Glaucomatous Visual Field Defects Research Articles

Glaucoma: Confrontation visual field test using Bagolini striated glasses — a new screening method for detecting visual field defects

INTRODUCTION. Glaucoma diagnosis is based on elevated intraocular pressure, altered morphology of the optic disc, and perimetric visual field defects. Next to funduscopy and optical coherence tomography, perimetric data are important. In developing countries, large parts of the population have only limited access to medical care. Especially in these cases, a quick and affordable method for detecting visual field defects would be desirable. The aim of this study was to investigate the potential use of Bagolini striated glasses in detecting glaucomatous visual field defects. MATERIALS AND METHODS . Ninety subjects of the Erlangen Glaucoma Register (ISSN 2191-5008, CS-2011. ClinicalTrials.gov, Identifier: NCT00494923) were tested using the confrontation visual field test with Bagolini striated glasses [10 normals, 17 ocular hypertensions (OHT), 31 preperimetric open-angle glaucomas (preOAG), 16 normal tension glaucomas (NTG), 16 open-angle glaucomas (OAG)]. All probands underwent standard ophthalmological examination including slit-lamp biomicroscopy, funduscopy, and Goldmann-tonometry. Additionally, standard white-on-white perimetry and measurements of the global retinal nerve fibre layer (RNFL) of the optic disc were performed. RESULTS. 1. All normals, all OHTs, and 96% of preOAGs showed normal Bagolini test results. 2. 74% of NTGs and 73% of OAGs yielded pathological Bagolini test results. 3. Specificity of patients with normal visual fields was 98% and sensitivity was 73–80%. 4. Visual field defects resulted in altered Bagolini test results. 5. Localised visual field defects were detected in 78% (NTG) and 80% (OAG) using Bagolini striated glasses. CONCLUSIONS. Glaucoma-related visual field defects can be detected by confrontation visual field testing using Bagolini striated glasses. This quick, easily performed, and affordable method can be used as a bedside test and is suitable as a screening method for persons in developing countries.

Glaucoma detection with damato multifixation campimetry online.

PurposeTo evaluate Damato Multifixation Campimetry Online (DMCO), a free-of-charge internet-based visual field test. DMCO exists in three versions: DMCO BASIC, DMCO STANDARD, and DMCO ADVANCED. The main focus was (i) to investigate the sensitivity and the specificity of the existing DMCO versions in the detection of glaucomatous visual field loss and (ii) to define and evaluate algorithms for the interpretation of DMCO results.MethodsThe study design was an evaluation of a diagnostic test and included 97 individuals performing DMCO and white-on-white perimetry. Interpretation algorithms were devised to define abnormality, and these were evaluated using the Glaucoma Staging System as gold standard. Receiver operating characteristic (ROC) curves and area under the ROC (AUC) were calculated.ResultsAUCs from 15 algorithms ranged from 0.79 to 0.90. The most promising algorithm combined results from two successive DMCO STANDARD tests. The sensitivity was highly dependent on the severity of glaucoma. Hence, for eyes with mild, moderate, advanced, and severe glaucoma, the DMCO test demonstrated a sensitivity of 11.8, 71.4, 100, and 100%, respectively. The specificity was as high as 98.1%. Median duration per eye to complete the DMCO STANDARD test was 86 s for the control group and 125 s in participants with glaucoma.ConclusionsDMCO shows promise as a free-of-charge online tool to identify glaucomatous visual field defects in a preselected population. Ongoing studies are evaluating the use of DMCO in a nonselected population.

Prevalence of ocular hypertension and glaucoma in patients with chronic ocular graft-versus-host disease.

