Field Testing In Patients Research Articles

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.

Effect of presbyopic correction lens on humphrey visual field testing in patients with multifocal intraocular lens.

Most previous studies on the effects of multifocal intraocular lenses (MIOL) on Humphrey visual field (HVF) used presbyopic corrective lens (PC). There has been insufficient data from patients with MIOL performing HVF with and without PC. This study aimed to determine the effect of PC on HVF testing in patients with MIOL. This was a prospective, comparative crossover study at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University between June 2015 and July 2018. Early-stage glaucomatous and non-glaucomatous pseudophakic patients with 2 models of MIOL completed HVF testing with and without PC. Mean deviation (MD), pattern standard deviation (PSD), and reliability indices (fixation losses, false positives, and false negatives) were compared. Ninety-four eyes of 59 patients were enrolled. After excluding patients with confirmed unreliable visual field, 82 eyes of 51 patients (male, 22; female, 29) with a mean age of 65.4 years were included in the study. Forty-nine eyes were non-glaucoma and 33 eyes were early-stage glaucoma. Forty-four eyes received TECNIS ZM900 and 38 eyes received Acrysof IQ ReSTOR SN6AD1. The overall MD standard deviation was -3.5 (2.1) with PC and -3.1 (2.1) without PC (P = .01). The overall PSD standard deviation was 2.8 (1.5) with PC and 2.7 (1.5) without PC (P = .93). The reliability indices were not statistically significantly different with and without PC. There was a good intraclass correlation (ICC) of MD (ICC = 0.87) and PSD (ICC = 0.88) with and without PC. Eyes with TECNIS ZM 900 had significantly better MD when performing HVF without PC (mean difference -0.7, P < .01), but not with Acrysof IQ ReSTOR SN6AD1 (mean difference -0.1, P = .74). Pseudophakic eyes with MIOL may not require PC during HVF testing regardless of the MIOL model. Although eyes with TECNIS ZM900 performed HVF without PC resulted in a significantly better MD value compared with PC, the difference was not clinically significant.

Influence of ACPA-positive rheumatoid arthritis on visual field testing in patients with arterial hypertension: A comparative cross-sectional study.

PurposeTo evaluate a possible influence of anti‐cyclic citrullinated peptide autoantibodies (ACPA) ‐ positive rheumatoid arthritis (RA) on visual field (VF) testing in patients with arterial hypertension (aHT).MethodsWe conducted an observational cross‐sectional study comparing patients with ACPA‐positive RA and aHT, patients with aHT and healthy subjects. Further inclusion criteria were visual acuity (VA) of 0.8 or better and age between 40 and 60 years. VF testing was performed with standard automated achromatic perimetry (SAP), short wavelength automated perimetry (SWAP) (Octopus 300®) and flicker perimetry (Pulsar®). Results were analysed for a possible correlation with blood pressure or RA‐activity.ResultsTwenty subjects with RA and aHT, 26 patients with aHT and 22 healthy participants were examined. Significant differences were found for mean sensitivity (MS) in SWAP comparing RA‐patients with healthy participants (ΔMS −3.06, p = 0.001) and with hypertensive patients (ΔMS −2.32, p = 0.007). In SAP we observed a significant difference between patients with RA and healthy subjects regarding loss variance (LV) (ΔLV = +9.77, p = 0.004). Flicker perimetry did not demonstrate significant differences between groups. A correlation of VF changes with blood pressure level or RA‐activity was not observed.ConclusionPatients with ACPA‐positive RA and aHT showed significant impairment of VF performance in SWAP compared to patients with aHT alone and healthy subjects. SAP also revealed a significant difference of LV between RA‐patients and healthy subjects. aHT does not seem to induce functional changes in VF testing alone.

Introducing the 24-2C Visual Field Test in Neuro-Ophthalmology.

