Glaucoma Hemifield Test Research Articles

Baseline factors predicting the risk of conversion from ocular hypertension to primary open-angle glaucoma during a 10-year follow-up.

PurposeTo evaluate the ability of baseline clinical, morphological, and functional factors to predict the conversion to primary open-angle glaucoma (POAG) in ocular hypertensive (OHT) patients.MethodsThis single-center prospective longitudinal observational study included 116 eyes of 116 OHT patients followed for a 10-year period. All patients had intraocular pressure (IOP) ≥24 mm Hg in one eye and >21 mm Hg in the other eye, normal visual fields (VFs) and normal optic disc (OD) appearance in both eyes at baseline. All OHT patients were untreated at baseline with subsequent treatment upon need according to clinical judgement. Only one eye per subject was randomly selected. Patient age, gender, IOP, central corneal thickness (CCT), and ibopamine test results were collected at baseline. All patients underwent standard automated perimetry, short-wavelength automated perimetry (SWAP), frequency-doubling technology, confocal scanning laser ophthalmoscopy (CSLO), and scanning laser polarimetry (SLP) at baseline and every 6 months thereafter. Main outcome measure was the conversion to POAG, defined as the development of reproducible VF and/or OD abnormalities attributable to glaucoma. Cox proportional hazards models were used to identify the baseline factors predictive of POAG conversion.ResultsDuring the 10-year follow-up, 25% of eyes converted to POAG. In multivariate Cox models, baseline factors that were significant predictors of POAG development included: older age (hazard ratio (HR) 1.0, 99% confidence intervals (CIs) 1.0-1.2, per 1 year older); SWAP Glaucoma Hemifield test 'outside normal limits' (HR 4.3, 99% CIs 1.2-17.9); greater SLP 'Inter-eye Symmetry' (HR 1.1, 99% CIs 0.4-3.0, per 1 unit lower); lower CSLO Rim Volume (HR 1.1, 99% CIs 0.3-3.2, per 0.1 mm(3) lower); and greater CSLO cup-to-disc ratio (HR 6.0, 99% CIs 3.6-16.8, per 0.1 unit greater).ConclusionsThe baseline parameters that proved to be useful in assessing the likelihood of an OHT patient to develop POAG included age, functional variables provided by SWAP, and structural variables provided by SLP and CSLO. In this cohort of patients, baseline IOP, CCT, and ibopamine provocative test results were not significant predictors of POAG conversion.

Correlations Between the Individual Risk for Glaucoma and RNFL and Optic Disc Morphometrical Evaluations in Ocular Hypertensive Patients.

To assess the correlation between the 5-year risk of developing primary open-angle glaucoma (POAG) [on the basis of the Ocular Hypertension Treatment Study (OHTS)-European Glaucoma Prevention Study (EGPS) model] and optic nerve head and retinal nerve fiber layer (RNFL) indices as evaluated by optical coherence tomography (Stratus OCT), scanning laser polarimetry (GDx ECC), and confocal laser ophthalmoscopy [Heidelberg Retinal Tomograph (HRT) III] in ocular hypertensive (OHT) individuals. Sixty-eight OHT individuals with the untreated intraocular pressure in both eyes between 22 and 32 mm Hg, an ophthalmoscopically normal optic disc with a cup/disc ratio asymmetry between the 2 eyes of ≤0.2, and a visual field with glaucoma hemifield test within normal limits, and pattern SD within P<0.05 were recruited. A comprehensive glaucoma workup and examination by means of OCT, GDx ECC, and HRT III were performed in all of the patients. The probability of developing POAG in 5 years was calculated by means of the OHTS-EGPS model (risk calculator score-RS), which has been developed by the OHTS-EGPS Collaborative Study Group by taking into account the age and the mean values of the central corneal thickness, the intraocular pressure, the pattern SD, and the cup/disc ratio collected in the 2 eyes. Correlations between the individual RS and OCT, GDx, and HRT parameters were then assessed by regression analysis (exponential and linear), with a statistically significant level of P<0.01. The RS of the 68 individuals ranged between 1.5% and 28.6%, with a mean of 10.2% (SD 6.4). Only OCT RNFL-related parameters showed a statistically significant correlation with the RS. The average RNFL thickness had an exponential regression r of 0.21 (P<0.0001) and a linear regression r of 0.14 (P=0.0012); the superior average RNFL thickness had an exponential regression r of 0.26 (P<0.0001) and a linear regression r of 0.23 (P<0.0001); the nasal average RNFL thickness had an exponential regression r of only 0.12 (P=0.0031). Neither GDx RNFL-related parameters nor HRT disc-related parameters showed statistically significant correlations with the RC score. This explorative study showed that the individual risk to develop POAG within 5 years in OHT individuals is significantly correlated with OCT RNFL parameters, but not with GDx RNFL parameters or HRT disc parameters. OCT parameters could explain about 20% to 25% of the variability in individual RS. The RS seems to take into account the subclinical RNFL thinning shown by the OCT.