To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with chronic ocular graft-versus-host disease (GVHD). We performed a retrospective chart review of 218 patients diagnosed with chronic ocular GVHD. Ocular hypertension was defined as intraocular pressure (IOP) ≥ 24mmHg in either eye without any glaucomatous optic disc changes. Glaucoma suspect was defined as optic disc changes with a cup-to-disc ratio ≥ 0.7 in either eye or asymmetry of ≥ 0.3 between the two eyes. Glaucoma was defined by glaucomatous optic disc changes plus glaucomatous visual field defects in two consecutive reliable visual field tests. The number of cases of ocular hypertension, glaucoma, and glaucoma suspects was evaluated. Thirty-three patients (15%) were diagnosed with OHT, eight patients (3.6%) with suspicion of glaucoma, and one patient (0.4%) with glaucoma. OHT occurred within 6months of developing ocular GVHD in 60% of the cases and within the first year in 76%. High IOP normalized in 67% of patients when the dosage of topical or systemic corticosteroids was lowered, and 27% of patients required anti-glaucoma therapy. Ocular hypertension is a common complication in patients with ocular GVHD, with a prevalence of 15%. The rise in intraocular pressure is often transient and resolves with management of corticosteroids in most cases. However, clinicians should be aware that nearly one-third of the patients with OHT might require anti-glaucoma treatment. The prevalences of glaucoma and suspicion of glaucoma were not higher than in the general population.

Fast Visual Field Progression Is Associated with Depressive Symptoms in Patients with Glaucoma

To evaluate the association between the rates of progressive visual field loss and the occurrence of depressive symptoms in patients with glaucoma followed over time. Prospective observational cohort study. The study included 204 eyes of 102 patients with glaucomatous visual field defects on standard automated perimetry (SAP). All patients had Geriatric Depression Scale (GDS) questionnaires and visual field tests obtained over a mean follow-up time of 2.2±0.6 years. Change in depressive symptoms was assessed by calculating the difference between GDS scores at the last follow-up visit from those at baseline. Rates of visual field loss were assessed by SAP. An integrated binocular visual field was estimated from the monocular SAP tests, and rates of change in mean sensitivity (MS) over time were obtained from linear mixed models. Regression models were used to investigate the association between progressive visual field loss and changes in depressive symptoms, adjusting for potentially confounding clinical and socioeconomic variables. The association between rates of change in binocular SAP MS and change in GDS questionnaire scores. There was a significant correlation between change in the GDS scores during follow-up and change in binocular SAP sensitivity. Each 1 decibel (dB)/year change in binocular SAP MS was associated with a change of 2.0 units in the GDS scores during the follow-up period (P = 0.025). In a multivariable model adjusting for baseline disease severity, change in visual acuity, age, gender, race, Montreal Cognitive Assessment score, education, income, and comorbidity index, each 1 dB/year change in binocular SAP MS was associated with a change of 3.0 units in the GDS score (P = 0.019). Faster visual field progression was associated with the occurrence of depressive symptoms in patients with glaucoma.

Photopic negative response of full-field electroretinography in patients with different stages of glaucomatous optic neuropathy

PurposeTo evaluate photopic negative response (PhNR) discrimination ability between healthy and glaucomatous patients. MethodsNinety eyes of 50 patients with primary open angle glaucoma (POAG) and 45 eyes of 23 healthy age- and sex-matched controls were investigated. Based on European Glaucoma Society criteria, POAG patients were divided into three groups: early, moderate and advanced glaucoma. Following measurements were analysed: mean defect (MD) from Humphrey Visual Field Analyzer, SITA standard 24-2 white on white perimetry; nerve fibre index (NFI) obtained from scanning laser polarimetry; and GDx and PhNR amplitude and PhNR/b-wave ratio. PhNR was elicited by red stimuli with flash strength of 1.6 cd s/m2 on blue background of 25 cd/m2. Correlations between retinal ganglion cells function (PhNR), retinal sensitivity (MD) and structure (NFI) were calculated. Sensitivity and specificity of PhNR parameters were calculated with standard formulas. Receiver operating characteristic (ROC) curves were used to determine optimal cut-off values. The area under the curve (AUC) was used to compare the ROC curves results between PhNR amplitude and ratio.ResultsPhNR amplitude and ratio were significantly reduced in early, moderate and advanced glaucoma groups compared to controls. The sensitivity and specificity to detect glaucoma in early POAG were equal to 53.3 and 90.0 % for PhNR amplitude and 60.0 and 70.0 % for PhNR ratio; in moderate POAG 63.3 and 80.0 % for PhNR amplitude and 60.0 and 86.7 % for PhNR ratio; and in advanced POAG 76.6 and 80.0 % for PhNR amplitude, 90.0 and 73.3 % for PhNR ratio. There were no significant differences between AUC for PhNR amplitude (0.76–0.86) and PhNR ratio (0.78–0.86), p > 0.05. PhNR amplitudes and ratios correlated significantly with MD measured by SAP and NFI obtained from GDx (p < 0.05). PhNR amplitude significantly decreases with advancement of visual field defects in glaucoma patients.ConclusionsPhNR reveals dysfunction of RGCs in early, moderate and advanced stage of POAG. PhNR has good discrimination ability in detecting glaucomatous patients. PhNR might be a useful test in glaucoma diagnosis.

