Esterman Visual Field Research Articles

Esterman Visual Field Testing Using a Virtual Reality Headset in Glaucoma

To test the use of a virtual reality visual field headset (VRVF) for implementation of the Esterman visual field (EVF) test as compared with standard automated perimetry (SAP) among people with glaucoma. Experimental design. Patients with mild to severe glaucoma ranging from 10 to 90 years who presented for follow-up at a glaucoma clinic in Miami, Florida were eligible. Participants performed the EVF test on both SAP and VRVF. Five glaucoma-trained ophthalmologists were then asked to rate all anonymized SAP and RVF tests as a "pass" or "failure" based on Florida state law. Point-by-point concordance between original VRVF EVF test results and SAP EVF test results was calculated using the Kappa statistic. Concordance between SAP and VRVF was secondarily assessed with a conditional logistic regression based on the pass-failure determinations by the glaucoma-trained ophthalmologists. Interrater agreement on test pass-failure determinations was also calculated. Finally, test results on SAP versus VRVF were compared based on Esterman efficiency score (EES), the number of correct points divided by the number of total points, and duration of testing. Twenty-two subjects were included in the study with ages ranging from 14 to 78 years old. Concordance between VRVF and SAP test using point-by-point analysis was poor (κ=0.332, [95% confidence intervals {CI}: 0.157, 0.506]) and somewhat increased using pass-failure determinations from ophthalmologists (κ=0.657, [95% CI: 0.549, 0.751]). Ophthalmologists were more likely to agree amongst themselves on pass-failure determinations for VRVF tests (κ=0.890, [95% CI: 0.726, 0.964]) than for SAP (κ=0.590, [95% CI: 0.372, 0.818]); however, VRVF demonstrated significantly lower EES than SAP (median EES difference: 4.5 points, P=0.021). This pilot study is the first to assess the implementation of the EVF test using a virtual reality headset. Based on the weak overall agreement between VRVF and SAP, the current VRVF EVF test is not an acceptable determinant of driver's licensing. However, ophthalmologists were more likely to agree amongst themselves on VRVF test reports than on SAP reports. With further testing and improvement, virtual reality may eventually become a portable and convenient method for administering the EVF test. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Reliability of Binocular Esterman Visual Field Test in Patients with Glaucoma and Other Ocular Conditions.

The binocular Esterman visual field test (EVFT) of 120 points was the first method to quantify the defects in the binocular visual field. It is used in many parts of the world as a standard test to determine whether an individual has the visual capabilities to drive safely. In Japan, it is required for the grading and issuance of visual disability certificates. The purpose of this study was to determine the reliability of the EVFT results. We studied 104 patients who had undergone the binocular EVFT at Mie University Hospital. Their mean age was 68.0 ± 11.4 years, and the best-corrected visual acuity of the better eye was 0.18 ± 0.38 logMAR units. The EVFT was performed twice on the same day, and the results of the first and second tests were compared. The mean Esterman scores for the first and second test were 89.3 ± 30.5 and 89.1 ± 30.2, respectively, and the test times were 338.9 ± 86.8 and 336.7 ± 76.4 s, respectively. The differences were not significant (p = 0.69 and p = 0.33). In the Bland-Altman analyses (second-first test) of the Esterman scores, the mean difference was 0.38 without significant fixed errors (p = 0.20) or proportional errors (p = 0.27). The limits of agreement within the 1.96 standard deviation were -8.96 to +9.45 points. The agreement rate for the most peripheral 24 test points was significantly lower than the agreement rate for the other 96 test points (p < 0.01). The agreement rate of the upper visual field was significantly lower than that of the lower field (p < 0.01). The overall reliability rate of the EVFT is acceptable, but the peripheral and upper test points have relatively low reliability rates. These findings are important for interpretations of the EVFT results.

