Glaucomatous Visual Field Defects Research Articles

Impact of Social Vulnerability Index on the Development of Severe Visual Impairment or Blindness from Glaucoma

PurposeTo evaluate whether geocoded social risk factor data predict the development of severe visual impairment or blindness due to glaucoma during follow-up using a large electronic health record (EHR) database. DesignCohort study. MethodsPatients diagnosed with open-angle glaucoma (OAG) at a tertiary care institution. All eyes had glaucomatous visual field defects at baseline. Sociodemographic and ocular data were extracted from EHR, including age, gender, self-reported race and ethnicity, insurance status, OAG type, prior glaucoma laser or surgery, baseline disease severity using Hodapp-Anderson-Parrish criteria, mean intraocular pressure (IOP) during follow-up, and central corneal thickness. Social vulnerability index (SVIndex) data at the census tract level were obtained using geocoded patient residences. Mixed-effects Cox proportional hazard models were completed to assess for the development of severe visual impairment or blindness during follow-up, defined as BCVA ≤20/200 at the last two clinic visits or standard automated perimetry (SAP) mean deviation (MD) ≤-22dB confirmed on two tests. ResultsA total of 4,046 eyes from 2,826 patients met inclusion criteria and were followed for an average of 4.3±2.2 years. Severe visual impairment or blindness developed in 79 eyes (2.0%) from 76 patients (2.7%) after an average of 3.4±1.8 years, leading to an incidence rate of severe visual impairment or blindness of 0.5% per year. Older age (adjusted hazards ratio (HR) 1.36 per decade, p=0.007), residence in areas with higher SVIndex (HR 1.56 per 25% increase, p<0.001), higher IOP during follow-up (HR 3.01 per 5 mmHg increase, p<0.001), and moderate or severe glaucoma at baseline (HR 7.31 and 26.87, p<0.001) were risk factors for developing severe visual impairment or blindness. Concordance index of the model was 0.87. Socioeconomic, minority status/language, and housing type/transportation SVIndex themes were key contributors to developing severe visual impairment or blindness. ConclusionsRisk factors for developing glaucoma-related severe visual impairment or blindness included older age, elevated IOP during follow-up, moderate or severe disease at baseline, and residence in areas associated with greater social vulnerability. In addition to ocular risk factors, geocoded EHR data regarding social risk factors could help identify patients at high risk of developing glaucoma-related visual impairment.

Association between Skin Carotenoid Levels and Cognitive Impairment Screened by Mini-Cog in Patients with Glaucoma

Carotenoids, having strong antioxidant properties, have been associated with neurodegenerative conditions like dementia and glaucoma, characterized by neuronal loss leading to cognitive and visual dysfunction. Therefore, carotenoids have attracted attention as factors predictive of the onset and progression of these neurodegenerative diseases. However, the impact of carotenoids on cognitive impairment and glaucomatous visual field defects remains unexplored. We conducted a retrospective, observational clinical study to investigate the association between skin carotenoid (SC) levels and cognitive impairment, as screened by the Mini-Cog test, in glaucoma patients. The study included 406 participants and 812 eyes were examined (average age: 69.7 ± 11.4 years; 228 men, 178 women) with various types of glaucoma: primary open angle (57.6%), exfoliation (18.6%), and other types (23.8%). SC levels were estimated via pressure-mediated reflection spectroscopy. Mixed-effects regression models were utilized to examine the relationship between SC levels, visual field defects, and Mini-Cog results. Of the participants, 28 (6.9%) tested positive on the Mini-Cog, suggesting cognitive impairment. The average SC level in the Mini-Cog positive group was significantly lower than in the negative group (269.5 ± 86.4 A.U. vs. 329.2 ± 120.4 A.U., respectively; p = 0.01). Additionally, the visual field mean deviation (MD) in the Mini-Cog positive group was notably worse than that in the negative group (−19.64 ± 9.07 dB vs. −12.46 ± 9.28 dB, respectively; p &lt; 0.0001). The mixed-effects regression analysis revealed a significant association between Mini-Cog positivity and lower SC levels (p = 0.0006), although SC levels did not significantly correlate with MD (p = 0.3). Our findings suggest that cognitive impairment in glaucoma patients is associated with lower SC levels, underscoring the potential benefits of maintaining carotenoid levels to slow cognitive function decline. The protective role of carotenoids in glaucoma merits further investigation.

A validated web-application (GFDC) for automatic classification of glaucomatous visual field defects using Hodapp-Parrish-Anderson criteria.