Efficacy of the Amsler Grid Test in Evaluating Glaucomatous Central Visual Field Defects

To investigate the efficacy of the Amsler grid test in detecting central visual field (VF) defects in glaucoma. Prospective, cross-sectional study. Patients with glaucoma with reliable Humphrey 10-2 Swedish Interactive Threshold Algorithm standard VF on the date of enrollment or within the previous 3 months. Amsler grid tests were performed for each eye and were considered "abnormal" if there was any perceived scotoma with missing or blurry grid lines within the central 10 degrees ("Amsler grid scotoma"). An abnormal 10-2 VF was defined as ≥3 adjacent points at P < 0.01 with at least 1 point at P < 0.005 in the same hemifield on the pattern deviation plot. Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area were calculated with the 10-2 VF as the clinical reference standard. Among eyes with an abnormal 10-2 VF, regression analyses were performed between the Amsler grid scotoma area and the 10-2 VF parameters (mean deviation [MD], scotoma extent [number of test points with P < 0.01 in total deviation map] and scotoma mean depth [mean sensitivity of test points with P < 0.01 in total deviation map]). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area. A total of 106 eyes (53 patients) were included (mean ± standard deviation age, 24-2 MD and 10-2 MD = 66±12 years, -9.61±8.64 decibels [dB] and -9.75±9.00 dB, respectively). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid test were 68%, 92%, 97%, and 46%, respectively. Sensitivity was 40% in eyes with 10-2 MD better than -6 dB, 58% in eyes with 10-2 MD between -12 and -6 dB, and 92% in eyes with 10-2 MD worse than -12 dB. The area under the receiver operating characteristic curve of the Amsler grid scotoma area was 0.810 (95% confidence interval, 0.723-0.880, P < 0.001). The Amsler grid scotoma area had the strongest relationship with 10-2 MD (quadratic R(2)=0.681), followed by 10-2 scotoma extent (quadratic R(2)=0.611) and 10-2 scotoma mean depth (quadratic R(2)=0.299) (all P < 0.001). The Amsler grid can be used to screen for moderate to severe central vision loss from glaucoma.

Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma.

Purpose. To describe a modified guarded filtration surgery, stab incision glaucoma surgery (SIGS), for primary open angle glaucoma (POAG). Methods. This prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual field defects). After sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superficial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5–1 mm into cornea and anterior chamber (AC) was entered. Kelly Descemet's punch (1 mm) was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fluid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured. Results. Mean preoperative IOP was 27.41 ± 5.54 mmHg and mean postoperative IOP was 16.47 ± 4.81 mmHg (n = 17). Mean reduction in IOP was 38.81 ± 16.55%. There was significant reduction of IOP (p < 0.000). 64.7% had IOP at final follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered. Conclusion. Satisfactory IOP control was noted after SIGS in interim follow-up (14.18 ± 1.88 months).

Evaluation of the "IS" Rule to Differentiate Glaucomatous Eyes From Normal.