Binocular visual field in adults with horizontal strabismus and driving requirements

ObjectiveTo determine the horizontal extent of the binocular visual field (BVF) in subjects with horizontal strabismus and whether the BVF falls below the driving standard.Methods and analysisAdults with congenital esotropia and infantile exotropia ≤45 Prism Dioptres (PD), and subjects with orthotropia were recruited. The manifest angle of deviation was measured using a simultaneous prism cover test. Monocular Visual Field (MVF) and BVF were measured using the Esterman visual field test. Subjects with diplopia or a manifest angle of strabismus that varied by>8PD or the present of a vertical tropia >8PD were excluded.ResultsForty-nine subjects were included: 10 with orthotropia, 20 with exotropia and 19 with esotropia. The horizontal extent of BVF (degrees) was significantly smaller in esotropes (122.8 ± 18.8) than in orthotropes (141 ± 6.6) or exotropes (138.3 ± 8.3) (p < 0.01). In 6 (31.6%) subjects with an esotropia, the BVF was below the driving standard. The horizontal extent of the visual field (VF) of the amblyopic eyes of patients with esotropia (98.70 degrees, SD 19.76) and exotropia (104.75 degrees, SD16.93) were significantly smaller than those with orthotropia (121.00 degrees SD 3.16) by 22.3 degrees (p = 0.004) and 16.25 degrees (p = 0.045), respectively. The difference between the summation of MVFs and the BVF was significantly greater in orthotropes (100.6 ± 2.7) than in exotropes (68.9 ± 34.4) and esotropes (74.2 ± 20.7) (p < 0.01).ConclusionThe horizontal extent of BVF is significantly smaller and more variable in adults with congenital esotropia and may fall below the driving standard.Strengths and limitationsLargest study on visual fields in subjects with horizontal strabismus including an orthotropic control group who do not have diplopia and who would otherwise meet the driving standard.Visual field quality was high but limitation is that visual field repeatability was not undertaken.How this study might affect research, practice, or policyThe findings of this study would suggest that people with an esotropia should be offered the opportunity to have a binocular visual field test before applying for a driving license. The DVLA may want to consider requesting people with an esotropia to have a binocular visual field test as is a requirement with other ophthalmic conditions such as glaucoma.

Glaucoma and Driving License: How to Identify Patients at Risk of Revocation

AimTo identify clinical criteria that are easily achievable with follow-up tests and can identify subjects not suitable for driving.Patients and methodsWe recruited 194 subjects with a clear diagnosis of glaucoma, with no other conditions that could affect the visual field (VF), and who performed a reliable VF examination. All patients underwent a full ophthalmologic evaluation and a questionnaire considering driving habits. An integrated visual field (IVF) was built using both monocular VF charts; the number of missed points (NoMP) within the central 20°, the average sensitivity (AS), and the better eye mean deviation (BEMD) were evaluated.ResultsA total of 128 subjects showed a valid driving license (DL); 61.7% of drivers did not show missed points within the central 20° of the IVF, 27.4% presented one to three missed points, and 10.9% had four or more missed points. Best corrected visual acuity (BCVA) was highly above the legal criteria.Stratifying drivers by their BEMD (−7, −10, and −14 dB), we confirmed that the BEMD decrease corresponds to an increased NoMP and a decreased AS.ConclusionBetter eye mean deviation can be useful in clinical practice to identify patients at increased risk of being unsuitable for driving. Nevertheless, it is important to set specific cut-offs based on on-road driving performance. IVF evaluation may also be implemented in perimeter analysis software so that the composition of IVF, the BEMD, and the AS could directly describe the patient's binocular VF, excluding recourse to the Esterman visual field test (EVFT).Clinical significanceThis new methodology will allow every physician—not just ophthalmologists—even if not an expert in evaluating a VF test, in assessing the ability to drive of glaucomatous patients.How to cite this articleLandini L, Donati S, Digiuni M, et al. Glaucoma and Driving License: How to Identify Patients at Risk of Revocation. J Curr Glaucoma Pract 2022;16(2):117-123.

Evaluating the efficacy and safety of transdermal electrical stimulation on the visual functions of patients with retinitis pigmentosa: a clinical trial protocol for a prospective, multicentre, randomised, double-masked and sham-controlled design (ePICO trial)

IntroductionPreviously, we conducted a clinical trial to evaluate the safety and efficacy of transdermal electrical stimulation (TdES) with skin electrodes to improve the visual functions in patients with retinitis pigmentosa...

Predictive Value of the Esterman Visual Field Test on the Outcome of the On-Road Driving Test.

