Glaucomatous Visual Field Defects Research Articles

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.

Association of baseline optical coherence tomography angiography with the development of glaucomatous visual field defects in preperimetric glaucoma eyes

AimsTo evaluate whether baseline vessel density (VD) parameters derived from optical coherence tomography angiography (OCT-A) is associated with the development of glaucomatous visual field (VF) defects in preperimetric glaucoma (PPG)...

Microvasculature Dropout and Development of Normal Tension Glaucoma in Glaucoma Suspects: The Normal Tension Glaucoma Suspect Cohort Study

To investigate the contribution of vessel parameters to identify normal tension glaucoma (NTG) suspects at risk of NTG development. Multicenter prospective cohort study. A total of 307 eyes of 307 NTG suspects having intraocular pressure within the normal range; a suspicious optic disc, but without definite localized retinal nerve fiber layer (RNFL) defects; and a normal visual field (VF). To measure laminar vessel density (VD), the VD was measured in the intradisc region from images of the deep vascular layers of optical coherence tomography angiography (OCT-A). Conversion to NTG was defined either by a new localized RNFL defect in the superotemporal or inferotemporal region, or the presence of a glaucomatous VF defect on 2 consecutive tests according to the pattern deviation plots. Conversion to NTG. In total, 73 (23.8%) of the 307 NTG suspects converted to NTG during the follow-up period of 59.84 ± 12.44 months. Detection rate of microvasculature dropout (MvD) was significantly higher in NTG suspects who progressed to NTG (50.7%) than in those who did not (6.4%; P < .001). The macular deep VD (P=.006) and laminar deep VD (P=.004) were significantly lower in NTG suspects who progressed to NTG. The presence of MvD (P < .001) and lower laminar deep VD (P=.006) were significantly associated with NTG conversion. NTG suspects with baseline MvD or a lower laminar deep VD on OCT-A had a higher risk of conversion.

Predicting Visual Field Progression by Optical Coherence Tomography Angiography and Pattern Electroretinography in Glaucoma.

Reduced P50-N95 amplitude on pattern electroretinography (PERG) and the presence of microvasculature dropout (MvD) on optical coherence tomography angiography (OCT-A) at baseline were significant factors associated with visual field (VF) progression in predominantly normal tension glaucoma (NTG) patients. We investigated the baseline demographics and ocular characteristics that predict future progression in glaucoma patients, including PERG and OCT-A parameters. One Hundred forty eyes with open angle glaucoma that were prospectively enrolled and followed up for at least 3 years, and underwent at least 5 serial VF tests were included. Baseline PERG was performed, and N35, P50, and N95 latencies and amplitudes were obtained. Superficial vessel density at the macula and complete loss of microvasculature within the deep retinal layer of the parapapillary region (MvD) were evaluated from baseline OCT-A images. Eyes with a glaucomatous VF defect in either both hemifields within 24 points of a central 10 degrees of fixation, and with no VF abnormality in the nasal periphery outside 10 degrees of fixation, were considered to have isolated central scotoma. During follow-up, detected disc hemorrhage (DH) was recorded. Parameters associated with VF progression were determined using linear regression analysis of the mean deviation (MD) values, in combination with an event-based analysis using the Glaucoma Progression Analysis (GPA) software from the Humphrey Field Analyzer. "Likely progression" using GPA was considered to have glaucoma progression. Of the 140 eyes, 107 (76.4%) were NTG and 57 (40.7%) exhibited glaucoma progression as defined by Humphrey VF GPA. The MD slopes were -0.43±1.11dB/y in the progressors and 0.59±1.27dB/y in the nonprogressors ( P <0.001). Glaucoma patients with progression showed frequent MvD on OCT-A, isolated central scotoma, frequent DH, and reduced baseline P50-N95 amplitude compared with patients without progression. Age at diagnosis ( P =0.038) and baseline P50-N95 amplitude ( P =0.019) showed significant associations with the MD slope. The presence of MvD on OCT-A ( P <0.001) and baseline P50-N95 amplitude ( P =0.037) were significantly associated with VF progression on GPA. The presence of MvD and retinal ganglion cell dysfunction by PERG at baseline, DH or central scotoma were significant factors associated with VF progression in predominantly NTG patients. These patients should be monitored more closely.