To compare the accuracy of the "ISNT" rule [neural rim width of inferior(I)≥superior(S)≥nasal(N)≥temporal(T) regions] and the abbreviated variant, the "IS" rule (inferior≥superior regions) to differentiate normal from glaucomatous eyes. Medical records of patients who were evaluated in 2011, had glaucomatous optic neuropathy and visual field defects, on glaucoma treatment, and had stereoscopic optic disc photographs were reviewed. Optic discs with focal complete loss of neural rim or long axis rotated >30 degrees from vertical meridian, and patients with ≥5 D of myopia or any retinal pathology or nonglaucomatous optic neuropathy were excluded. One eye per patient was randomly enrolled. Normal control eyes were also included. Rim widths were measured with an image processing program (ImageJ, National Institutes of Health) in a masked manner. The sensitivity and specificity of the ISNT rule, the IS rule, and cup-to-disc ratio (CDR) were compared. A total of 134 glaucoma and 110 normal eyes were enrolled. The mean CDRs of the glaucoma and normal eyes were 0.65±0.13 and 0.39±0.15, respectively. Sensitivities of the ISNT and IS rules were 85% and 41%, respectively, whereas specificities were 46% and 85%, respectively. Application of the IS rule in eyes with larger CDR (>0.57) increased the specificity of the IS rule to 93% while keeping the sensitivity at 41%. When ISNT or IS rule and CDR>0.57 were combined in differentiating normal from glaucomatous eyes for the entire sample, specificities approached 90% and 99%, respectively. The ISNT rule alone has a high sensitivity but relatively low specificity. Application of the IS rule in eyes with increased CDR yields a much higher specificity for differentiating normal from more advanced glaucomatous eyes. A combination of different features of the optic disc (increase of CDR and ISNT or IS rule) improves the specificity of optic disc evaluation for glaucoma.

Location of Initial Visual Field Defects in Glaucoma and Their Modes of Deterioration.

To describe the location of initial visual field defects (VFD) in glaucoma, their modes of deterioration, and those factors associated with different modes of deterioration. Patients with POAG were categorized into four groups based on three consecutive initial VFD: (1) superior paracentral defects (PD), (2) inferior PD, (3) superior nasal defects (ND), and (4) inferior ND. According to the worsening of the VF, four further subgroups were identified: (1) superior central worsening (CW), (2) inferior CW, (3) superior peripheral or nasal worsening (NW), and (4) inferior NW. Systemic and ocular factors were analyzed for each of the subgroups to identify possible associations. One hundred sixty-two eyes of 162 subjects were analyzed. Superior PD (n = 40) were more frequent in females and associated with disc hemorrhage (DH), and were less frequent in patients with systemic hypertension (HT). Inferior PD (n = 35) showed a significant association with cup shape measure and axial length. Superior ND (n = 37) were more highly associated with HT and diabetes. Inferior ND (n = 50) showed a lower incidence of DH. With binary logistic regression analysis, superior PD showed a significant association with both HT and DH. With respect to VF worsening, superior CW showed a significant association with HT and diabetes, whereas superior NW was associated with a high minimum IOP during follow-up, and inferior NW was associated with a high maximum IOP during follow-up. The initial location and subsequent direction of worsening of VFD were associated with different systemic and ocular factors.

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.

A Portable Platform for Evaluation of Visual Performance in Glaucoma Patients.

PurposeTo propose a new tablet-enabled test for evaluation of visual performance in glaucoma, the PERformance CEntered Portable Test (PERCEPT), and to evaluate its ability to predict history of falls and motor vehicle crashes.DesignCross-sectional study.MethodsThe study involved 71 patients with glaucomatous visual field defects on standard automated perimetry (SAP) and 59 control subjects. The PERCEPT was based on the concept of increasing visual task difficulty to improve detection of central visual field losses in glaucoma patients. Subjects had to perform a foveal 8-alternative-forced-choice orientation discrimination task, while detecting a simultaneously presented peripheral stimulus within a limited presentation time. Subjects also underwent testing with the Useful Field of View (UFOV) divided attention test. The ability to predict history of motor vehicle crashes and falls was investigated by odds ratios and incident-rate ratios, respectively.ResultsWhen adjusted for age, only the PERCEPT processing speed parameter showed significantly larger values in glaucoma compared to controls (difference: 243ms; P<0.001). PERCEPT results had a stronger association with history of motor vehicle crashes and falls than UFOV. Each 1 standard deviation increase in PERCEPT processing speed was associated with an odds ratio of 2.69 (P = 0.003) for predicting history of motor vehicle crashes and with an incident-rate ratio of 1.95 (P = 0.003) for predicting history of falls.ConclusionA portable platform for testing visual function was able to detect functional deficits in glaucoma, and its results were significantly associated with history of involvement in motor vehicle crashes and history of falls.