The 24-2 Visual Field Test Misses Central Macular Damage Confirmed by the 10-2 Visual Field Test and Optical Coherence Tomography.

PurposeTo determine the extent to which the 24-2 visual field (VF) misses macular damage confirmed with both 10-2 VF and optical coherence tomography (OCT) tests and to evaluate the patterns of damage missed.MethodsOne hundred forty-one eyes of 141 glaucoma patients or suspects underwent 24-2 VF (mean deviation [MD] better than −6 dB), 10-2 VF, and OCT testing. Retinal nerve fiber layer (RNFL) and retinal ganglion cell plus inner plexiform (RGC+) probability plots were combined with 10-2 VF probability plots. Eyes were classified as “abnormal macula” if abnormal regions on both the 10-2 VF and OCT plots agreed. The number of abnormal eyes missed (i.e., false negatives) was determined for the following 24-2 VF metrics: MD; pattern standard deviation (PSD); glaucoma hemifield test (GHT); cluster criteria (CC); and abnormal points within ± 10°. Eyes that were missed on one or more of the 24-2 metrics were classified by damage type based upon circumpapillary RNFL thickness plots.ResultsFifty-nine (41.8%) eyes were classified as “abnormal macula,” and comprised the reference standard. Of the 59, 31 (52.5%) were missed by one or more of the 24-2 metrics. The individual 24-2 metrics missed between 7 (CC) and 20 (MD) eyes. The eyes missed had widespread macular damage, as well as both shallow and deep local defects.ConclusionsEyes with macular glaucomatous damage may be classified as normal based on the 24-2 VF alone.Translational RelevanceTo detect macular damage with perimetry, the 10-2 VF test (or a modified 24-2 VF test) is essential.

Enhancement of Visual Field Predictions with Pointwise Exponential Regression (PER) and Pointwise Linear Regression (PLR).

PurposeThe study was conducted to evaluate threshold smoothing algorithms to enhance prediction of the rates of visual field (VF) worsening in glaucoma.MethodsWe studied 798 patients with primary open-angle glaucoma and 6 or more years of follow-up who underwent 8 or more VF examinations. Thresholds at each VF location for the first 4 years or first half of the follow-up time (whichever was greater) were smoothed with clusters defined by the nearest neighbor (NN), Garway-Heath, Glaucoma Hemifield Test (GHT), and weighting by the correlation of rates at all other VF locations. Thresholds were regressed with a pointwise exponential regression (PER) model and a pointwise linear regression (PLR) model. Smaller root mean square error (RMSE) values of the differences between the observed and the predicted thresholds at last two follow-ups indicated better model predictions.ResultsThe mean (SD) follow-up times for the smoothing and prediction phase were 5.3 (1.5) and 10.5 (3.9) years. The mean RMSE values for the PER and PLR models were unsmoothed data, 6.09 and 6.55; NN, 3.40 and 3.42; Garway-Heath, 3.47 and 3.48; GHT, 3.57 and 3.74; and correlation of rates, 3.59 and 3.64.ConclusionsSmoothed VF data predicted better than unsmoothed data. Nearest neighbor provided the best predictions; PER also predicted consistently more accurately than PLR. Smoothing algorithms should be used when forecasting VF results with PER or PLR.Translational RelevanceThe application of smoothing algorithms on VF data can improve forecasting in VF points to assist in treatment decisions.