Subjectivity and ambiguity of visual field classification limits the accuracy and reliability of glaucoma diagnosis, prognostication, and management decisions. Standardised rules for classifying glaucomatous visual field defects exist, but these are labour-intensive and therefore impractical for day-to-day clinical work. Here a web-application, Glaucoma Field Defect Classifier (GFDC), for automatic application of Hodapp-Parrish-Anderson, is presented and validated in a cross-sectional study. GFDC exhibits perfect accuracy in classifying mild, moderate, and severe glaucomatous field defects. GFDC may thereby improve the accuracy and fairness of clinical decision-making in glaucoma. The application and its source code are freely hosted online for clinicians and researchers to use with glaucoma patients.

Measuring Visual Fields in Children With Glaucoma Using a Portable Tablet.

To compare perimetric outcomes of an iPad perimetry app (Melbourne Rapid Fields [MRF]) with those of the Humphrey Field Analyser (HFA) testing children with glaucoma. Sixteen children diagnosed and treated for glaucoma were recruited to evaluate their perimetric performance over two visits. At each visit, they undertook visual field assessment using the MRF application as well as the HFA. The HFA test was part of their usual clinical work up and a clinical assistant judged which test format (24-2 SITA standard or SITA fast) might be suited to the testing of that child. The primary outcome measure was the association and repeatability of mean deviation (MD) for the MRF and HFA tests, by way of regression, intraclass correlation coefficient and Bland-Altman analysis. Secondary measures were comparisons of pattern deviation indices, test times as well as an indication of participant test preference. Summary data show means ± standard deviation. The age for our cohort was 7 to 15 years of age (mean, 10.0 ± 2.4years of age). The MRF MD was in close concordance to HFA MD with an intraclass correlation coefficient of 0.91 (95% confidence interval, 0.82-0.95). Bland-Altman analysis found little bias (-0.6dB) and a 95% coefficient of repeatability of 2.1dB in eyes having a normal HFA MD. In eyes with glaucomatous visual field defects the 95% coefficient of repeatability at retest was much larger for both the MRF (10.5dB) as well as for the HFA (10.0dB). Average MRF test times (5.6 ± 1.2 minutes) were similar to SITA Fast (5.4 ± 1.9 minutes) with both being significantly faster than SITA standard (8.6 ± 1.4 minutes; P < 0.001). All children chose testing with the MRF as their preference. MRF correlated strongly with HFA and was preferred by the children over the HFA. MRF is suitable for perimetric evaluation of children with glaucoma. This study finds that an iPad based visual field test can be used with children having glaucoma to yield outcomes similar to SITA-fast. Children indicate a preference for such testing.

Correlation of retrobulbar perfusion deficits with glaucomatous visual field defects.

This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects. Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined. The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects. Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV. ChiCTR2200059048 (2022-04-23).

Clinical outcomes after implantation of a new monofocal intraocular lens with enhanced intermediate function in patients with preperimetric glaucoma.

We evaluated the clinical outcomes after implantation of a new monofocal intraocular lens (IOL) with enhanced intermediate function in patients with preperimetric glaucoma and compared those with patients without retinal nerve fiber layer (RNFL) defects. All patients were implanted bilaterally a new monofocal IOL with enhanced intermediate function. Patients with bilateral RNFL defects and no glaucomatous visual field defects were classified as the preperimetric glaucoma group. A total of 60 eyes of 30 patients with preperimetric glaucoma were compared with 60 eyes of 30 patients without RNFL defects. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, contrast sensitivity, and questionnaire were evaluated 1 month and 3 months after surgery. No difference in binocular UDVA, UIVA, and UNVA was evident between the two groups at 1 and 3 months postoperatively. Additionally, there were no significant differences between the two groups regarding the proportion of severe or very severe photic phenomena, such as glare and halos, or the overall satisfaction. Bilateral implantation of a new monofocal IOL with enhanced intermediate function in patients with preperimetric glaucoma demonstrated commensurate clinical outcomes and could be considered a feasible alternative.

Does the sampling frequency of an eye tracker affect the detection of glaucomatous visual field loss?