Structure-Function Relationship Between Bruch's Membrane Opening-Based Optic Nerve Head Parameters and Visual Field Defects in Glaucoma.

This study was performed to evaluate the structure-function relationship between Bruch's membrane opening (BMO) parameters of the optic nerve head (ONH) and visual field (VF) sensitivity. Forty-six right eyes of 46 patients with open-angle glaucoma (OAG) in the patient group and 12 right eyes in the control group were included. Standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SD-OCT) were assessed. Three BMO-based distances and two areas of the neuroretinal rim were used for correlation: the minimum rim width (MRW), the perpendicular rim width (PRW), the horizontal rim width (HRW), the minimum rim area (MRA) within the neuroretinal tissue defined by the MRW, and the perpendicular rim area (PRA) within the neuroretinal tissue defined by the PRW. These parameters were correlated with global and sectoral VF sensitivities. Spearman's correlation coefficients between BMO parameters and global and sectoral VF sensitivities were obtained. Within the patient group, significant correlations could be observed between global and sectoral VF sensitivities and BMO parameters, with PRW and PRA showing the highest values. In the sectoral analysis the highest correlations were found for the temporal-inferior VF sector (MD-TI): PRW-TI (ρ = 0.72394; P < 0.00001) and PRA-TI (ρ = 0.77205; P < 0.00001). Minimum rim width and MRA performed more weakly than PRW and PRA. The BMO-based parameters PRW and PRA presented with a very good structure-function relationship in glaucoma patients, statistically at least equal to MRW and MRA. Using new BMO-based parameters might allow early objective assessments of functional glaucomatous impairments.

Detection of the progression of retinal nerve fiber layer loss by optical coherence tomography in a patient with glaucomatocyclitic crisis

A 30-year-old man presented with glaucomatocyclitic crisis, also known as Posner–Schlossman syndrome, and acute intraocular pressure elevation. Changes in the longitudinal retinal nerve fiber layer (RNFL) and the cup-to-disc (C/D) ratio of the optic disc were detected by Stratus optical coherence tomography (OCT). The average RNFL thickness in the affected eye was greater than that in the unaffected eye on Day 3 (132.99 μm, C/D ratio: 0.24 vs. 105 μm, C/D ratio: 0.26). However, the RNFL thickness continued to decrease and the C/D ratio progressively increased in the affected eye over 12 months (60 μm, C/D ratio: 0.67), although the intraocular pressure was controlled at <21 mmHg during that period. Glaucomatous visual field defects were also found. A progressive decrease in the thickness of the RNFL was demonstrated by Stratus optical coherence tomography following an elevation in the acute intraocular pressure in the patient. Prompt treatment and longitudinal monitoring are necessary to prevent and detect glaucomatous damage.

Correlation of localized glaucomatous visual field defects and spectral domain optical coherence tomography retinal nerve fiber layer thinning using a modified structure-function map for OCT.

To study the correlation between glaucomatous visual field (VF) defects assessed by standard automated perimetry (SAP) and peripapillary retinal nerve fiber layer (RNFL) thinning measured by spectral domain optical coherence tomography (OCT) using a modified OCT-based peripapillary RNFL structure-function map. Perimetric glaucoma patients and age-matched normal control subjects were recruited from a university hospital clinic. All eyes underwent testing with the Spectralis spectral domain OCT and SAP on the same day. An OCT-based correspondence map, which correlated VF areas with peripapillary RNFL sectors was created to evaluate the relationship between glaucomatous RNFL thinning and VF loss in six nerve fiber layer bundle areas. Correlations of RNFL thinning with corresponding VF defects were examined using Spearman rank-order correlations. To demonstrate the association between localized VF defects and RNFL thickness, the theoretical curves were made according to an established log-linear model. The measured RNFL thickness values and VF defects were presented in the same scatterplot for each sector. Fifty-six glaucoma patients and 85 normal subjects were included in the study. Significant association between localized VF loss and RNFL thinning was found in corresponding areas. Data from the current study fit well with established log-linear models, which compare RNFL thickness values with VF defects. Analysis of RNFL thinning in eyes with localized glaucomatous VF defects showed good structure-function correlation in a new OCT-based structure-function correspondence map.