PurposeAs the prevalence of age-related visual field disorders and the number of older drivers are rising, clear criteria on visual field requirements for driving are important. This article explores the predictive value of the Esterman visual field in relation to the outcome of an on-road driving test.MethodsA retrospective chart review was performed for driver's license applicants who, based on their visual field, performed an on-road driving test. Cases (N = 101) with a failed on-road driving test were matched with 101 controls with a passed outcome. The Esterman visual field was divided in regions, and the number of points missed per region was counted. Logistic regression models and receiver operating characteristic (ROC) curves were computed for each region.ResultsMost regions presented a significantly increased odds for failing the driving test when more points were missed. The odds ratio for the whole visual field was 2.52 (95% confidence interval, 1.53–4.14, P < 0.001) for all the participants. However, ROC curves failed to reveal distinct fail–pass criteria based on the number of points missed, as revealed by a large amount of overlap between cases and controls.ConclusionsThese findings confirm the relation between visual field damage and impaired driving performance. However, the Esterman visual field results were not conclusive for predicting the driving performance of the individual driver with visual field defects.Translational RelevanceIn our group of participants, the number of on-road driving tests cannot be further reduced by a more detailed definition of fail–pass criteria, based on the Esterman visual field test.

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.

Impact of binocular visual field loss on driving performance in glaucoma patients.

To evaluate the driving performance in young and middle-aged Chinese glaucoma patients with mild to severe visual field loss compared to those without glaucoma by using a driving simulation test. Twenty-nine participants were included in this study: nine patients with glaucoma but pass the binocular Esterman visual field test, ten patients with glaucoma and fail the binocular Esterman visual field test, and ten age-matched healthy controls. A driving simulation test was designed as a frequency-based analysis of a lane-keeping task. The total performance error, the control-response amplitude and delay were calculated. Esterman visual field test fail group showed the longest delay of control-response among three groups (P=0.02). And the delay in lane-keeping task was significantly associated with inferior field of better-eye (r=0.51, P=0.004) and integrated visual field (r=0.55, P=0.002). Young and middle-aged glaucoma patients with binocular visual field loss suffered from a longer delay of response in driving simulation test, while inferior visual field having more impact than superior visual field.

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.

Correlation Between Visual Function and Performance of Simulated Daily Living Activities in Glaucomatous Patients.

To analyze the correlations between functional clinical tests and the performance of glaucoma patients in simulated daily living activities. Thirty-two patients with chronic glaucoma, followed at the Quinze-Vingts National Ophthalmology Hospital, were included. All patients had a clinical evaluation of visual function including best-corrected visual acuity, contrast sensitivity, and monocular and binocular visual field (VF) tests. Four different simulated activities of daily living were evaluated in standardized artificial platforms (StreetLab and HomeLab): "mobility" and an obstacle avoidance task in an artificial street, "reaching and grasping" large and small objects on a kitchen work surface, "localization of people" and "face orientation recognition." Patient performance in the different tasks was correlated with VF evaluation including integrated binocular visual field (IVF), VF mean deviation (MD) of the better and the worse eye, Esterman binocular VF, best-corrected visual acuity, and contrast sensitivity. The IVF score was significantly correlated with "localization of people" time (r=0.49; P=0.003), "face orientation recognition" time (r=0.50; P=0.002), and "movement onset" for reaching and grasping small objects (r=0.38; P=0.029). The MD of the better eye appeared significantly correlated with "face orientation recognition" time (r=-0.44; P=0.009) and "localization of people" time (r=-0.46; P=0.005). The Esterman score appeared significantly correlated with "mobility time" (r=-0.40; P=0.018), "localization of people" (r=-0.37; P=0.030), "face orientation recognition" times (r=-0.39; P=0.024), and "movement onset" for reaching and grasping large objects (r=-0.43; P=0.015). The IVF score and the MD of the better eye appeared to better evaluate "reaching and grasping," "face orientation recognition," and "localization of people" simulated tasks, whereas for the "mobility" task, the Esterman VF seemed more useful. The precise evaluation of the glaucoma patient's ability to perform everyday life tasks is complex and may require both monocular and binocular VF tests.

