Humphrey Field Analyzer Research Articles

Dysfunction and Morphological Involvement of Inner Macular Layers in Glaucoma.

Objectives: This study aimed to study the inner retina functional and morphological impairment of retinal ganglion cells (RGCs) from specific macular rings and sectors to identify whether selective macular regions were more vulnerable than others within the 20 central degrees in patients with open-angle glaucoma (OAG). Methods: In total, 21 OAG patients [mean age 50.19 ± 7.86 years, Humphrey Field Analyzer (HFA) 24-2 mean deviation (MD) between -5.02 and -22.38 dB, HFA 10-2 MD between -3.07 and -17.38 dB], providing 21 eyes, were enrolled in this retrospective case-control study. And 20 age-similar healthy subjects, providing 20 eyes, served as controls. The multifocal photopic negative response (mfPhNR) response amplitude density (RAD) from concentric rings and macular sectors and ganglion cell layer thickness (GCL-T) assessed by Spectral Domain-Optical Coherence Tomography (SD-OCT) was measured. Mean RAD and GCL-T values were compared between OAG and control ones by ANOVA. In OAG eyes, the relationship between mfPhNR and SD-OCT data was examined by linear regression analysis, and Pearson's correlation coefficients were computed. Results: In considering all rings and sectors, compared to the controls, the OAG group showed a significant (p < 0.01) reduction in mean mfPhNR RAD and in GCL-T values with the greatest reduction in the central area. In OAG eyes, a significant (p < 0.01) correlation between all mfPhNR RAD and GCL-T values, with significant (p < 0.01) correlation coefficients, were found. Conclusions: In OAG eyes, RGC dysfunction was detectable by abnormal mfPhNR responses in localized macular areas, mainly in the central one. Localized macular RGC dysfunction was linearly correlated with the GCL morphological changes.

Comparison of a Novel Head-Mounted Perimeter versus the Humphrey Field Analyzer

Comparison of a Novel Head-Mounted Perimeter versus the Humphrey Field Analyzer

Visual field prediction based on temporal-spatial feature learning

Glaucoma stands as the leading irreversible cause of blindness worldwide. Regular visual field examinations play a crucial role in both diagnosing and treating glaucoma. Predicting future visual field changes can assist clinicians in making timely interventions to manage the progression of this disease. To integrate temporal and spatial features from past visual field examination results and enhance visual field prediction, a convolutional long short-term memory (ConvLSTM) network was employed to construct a predictive model. The predictive performance of the ConvLSTM model was validated and compared with other methods using a dataset of perimetry tests from the Humphrey field analyzer at the University of Washington (UWHVF). Compared to traditional methods, the ConvLSTM model demonstrated higher prediction accuracy. Additionally, the relationship between visual field series length and prediction performance was investigated. In predicting the visual field using the previous three visual field results of past 1.5~6.0 years, it was found that the ConvLSTM model performed better, achieving a mean absolute error of 2.255 dB, a root mean squared error of 3.457 dB, and a coefficient of determination of 0.960. The experimental results show that the proposed method effectively utilizes existing visual field examination results to achieve more accurate visual field prediction for the next 0.5~2.0 years. This approach holds promise in assisting clinicians in diagnosing and treating visual field progression in glaucoma patients.

Characterizing visual field loss from past mercury exposure in an Indigenous riverine community (Grassy Narrows First Nation, Canada): a cluster-based approach

BackgroundBetween 1962 and 1975, a chlor-alkali plant in Canada discharged approximately 9 metric tons of mercury (Hg) into the Wabigoon River. Over the following decades, biomarkers of Hg exposure of persons from Grassy Narrows First Nation (Asubpeeschoseewagong Anishinabek), located downriver from the discharge, reflected Hg concentrations in fish. Hg exposure is known to target the calcarine fissure, resulting in visual field (VF) loss. Most studies and clinical reports focus solely on peripheral VF loss; little is known about the impact of Hg on the central and paracentral portions. The present study sought to characterize the patterns of VF loss with respect to past and current Hg.MethodsA 28-year hair-Hg (HHg) database, created from a 1970–97 government biomonitoring program, served to select study participants with ≥ 4 year-based HHg measurements (n = 81). Blood-Hg was assessed for current exposure. Light sensitivity thresholds across the VF were analyzed monocularly, using a Humphrey Field Analyzer (HFA). Following post-hoc exclusions, based on HFA interpretation indices, 65 participants were retained. Both eyes were combined for analyses (n = 130 eyes). Unsupervised hierarchical clustering of HFA plot data was used to identify patterns of VF loss. A series of mixed effects models (MEM) were performed to test the associations for current Hg exposure with respect to HFA interpretation indices and clusters, as well as for longitudinal past Hg exposure.ResultsThe clustering approach decomposed the light sensitivity deficits into 5 concentric clusters, with greatest loss in the peripheral clusters. No relation was observed between any of the cluster scores and current blood-Hg. VF deficits increased with past Hg exposure. Longitudinal MEM showed that HHg was significantly (p < 0.05) associated with all peripheral, paracentral, and central cluster scores, as well as with HFA interpretation indices.ConclusionsPast Hg exposure in Grassy Narrows First Nation was associated with present day VF loss. The cluster-based location-specific approach identified patterns of VF loss associated with long-term Hg exposure, in both the peripheral and the central areas. The functional implications of this type of visual loss should be investigated.