Correlation of Intraocular pressure and Visual Field Defects in Primary Open Angle Glaucoma

Aim: To correlate between intraocular pressure (IOP) with visual field pattern in primary open angle glaucoma (POAG). Methods: Pretreatment IOP at presentation was measured in 94 eyes of patients diagnosed with POAG in a descriptive correlational study. At least two Humphrey Visual Field(HVF) assessment two weeks apart was performed. Glaucomatous visual field defect and its severity was diagnosed on the basis of Hodapp-Parrish-Anderson criteria. The relationship between visual field defect and IOP were analyzed. Results: Superior arcuate scotoma was most common visual field defect seen in 18(19.1%) eyes. 56 eyes (59.6%) had mild POAG (MD of &lt;-6dB) with no cases having double arcuate scotoma whereas 1 eye (16.0%) with moderate POAG (MD of -6 to -12dB) had 1 double arcuate scotoma and 23 eyes (24.5%) with severe POAG (MD of &gt;-12dB) had 14 double arcuate scotoma. The mean IOP in mild POAG was 24.29 mmHg (range 21-30); 26.40mmHg (range 22-31) in moderate POAG and 29.70 mmHg (range 22-36) in severe POAG. Significant relation was demonstrated between elevated IOP at presentation and higher negative values of MD (p&lt;0.001). Conclusions: Higher IOP at presentation is associated with severity of POAG. Aggressive treatment should be initiated to arrest the rate of progression.

Comparison between frequency-doubling technology perimetry and standard automated perimetry in early glaucoma

This study aimed to find out the significance of the difference between frequency-doubling technology perimetry (FDT) and standard automated perimetry (SAP) in terms of the detected visual field (VF) damage, and evaluate associated factors to SAP–FDT difference in early glaucoma. Glaucoma patients in early stage (MD better than − 6.0 decibel, 96 eyes) were included in this cross-sectional study. We subtracted mean deviation (MD) and pattern standard deviation (PSD) of FDT from those of SAP, respectively. Additionally, we counted significantly depressed points of P < 5% and P < 1% on the pattern deviation probability plot of both FDT and SAP and defined eyes with significant SAP–FDT difference when the number of abnormal points were greater than 4 points on FDT. We measured lamina cribrosa depth (LCD) and lamina cribrosa curvature index (LCCI) for structural parameters of the optic nerve head from images using enhanced depth imaging of the optical coherence tomography (OCT). Peripapillary vessel density (VD) and presence of microvasculature dropout (MvD), the complete loss of choriocapillaris in localized regions of parapapillary atrophy, was evaluated using deep layer map of OCT angiography (OCT-A) for vascular parameters. Peripheral nasal step (PNS) group had an isolated glaucomatous VF defect within nasal periphery outside 10° of fixation. Parafoveal scotoma (PFS) group had an isolated glaucomatous VF defect within 12 points of a central 10˚ radius. Eyes with significant SAP–FDT difference showed higher detection of MvD on deep layer map of OCT-A, greater LCD, and greater LCCI (all P < 0.05, respectively). In logistic regression analysis, frequent presence of MvD, less presence of disc hemorrhage, and greater LCD were significantly associated with significant SAP–FDT difference. Sub-analysis was performed in eyes with PNS (50 eyes) and PFS (46 eyes). SAP–FDT difference of MD value showed positive association with peripapillary VD on deep layer of OCT-A, which was significant in eyes with PFS compared to eyes with PNS. SAP–FDT difference of PSD value showed negative association with LCCI and LCD, which was significant in eyes with PNS compared to eyes with PFS. Glaucomatous eyes classified by the difference of the detected VF damage on FDT versus SAP showed different clinical features. Greater SAP–FDT difference was significantly associated with structural parameters such as LCD and LCCI. Less SAP–FDT difference was associated with presence of disc hemorrhage and lower deep layer peripepillary VD. There is possibility to use the difference of SAP and FDT to identify associated risk factors in glaucoma patients.

Association Between Ocular Biomechanics Measured With Corvis ST and Glaucoma Severity in Patients With Untreated Primary Open Angle Glaucoma.