A comparison of the interpretation of Esterman visual field charts using the Australian assessing fitness to drive 2012 standards and the UK Driver and Vehicle Licensing Agency 2014 guidelines

A comparison of the interpretation of Esterman visual field charts using the Australian assessing fitness to drive 2012 standards and the <scp>UK</scp> Driver and Vehicle Licensing Agency 2014 guidelines

Methods for Prism Placement for Hemianopic Visual Field Loss in Adults with Low Vision

Several adult patients with low vision have come to the Advanced Low Vision Clinic at the Corporal Michael Crescenz Department of Veterans Affairs Medical Center (CMCVAMC), in Philadelphia, Pennsylvania, and to the Bucks County Association for the Blind and Visually Impaired, in Newton, Pennsylvania, with a diagnosis of hemianopic loss secondary to a stroke in the visual cortex; brain tumors; or traumatic brain injury. Prism placement for peripheral field loss allows patients to have enhanced peripheral awareness and an increased peripheral field depending on the type of prism used (Brillant, 1999). To determine prism placement, a low vision optometrist evaluates the patient. The evaluation consists of trials of different types of prism systems, including Fresnel, Gottlieb, Onufryk, and Eli Peli. When a preference for a particular prism system is shown, it is temporarily placed. The optometrist confers with the orientation and mobility (O&M) specialist to discuss patient goals and a plan of care. The O&M specialist performs an evaluation and provides visual scanning training as well as instruction in the functional use of prisms. This report describes the process used in these centers for assessing and placing the prism for these individuals. Prior to prism placement, a full visual field test is completed using a Zeiss, Octopus, or Goldman perimeter, which accurately define the visual field loss. The optometrist and O&M specialist review the results of this test to determine the plan of care for the patient. An Esterman visual field test is completed if the patient is interested in driving again. The Esterman test measures the visual field with both eyes open, as this is required by states that permit driving only if an individual has a visual field of 120 degrees across the horizontal meridian. Prism placement is first tested with a 20-40D Fresnel prism cut to the shape of the spectacle lens in the area of field loss with the prism's base facing in the direction of vision loss. The prism is placed by the optometrist to bisect the pupil so its edge can be seen without scanning into the prism. The edge is then trimmed with iridectomy scissors to the edge of the pupil. The patient then scans into the edge and is asked to count fingers within 10-15 degrees of the non-seeing field. The individual is then asked to ambulate and to detect objects in the non-seeing field. For example, if the non-seeing field is temporal, the scan would be to the left or right to view a painting on the wall, a doorway, or a person passing to the side. If the prism edge is causing diplopia, it is trimmed again to the edge of the dilated pupil. In another method of prism placement, an individual is asked to look straight ahead at his or her nose (if the nose can be seen). If they cannot see their nose, then they are asked to look towards the center of their face, then bring a Post-it note (a small self-adhesive piece of paper) along the plane of their glasses from the non-seeing area into the plane of where they can just see the edge of the Post-it note. They then move the Post-it note back 1 millimeter (mm) until they can no longer see it. When viewing straight ahead, they should not see the edge of the Post-it note. A permanent marker pen such as a Sharpie can then be used to mark the eyeglass lens for later placement of the Fresnel prism (Giorgi, Woods, & Peli, 2009). Choosing the strength of the prism depends on the size of the defect and the individual's tolerance. As a general rule of thumb, the number of degrees the image is moved is half the dioptric power of the prism. Therefore, a 30-diopter prism will move the image approximately 15 degrees. The base of the prism is always placed towards the area of the defect in order to move the image towards the seeing area. The base is marked on the Fresnel prism for orientation. The clinician places the prism to the edge of the defect as described above (Warren & Barstow, 2011). …

The Effect of Multispot Laser Panretinal Photocoagulation on Retinal Sensitivity and Driving Eligibility in Patients With Diabetic Retinopathy.

Panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) may lead to peripheral field loss that prevents driving. Anti-vascular endothelial growth factor agents are proposed as treatments for PDR that spare peripheral vision. If multispot lasers cause less visual field loss, continuing to perform PRP may be justified. To assess the effect of bilateral multispot laser PRP on retinal sensitivity and driving visual fields in PDR. This prospective nonrandomized interventional cohort analysis performed at a tertiary referral center included 43 laser-naive patients with PDR that required bilateral PRP. Participants were recruited from June 27, 2012, to October 14, 2013. At baseline and 6-month follow-up, patients underwent detailed static and kinetic perimetry, microperimetry, optical coherence tomography, wide-field color fundus photography, and fluorescein angiography. Quantitative change in retinal sensitivity was assessed by comparing the mean global retinal sensitivity before and after laser treatment and by comparing the modeled hill of vision by deriving a volumetric measure. Final follow-up was completed on May 21, 2014. Multispot laser treatment was applied using standard parameters, until neovascularization regressed or complete retinal coverage was achieved. Participants who passed the Esterman binocular visual field test for driving in the United Kingdom (at least 120° horizontal field with no significant defects within the central 20°) and full-field and macular retinal sensitivity. Of the 43 patients (17 men; 26 women; mean [SD] age, 46.6 [13.3] years), 38 (88%) completed the study. Before treatment, 41 of 43 patients (95%) passed the Esterman visual field test for driving; after completion of laser treatment, 35 of 38 patients (92%) passed. The mean (SD) change in retinal sensitivity on static perimetry was -1.4 (3.7) (95% CI, -2.7 to -0.1) dB OD and -2.4 (2.9) (95% CI, -3.4 to -1.4) dB OS. Mean (SD) 4° macular sensitivity decreased by 3.0 (5.2) dB OD and 2.6 (5.4) dB OS. This prospective study investigating the effects of multispot laser PRP on retinal sensitivity demonstrates a high likelihood of retaining eligibility to drive based on adequate visual field. A mild loss of retinal sensitivity was detected at 6 months after completion of laser treatment. Further change to visual fields may have occurred with longer follow-up. This study provides information that might be used to counsel patients requiring PRP and informs the debate regarding the role of anti-vascular endothelial growth factor therapy in patients with PDR who might otherwise receive laser treatment.

Assessment of the Vision-Specific Quality of Life Using Binocular Esterman Visual Field in Glaucoma Patients

Assessment of the Vision-Specific Quality of Life Using Binocular Esterman Visual Field in Glaucoma Patients

Comparison of the monocular Humphrey visual field and the binocular Humphrey esterman visual field test for driver licensing in glaucoma subjects in Sweden

BackgroundThe purpose of this study was to compare the monocular Humphrey Visual Field (HVF) with the binocular Humphrey Esterman Visual Field (HEVF) for determining whether subjects suffering from glaucoma fulfilled the new medical requirements for possession of a Swedish driver’s license.MethodsHVF SITA Fast 24–2 full threshold (monocularly) and HEVF (binocularly) were performed consecutively on the same day on 40 subjects with glaucomatous damage of varying degrees in both eyes. Assessment of results was constituted as either “pass” or “fail”, according to the new medical requirements put into effect September 1, 2010 by the Swedish Transport Agency.ResultsForty subjects were recruited and participated in the study. Sixteen subjects passed both tests, and sixteen subjects failed both tests. Eight subjects passed the HEFV but failed the HVF. There was a significant difference between HEVF and HVF (χ2, p = 0.004). There were no subjects who passed the HVF, but failed the HEVF.ConclusionsThe monocular visual field test (HVF) gave more specific information about the location and depth of the defects, and therefore is the overwhelming method of choice for use in diagnostics. The binocular visual field test (HEVF) seems not be as efficient as the HVF in finding visual field defects in glaucoma subjects, and is therefore doubtful in evaluating visual capabilities in traffic situations.

Fitness to drive in glaucoma patients‐ Preliminary study results

Abstract Purpose To develop a useful binocular 30° visual field criterion to predict safe driving behaviour in glaucoma patients by comparing perimetric data with an actual driving test on the road. Methods The sample will consist of 200 driving glaucoma patients, recruited in 2 university based glaucoma clinics (Ghent and Leuven, Belgium). Inclusion criteria are glaucomatous optic disc damage and/or glaucomatous field defects. Exclusion criteria are concomitant ocular disease, cataract &gt; LOCS 2, systemic disease or medication affecting the visual field. Data collection will include demographic and medical data, driving habits, and Mini Mental Status. A complete ophthalmic examination wil be done including Goldmann, SAP and Esterman visual field testing. In addition, UFOV test, stereopsis and contrast sensitivity testing will be performed. All subjects will perform an on the road driving test with a driving expert of the Belgian Institute for Traffic Safety. Subjects can pass, fail, or pass the test with limitations. An attempt will be made to develop an algorithm of visual field abnormalities that predict as accurately as possible the outcome of the practical driving test. Results Preliminary results of the first 50 included patients will be presented.