Comparison of Elisar-Fast and Sita-Fast Strategy for Visual Field Assessment in Glaucoma.

To compare two fast threshold strategies of visual field assessment: SITA-Fast (SF; Humphrey field analyser) and Elisar-Fast (EF; Advanced vision analyser) in patients with glaucoma. In this cross-sectional observational study, of total 192 subjects, 138 subjects [150 eyes, 80 glaucoma subjects (91 eyes) and 58 healthy controls (59 eyes)] were analysed and included. Each subject underwent 24-2 EF and SF in randomized order with a minimum time interval of 1 hour between tests. Mean test-time, pointwise and sectoral sensitivity, significance of values of mean sensitivity (MS) and global indices [mean deviation (MD) & pattern standard deviation (PSD)] and their correlation. The mean test-time was 2.59±0.25 and 3.38±0.28 minutes (P = 0.001) with SF and EF respectively. Correlation coefficient for pointwise threshold values correlated strongly for both the devices (range from 0.70 to 0.92). The Intra class correlation (ICC) value of ≥ 0.8 was observed across all sectors indicating good reliability. Bland-Altman plot denoted 95% of data for MS values within limit of Agreement (LOA). The ICC values for overall MS, MD and PSD were 0.916, 0.913 and 0.872 respectively indicating good reliability. High degree of correlation was observed for MD (r = 0.912, P=0.00) and PSD values (r=0.732, P=0.00). Comparison of values indicated a difference of 1.09dB for MD and 0.06dB for PSD between both strategies. High degree of correlation existed between the global indices and pointwise threshold values. The study documents the ability of EF to successfully assess visual field in patients with glaucoma.

Prevalence of Normal-Tension Glaucoma in Patients With Primary Aldosteronism

PurposeTo investigate patients with primary aldosteronism (PA) and the prevalence of normal-tension glaucoma (NTG). DesignCross-sectional study. MethodsNewly diagnosed PA patients were evaluated in this cross-sectional study, with ophthalmic examinations such as intraocular pressure (IOP) measurements by a Goldmann applanation tonometer, central corneal thickness (CCT), slit-lamp biomicroscopic examination, gonioscopy, ophthalmoscopy, fundus photography, visual field test with a Humphrey Field Analyzer 24-2 SITA Standard program, and optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (RNFL), performed in each of the subjects. Optic disc appearance, perimetric results, OCT results, and other ocular findings were all used for determining the glaucoma diagnosis. The primary outcome was shown the prevalence of NTG in patients with PA. ResultsNTG prevalence in the 212 PA patients was 11.8% (95% confidence interval [CI], 4.7%-20.7%). As compared to the hypertensive patients without PA, the hypertensive patients with PA exhibited a significantly increased NTG prevalence (odds ratio; 4.019, 95% CI, 1.223-13.205; P = .022). Increased NTG prevalence was associated with age, ranging from 8.8% (95% CI, 2.1%-15.6%) for those aged 40 to 49 years, to 37.5% (95% CI, 13.8%-61.2%) for those aged 70 years and older. In 72 hypertensive patients without PA, who were used as the controls, NTG prevalence was 5.2%, with a 95% CI ranging from 0.5% to 14.4%. ConclusionsThere was an 11.8% prevalence of NTG in PA patients, with these patients at an elevated risk of NTG, which was not mediated by blood pressure.

The impact of visual field defects following anterior temporal lobectomy

Objective: This prospective study aimed to quantify visual field defects (VFDs) along with other defects in ophthalmic functions after anterior temporal lobectomy (ATL) in patients with mesial temporal lobe epilepsy (MTLE) and their impact on quality of life using a VFQ-25 questionnaire. Methods: Ophthalmic evaluation was done during pre-operative evaluation as well as 3 months after surgery. It included the Best Corrected Visual Acuity (BCVA), visual field evaluation, colour vision examination, fundoscopy, extraocular movements and diplopia charting. Visual field evaluation was done using a Humphrey field analyser. The foveal threshold (FT), mean deviation (MD) and pattern standard deviation (PSD) were calculated for each patient. Quality of life assessment was done using the Visual Functioning Questionnaire-25 (VFQ-25). Two-tailed independent T-tests and Chi-square tests were performed for comparison of results. Results: Thirty-four patients were included in this study (23 men and 11 women). The mean age was 26.6 years (range 9-44 years). Post-operatively, none complained of a visual field disturbance. Thirty-one (91.17%) of 34 patients had a new quantifiable superior quadrantanopia. FT, MD and PSD of patients ranged between 29db to 40db, -1.23 to -14.28 and 1.75 to 15.34, respectively. There was no detectable abnormality in visual acuity, colour vision, fundoscopy, diplopia charting or extraocular movements. VFQ-25 scores ranged from 84 to 100. The difference between VFQ scores of patients with and without quadrantanopia was not significant. Conclusion: Standard ATL produces asymptomatic VFDs that do not affect quality of life. A combined effort of the neurologist and ophthalmologist is recommended to counsel the patient before surgery.