The Humphrey 24-2C visual field test is a modified 24-2 visual field test that incorporates 10 additional test points in the central 10° of vision. This study compares the new 24-2C test to the standard Humphrey 10-2 visual field test in patients presenting for neuro-ophthalmology evaluation to evaluate its ability to detect central visual field defects. Twenty-five neuro-ophthalmology patients (42 eyes) underwent both 24-2C and 10-2 visual field testing using the Humphrey perimeter. The number of flagged total deviation (TD) and pattern deviation (PD) points of the 10 added test points of the 24-2C were compared with the corresponding 10-2 fields at the P < 5%, P < 2%, and P < 1% significance levels. The total number of flagged TD points were further analyzed by diagnosis. An experienced neuro-ophthalmologist evaluated all visual fields, commenting on the added value for clinical practice. There was no significant difference between the number of flagged TD and PD points of the 10 extra 24-2C points and corresponding 10-2 points at all significance levels. When analyzed by diagnosis, there was no significant difference in the number of flagged TD points in patients with optic neuritis, ischemic optic neuropathy, optic atrophy, and no neuro-ophthalmic disease. The added 24-2C points aided in identifying visual field defects and areas of spared central vision and had similar diagnostic value as the 10-2. The 24-2C is able to detect visual field loss in the central 10° that corroborates with loss detected in the 10-2 pattern. The 24-2C exhibits potential to be used as a hybrid between the 24-2 and 10-2 to better evaluate visual field defects.

A Novel Method of Visual Field Assessment for Patients with Unilateral Severely Limited Central Vision: A Pilot Study.

PurposeReliable visual field testing requires the tested eye to be fixated on a central target. This poses a major obstacle for eyes with severe central vision loss. This pilot study assesses whether it may be feasible to examine such patients with a modified method.MethodsA green filter was placed over the fellow eye. A FASTPAC algorithm was used with a red stimulus. The green filter prevented transmission of the red stimuli but allowed visualization of the yellow fixation light. Subjects were tested by both the conventional and the novel method, performed in a randomized order. We compared the reliability indices and also the precision of the two methods.ResultsWe present results from six patients. The novel method was associated with an 85% reduction in fixation losses (P=0.028) and a 58% reduction in eye motion on gaze tracking (P=0.007). Further, specialized testing in one of the volunteers demonstrated that the novel technique could more precisely define a small zone of preserved peripheral vision (P=0.008).ConclusionThe results of this pilot study suggest that the novel method described may be a feasible strategy for visual field testing in patients with unilateral severe central vision loss.

The effect of pupillary dilatation on visual field testing in glaucoma

Introduction The concern on the effect of pupillary dilatation on visual field parameters in patients with glaucoma comes from the fact that patients usually seek field examination after their pupils have been dilated for fundus examination. Aim To investigate the influence of pupillary dilatation on visual field testing in patients with glaucoma, by using automated static perimetry. Patients and methods A prospective comparative noninterventional clinical study was conducted on 20 eyes (11 patients) with open-angle glaucoma. Two consecutive visual field examinations were performed on each eye of all participants. The first was done on the undilated normal pupil size, whereas the second was done after dilating the pupil to 6–8 mm. Results After pupillary dilatation, fixation losses were significantly higher. There was no significant difference in false-negative or false-positive results. There was improvement in the mean deviation with no statistical significance. Pattern standard deviation showed also improvement, which was statistically significant. Discussion and conclusion It was found that pupillary dilatation caused variability and difference in the visual field parameters, which emphasizes the importance of consistent pupillary size in performing the serial automated visual field tests, especially in patients with glaucoma to allow standardized judgment on the patient’s progression.