Water-drinking test and its importance in glaucoma management

Water-drinking test (WDT) was first described as a diagnostic tool for glaucoma; however, it was later abandoned because of its poor diagnostic accuracy. This test has gained significant attention in recent years because different studies have shown its use as a surrogate for detecting patients who have intraocular pressure (IOP) spikes not measured during regular office hours. According to the peer-reviewed literature, IOP peaks detected by the WDT positively correlate with the severity of visual field defects in glaucoma and may predict visual field progression. Furthermore, it was demonstrated that IOP peaks detected by the WDT were correlated and in agreement with the IOP peaks that normally occurred during the day. The WDT is also used to evaluate the quality of different clinical and surgical treatment options in glaucoma. The main objective of this review was to present and discuss the evidence and applicability of the WDT as an assessment tool for glaucoma.

Temporal Retinal Thickness in Eyes With Glaucomatous Visual Field Defects Using Optical Coherence Tomography

To evaluate the temporal macular retinal thickness in normal, early, and advanced glaucomatous eyes using optical coherence tomography 3 (OCT-3) and correlate the superior-to-inferior retinal thickness (S/I RT) ratio with corresponding field defects in early and advanced glaucoma patients. Forty normal eyes, 40 eyes with early glaucomatous visual field defects, and 33 eyes with advanced visual field defects were included. All participants underwent complete ocular and visual field examinations and OCT-3 imaging on the same day. A 3×3 mm area temporal to the foveal reflex was scanned with the OCT-3 using 6 horizontal, equally spaced raster lines. Retinal thickness was evaluated at points 500 μm apart for each line and S/I RT ratio computed between similar points above and below the fovea for each patient. One-way ANOVA was used to compare S/I RT ratio between the normal, early, and advanced glaucoma eyes. Average retinal thickness increased progressively, as points temporal to the fovea were scanned. There was a statistically significant difference between the average superior and inferior retinal thickness at points 1500, 2000, and 2500 μm temporal to the fovea in both early and advanced glaucoma eyes (P<0.05) with corresponding significant differences in the S/I RT ratios, when compared with the normal participants (P<0.017). OCT-3-generated S/I RT ratios were successfully able to reproduce the structural damage in eyes with early and advanced glaucoma field defects and can complement optic disc scanning protocols in diagnosing glaucoma at an early stage.

Glaucomatous visual field defect severity and the prevalence of motor vehicle collisions in Japanese: a hospital/clinic-based cross-sectional study.

Purpose. This study examined the association between the severity of visual field defects and the prevalence of motor vehicle collisions (MVCs) in subjects with primary open-angle glaucoma (POAG). Methods. This is a cross-sectional study. Japanese patients who have had driver's licence between 40 and 85 years of age were screened for eligibility. Participants answered a questionnaire about MVCs experienced during the previous 5 years. Subjects with POAG were classified as having mild, moderate, or severe visual field defect. We evaluated associations between the severity of POAG and the prevalence of MVCs by logistic regression models. Results. The prevalence of MVCs was significantly associated with the severity of POAG categorized by worse eye MD (control: 30/187 = 16.0%; mild POAG: 17/92 = 18.5%; moderate POAG: 14/60 = 23.3%; severe POAG: 14/47 = 29.8%; P = 0.025, Cochran-Armitage trend test). Compared to the control group, the adjusted OR for MVC prevalence in subjects with mild, moderate, or severe POAG in the worse eye was 1.07 (95% CI: 0.55 to 2.10), 1.44 (95% CI: 0.68 to 3.08), and 2.28 (95% CI: 1.07 to 4.88). Conclusions. There is a significant association between the severity of glaucoma in the worse eye MD and the prevalence of MVCs.

Choice of Stimulus Range and Size Can Reduce Test-Retest Variability in Glaucomatous Visual Field Defects.