PurposeTo compare the ocular biomechanical differences between normal controls and patients with untreated primary open angle glaucoma, including normal-tension glaucoma (NTG) and high-tension glaucoma (HTG), and to investigate the association between ocular biomechanics and glaucoma severity in each group.MethodsOne hundred fifty-three eyes of 153 subjects, including 51 controls, 47 NTG, and 55 HTG cases, were enrolled in this cross-sectional study. Each participant underwent biomechanical measurements by using the Corneal Visualization Scheimpflug Technology. Glaucoma severity was evaluated by mean deviation (MD), pattern standard deviation (PSD), ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) thickness.ResultsDeformation amplitude (P = 0.001) significantly increased, whereas first applanation time (P < 0.0001), highest concavity time (P = 0.001), stiffness parameter at first applanation (P = 0.009), and time of whole eye movement (WEM, P = 0.008) decreased significantly in NTG eyes compared with controls. Besides, NTG had the highest first applanation velocity than controls (P < 0.0001) and HTG (P = 0.044). Shorter time of WEM was independently correlated with worse MD (P = 0.02) and higher values of PSD (P = 0.03) in NTG. Axial length was positively related to PSD (P = 0.02) and negatively related to GCC (P < 0.0001) and RNFL (P < 0.0001) thickness in HTG.ConclusionsNTG corneas are more deformable than healthy ones and HTG. Time of WEM, which relates to orbital compliance, is significantly associated with glaucomatous visual field defect in NTG, whereas axial length is correlated with glaucoma severity in HTG.Translational RelevanceOcular biomechanics may partly account for the differences of pathogenic mechanisms between NTG and HTG.

A Global and Sector-Based Comparison of OCT Angiography and Visual Field Defects in Glaucoma.

Purpose To evaluate the correlation of optical coherence tomography angiography (OCTA) and spectral-domain optical coherence tomography (SD-OCT) with visual field for global and sector-based indices among glaucoma and glaucoma-suspected eyes. Patients and Methods. This is a retrospective study, and in total, 48 glaucoma eyes and 31 glaucoma suspect eyes were included. The correlation between visual field parameters and radial peripapillary capillary (RPC) vessel density via OCTA was compared to the correlation with retinal nerve fiber layer (RNFL) thickness via SD-OCT. The RPC vessel density and RNFL thickness were divided into eight sectors, which included the temporal upper, temporal lower, superotemporal, inferotemporal, superonasal, inferonasal, nasal upper, and nasal lower sectors. Pearson correlations with 95% confidence intervals were calculated with resampling, and correlations were compared with a Fisher Z transformation. Results Both RPC vessel density (R = 0.63, 95% CI [0.24, 0.86]) and RNFL thickness (R = 0.49, 95% CI [0.23, 0.69]) were correlated with the mean deviation when comparing global indices of glaucoma patients. In glaucoma suspects, the correlations between the mean deviation and RPC vessel density (R = 0.21, 95% CI [−0.05, 0.49]) and RNFL thickness (R = 0.01, 95% CI [−0.35, 0.39]) were not significant. Glaucoma eyes had the highest correlation between the mean sensitivity and RPC vessel density and RNFL thickness for the superotemporal, superonasal, temporal upper, and inferotemporal sectors. Conclusion Across a diverse population and heterogeneous glaucoma types, RPC vessel density measurements correlate with global and sector-wise visual field indices similar to RNFL thickness.

Optical Coherence Tomography in Glaucoma

Optical coherence tomography (OCT) evaluates the optic nerve head (ONH), peripapillary retinal nerve fiber layer, and inner retinal layers at the macula for detecting structural abnormalities in glaucoma. The optic disc and retinal nerve fiber layer are the principal sites of apparent glaucomatous damage, which precedes glaucomatous visual field defects. The currently accepted gold standards for glaucoma diagnosis are ONH analysis for structural changes and perimetry to monitor changes in function. However, imaging technology OCT is playing an increasing role in glaucoma diagnosis, monitoring of disease progress, and quantification of structural damage. This article focused on the principle of OCT, applications of both anterior and posterior segment OCT in glaucoma management, and interpretation of OCT reports.