Factors Affecting the Duration of a Humphrey&lt;sup&gt;®&lt;/sup&gt; Visual Field Test in Patients with Glaucoma

Factors Affecting the Duration of a Humphrey&lt;sup&gt;®&lt;/sup&gt; Visual Field Test in Patients with Glaucoma

Evaluation of Central Scotoma Based on Stimulus Size of the Visual Field Test in Patients with Leber Hereditary Optic Neuropathy

Evaluation of Central Scotoma Based on Stimulus Size of the Visual Field Test in Patients with Leber Hereditary Optic Neuropathy

The importance of visual field testing in patients with papilledema and idiopathic intracranial hypertension

The importance of visual field testing in patients with papilledema and idiopathic intracranial hypertension

Investigation of goldmann perimetry in evaluation of patients for upper eyelid blepharoplasty

ABSTRACTPurpose: To determine if preoperative Goldmann Visual Field (GVF) testing in patients with functional dermatochalasis accurately depicts the postoperative superior visual field (SVF) outcome.Methods: A prospective cohort study was done to compare preoperative and postoperative GVF field tests in patients undergoing upper eyelid blepharoplasty for treatment of dermatochalasis. This study was conducted in accordance with the Declaration of Helsinki and approved by the University of Arkansas for Medical Sciences institutional review board. A preoperative GVF was obtained with the eyelids in the natural position (untaped) and then again with excess skin elevated (taped). One month post-blepharoplasty, another GVF was conducted with eyelids untaped. The pre- and post GVF tests were analyzed to determine if preoperative testing accurately predicts the SVF improvement post-blepharoplasty.Results: Forty-six eyelids (23 patients) who underwent blepharoplasty for dermatochalasis were included. The preoperative testing underestimated 76% (35/46) of cases by a mean of 61%; and overestimated the final outcome in 24% (11/46) of cases by mean of 23%. Overall, the preoperative GVF testing underestimated the postoperative outcome by a mean of 35%.Conclusion: Improvement of the SVF after a blepharoplasty is typically greater than the preoperative GVF testing predicts.

Isolated reversible toxic optic neuropathy secondary to linezolid

A 67-year-old male diagnosed with methicillin-resistant Staphylococcus aureus-induced osteomyelitis was started on second-line antibiotic therapy (linezolid). One year following initiation of treatment, he presented to the emergency room with bilateral painless acute deterioration in vision. Visual field testing suggested bilateral optic neuropathy. Following cessation of linezolid visual acuity and visual fields reverted to normal. A handful of case reports has described reversible optic neuropathy occurring shortly after initialization of linezolid treatment. This is, to the best of our knowledge, the first report of isolated delayed onset reversible optic neuropathy with concomitant use of linezolid unaccompanied by any other systemic toxic manifestations. Reversible optic neuropathy may occur in patients receiving long-term linezolid treatment. Ophthalmic follow-up including visual field testing in patients receiving long-term linezolid treatment may assist in early recognition.

Influence of RNFL Thickness on Visual Acuity and Visual Field in Bilateral Temporal Optic Atrophy

Purpose: To investigate the influence of retinal nerve fiber layer (RNFL) thickness on visual acuity and visual field in patients with bilateral temporal optic atrophy. Methods: Patients with characteristic features of gradual visual loss and temporal atrophy of both optic nerves were enrolled in this study. Among the patients, RNFL thickness of each area was measured with optical coherence tomography, and its influence on the best corrected visual acuity, mean deviation and pattern standard deviation calculated from the refractive test and Humphrey visual field test was analyzed. Results: The present study included 13 patients with bilateral temporal optic atrophy (26 eyes) and 13 normal controls (26 eyes). Optical coherence tomography was performed to calculate RNFL thickness in the 52 eyes. Among 26 eyes of patients with bilateral temporal optic atrophy, the Humphrey visual field test was performed to calculate the mean deviation and pattern standard deviation. The mean age in the patient group was 66.0 ± 12.3 years (37‒80 years), and 8 (30.8%) patients were male and 18 (69.2%) female. The mean best corrected visual acuity was 30/50 (20/200‒20/20). Simple regression analysis showed that a thinner temporal RNFL thickness was correlated with a lower the best corrected visual acuity (p = 0.015). The mean deviation was low when inferotemporal RNFL was thin (p = 0.005). Pattern standard deviation was high when inferotemporal (p = 0.003), inferonasal (p = 0.04) and nasal (p = 0.008) RNFLs were thin. Conclusions: Inferotemporal RNFL thickness was significantly correlated with best corrected visual acuity, mean deviation and pattern standard deviation of automated visual field test in patients with bilateral temporal optic neuropathy. Optical coherence tomography can be further used to estimate visual acuity and visual field defects in patients with optic atrophy. J Korean Ophthalmol Soc 2016;57(6):969-976