Is Myopic Optic Disc Appearance a Risk Factor for Rapid Progression in Medically Treated Glaucomatous Eyes With Confirmed Visual Field Progression?

To investigate visual field (VF) progression rates in glaucomatous eyes with myopic optic disc appearance, refractive error, and progressive VF changes and to compare the rates with those of a nonmyopic group. Data on 158 eyes from 131 patients with open-angle glaucoma who had progressive VF deterioration during follow-up were retrospectively analyzed. The myopic and nonmyopic groups were compared in terms of rates of change of mean thresholds in global and regional areas using central 10 degrees, peripheral 10 to 24 degrees, and glaucoma hemifield test maps by using a linear-mixed model and controlling for confounding covariates. Clinical factors associated with rapid VF progression at global and regional VF areas were investigated in each group. The 2 groups did not significantly differ in the mean global VF progression rate (-0.36 vs. -0.35 dB/y, respectively; P=0.951). Likewise, both groups showed similar VF progression rates at all regional clusters (P>0.05). No significant association was found between the rate of VF change and clinical factors in the myopic group. The mean follow-up intraocular pressure was significantly associated with VF progression rates in the nonmyopic group (P<0.05). Open-angle glaucoma eyes with myopic optic disc appearance experiencing progressive VF changes showed similar VF progression rates globally and regionally when compared with nonmyopic eyes after controlling for clinical factors related to VF progression. None of the clinical factors in the myopic group were significantly associated with VF progression rate, whereas the mean follow-up intraocular pressure was in the nonmyopic group.

A comparison between the diagnostic results of short wavelength automated perimetry and standard automated perimetry in glaucoma patients

Purpose The aim of this study was to compare the diagnostic results of short wavelength automated perimetry (SWAP) and standard automated perimetry (SAP) in glaucoma patients. Patients and methods This study was held in Qena University Hospital from March 2012 to December 2012 and included 60 individuals who underwent full ophthalmological examination by means of slit-lamp biomicroscopy, gonioscopy, best-corrected visual acuity testing on Landolt's chart, fundus and optic nerve head examination using a +90 D lens, intraocular pressure (IOP) measurement by means of applanation tonometry, and finally optic nerve head photography using a Zeiss Visucam 500 fundus camera. The participants were divided into three groups: a normal age-matched control group (group A); a group with primary open-angle glaucoma POAG (group B); and a group with ocular hypertension OHT and glaucoma suspects (group C). Informed consent was obtained from all controls and patients after the nature and possible consequences of the procedure had been fully explained to them. All statistical analyses were performed by using IBM SPSS statistics. Results Thirty randomly selected eyes of 30 volunteers made up group A, 20 eyes of 20 POAG patients comprised group B, and 10 eyes of 10 ocular hypertension patients and glaucoma suspects comprised group C. The mean age of the 60 individuals included in the present study was 70.18 years (range: 60-82 years, SD: ±8.068); 29 were female and 31 were male. The prevalence of SWAP and SAP in glaucoma patients showed deficits in groups B and C, as defined by the presence of a glaucoma hemifield test 'outside normal limits'. According to this criterion, three of 10 (33.3%) group C eyes demonstrated a SWAP deficit at the second visit, whereas no (0%) eyes showed a deficit in SAP at the same time point. All 20 patients of group B manifested abnormal SWAP. The level of agreement in terms of the severity of field loss between SWAP and SAP for groups B and C, based on the pattern SD, was studied. In the present study we found that visual field loss was greater and more diffuse in SWAP than in SAP, but no patient exhibited new scotomata. Conclusion SWAP is superior to SAP in identifying patients with early glaucoma, ocular hypertension, glaucoma suspects, and patients with progressive optic disc cupping and may therefore be quite useful for determining early and progressive changes in glaucoma.

Association Between Alzheimer's Disease and Glaucoma: A Study Based on Heidelberg Retinal Tomography and Frequency Doubling Technology Perimetry.