ISK Factors for Progressive Visual Field Loss in Primary Open-Angle Glaucoma: A Retrospective Cross-Sectional Study

Aim: To assess the risk factors of visual field defects in primary open-angle glaucoma Study design: A retrospective cross-sectional study Place and Duration: Institute of Ophthalmology LUMHS, Jamshoro from May 2020 to April 2021 Methodology: This study comprised a total of 100 participants with glaucoma. Males outnumbered females in the gender distribution. Instead of using a formal definition defined by the investigators, a clinical diagnosis of POAG was used in this investigation. In the presence of gonioscopically open anterior chamber angles in both eyes, POAG was pragmatically defined as glaucomatous visual field defects (GVFD). Results: Primary open-angle glaucoma affected 80 percent of men and 20 percent of women. The prevalence of open-angle glaucoma was 44 percent in the 55-65-year-old group, and 30 percent in the 45-54-year-old group. In 44 percent of instances, the eyesight loss lasted two years, whereas 31 percent had a one-year history. Hypertension was observed in 23.5 percent of patients with primary open-angle glaucoma, followed by myopia and diabetes. Conclusion: It was observed that hypertension was the leading risk factor of Primary Open angle glaucoma, followed by myopia, family history, diabetes, and smoking. Keywords: Glaucoma, risk factors, hypertension, diabetes

Cluster Formation for Analyses of Glaucomatous Visual Field Defects in Central 10-2 Visual Field in Normal Tension Glaucoma Eyes.

PurposeTo develop a cluster system to analyze the retinal sensitivity loss of 68 test points in the central 10 degrees of standard automated perimetry (SAP) in eyes with normal tension glaucoma (NTG).Patients and MethodsPatients with NTG who met the following criteria were included: visual acuity ≥0.7, SAP-derived mean deviation ≥−15 dB, and pattern deviation probability plots with at least one point with a probability of <0.5% and/or two or more contiguous points with a probability of <1% that did not cross the horizontal meridian in the central 12 points of the 24-2 test points. SAP with the Swedish Interactive Threshold Algorithm Standard (SITA-S) 10-2 program (10-2) was performed within 6 months of the SITA-S 24-2. The averaged total deviation (TD) for each of the 68 test points in the 10-2 was calculated. Hierarchical cluster analyses were performed based on the deviation of the TDs of the test points, and a dendrogram was created. The number of clusters was determined following the Sturges’ rule.ResultsOne hundred and twenty-six eyes of 126 patients (61.9±11.4 years) were studied. Hierarchical cluster analysis of the TD values statistically obtained a dendrogram that divided the 68 test points into 7 clusters. Of these 7 clusters, 21 points belonging to the clusters in the papillomacular region included cluster 5. Cluster 5 was distributed above and below the horizontal meridian, which does not agree with the course of the retinal nerve fiber layer (RNFL).ConclusionThe hierarchical cluster analysis of the TD values stratified the 68 test points of the 10-2 into seven clusters. Considering the course of the RNFL, cluster 5 was divided into clusters of 5a and 5b, and consequently eight clusters were considered to be appropriate for detecting glaucomatous visual field defects in the central 10 degrees in NTG eyes.

Physical Activity Is Associated with Improved Visuomotor Processing in Older Adults with Moderate and Advanced Glaucomatous Visual Field Defect: A Cross-Sectional Study.

Glaucoma affects a wide spectrum of daily essential activities in older adults. This study examined whether older adults with moderate and advanced stages of glaucoma exhibit differences in visuomotor task performance compared with age- and gender-matched ophthalmologically healthy control subjects and estimated the effects of physical activity (PA) levels, age, and severity of visual impairment on patients’ visuomotor task performance. Sixty older adults with moderate glaucoma, advanced glaucoma, and normal sight participated in the study. Visuomotor processing was assessed using laboratory-based simple and complex visuomotor reaction tasks. Monocular Humphrey Visual Field and binocular Humphrey Esterman Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to assess PA levels. Participants with glaucoma had poorer scores in visuomotor tasks compared to participants with normal sight. Glaucoma patients’ PA levels, age, and binocular visual field defect explained 54% of the variation in complex reaction time. Low PA levels were identified as a risk factor for visuomotor processing decline. Compensatory mechanisms to improve the efficiency of visual field scanning in patients with more severe visual field defects may exist.

Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad.