To develop guidelines for engineering perimetric stimuli to reduce test-retest variability in glaucomatous defects. Perimetric testing was performed on one eye for 62 patients with glaucoma and 41 age-similar controls on size III and frequency-doubling perimetry and three custom tests with Gaussian blob and Gabor sinusoid stimuli. Stimulus range was controlled by values for ceiling (maximum sensitivity) and floor (minimum sensitivity). Bland-Altman analysis was used to derive 95% limits of agreement on test and retest, and bootstrap analysis was used to test the hypotheses about peak variability. Limits of agreement for the three custom stimuli were similar in width (0.72 to 0.79 log units) and peak variability (0.22 to 0.29 log units) for a stimulus range of 1.7 log units. The width of the limits of agreement for size III decreased from 1.78 to 1.37 to 0.99 log units for stimulus ranges of 3.9, 2.7, and 1.7 log units, respectively (F = 3.23, P < 0.001); peak variability was 0.99, 0.54, and 0.34 log units, respectively (P < 0.01). For a stimulus range of 1.3 log units, limits of agreement were narrowest with Gabor and widest with size III stimuli, and peak variability was lower (P < 0.01) with Gabor (0.18 log units) and frequency-doubling perimetry (0.24 log units) than with size III stimuli (0.38 log units). Test-retest variability in glaucomatous visual field defects was substantially reduced by engineering the stimuli. The guidelines should allow developers to choose from a wide range of stimuli.

Eye movements and reading in glaucoma: observations on patients with advanced visual field loss.

To investigate the relationship between reading speed and eye movements in patients with advanced glaucomatous visual field (VF) defects and age-similar visually healthy people. Eighteen patients with advanced bilateral VF defects (mean age: 71, standard deviation [SD]: 7 years) and 39 controls (mean age: 67, SD: 8 years) had reading speed measured using short passages of text on a computer set-up incorporating eye tracking. Scanpaths were plotted and analysed from these experiments to derive measures of 'perceptual span' (total number of letters read per number of saccades) and 'text saturation' (the distance between the first and last fixation on lines of text). Another eye movement measure, termed 'saccadic frequency' (total number of saccades made to read a single word), was derived from a separate lexical decision task, where words were presented in isolation. Significant linear association was demonstrated between perceptual span and reading speed in patients (R (2) = 0.42) and controls (R (2) = 0.56). Linear association between saccadic frequency during the LDT and reading speed was also found in patients (R (2) = 0.42), but not in controls (R (2) = 0.02). Patients also exhibited greater average text saturation than controls (P = 0.004). Some, but not all, patients with advanced VF defects read slower than controls using short text passages. Differences in eye movement behaviour may partly account for this variability in patients. These patients were shown to saturate lines of text more during reading, which may explain previously-reported difficulties with sustained reading.

Vascular comorbidity in patients with low-tension glaucoma.

To report vascular comorbidities, arterial hypertension (HT), ischemic heart disease (IHD), and diabetes mellitus (DM) in patients with low-tension glaucoma (LTG) with maximum intraocular pressure (IOP) of 18 mm Hg or less. Uniform criteria for glaucoma and the comorbidities were applied. We reviewed records of 519 consecutive patients to whom the Finnish National Social Insurance Institution (FSII) had granted cost-free medication for the treatment of glaucoma. The FSII operates national health insurance, which is compulsory for all Finnish citizens. There were 344 patients with primary open-angle glaucoma (POAG) and 155 with exfoliative glaucoma (EG). Twenty cases were discarded for having other types of glaucoma. In the POAG group, there were 38 patients, with a median IOP of 16 mm Hg (range 12-18). We were masked to the systemic comorbidities when the registry provided us data on those to whom FSII had also granted cost-free medication for HT, IHD, or DM according to the uniform national criteria. None of the patients with LTG had exfoliation syndrome. There was a female predominance, 81%, compared to 68% in high-tension POAG. Hypertension had been diagnosed in 34%, which is the same as in high-tension POAG. A total of 24% had IHD, which is the same as in the Finnish population registry. Diabetes mellitus was present in only 5%. In all groups, patients with LTG with systemic comorbidity were markedly older than those without. In patients with LTG with median IOP 16 mm Hg (range 12-18), glaucomatous optic disc cupping and glaucomatous visual field defects probably developed independently of the systemic vascular comorbidity. However, the diagnostic criteria for HT, IHD, and DM used in the current study were based on the severity of stages set in the FSII system.