Aim: To assess the frequency of glaucoma-like alterations in Alzheimer's disease (AD) patients using Heidelberg Retinal Tomograph III (HRT-3) and Frequency Doubling Technology (FDT) perimetry.Methods: The study included 51 eyes of 51 AD subjects and 67 eyes of 67 age- and sex-matched controls. Subjects underwent an ophthalmological examination including measurements of intraocular pressure (IOP), Matrix FDT visual field testing, optic nerve head morphology and retinal nerve fiber layer thickness (RNFLt) assessment by slit-lamp biomicroscopy and HRT-3.Results: The frequency of alterations was significantly higher in the AD group (27.5 vs. 7.5%; p = 0.003; OR = 4.69). AD patients showed lower IOP (p = 0.000) despite not significantly different values of central corneal thickness (CCT) between the groups (p = 0.336). Of all the stereometric parameters measured by HRT-3, RNFLt was significantly lower in AD patients (p = 0.013). This group also had significantly worse results in terms of Moorfields Regression Analysis (p = 0.027). Matrix showed significantly worse Mean Deviation (MD) (p = 0.000) and Pattern Standard Deviation (PSD) (p = 0.000) values and more altered Glaucoma Hemifield Test (p = 0.006) in AD patients. Pearson's R correlation test showed that Mini Mental State Examination is directly correlated with MD (R = 0.349; p = 0.034) and inversely correlated with PSD (R = −0.357; p = 0.030).Conclusion: Patients with AD have a higher frequency of glaucoma-like alterations, as detected by the use of HRT-3. These alterations were not associated with elevated IOP or abnormal CCT values.

Predicting Development of Glaucomatous Visual Field Conversion Using Baseline Fourier-Domain Optical Coherence Tomography

To predict the development of glaucomatous visual field (VF) defects using Fourier-domain optical coherence tomography (FD OCT) measurements at baseline visit. Multicenter longitudinal observational study. Glaucoma suspects and preperimetric glaucoma participants in the Advanced Imaging for Glaucoma Study. The optic disc, peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) were imaged with FD OCT. VF was assessed every 6 months. Conversion to perimetric glaucoma was defined by VF pattern standard deviation (PSD) or glaucoma hemifield test (GHT) outside normal limits on 3 consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. Predictive accuracy was measured by the area under the receiver operating characteristic curve (AUC). Of 513 eyes (309 participants), 55 eyes (46 participants) experienced VF conversion during 41 ± 23 months of follow-up. Significant (P < .05, Cox regression) FD OCT risk factors included all GCC, NFL, and disc variables, except for horizontal cup-to-disc ratio. GCC focal loss volume (FLV) was the best single predictor of conversion (AUC = 0.753, P < .001 for test against AUC = 0.5). Those with borderline or abnormal GCC-FLV had a 4-fold increase in conversion risk after 6 years (Kaplan-Meier). Optimal prediction of conversion was obtained using the glaucoma composite conversion index (GCCI) based on a multivariate Cox regression model that included GCC-FLV, inferior NFL quadrant thickness, age, and VF PSD. GCCI significantly improved predictive accuracy (AUC = 0.783) over any single variable (P = .04). Reductions in NFL and GCC thickness can predict the development of glaucomatous VF loss in glaucoma suspects and preperimetric glaucoma patients.

Reference Standard Test and the Diagnostic Ability of Spectral Domain Optical Coherence Tomography in Glaucoma.

To evaluate the relationship between the reference standard used to diagnose glaucoma and the diagnostic ability of spectral domain optical coherence tomograph (SDOCT). In a cross-sectional study, 280 eyes of 175 consecutive subjects, referred to a tertiary eye care center for glaucoma evaluation, underwent optic disc photography, visual field (VF) examination, and SDOCT examination. The cohort was divided into glaucoma and control groups based on 3 reference standards for glaucoma diagnosis: first based on the optic disc classification (179 glaucoma and 101 control eyes), second on VF classification (glaucoma hemifield test outside normal limits and pattern SD with P-value of <5%, 130 glaucoma and 150 control eyes), and third on the presence of both glaucomatous optic disc and glaucomatous VF (125 glaucoma and 155 control eyes). Relationship between the reference standards and the diagnostic parameters of SDOCT were evaluated using areas under the receiver operating characteristic curve, sensitivity, and specificity. Areas under the receiver operating characteristic curve and sensitivities of most of the SDOCT parameters obtained with the 3 reference standards (ranging from 0.74 to 0.88 and 72% to 88%, respectively) were comparable (P>0.05). However, specificities of SDOCT parameters were significantly greater (P<0.05) with optic disc classification as reference standard (74% to 88%) compared with VF classification as reference standard (57% to 74%). Diagnostic parameters of SDOCT that was significantly affected by reference standard was the specificity, which was greater with optic disc classification as the reference standard. This has to be considered when comparing the diagnostic ability of SDOCT across studies.