Aim and objectiveDeveloping improved methods for early detection of visual field defects is pivotal to reducing glaucoma-related vision loss. The Melbourne Rapid Fields screening module (MRF-S) is an iPad-based test, which allows suprathreshold screening with zone-based analysis to rapidly assess the risk of manifest glaucoma. The versatility of MRF-S has potential utility in rural areas and during infectious pandemics. This study evaluates the utility of MRF-S for detecting field defects in non-metropolitan settings.Materials and methodsThis was a prospective, multicenter, cross-sectional validation study. Two hundred and fifty-two eyes of 142 participants were recruited from rural sites through two outreach eye services in Australia. Participants were tested using MRF-S and compared with a reference standard; either Zeiss Humphrey Field Analyzer or Haag-Streit Octopus performed at the same visit. Standardized questionnaires were used to assess user acceptability. Major outcome measures were the area under the curve (AUC) for detecting mild and moderate field defects defined by the reference tests, along with corresponding performance characteristics (sensitivity, specificity).ResultsThe mean test duration for MRF-S was 1.88 minutes compared with 5.92 minutes for reference tests. The AUCs for mild and moderate field defects were 0.81 [95% confidence interval (CI): 0.75–0.87] and 0.87 (95% CI: 0.83–0.92), respectively, indicating very good diagnostic accuracy. Using a risk criterion of 55%, MRF-S identified moderate field defects with a sensitivity and specificity of 88.4 and 81.0%, respectively.Conclusion and clinical significanceThe MRF-S iPad module can identify patients with mild and moderate field defects while delivering favorable user acceptability and short test duration. This has potential application within rural locations and amidst infectious pandemics.How to cite this articleChia MA, Trang E, Agar A, et al. Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad. J Curr Glaucoma Pract 2021;15(3):125–131.

Archetypal Analysis Reveals Quantifiable Patterns of Visual Field Loss in Optic Neuritis.

PurposeIdentifying and monitoring visual field (VF) defects due to optic neuritis (ON) relies on qualitative clinician interpretation. Archetypal analysis (AA), a form of unsupervised machine learning, is used to quantify VF defects in glaucoma. We hypothesized that AA can identify quantifiable, ON-specific patterns (as archetypes [ATs]) of VF loss that resemble known ON VF defects.MethodsWe applied AA to a dataset of 3892 VFs prospectively collected from 456 eyes in the Optic Neuritis Treatment Trial (ONTT), and decomposed each VF into component ATs (total weight = 100%). AA of 568 VFs from 61 control eyes was used to define a minimum meaningful (≤7%) AT weight and weight change. We correlated baseline ON AT weights with global VF indices, visual acuity, and contrast sensitivity. For eyes with a dominant AT (weight ≥50%), we compared the ONTT VF classification with the AT pattern.ResultsAA generated a set of 16 ATs containing patterns seen in the ONTT. These were distinct from control ATs. Baseline study eye VFs were decomposed into 2.9 ± 1.5 ATs. AT2, a global dysfunction pattern, had the highest mean weight at baseline (36%; 95% confidence interval, 33%–40%), and showed the strongest correlation with MD (r = −0.91; P < 0.001), visual acuity (r = 0.70; P < 0.001), and contrast sensitivity (r = −0.77; P < 0.001). Of 191 baseline VFs with a dominant AT, 81% matched the descriptive classifications.ConclusionsAA identifies and quantifies archetypal, ON-specific patterns of VF loss.Translational RelevanceAA is a quantitative, objective method for demonstrating and monitoring change in regional VF deficits in ON.

Patterns of Visual Field Loss in Early, Moderate, and Severe Stages of Open Angle Glaucoma.

Even in the early stages of glaucomatous visual field defects (VFDs), 49% of the defects occurred in both hemifields and 28% involved the central 5 degrees of the visual field (VF), which may have prognostic values. The aim was to determine the patterns of glaucomatous VFDs in early, moderate and severe stages of primary open angle glaucoma, using the Glaucoma Staging Application. According to the Modified University of Sao Paulo Glaucoma Visual Field Staging System Classification, patients with early, moderate and advanced VFDs were selected by the Glaucoma Staging Application using all databases of the Humphrey Visual Field Analyser of a glaucoma referral practice. We analyzed one VF of the 100 patients included in each group. The analysis consisted of classifying all exams regarding the location of the defects, the hemifields involved, and the connection to the blind spot. We analyzed 300 VF. In the Early group, 27% of the VFDs are connected to the physiological blind spot, 64% in the Moderate group, and 95% in the Severe group ( P <0.01). In the Early group, 28% of the defects involved the central 5 degrees of the fixation, 59% in the Moderate and 88% in the Severe group. In the Early group, 49% of the defects involved both hemifields, 80% in the Moderate and 80% in the Severe group. With increasing glaucoma severity, VFD showed a more central pattern, connected to the blind spot, and involved both hemifields. In early disease, both hemifields were commonly affected and more than a quarter of VFD involved the central 5 degrees close to fixation. Careful monitoring of the central VF in glaucoma is suggested.