Evidence suggests that eye movements have potential as a tool for detecting glaucomatous visual field defects. This study evaluated the influence of sampling frequency on eye movement parameters in detecting glaucomatous visual field defects during a free-viewing task. We investigated eye movements in two sets of experiments: (a) young adults with and without simulated visual field defects and (b) glaucoma patients and age-matched controls. In Experiment 1, we recruited 30 healthy volunteers. Among these, 10 performed the task with a gaze-contingent superior arcuate (SARC) scotoma, 10 performed the task with a gaze-contingent biarcuate (BARC) scotoma and 10 performed the task without a simulated scotoma (NoSim). The experimental task involved participants freely exploring 100 images, each for 4 s. Eye movements were recorded using the LiveTrack Lightning eye-tracker (500 Hz). In Experiment 2, we recruited 20 glaucoma patients and 16 age-matched controls. All participants underwent similar experimental tasks as in Experiment 1, except only 37 images were shown for exploration. To analyse the effect of sampling frequency, data were downsampled to 250, 120 and 60 Hz. Eye movement parameters, such as the number of fixations, fixation duration, saccadic amplitude and bivariate contour ellipse area (BCEA), were computed across various sampling frequencies. Two-way ANOVA revealed no significant effects of sampling frequency on fixation duration (simulation, p = 0.37; glaucoma patients, p = 0.95) and BCEA (simulation, p = 0.84; glaucoma patients: p = 0.91). BCEA showed good distinguishability in differentiating groups across different sampling frequencies, whereas fixation duration failed to distinguish between glaucoma patients and controls. Number of fixations and saccade amplitude showed variations with sampling frequency in both simulations and glaucoma patients. In both simulations and glaucoma patients, BCEA consistently differentiated them from controls across various sampling frequencies.

Improvement of optic nerve head perfusion and reversible visual field defect following XEN Gel Stent implant

Background: Patients with juvenile onset ocular hypertension (OHT) have high intraocular pressure (IOP) and may develop early glaucomatous disc damage.&#x0D; Case presentation: A 26-year-old woman with family history of glaucoma was diagnosed with OHT at age 18. Her vision was 6/6, with a bilateral cup-to-disc ratio of 0.5, normal visual field (VF), and IOP in the mid-teens on 2 topical antiglaucoma medications. The patient started having IOP spikes (20–48 mmHg) in her left eye despite maximum tolerable medical therapy, associated with intermittent headache and nasal step defect on VF test. XEN Gel Stent was implanted and IOP reduced to 10–14 mmHg without medical therapy. Optical coherence tomography angiography showed improvement in optic nerve head (ONH) perfusion density and flux, while the VF defect disappeared.&#x0D; Conclusion: Improvement in ONH perfusion and reversibility of early glaucomatous VF defect is feasible with prompt XEN Gel Stent implant in juvenile OHT.

Awareness for glaucoma in the general population

Glaucoma is not arare entity but because very few symptoms occur and visual field defects are frequently first recognized at a late stage, alarge proportion of glaucoma diseases remain undetected. The aim of this study was to identify the proportion of undiagnosed glaucoma in German population-based cohort studies and to contextualize them in the context of the literature. The prevalence of glaucoma in the Gutenberg Health Study (GHS) and the age-related investigations on health of the University of Regensburg (AugUR) was evaluated based on visual field examinations and optic disc color photography according to the ISGEO criteria. Furthermore, the self-reported glaucoma diagnoses were collected and the proportion of undiagnosed glaucoma was determined. The proportion of undiagnosed glaucoma was 55% in the GHS, and 53% in the AugUR study. The results correlate with results from previous studies from other countries in which the proportion of unrecognized glaucoma ranged from 33% to 78%. In the GHS and the AugUR study the proportion of undiagnosed glaucoma was higher in younger age groups and in women. Roughly every second case of glaucoma is undetected. As the symptoms are often nonspecific or take a long time to appear, there is arisk of advanced glaucomatous visual field defects or blindness due to a lack of glaucoma awareness. Studies have shown that asystematic screening can halve this risk.

Factors associated with intrachoroidal cavitation and sinkhole formation in eyes with glaucomatous visual-field defects