Diagnostic Consistency and Relation Between Optical Coherence Tomography and Standard Automated Perimetry in Primary Open-Angle Glaucoma

Purpose: To assess diagnostic consistency and relation between spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study comprised 51 eyes of 51 patients with a confirmed diagnosis of POAG. The qualitative and quantitative SD-OCT parameters (retinal nerve fiber layer thicknesses [RNFL; average, superior, inferior, nasal and temporal], RNFL symmetry, rim area, disc area, average and vertical cup/disc [C/D] ratio and cup volume) were compared with parameters of SAP (mean deviation, pattern standard deviation, visual field index, and glaucoma hemifield test reports). Results: Fifty-one eyes of 51 patients with POAG were recruited. Twenty-nine eyes (56.9%) had consistent RNFL and visual field (VF) damage. However, nine patients (17.6%) showed isolated RNFL damage on SD-OCT and 13 patients (25.5%) had abnormal VF test with normal RNFL. In patients with VF defect, age, average C/D ratio, vertical C/D ratio, and cup volume were significantly higher and rim area was lower when compared to those of the patients with normal VF. In addition to these parameters, worsening in average, superior, inferior, and temporal RNFL thicknesses and RNFL symmetry was significantly associated with consistent SD-OCT and SAP outcomes. Conclusions: In routine practice, patients with POAG can be manifested with inconsistent reports between SD-OCT and SAP. An older age, higher C/D ratio, larger cup volume, and lower rim area on SD-OCT appears to be associated with detectable VF damage. Moreover, additional worsening in RNFL parameters might reinforce diagnostic consistency between SD-OCT and SAP.

Role of visual field reliability indices in ruling out glaucoma.

Standard automated perimetry is the current criterion standard for assessment of visual field (VF) loss in glaucoma. The 3 commonly used reliability indices to judge the quality of standard automated perimetry results are fixation losses (FLs) and false-positive (FP) and false-negative (FN) response rates. However, the influence of reliability indices, when within the manufacturer-recommended limits, on VF classification has been sparsely studied. To evaluate the role of VF reliability indices in ruling out glaucoma. A cross-sectional study of 291 eyes of 291 participants referred to a tertiary eye care facility by general ophthalmologists. The participants were suspected to have glaucoma based on optic disc appearance, but the eyes were judged to be normal with physiological cupping by glaucoma experts on masked evaluation of optic disc photographs. All participants underwent VF testing with the Swedish interactive threshold algorithm standard 24-2 program. Logistic regression models were used to evaluate the associations between reliability indices and FP classifications on VF testing (glaucoma hemifield test as outside normal limits and pattern standard deviation with P < .05). Median FL, FP, and FN response rates were 7%, 1%, and 2%, respectively. Among the 241 participants with reliable VF results (FL <20% and FP response rate <15%), the VF classification was normal in 188 (78.0%) and glaucoma (FP) in 53 (22.0%). Probability of FP VF classification was associated with FN response rates (odds ratio [OR], 1.36; 95% CI, 1.25-1.48, P < .001) but did not appear to be associated with FLs (OR, 0.96; 95% CI, 0.90-1.03, P = .30) or FP response rates (OR, 0.96; 95% CI, 0.83-1.12, P = .64). Predicted probability of FP VF classification was 9% (95% CI, 6%-14%), 40% (32%-49%), and 82% (68%-91%) at FN response rates of 0%, 8%, and 16%, respectively. This study suggests that FN response rates have an effect on the ability of automated VF assessments to rule out glaucoma. Since FN response rates are ignored by the manufacturer while flagging a test as unreliable, clinicians and researchers may benefit by realizing that FN response rates can lead to FP VF classification, even when their frequencies are small.