Anatomic and refractional correlations in earliest glaucomatous visual field defects.

In glaucoma, initial visual field scotomas can be peripheral or central, whereas central scotomas are more severe and can disrupt daily activities. Individual anatomical features may influence the distribution of retinal nerve fibers and the starting site of visual field defects in glaucoma. In this study, we aimed to correlate myopia and hyperopia or anatomical variation of the disk-fovea angle with initial central or peripheral lesions in the visual field. This cross-sectional study included patients with primary open-angle glaucoma divided into a group of isolated central or peripheral scotomas in the visual field with MD > or equal to -6 dB, correlating with the degree of ametropia and anatomical variations, such as the disk-fovea angle. We included 52 patients with glaucoma. Of 20 myopic patients, 6 (30%) had central scotomas, and 14 (70%) had peripheral scotomas. Of 32 hyperopic patients, 12 (37.5%) had central scotomas, and 20 (63.5%) had peripheral scotomas. Regarding the disk-fovea angle, 25 eyes had the disk-fovea angle of < -7°, with 9 (36%) eyes presenting with central scotoma, and 27 eyes presented with the disk-fovea angle of > -7°, with 9 (33.3%) eyes presenting with a central scotoma. This study showed an association between ametropia and scotomas on the perimetry in patients with glaucoma. Patients had a higher incidence of peripheral scotomas, but hyperopic patients had a greater number of central scotomas than myopic patients, and myopic patients had more peripheral scotomas than hyperopic patients. The disk-fovea angle was not correlated with scotomas in initial glaucoma.

Impact of intraocular pressure fluctuations on progression of normal tension glaucoma

To investigate short- and long-term intraocular pressure (IOP) fluctuations and further ocular and demographic parameters as predictors for normal tension glaucoma (NTG) progression. This retrospective, longitudinal cohort study included 137 eyes of 75 patients with NTG, defined by glaucomatous optic disc or visual field defect with normal IOP (<21 mm Hg), independently from therapy regimen. IOP fluctuation, mean, and maximum were inspected with a mean follow-up of 38mo [standard deviation (SD) 18mo]. Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry, Heidelberg retina tomograph (HRT) imaging, and optic disc photographs. The impact of IOP parameters, myopia, sex, cup-to-disc-ratio, and visual field results on progression of NTG were analyzed using Cox regression models. A sub-group analysis with results from optical coherence tomography (OCT) was performed. IOP fluctuations, average, and maximum were not risk factors for progression in NTG patients, although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression (P=0.054). The 46/137 (33.5%) eyes progressed over the follow-up period. Overall progression (at least three progression confirmations) occurred in 28/137 eyes (20.4%). Most progressions were detected by perimetry (36/46). Long-term IOP mean over all pressure profiles was 12.8 mm Hg (SD 1.3 mm Hg); IOP fluctuation was 1.4 mm Hg (SD 0.8 mm Hg). The progression-free five-year rate was 58.2% (SD 6.5%). Short- and long-term IOP fluctuations do not result in progression of NTG. As functional changes are most likely to happen, NTG should be monitored with visual field testing more often than with other devices.

Patients Prefer a Virtual Reality Approach Over a Similarly Performing Screen-Based Approach for Continuous Oculomotor-Based Screening of Glaucomatous and Neuro-Ophthalmological Visual Field Defects.