PurposeTo investigate factors associated with intrachoroidal cavitation (ICC) and sinkhole formation in eyes with glaucomatous visual-field defects.MethodsThis retrospective, cross-sectional study enrolled a total of 2808 eyes of 1482 patients who were diagnosed/treated for glaucoma and underwent swept-source optical coherence tomography (OCT). We first determined the prevalence of ICCs and sinkholes and their locations. Next, we selected one eye from each patient and compared the clinical characteristics of eyes with and without ICCs. Finally, in eyes with ICCs, we compared the clinical characteristics of eyes with and without sinkholes. Blood flow (BF), represented by laser speckle flowgraphy–measured tissue-area mean blur rate (MBR), was measured in the temporal optic nerve head (ONH), temporal peripapillary chorioretinal atrophy (PPA) zone, and in the ICC zone. ICC area and angle were analyzed in OCT en-face images. Mean deviation and total deviation in the central area (TD-central) were measured with Humphrey visual-field testing.ResultsA total of 86 eyes (3.1%) had ICCs and 52 eyes (1.9%) had sinkholes. ICC eyes had a lower spherical equivalent and longer axial length (AL) than non-ICC eyes (P < 0.05). Patients with eyes with sinkholes were more elderly and had worse best-corrected visual acuity, worse TD-central, a larger ICC, and lower tissue-area MBR in the temporal ONH, temporal PPA zone, and ICC zone (P < 0.05).ConclusionIn eyes with glaucoma, AL elongation might be linked to ICC formation. Sinkhole formation might be associated with ICC enlargement, impaired ocular BF, and impaired retinal structure and function involving the central area.

Premium Intraocular Lenses in Glaucoma-A Systematic Review.

The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments.

Detectability of Visual Field Defects in Glaucoma Using Moving Versus Static Stimuli for Perimetry.

We have previously shown that using moving, instead of static, stimuli extends the effective dynamic range of automated perimetry in glaucoma. In this study, we further investigate the effect of using moving stimuli on the detectability of functional loss. We used two experimental perimetry paradigms to test 155 subjects with a diagnosis of glaucoma or glaucoma suspect, and 34 healthy control subjects. One test used stimuli moving parallel to the average nerve fiber bundle orientation at each location; the other used static stimuli. Algorithms were otherwise identical. Sensitivities to moving stimuli were transformed to the equivalent values for static stimuli based on a Bland-Altman plot. The proportions of locations outside age-corrected normative limits were compared, and test-retest variability was compared against defect depth for each stimulus type. More tested locations were below the fifth percentile of the normative range for that location using static stimuli. However, among locations abnormal according to standard clinical perimetry on the same day, 19.2% were abnormal using static stimuli, versus 20.5% using moving stimuli (P = 0.372). Test-retest variability was 44% lower for moving stimuli across the range of defect depths. When compared with static automated perimetry and expressed on a common scale, moving stimuli extend the effective dynamic range and decrease variability, without decreasing the detectability of known functional defects. Moving stimuli provide a method to improve known problems of current clinical perimetry.

Comparing Static Perimetry Protocols of Central Field Testing among Patients with Glaucoma.

On comparing the Humphrey Field Analyzer (HFA) 24-2C Faster, which tests 10 additional points in the central field, with the 24-2 Swedish Interactive Thresholding Algorithm (SITA) Standard for detecting central field defects, we found that the HFA 24-2C Faster may be used for the initial field evaluation in glaucoma with the advantage of a shorter testing time. This study aimed to compare the HFA 24-2C Faster with the 24-2 SITA Standard and 10-2 among patients with glaucoma for the number of defective central points, global indices, and testing time. Sixty eyes of 60 patients with glaucoma and glaucomatous visual field defects on the 24-2 SITA Standard algorithm underwent the 24-2C Faster and 10-2 field tests. The number of central points detected, global indices, and reliability indices were compared between the 24-2C Faster and the 24-2 SITA Standard and 10-2 field tests. The 24-2C Faster, on average, detected 5.5 defective points more on the total deviation plot and 2 defective points more on the pattern deviation plot than the 24-2 SITA Standard in central 10°. The 10-2 algorithm detected 2.5 times more points on the total deviation plot than the 24-2C Faster. There was excellent consistency by an intraclass correlation coefficient of 0.95 for the mean deviation and 0.93 for the pattern standard deviation between the 24-2C Faster and the 24-2 SITA Standard. There was good consistency by an intraclass correlation coefficient of 0.80 for both mean deviation and pattern standard deviation between the 24-2C Faster and the 10-2. The testing time was significantly lower with the 24-2C Faster compared with the 24-2 SITA Standard and 10-2 test. Our study demonstrates that the HFA 24-2C Faster may be used for the initial evaluation of the visual field in glaucoma with the added advantage of a shorter testing time compared with the 24-2 SITA Standard program.