Visual status in primary open-angle glaucoma: A hospital-based report from Nepal

Background: Primary open-angle glaucoma (POAG) is the commonest cause of irreversible blindness. Most hospitals in Nepal are carrying out opportunistic glaucoma screening for those attending hospitals for any eye consultation. However, there are no reports detailing the visual damage at the time of diagnosis confirming the early detection of cases.Objectives: This study aimed to investigate the clinical features and visual status at the time of diagnosis of POAG in the Nepalese population.Methods: We evaluated 173 newly diagnosed consecutive cases of POAG from three hospitals across Nepal. Glaucoma evaluation was carried out detailing the findings of visual acuity and visual fields. Continuous data were presented as means and standard deviations (SD) and categorical data as proportions (95% CI). Unpaired t-tests compared continuous variables with p value set at a 5% level of significance.Results: Out of total patients, 82.1% were diagnosed incidentally while they visited the hospital for symptoms not expected to be for glaucoma. Only 9.8% of cases were aware of them being at risk of developing glaucoma and thus attended hospitals for regular check-up. Visual field examination revealed mean scores of mean deviation (MD) as low as-13.24 dB and pattern standard deviation of 7.34 dB. Glaucoma hemifield test was outside normal limits in 61.5% of eyes tested. Additionally, 4.7% patients were blind.Conclusion: POAG cases presented late with significant visual damage. Existing opportunistic screening for glaucoma in Nepal needs to be combined with community-based glaucoma awareness programs to bring more people to hospital at the early stage of the disease.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11226Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page : 49-57

Flicker Defined Form Perimetry in Glaucoma Suspects with Normal Achromatic Visual Fields

Background: To evaluate if repeated flicker-defined form (FDF) perimetry can detect visual field (VF) defects in glaucoma suspects with normal findings in achromatic standard automated perimetry (SAP).Methods: Patients with optic nerve heads (ONHs) or retinal nerve fiber layer (RNFL) findings clinically suspicious for glaucoma and normal SAP were enrolled. Patients underwent VF testing with FDF perimetry (Heidelberg Edge Perimetry, HEP) at two consecutive visits (HEP I and HEP II) and confocal scanning laser ophthalmoscopy with the Heidelberg Retina Tomograph (HRT). Abnormal HEP was defined by cluster-point analysis (CPA) and by the HEP specific glaucoma hemi-field test (GHT). Results were compared with an age-matched control group of healthy individuals.Results: In 65 eyes of 36 glaucoma suspects, the mean deviation (MD) in SAP was −0.9 ± 1.3 dB. In HEP I and HEP II, mean MD was −3.6 ± 3.0 and −3.3 ± 3.7 dB, respectively (p = 0.276). The HRT assessed CDR was significantly correlated with the MD in HEP II (r = −0.281, p = 0.04). In HEP I, VF defects on CPA testing were found in 38 study eyes (58.5%). In HEP II, 34 eyes (51.8%) had VF defects on CPA testing. In 46 eyes of 46 age-matched healthy individuals in the control group, the mean MD was −0.2 ± 1.1 and −1.6 ± 2.3 dB in SAP and HEP testing, respectively. The FDF was abnormal in 21.7% in the control group compared to 58.5% in the glaucoma suspect group in HEP I.Conclusions: In more than half of the patients with ONHs or RNFLs clinically suspicious for glaucoma and normal SAP second FDF perimetry depicts VF defects.

Assessment methods of visual field defects of patients with glaucoma

Glaucoma is a common eye disease which may cause irreversible blindness.This ocular degenerative disease affects retinal ganglion cells (RGCs) and eventually causes optic nerve dysfunction by way of axonal loss.Patients with glaucoma may show characteristic changes of optic disc,damages of visual field and impairment of vision.Detection and evaluation of the impairment of visual field in patients with glaucoma are essential for the diagnosis and estimation of progression of this disease.Numerous techniques have been developed to detect field progression,but no standard has been widely accepted.Assessment Methods including visual field indices,glaucoma hemifield test (GHT),Advanced Glaucoma Intervention Study (AGIS),Early Manifest Glaucoma Trial (EMGT),Collaborative Initial Glaucoma Treatment Study(CIGTS),as well as the strength and limitation of each method were reviewed in this article in order to find out suitable ways to evaluate visual field defects in patients with glaucoma in clinical works and researches. Key words: Glaucoma; Visual field defect; Assessment

Prevalence and spatial concordance of visual field deterioration in fellow eyes of glaucoma patients.

