the steady-pedestal paradigm were fit with an exponential decay function, whereas the pulsed-pedestal data were fit with a linear function, demonstrating different spatial summation properties for the M and P pathways, consistent with previous studies using this methodology. Analyses of the curve parameters obtained from the curve fits indicated no significant difference in the shape of the curves between glaucoma and control participants. Although spatial summation properties are different for presumed M- and P-mediated pathways, the underlying spatial summation properties associated with these pathways are similar in the control and glaucoma participants in this study, centrally and midperipherally.

Detection of Early Glaucoma With Optical Coherence Tomography (StratusOCT)

To evaluate the performance of optical coherence tomography (StratusOCT) for discriminating eyes with early glaucoma from normal eyes. Thirty eyes with established early glaucomatous visual field defects (EGVF group), 30 eyes with evidence of early glaucomatous optic neuropathy with normal standard achromatic perimetry [early glaucoma by disc (EGD)], and 33 age-matched normal eyes with good quality StratusOCT nerve fiber layer (NFL) images were enrolled. Average NFL thickness and NFL thickness at quadrants and sectors, areas under receiver operator characteristic curves, and sensitivities at 80% and 90% specificity were evaluated. The average (+/-SD) mean deviation in the EGVF group was -3.4 (+/-1.7) dB. Receiver operator characteristic curves showed areas under the curve (AUC) for NFL thickness in the superior quadrant (AUC=0.75+/-0.07) and in the inferior quadrant (AUC=0.94+/-0.03) to be the best StratusOCT parameters for discrimination of normal controls from EGD and EGVF eyes, respectively. The best parameter for detection of EGD eyes at 80% and 90% specificities was NFL thickness at superior quadrant (51% and 36% sensitivities, respectively). The best parameter for detection of EGVF eyes at 80% and 90% specificities was NFL thickness in the inferior quadrant (90% and 87% sensitivities, respectively). Optical coherence tomography (StratusOCT) showed good sensitivity and specificity in a group of glaucoma patients with early visual field loss. In patients with normal visual fields in whom the optic disc appeared glaucomatous to glaucoma specialists, half were confirmed to have StratusOCT findings consistent with damage from glaucoma.

Assessing Visual Field Clustering Schemes Using Machine Learning Classifiers in Standard Perimetry

To compare machine learning classifiers trained on three clustering schemes to determine whether distinguishing healthy eyes from those with glaucomatous optic neuropathy (GON) can be optimized by training with clustered data. Two machine learning classifiers-quadratic discriminant analysis (QDA) and support vector machines with Gaussian kernel (SVMg)-were trained separately using standard perimetry data from the Diagnostic Innovations in Glaucoma Study (DIGS), clustered using three clustering schemes on a training data set (123 eyes/123 glaucoma patients with GON; 135 eyes/135 normal control subjects). Trained classifiers were then applied to an independent data set containing 69 eyes of 69 glaucoma patients with early visual field loss and 83 eyes of 83 normal control subjects. Two control conditions were included: unclustered data and a random assignment of locations to clusters. Areas under the receiver operating characteristic (ROC) curve ranged from 0.85 (SVMg, thresholds clustered by Glaucoma Hemifield Test sectors) to 0.92 (QDA, thresholds clustered by Garway-Heath mapping) for the training data set. Use of clustered data showed no significant optimization of sensitivity over use of unclustered data, and no single clustering method resulted in significantly higher performance in the independent data set. Sensitivities tended to be higher with QDA than with SVMg, regardless of specificity cutoff and clustering QDA performed better with the early glaucoma data set than did the SVMg. Clustering may be advantageous when data-dimension reduction is needed-for example, when combining field results with other high-dimensional data (e.g., structural imaging data)-but it is not necessary for visual field data alone.

Contrast Sensitivity Changes Due to Glaucoma and Normal Aging: Low-Spatial-Frequency Losses in Both Magnocellular and Parvocellular Pathways

To explore the effects of glaucoma and aging on low-spatial-frequency contrast sensitivity by using tests designed to assess performance of either the magnocellular (M) or parvocellular (P) visual pathways. Contrast sensitivity was measured for spatial frequencies of 0.25 to 2 cyc/deg by using a published steady- and pulsed-pedestal approach. Sixteen patients with glaucoma and 16 approximately age-matched control subjects participated. Patients with glaucoma were tested foveally and at two midperipheral locations: (1) an area of early visual field loss, and (2) an area of normal visual field. Control subjects were assessed in matched locations. An additional group of 12 younger control subjects (aged 20-35 years) were also tested. Older control subjects demonstrated reduced sensitivity relative to the younger group for the steady (presumed M)- and pulsed (presumed P)-pedestal conditions. Sensitivity was reduced foveally and in the midperiphery across the spatial frequency range. In the area of early visual field loss, the glaucoma group demonstrated further sensitivity reduction relative to older control subjects across the spatial frequency range for both the steady- and pulsed-pedestal tasks. Sensitivity was also reduced in the midperipheral location of "normal" visual field for the pulsed condition. Normal aging results in a reduction of contrast sensitivity for the low-spatial-frequency-sensitive components of both the M and P pathways. Glaucoma results in a further reduction of sensitivity that is not selective for M or P function. The low-spatial-frequency-sensitive channels of both pathways, which are presumably mediated by cells with larger receptive fields, are approximately equivalently impaired in early glaucoma.