Effect of artificial tears on automated visual field testing in patients with glaucoma and dry eye

ObjectiveTo evaluate the effects of artificial tears on automated visual field (VF) testing in patients with glaucoma with dry eye syndrome. DesignProspective study. ParticipantsFifty eyes of 50 patients with medically treated primary open-angle glaucoma (POAG) were recruited for this study. The patients were subdivided into 2 subgroups: those with dry eye syndrome (group I) and those without dry eye syndrome (group II). MethodsTear break-up time, Lissamine green staining, and Schirmer I test with topical anesthesia were performed in the same order in all patients. Ocular Surface Disease Index questionnaire was completed by the patients. All participants underwent automated perimetry using the 24-2 SITA (Swedish interactive threshold algorithm) standard strategy before and after 1-week treatment with a lubricating eye drop 4 times daily. VF results were compared before and after the treatment using Wilcoxon signed rank test, and Mann–Whitney test was performed to compare the results of patients in groups I and II. ResultsOf the 50 patients, 25 (50%) were diagnosed with dry eye syndrome. No significant differences between both groups were found with respect to age (P = 0.779) and glaucoma duration (P = 0.722). In patients with glaucoma with dry eye syndrome, there was a significant improvement in test duration, mean deviation, and the number of depressed points at probability level less than 0.5% and less than 1% in pattern deviation plots after the treatment (P< 0.05). ConclusionsThe use of artificial tears in patients with glaucoma with dry eye syndrome decreased VF testing time and improved test results.

Value of Red Targets and Pattern Deviation Plots in Visual Field Screening for Hydroxychloroquine Retinopathy

To compare the value of red vs white 10-2 visual field testing in patients with different levels of hydroxychloroquine exposure and retinopathy in reference to recent American Academy of Ophthalmology recommendations on screening for hydroxychloroquine retinopathy that advised the use of 10-2 visual field testing with a white test object. We studied retrospectively 13 patients using hydroxychloroquine who had undergone both red (FASTPAC) and white (SITA) 10-2 automated visual field testing in the course of their management. On clinical grounds, they were judged to have no retinopathy, early retinopathy, or moderate or severe hydroxychloroquine retinopathy. White visual field diagrams were difficult to interpret, but pattern deviation plots consistently showed parafoveal sensitivity losses in early retinopathy. Red fields often showed more prominent scotomas in early retinopathy but sometimes showed irregular losses that were hard to evaluate. Either modality showed clear losses in moderate retinopathy. On repeated testing, the pattern deviation plots were somewhat more consistent than red fields in showing parafoveal damage. With white 10-2 visual field hydroxychloroquine screening, the use of pattern deviation plots should be standard practice. Red testing appears to be more sensitive for early retinopathy but may be slightly less specific or consistent. We believe the main application for red testing is in screening for the earliest signs of retinopathy. Either red or white fields should be acceptable for hydroxychloroquine screening, as long as the clinician is sensitive to the characteristic patterns of early parafoveal damage and is prepared to retest fields and add objective tests.

Primer on visual field testing, electroretinography, and other visual assessments for patients treated with vigabatrin