Assessing visual fields for driving in patients with paracentral scotomata

Background:The binocular Esterman visual field test (EVFT) is the current visual field test for driving in the UK. Merging of monocular field tests (Integrated Visual Field, IVF) has been proposed...

Visual fields in patients who have undergone vitrectomy for complications of diabetic retinopathy. A prospective study

BackroundTo determine the extent of visual field loss in patients who had required a pars plana vitrectomy secondary to complications of proliferative diabetic retinopathy.MethodsPatients that had undergone a vitrectomy on at least one eye for treatment of either vitreous haemorrhage or tractional retinal detachment were selected for study. ETDRS acuity and Humphrey binocular Esterman visual field testing were performed and compared to the minimum standards for safe driving as defined by the Royal College of Ophthalmologists in 1999. In addition to this Goldman kinetic visual fields using a III4e and V4e stimulus size and central 24-2 threshold test with the SITA-fast strategy were performed on the vitrectomised eye.Results20 patients (n = 20) were recruited. Mean visual acuity in the eye being tested was 0.20 (Snellen 6/9.5). Results from the Humphrey field analyzer showed a mean number of abnormal stimulus locations of 71.2% (p < 0.005). 70% of patients had sufficient binocular acuity to drive and of these 71.4% were shown not to have a minimum visual field for safe driving on binocular Esterman field analysis.ConclusionVitrectomy potentially allows retention/restoration of good visual acuity in patients with complications of proliferative diabetic retinopathy. However patients may be suffering from unrecognized visual impairment consequent upon extensive visual field loss which in over two thirds of patients may be sufficiently severe to preclude safe driving.

Integrated visual fields: a new approach to measuring the binocular field of view and visual disability

We have developed a method of quantifying the central binocular visual field by merging results from monocular fields (Integrated visual field). This study aims to compare the new measure with the binocular Esterman visual field test in identifying patients with self-reported visual disability. Forty-eight patients with glaucoma each recorded Humphrey 24-2 fields for both eyes and an Esterman on the same day, and each completed a binary forced-choice questionnaire relating to perceived visual disability. Computer software merged sensitivity values from monocular fields to generate an integrated visual field and a related score of the number of defects at the <10 dB and <20 dB level. Receiver operating characteristic (ROC) analysis was used to compare the integrated visual field score and the Esterman disability score with individual responses to the questions on perceived difficulty with visual tasks. Comparison of areas under ROC curves revealed that a score based on the integrated visual field was generally better (median area: 0.79) than Esterman scores (median area: 0.70) in classifying patients with or without a self-reported perceived difficulty with visual tasks. The integrated visual field offers a rapid assessment of a glaucoma patient's binocular visual field without extra perimetric testing. As compared to an actual binocular field test (Esterman), the integrated visual field provides a better prediction of a glaucoma patient's perceived inability to perform certain visual tasks.

Visual field attention is reduced by concomitant hands-free conversation on a cellular telephone

Purpose To quantify the central attention-diverting effect of hands-free cellular phone conversation on visual field awareness. Design Experimental study. Methods Twenty male and 21 female healthy participants performed a pretest and baseline Esterman visual field examinations with the Humphrey Systems Visual Field Analyzer II. During the consequent third examination, each participant engaged in a hands-free conversation using a cellular phone. The conversation was the same for all participants. Visual field performance parameters were compared between the second (baseline) examination, and the third (test) examination for each eye. Results During phone conversation, missed points increased from mean 1.0 ± 1.5 to 2.6 ± 3.4 ( P ≤ .001) in the right eye and from 1.1 ± 1.53 to 3.0 ± 3.4 ( P < .001) in the left eye. Fixation loss increased from mean 7.8% to 27.4% ( P < .0001) and from 7.2% to 34.8% ( P < .0001) for the right and left eyes, respectively. Test duration increased by a mean of 0.28 seconds (15%) per stimulus ( P < .0001). Approximately half of missed points were inside the central 30 degrees. There was no significant difference in the performance of male and female participants. Conclusion We describe a new model for the quantification of the attention-diverting effect of cellular-phone conversation on the visual field. In the current study, cellular hands-free conversation caused some subjects to miss significantly more points, react slower to each stimulus, and perform with reduced precision. Legislative restrictions on concomitant cellular-phone conversation and driving may need to be based on individual performance rather than a general ban on cellular phone usage.