Diagnostic Accuracy of the Moorfields Regression Analysis Using the Heidelberg Retina Tomograph in Glaucoma Patients with Visual Field Defects

This study was designed to determine the specificity and sensitivity of the Heidelberg Retina Tomograph I (HRT) using the Moorfields Regression Analysis (MRA) in differentiating healthy from glaucomatous eyes. In this cross-sectional study, 74 eyes of 37 healthy subjects and 87 eyes of 47 glaucoma patients were examined with Octopus standard automated perimetry and HRT. Only one eye per patient was used for statistical analysis. According to visual field index mean defect (MD) glaucoma patients were divided into three groups with early (MD < 6 dB), moderate (6 dB < MD < 12 dB), and advanced visual field loss (MD > 12 dB). The sensitivity and specificity of optic nerve head examinations using the MRA of HRT were evaluated by two criteria (criteria 1, as diseased if classified by MRA as outside normal limits; criteria 2, as diseased if classified by MRA as borderline). The correlations between the topographic parameters and visual field index MD were measured by correlation coefficient and presented by scatter plot. The specificity and sensitivity of HRT-MRA examination were, respectively, 100% and 68.1% when borderline cases were considered normal (criteria 1) and 97.3% and 85.1% when borderline cases were considered glaucomatous (criteria 2). The sensitivity of the MRA in eyes with different stages of visual field loss was 59.1% for early, 54.5% for moderate, and 92.8% for advanced visual field loss with criteria 1; the figures were, respectively, 81.8%, 72.7%, and 100% with criteria 2. The statistically significant correlations with moderate strength of association (r = 0.40-0.59) were found for rim area, rim volume, cup to disc area ratio, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area. The MRA showed an excellent specificity and good sensitivity using criteria 2 including as glaucomatous optic discs those classified by MRA as borderline. Although correlations of moderate strength were found between rim area, rim volume, mean RNFL thickness, RNFL cross-sectional area, and visual field index MD, great interindividual variation limits the prediction of one parameter from the other. Therefore, in clinical practice both structural and functional examinations should be performed in order to characterize glaucomatous damage.

Interpretation of Frequency Doubling Technology Perimeter in Diagnosis of Glaucoma and Glaucoma Suspect

Purpose: To find applicable parameters of the frequency doubling technology perimeter (FDP), which is known to be useful in detecting early visual field loss. Methods: The subjects were 65 eyes of normal individuals, 58 eyes of glaucoma suspects, and 37 eyes of glaucoma patients. FDP (MD, PSD), SAP (MD, PSD, CPSD), and 5 parameters of OCT were analyzed. The receiver operating characteristic (ROC) curve, sensitivity, and specificity of each parameter were evaluated, and the comparison of FDP parameters by Pearson's chi-square was made between the glaucoma suspect group and the normal group. The same comparison was made among the normal+glaucoma suspect and glaucoma group. Results: In discriminating between the normal and glaucoma suspect groups, the FDP-PSD revealed an AUC of 0.745 (cutoff: 3.17dB), which was significantly larger than that of SAP-PSD with an AUC of 0.660 (cutoff: 1.73dB). In comparing FDP, PSD by Anderson criteria was most reliable with a hit ratio of 0.732. On the other hand, in discriminating among the normal+glaucoma suspect group and glaucoma group, the SAP-PSD showed an AUC 0.971 (cutoff: 2.92dB), much larger than the FDP-PSD with an AUC of 0.863 (cutoff: 3.78dB). In addition, in comparing the parameters of FDP by Pearson chi-square, PSD 1% was the most reliable with a hit ratio of 0.813. Conclusions: FDP is a valuable screening tool in detecting early visual field loss. PSD by Anderson criteria can be a reliable parameter for the diagnosis of pre-perimetric glaucoma, and PSD 1% can be used in the discrimination of perimetric glaucoma.

Early Paracentral Visual Field Loss in Patients Taking Hydroxychloroquine

To review the natural history and ocular and systemic adverse effects of patients taking hydroxychloroquine sulfate who attended an ophthalmic screening program. Retrospective study. Records of 262 patients who were taking hydroxychloroquine and screened in the Department of Ophthalmology were reviewed. Of the 262 patients, 14 (18%) of 76 who had stopped treatment at the time of the study experienced documented adverse effects. Systemic adverse effects occurred in 8 patients (10.5%) and ocular adverse effects, in 5 (6.5%). Thirty-five patients (13.4%) had visual field abnormalities, which were attributed to hydroxychloroquine treatment in 4 patients (1.5%). Three of the 4 patients were taking less than 6.5 mg/kg per day and all patients had normal renal and liver function test results. The current study used a protocol of visual acuity and color vision assessment, funduscopy, and Humphrey 10-2 visual field testing and shows that visual field defects appeared before any corresponding changes in any other tested clinical parameters; the defects were reproducible and the test parameters were reliable. Patients taking hydroxychloroquine can demonstrate a toxic reaction in the retina despite the absence of known risk factors. Screening, including Humphrey 10-2 visual field assessment, is recommended 2 years after the initial baseline and yearly thereafter.