Vigabatrin, an irreversible inhibitor of γ-aminobutyric acid transaminase, is an antiepileptic drug indicated in the United States as adjunctive therapy for adult patients with refractory complex partial seizures who have responded inadequately to several alternative treatments and for monotherapy treatment of infantile spasms in patients 1 month to 2 years of age. Approval of vigabatrin in the United States was contingent on the implementation of a Risk Evaluation and Mitigation Strategy (REMS) to manage the threat of a progressive, permanent bilateral concentric peripheral visual field defects (pVFDs) that may occur in patients treated with vigabatrin. The REMS is designed to promote compliance with evidence-based recommendations for baseline (within 4 weeks of the start of treatment) ophthalmologic evaluations and ongoing vision monitoring in all patients treated with vigabatrin. In view of the challenges associated with visual field testing in patients with epilepsy and in infants, clinicians must understand the qualitative (pattern of damage), quantitative (degree of damage), electrophysiologic, and adjunctive techniques recommended for monitoring vigabatrin-treated patients. The objectives of ongoing research are to characterize the onset, progression, and risk of developing vision loss during the first year of vigabatrin treatment and to evaluate the potential of noninvasive imaging as a method for monitoring retinal changes corresponding to the pVFD. This article provides an overview of visual field testing procedures and electroretinography, summarizes the clinical characteristics of vigabatrin-associated pVFDs, and provides recommendations for visual field and visual electrophysiology testing relevant to both adult and infant patients treated with vigabatrin.

Effect of Cataract Extraction on Visual Field Test in Patients with Glaucoma

Purpose: To determine the effect of cataract extraction on visual field damage in glaucoma patients with cataracts. Methods: Sixty-two eyes of fifty glaucoma patients (primary open-angle glaucoma, angle-closure glaucoma, and normal-tension glaucoma) were divided into three groups according to the MD (mean deviation) value from the Humphrey automatic visual field test. The PSD (pattern standard deviation) values were analyzed before and after the cataract surgery. Additionally, the visual acuity, intraocular pressure and the number of antiglaucomatous agents were compared. Results: All of the three groups, showed significant improvement in visual acuity. However, there was only a significant decrease in intraocular pressure at three months postoperatively. When comparing the mean MD values of each group, there was a statistically significant difference between the mild defect group and the severe defect group, but no statistically significant difference in the moderate defect group. There was also no statistically significant difference in PSD values in the any of the groups before and after cataract surgeries. Conclusions: In glaucoma patients with cataracts, there were no significant differences in PSD values before and after cataract surgery. Additionally, to perform an adequate cataract operation in advanced glaucoma patients without the progression of visual field damage, lowering intraocular pressure and improving visual acuity is helpful.

VISUAL FIELD DEFECTS AFTER RADIAL OPTIC NEUROTOMY FOR CENTRAL RETINAL VEIN OCCLUSION

Surgical decompression of the vein in central retinal vein occlusion (CRVO) by radial optic neurotomy (RON) was recently proposed as being surgically feasible, safe, and beneficial. The effect of RON on the visual field has not been systematically reported, although possible visual field defects are expected due to iatrogenic cutting of the optic nerve fibers. The authors report the results of visual field testing in patients who underwent RON at the Tel Aviv Medical Center. Twelve consecutive patients (8 men, mean age of all patients 68 years) with nonperfused or indeterminate CRVO whose initial visual acuity (VA) was < or =20/400 underwent RON. Nine of these patients were able to perform visual field tests at 6 months post-RON and their visual field results are presented. : VA improved by > or =3 lines in 5 patients (42%). Three (25%) patients had a final VA of > or =20/200 and another had a final VA > or =20/50. Fundus and VA improvement were relatively slow. Two patients had clearing of the intraretinal blood, resolution of the venous dilation, and improved VA at the 2-month follow-up visit. Temporal visual field defects consisting of temporal ones that could be correlated to the site of the RON incision were detected in five out of the nine patients who were able to perform visual field tests. No temporal visual field defects were found in the remaining four patients, and three other patients were unable to perform visual field tests due to inability to identify the largest target size. VA improvement in 5 of 12 patients with ischemic or indeterminate CRVO following RON may be better than the natural history of CRVO. The risk of visual field defects may, however, be heightened by possibly cutting off blood supply to the optic nerve head and possible damage to nerve fibers in the optic nerve head, both inherent to the surgical procedure and both likely to produce visual loss.