Standard automated perimetry (SAP) is the gold standard for evaluating the presence of visual field defects (VFDs). Nevertheless, it has requirements such as prolonged attention, stable fixation, and a need for a motor response that limit application in various patient groups. Therefore, a novel approach using eye movements (EMs) – as a complementary technique to SAP – was developed and tested in clinical settings by our group. However, the original method uses a screen-based eye-tracker which still requires participants to keep their chin and head stable. Virtual reality (VR) has shown much promise in ophthalmic diagnostics – especially in terms of freedom of head movement and precise control over experimental settings, besides being portable. In this study, we set out to see if patients can be screened for VFDs based on their EM in a VR-based framework and if they are comparable to the screen-based eyetracker. Moreover, we wanted to know if this framework can provide an effective and enjoyable user experience (UX) compared to our previous approach and the conventional SAP. Therefore, we first modified our method and implemented it on a VR head-mounted device with built-in eye tracking. Subsequently, 15 controls naïve to SAP, 15 patients with a neuro-ophthalmological disorder, and 15 glaucoma patients performed three tasks in a counterbalanced manner: (1) a visual tracking task on the VR headset while their EM was recorded, (2) the preceding tracking task but on a conventional screen-based eye tracker, and (3) SAP. We then quantified the spatio-temporal properties (STP) of the EM of each group using a cross-correlogram analysis. Finally, we evaluated the human–computer interaction (HCI) aspects of the participants in the three methods using a user-experience questionnaire. We find that: (1) the VR framework can distinguish the participants according to their oculomotor characteristics; (2) the STP of the VR framework are similar to those from the screen-based eye tracker; and (3) participants from all the groups found the VR-screening test to be the most attractive. Thus, we conclude that the EM-based approach implemented in VR can be a user-friendly and portable companion to complement existing perimetric techniques in ophthalmic clinics.

Bilateral Cataract Development and Pupillary Block Glaucoma Following Implantable Collamer Lens.

Aim and objectiveWe report the first case of bilateral cataract formation and pupillary block glaucoma and high intraocular pressure (IOP) following implantable Collamer lens (ICL) implantation that resulted in advanced visual field loss.BackgroundThe patient who underwent bilateral ICL implantation can develop bilaterally elevated IOP and an anterior subcapsular cataract with altitudinal visual field defect.Case descriptionA 38-year-old man with high myopia presented for routine follow-up status post bilateral phakic ICL placement. The visual acuity was reduced due to an anterior subcapsular cataract and elevated IOP in both eyes with advanced glaucomatous visual field defects. The patient was treated with topical glaucoma medications. The left eye underwent same-day phakic ICL explanation and cataract surgery to prevent further visual field loss.ConclusionCataract and glaucoma are serious complications after phakic ICL implantation; therefore, regular postoperative monitoring may prevent advanced visual impairment.Clinical significanceThe use of a phakic intraocular lens for the correction of myopia may result in complications. As a measure is to reduce such complications, refractive surgeons preferred using phakic posterior chamber intraocular Collamer lens for the correction of myopia.How to cite this articleOwaidhah O, Al-Ghadeer H. Bilateral Cataract Development and Pupillary Block Glaucoma Following Implantable Collamer Lens. J Curr Glaucoma Pract 2021;15(2):91–95.

Periphery kinetic perimetry: clinically feasible to complement central static perimetry

BackgroundExisting evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals. The following study compared the central visual field defects with the peripheral visual field defects in patients with suspect glaucoma and primary open-angle glaucoma (POAG) and investigated whether using the central visual field test alone could result in loss of clinically valuable information.MethodsIn this prospective observational study, 167 eyes from 89 patients with suspect glaucoma or POAG were first examined with static automated perimetry (SAP), followed by a peripheral visual field test on Octopus 900 perimeter (Haag-Streit, Koeniz, Switzerland). The peripheral visual field test was performed by “Auto Kinetic Perimetry” program, in which Goldmann III4e stimuli randomly moved along 16 vectors at a constant angular velocity of 5 deg/s.ResultsGlaucomatous peripheral visual field defects were seen in 18% of the eyes with a normal central visual field. In addition, 86% of glaucoma patients with moderate-to-severe central visual field defects had corresponding peripheral visual field defects in the form of localized or diffuse depression of the isopters. Furthermore, a moderate correlation was found between the central and peripheral visual fields. The median test duration was 71 s for the peripheral test and 803 s for the central test (p < 0.001).ConclusionsOur study demonstrated the diversity of glaucomatous visual field defects, as well as the possibility of losing the clinically valuable information due to focusing on the central visual field test alone. The peripheral kinetic perimetry is clinically feasible to complement the central static perimetry for a comprehensive assessment of visual function in glaucoma patients.