Glaucomatous optic nerve damage in the contralateral eye of a patient with peripapillary retinoschisis: a case report

BackgroundPeripapillary retinoschisis (PPRS) is often associated with glaucomatous eyes. It usually occurs in eyes with a more advanced stage of glaucoma with obvious optic nerve damage. We report a patient who was found to have PPRS in one eye during a routine physical examination without obvious glaucoma symptoms. Further examination revealed glaucomatous visual field loss and retinal nerve fiber layer defects in the contralateral eye.Case presentationA 55-year-old man presented for a routine physical examination. The anterior segment was normal in both eyes. Fundus examination revealed an elevated and red optic disc in the right eye. In addition, scattered patchy red lesions were seen on the retina on the temporal side of the optic disc. The color and boundary of the left optic disc were normal, and the cup-to-disc ratio was 0.6. Optical coherence tomography showed retinoschisis on the optic nerve head of the right eye throughout the entire circumference, extending to the retina on the temporal side of the optic disc. The intraocular pressure was 18 mmHg OD and 19 mmHg OS. The patient was diagnosed with PPRS (OD). However, no optic disc pit or optic disc coloboma was found. Further examination showed that the visual field of the patient’s right eye was generally normal, while a glaucomatous visual field defect was found in the left eye, which manifested as a nasal step visual field defect. Moreover, stereophotography and a red-free fundus image revealed two retinal nerve fiber layer defects in the supratemporal and infratemporal regions of the retina of the left eye. Continuous intraocular pressure measurement found that the intraocular pressure fluctuated between 18 and 22 mmHg OD and 19–26 mmHg OS during the daytime. Primary open-angle glaucoma was then diagnosed.ConclusionsIn this case, we found that PPRS was associated with glaucomatous optic nerve changes and visual field defects in the fellow eye.

Vision-Related Quality of Life in Primary Angle-Closure Glaucoma Patients with or without Visual Field Dysfunction.

To evaluate the association between visual-related quality of life (VRQoL) and visual field (VF) loss in patients with primary angle-closure glaucoma (PACG). In this case-control study, a total of 79 patients with PACG (with or without VF detects) and 35 healthy controls were included. The patients underwent the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), clinical examination, and VF testing. VF defects were identified by simplified Hodapp's classification. NEI VFQ-25 scores were compared between the three groups. No significant differences were found in gender, VFQ rating for "composite score" and "color vision" between the three groups. PACG patients with VF loss were most likely to be older and had lower best corrected visual acuity (BCVA), spherical equivalent (SE), mean deviation (MD), and visual field index (VFI), but higher pattern standard deviation (PSD) (all P < 0.05). Furthermore, patients with VF loss had significantly lower NVE-VFQ-25 subscale scores for general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, and peripheral vision than PACG patients without VF loss and healthy controls (all P < 0.05). VFI (β = 1.498, P=0.003) and MD (β = -3.891, P=0.016) were significantly correlated with Role Difficulties scores. Additionally, PSD was significantly correlated with Peripheral Vision scores (β = -1.346, P=0.003). PACG patients with VF loss reported lower NEI VFQ-25 composite and subscale scores. VF indices including VFI, MD, and PSD were strongly correlated with VRQoL as assessed by NEI VFQ-25; thus, VRQoL may be significantly impacted by glaucomatous VF defects.

Correlation between Interocular Asymmetry of Corneal Hysteresis and Visual Field Defect in Glaucoma.

To evaluate the relationship between interocular asymmetries of corneal hysteresis (CH) and visual field defects in Korean patients with glaucoma. A total of 444 eyes from 222 participants with glaucoma in at least one eye were enrolled. CH was measured using an ocular response analyzer (Reichert Technologies Inc). Eyes of each participant were classified into "better eye" and "worse eye" based on the mean deviation (MD) value of visual field test. The correlation between interocular differences in intraocular pressure, axial length, central corneal thickness, CH, and MD values was evaluated using Spearman correlation analysis. To exclude the possible effect of antiglaucoma medication on corneal properties, additional analyses were performed on eyes without any glaucoma treatment at the time of CH measurement (treatment-naive group). Median (interquartile range) MD value was -3.71 dB (-6.87 to -1.30 dB) in the better eye and -10.20 dB (-16.32 to -5.62 dB) in the worse eye. When the correlation between the asymmetry of the MD value and asymmetry of intraocular pressure, axial length, central corneal thickness, and CH were evaluated, only interocular differences in CH were significantly associated with interocular differences in MD values (rho = 0.214, p = 0.001). Among the 222 participants, 60 (27.0%) were treatment-naive group. In these eyes, interocular differences in CH were also significantly associated with interocular differences in the MD values (rho = 0.285, p = 0.029). The interocular asymmetry of CH was significantly correlated with the interocular asymmetry of visual field defects in glaucoma.

Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma.

Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp-Parrish-Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.

Quality of life of patients with primary open-angle glaucoma, primary angle closure glaucoma, and pseudoexfoliation glaucoma in Central Serbia

Background/Aim. Impaired vision resulting from glaucoma can have deleterious effects on both physical and mental health. This study aims to examine the adverse im-pacts of primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), and pseudoexfoliation glaucoma (PEG) on the quality of life (QoL) in Central Serbia. Methods. This research, designed as a cross-sectional study, included 102 patients treated for POAG, PACG, or PEG. The patients were divided into three groups (POAG, PACG, and PEG) based on the type of glaucoma they suffered from and were monitored for six months. The data on the QoL were obtained with the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Using the appropriate algorithm, the total NEI VFQ-25 scores were calculated for each group. Results. The questionnaire showed that scores for general vision were significantly lower in the PEG group than in the other two groups (PEG: 61.1 ? 12.6; POAG: 71.6 ? 17.9; PACG: 75.7 ? 11.6), p &lt; 0.001. General health, eye pain, distance vision, social functioning, peripheral vision, reduced ability in daily activities, and dependence on others were also statistically significantly lower in the PEG group. The highest value of near vision was recorded for the POAG group (76.2 ? 21.2). The highest mean value in glaucomatous visual field defect was recorded in the PEG group (14.5 ? 3.6 dB). Conclusion. This research has demonstrated that the QoL is significantly lower in patients suffering from PEG compared to those suffering from POAG and PACG. Concerning the general health of patients, eye pain, distance vision, as well as the domain of social and everyday functioning, the lowest scores for individual areas of examination according to the NEI VFQ-25 were recorded in PEG patients. The results indicate that serious measures should be taken in order to improve the QoL of glaucoma patients.

Local neuroplasticity in adult glaucomatous visual cortex

The degree to which the adult human visual cortex retains the ability to functionally adapt to damage at the level of the eye remains ill-understood. Previous studies on cortical neuroplasticity primarily focused on the consequences of foveal visual field defects (VFD), yet these findings may not generalize to peripheral defects such as occur in glaucoma. Moreover, recent findings on neuroplasticity are often based on population receptive field (pRF) mapping, but interpreting these results is complicated in the absence of appropriate control conditions. Here, we used fMRI-based neural modeling to assess putative changes in pRFs associated with glaucomatous VFD. We compared the fMRI-signals and pRF in glaucoma participants to those of controls with case-matched simulated VFD. We found that the amplitude of the fMRI-signal is reduced in glaucoma compared to control participants and correlated with disease severity. Furthermore, while coarse retinotopic structure is maintained in all participants with glaucoma, we observed local pRF shifts and enlargements in early visual areas, relative to control participants. These differences suggest that the adult brain retains some degree of local neuroplasticity. This finding has translational relevance, as it is consistent with VFD masking, which prevents glaucoma patients from noticing their VFD and seeking timely treatment.

Diagnostic accuracy of an iPad application for detection of visual field defects.

Tablet-based perimetry could be used to test for glaucomatous visual field defects in settings without easy access to perimeters, although few studies have assessed diagnostic accuracy of tablet-based tests. The goal of this study was to determine the diagnostic accuracy of iPad perimetry using the visualFields Easy application. This was a prospective, cross-sectional study of patients undergoing their first Humphrey Field Analyser (HFA) visualfield test at a glaucoma clinic in India. Participants underwent 24-2 SITA Standard HFA testing and iPad-based perimetry with the visualFields Easy application. Reference standards for both visualfield loss and suspected glaucoma were determined by ophthalmologist review of HFA results and optic disc photographs. Receiver operating characteristic curves were constructed to assess diagnostic accuracy at various test thresholds. 203 eyes from 115 participants were included, with 82 eyes classified as moderate or worse glaucoma. iPad perimetry had an area under the receiver operating characteristic (AUROC) curve of 0.64 (95% CI 0.57 to 0.71) for detection of any visualfield defect relative to HFA and an AUROC of 0.68 (0.59 to 0.76) for detection of moderate or worse glaucoma relative to ophthalmologist examination. At a set specificity of 90%, the sensitivity of iPad perimetry for detection of moderate or worse glaucoma was 35% (22-48%). iPad perimetry using the visualFields Easy application had inadequate diagnostic accuracy to be used as a screening tool for glaucoma in this South Indian population.