The effect of artificial tear administration on visual field testing in patients with glaucoma and dry eye

To examine the effects of artificial tear administration on perimetry of primary open-angle glaucoma patients with dry eye. A total of 40 patients with primary open-angle glaucoma experienced in automated perimetry with symptoms of dry eye were enrolled in this study. After their pretest visit, they were instructed to use artificial tear four times a day in both eyes for 1 week. After 1 week, patients had visual field testing. Test taking time, reliability parameters (false-positive and false-negative errors) visual field indices and number of depressed points at different probability levels (P<5%, P<2%, P<1%, P<0.5%) in both total and pattern deviation plots were compared using paired Ttest. We found significant improvement in reliability parameters (false-positive errors from 2.4+/-2.1 to 2.1+/-1.9, P=0.02; and false-negative errors from 7.3+/-6.4 to 4.8+/-3.6, P=0.01) and visual field indices (MD increased from 5.97+/-5.61 to 4.57+/-4.53, P=0.001; PSD from 4.67+/-2.95 to 4.13+/-2.77, P=0.04 and SF decreased from 2.24+/-1.23 to 1.83+/-0.77, P=0.04) in the second testing after artificial tear administration. Test time significantly increased from 11.66+/-2.55 min to 14.26+/-1.36, P=0.001. The number of depressed points at probability levels P<1% (P=0.03) and P<0.5% (P=0.04) at total deviation plot and P<2% (P=0.02) and P<0.5% (P=0.009) in pattern deviation plot decreased significantly. Artificial tear administration in glaucomatous patients with dry eye seems to improve significantly reliability parameters and visual field indices.

Comparison of Contrast Sensitivity, Visual Acuity, and Humphrey Visual Field Testing in Patients with Glaucoma

Despite their normal or near-normal Snellen visual acuity, patients with glaucoma often complain of "poor" vision. To investigate the relationship between large-letter contrast sensitivity, high-contrast visual acuity, and visual field defects in patients with glaucoma who have 20/40 or better visual acuity. Prospective, cross-sectional case series. We evaluated 250 eyes of 144 subjects from the Glaucoma Service at the University of Illinois at Chicago College of Medicine. Subjects with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension who met the 20/40 or better vision requirement were recruited. Visual acuity was measured using the rear-illuminated Lighthouse Visual Acuity Chart at 4 m. Contrast sensitivity was measured using the Pelli-Robson Chart in a front-illuminated box with even luminance across the chart. Visual fields of the patients were measured using the 24-2 full-threshold program on the Humphrey Visual Field Analyzer. A significant correlation (r = 0.57, P < 0.001, n = 127) was found between the visual field mean deviations and the contrast sensitivity scores. The correlation (r = -0.322, P < 0.001, n = 127) was less between the visual field mean deviation and the log MAR visual acuity values, as was the correlation between the contrast sensitivity scores and log MAR visual acuity values (r = -0.370, P < 0.001, n = 127). In the subgroup of patients with chronic open-angle glaucoma, the correlation between the mean visual field deviation and the contrast sensitivity score was higher at 0.689 (P < or = 0.001, n = 62). Reduced contrast sensitivity is significantly correlated with visual field losses in patients with glaucoma and a visual acuity of 20/40 or better. The study data support the conclusion that, compared with visual acuity, the disease process preferentially affects contrast sensitivity. In our previous work, contrast sensitivity was shown to be more related than visual acuity to real-world function in patients with early glaucomatous changes.

The effect of hemodialysis on visual field test in patients with chronic renal failure

Purpose. To investigate the visual field with FASTPAC 30-2 program before and after hemodialysis in patients with end stage renal disease. Materials and methods. Twenty eyes of 20 patients on regular hemodialysis were included in the study group. Twenty eyes of 20 healthy patients were chosen as control group. Intraocular pressures (IOP) were measured one hour before and one hour after the same hemodialysis session, and visual field was tested at the same times. Results. When IOP was compared before and after hemodialysis, no statistically significant difference was found (p > 0.05), however Mean Deviation (MD) (p = 0.008) improved after hemodialysis. When we compared first global indices of the control group with pre-hemodialysis global indices, we noted significant difference in MD (p = 0.009). Conclusion. Visual field testing should be done after hemodialysis in patients who are on regular hemodialysis program.