PurposeTo examine the prevalence of visual field deterioration in contralateral eyes of patients with worsening open-angle glaucoma and to evaluate the spatial concordance of visual field deterioration between both eyes.MethodsOne hundred sixteen open-angle glaucoma patients who underwent 8 or more visual field examinations over ≥6 years of follow-up were included. The rates of the fast and slow components of visual field decay for each of 52 visual field test locations were calculated with point-wise exponential regression analysis. The spatial concordance of visual field deterioration in contralateral eyes was evaluated with a concordance ratio (calculated as the number of overlapping locations divided by the total number of deteriorating locations) and by comparing the rate of decay in corresponding modified glaucoma hemifield test clusters.ResultsThe average visual field mean deviation (±standard deviation [SD]) was -8.5 (±6.4) dB and the mean (±SD) follow-up time was 9.0 (±1.6) years. Sixty-three patients had mild damage, 23 had moderate damage, and 30 had severe damage. The mean concordance ratio (±SD) was 0.46 (±0.32) for the mild group, 0.33 (±0.27) for the moderate group, and 0.35 (±0.21) for the severe group. Thirty-one patients (27%) had deterioration in concordant locations (p < 0.05). Visual field deterioration was greater in the superior hemifield than the inferior hemifield (p < 0.05) when evaluated with both the concordance ratio and modified glaucoma hemifield test cluster analysis methods.ConclusionsThere is only fair spatial concordance with regard to visual field deterioration between the both eyes of an individual. We conclude that testing algorithms taking advantage of inter-eye spatial concordance would not be particularly advantageous in the early detection of glaucomatous deterioration.

Initial central scotomas vs peripheral scotomas in normal-tension glaucoma: clinical characteristics and progression rates

To investigate clinical characteristics and progression rates of the initial central scotomas (ICS) compared with the initial peripheral scotomas (IPS) in normal-tension glaucoma (NTG) patients. Among NTG patients showing a single hemifield defect and who performed more than five reliable standard visual field (VF) tests, medical records of ICS (involvement of ≥3 adjacent points with P<5% within the central 12° of fixation and one point with a P<0.01 within the central 6° of fixation) (n=32) or IPS (no VF abnormality within the central 6° of fixation) (n=34) were retrospectively analyzed. The changes of mean thresholds from 10 zones of the glaucoma hemifield test, central 6° and 12° zones, peripheral zones other than central 6° and 12°, and the entire hemifield were inspected. To calculate the progression rates, linear mixed-effect model was employed. There were no significant differences between the two groups in age, gender, ocular factors including baseline/mean treated intraocular pressure, and systemic factors including systolic or diastolic blood pressure/perfusion pressure, mean ocular perfusion pressure (all P>0.05). There were no significant differences in baseline mean deviation and pattern standard deviation (P>0.05) between the two groups, but VF index was significantly lower in ICS group than in IPS group (P=0.001). The progression rates between the two groups were not significantly different in all zones we investigated (all P>0.05). Newly diagnosed cases of NTG with ICS may not differ from those with IPS in clinical characteristics and progression rates under treatment.

Effect of Ginkgo biloba Extract on Visual Field Progression in Normal Tension Glaucoma

To evaluate the long-term effect of Ginkgo biloba extract (GBE) on progression of visual field (VF) defects in patients with normal tension glaucoma (NTG). Forty-two eyes of 42 patients with treated NTG who received 80 mg GBE 2 times daily and who had at least 5 VF tests using the Humphrey Visual Field Analyzer for more than a 4-year period before and after GBE treatment were evaluated in this retrospective study. We evaluated the change of progression rate using mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) after GBE treatment. The time course of mean total deviation in 10 zones corresponding to the glaucoma hemifield test was analyzed using a linear mixed effects model with unequal random effect variances. The mean follow-up period was 12.3 years. The posttherapeutic intraocular pressures before and after GBE treatment were not significantly different (P=0.509 paired t test). Before GBE treatment, the regression coefficients (RCs) of MD, PSD, and VFI change were -0.619 dB/y, 0.626 dB/y, and -2.153%/y, respectively. After GBE treatment, the RCs of MD, PSD, and VFI change improved significantly to -0.379 dB/y, 0.342 dB/y, and -1.212%/y (P <0.001), respectively. In zone 1, the RC of mean total deviation change was significantly increased after GBE administration (P <0.005). GBE administration slowed the progression of VF damage in patients with NTG, especially in zone 1 corresponding to the superior central field.

Screening for Patients with Mild Alzheimer Disease Using Frequency Doubling Technology Perimetry

We compared the visual field performances of patients with mild Alzheimer disease (AD) with normal subjects and detected visual field impairment attributable to the magnocellular pathway using frequency doubling technology—Matrix (FDT-Matrix). We recruited 43 patients with mild AD (mean age: 68.0 ± 7.2 years) and 33 controls who are visually and cognitively normal (mean age: 64.1 ± 6.4 years). All participants had at least two reliable FDT-Matrix 30-2 tests. Reliability indices, global indices (mean deviation and pattern standard deviation), and glaucoma hemifield test results were measured with FDT-Matrix. The mean test duration was significantly longer in patient group compared with controls (p = 0.002). Among the reliability indices, false negatives were higher in patient group than controls (p = 0.003). There were statistically significant differences in mean deviation and pattern standard deviation values (p < 0.0001 and p < 0.0001, respectively) and glaucoma hemifield test results (p < 0.001) between the patient and the control group. Our results imply that the pathogenesis of cognitive deterioration may not only be confined to the cortical area but also to the magnocellular pathway. We underline that FDT testing can be useful for the identification of early impairment and the follow-up of patients with AD.

Linear Discriminant Functions to Improve the Glaucoma Probability Score Analysis to Detect Glaucomatous Optic Nerve Heads

The purpose of the study was to create a linear discriminant function (LDF) formula by using the new Glaucoma Probability Score (GPS) global and sectorial optic nerve head parameters measured by Heidelberg Retinal Tomograph 3 to improve the GPS diagnostic capacity to discriminate between healthy and glaucomatous eyes. This is a multicenter cross-sectional study. To calculate the LDF formula, 137 normal individuals and 96 glaucomatous patients were selected. Another independent sample of 60 healthy and 69 glaucomatous eyes was used to evaluate the diagnostic accuracy of the LDF formulas. All patients underwent a full eye examination, standard achromatic perimetry by using Humphrey Field Analyzer, and imaging with Heidelberg Retinal Tomograph 3. Glaucoma was defined on the basis of SITA-24-2 visual field loss (pattern standard deviation P<5% and glaucoma Hemifield test outside normal limits). The area under the receiver operating characteristics curves and sensitivity and specificity for different LDFs were analyzed as measures of diagnostic accuracy. The analysis was repeated after stratification for optic disc size and glaucoma stage. Two LDF formulas improved GPS algorithm results. At fixed specificities of 85% and 95%, the sensitivity values were 79.7% and 71%, respectively, for the GPS-only LDF, which used only the so-called GPS parameters, whereas the values were 85.5% and 79.7%, respectively, for the GPS-RA LDF, which used sectorial rim area parameters as well. When the so-called GPS parameters were used in an LDF formula, its diagnostic capacity slightly improved; however, the diagnostic performances of the GPS LDF, which used sectorial rim area parameters as well, were better.

Optic disc progression and rates of visual field change in treated glaucoma

To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma. Glaucoma patients with repeatable VF loss, ≥8 SITA-Standard 24-2 VF tests and good quality optic disc stereophotographs evaluated over a 10-year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta-zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results. Three-hundred and eighty nine eyes (389 patients; mean age 64.9 ± 13.0 years; mean baseline MD, -7.1 ± 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty-two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (-0.66 ± 0.7 versus -0.36 ± 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40). Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.