Glaucoma Home Self-Testing Using VR Visual Fields and Rebound Tonometry Versus In-Clinic Perimetry and Goldmann Applanation Tonometry: A Pilot Study.

This pilot study aimed to assess the feasibility, accuracy, and repeatability of unsupervised, at-home, multi-day glaucoma testing using the Olleyes VisuALL Virtual Reality Platform (VRP) and the iCare HOME handheld self-tonometer. Participants were trained to use two U.S. Food and Drug Administration-registered or approved devices before conducting self-tests at home over 3 consecutive days. The iCare HOME intraocular pressure (IOP) measurements were collected four times daily per eye, and VRP visual field tests were performed once daily. The results were compared with one in-clinic Humphrey Field Analyzer (HFA) visual field test performed on the day of device training, iCare HOME measurements by the trainer, and the last five Goldmann applanation tonometer (GAT) results. Of 15 enrolled participants, nine of them (60%) completed the study. The six excluded participants could not self-measure using iCare HOME. There was significant correlation between the average mean deviation (MD) values of the at-home VRP tests and in-clinic HFA test (r2 = 0.8793, P < 0.001). Additionally, the average of the sensitivities in five of six Garway-Heath sectors were significantly correlated. VRP test duration was also shorter than in-clinic HFA testing (P < 0.001). Finally, at-home tonometry yielded statistically similar values compared to trainer-obtained iCare HOME values. The mean and range of at-home tonometry were also statistically similar to those for in-clinic GAT, but at-home tonometry demonstrated higher maximum IOP values (P = 0.0429). Unsupervised, at-home, multi-day glaucoma testing using two devices resulted in the capture of higher maximum IOPs than in the clinic and good MD correlation of VRP with HFA. However, 40% of participants could not self-measure IOP using iCare HOME. The study findings suggest that at-home remote glaucoma monitoring correlates with in-office testing and could provide additional information for glaucoma management, although patients had more difficulty with the iCare HOME than the VRP.

Evaluating machine learning techniques for enhanced glaucoma screening through Pupillary Light Reflex analysis

Glaucoma is a leading cause of irreversible visual field degradation, significantly impacting ocular health. Timely identification and diagnosis of this condition are critical to prevent vision loss. A range of diagnostic techniques is employed to achieve this, from traditional methods reliant on expert interpretation to modern, fully computerized diagnostic approaches. The integration of computerized systems designed for the early detection and classification of clinical indicators of glaucoma holds immense potential to enhance the accuracy of disease diagnosis. Pupillary Light Reflex (PLR) analysis emerges as a promising avenue for glaucoma screening, mainly due to its cost-effectiveness compared to exams such as Optical Coherence Tomography (OCT), Humphrey Field Analyzer (HFA), and fundoscopic examinations. The noninvasive nature of PLR testing obviates the need for disposable components and agents for pupil dilation. This facilitates multiple successive administrations of the test and enables the possibility of remote execution. This study aimed to improve the automated diagnosis of glaucoma using PLR data, conducting an extensive comparative analysis incorporating neural networks and machine learning techniques. It also compared the performance of different data processing methods, including filtering techniques, feature extraction, data balancing, feature selection, and their effects on classification. The findings offer insights and guidelines for future methodologies in glaucoma screening utilizing pupillary light response signals.

Epidemiology of Field of Vision Disorders (eFOVID) study, Western Australia, 1988-2022. Report 1: Data collection and aggregation protocol.

Computerised static visual field testing using dedicated machines such as the Humphrey Field Analyzer (HFA) can assess and track changes in visual field sensitivity. The use of retrospective visual field databases is a novel undertaking, with no studies published utilising large scale population-level data. This study phase developed a method to extract HFA data into a large standardised population-based database including point sensitivity data with additional derived variables. Retrospective, longitudinal, population study of visual field data from people who attended an ophthalmology service and had a HFA field test, in Western Australia, between 1988 and 2022. Raw test data included patient demographic fields, sensitivity readings and test parameters. Calculated fields included reliability scores, and a novel combined reliability score. There were 606 230 tests for 92 215 study individuals, from 22 ophthalmology practices in metropolitan Perth and three public hospital eye clinics, representing around 85% of the field tests performed by ophthalmologists each year. Raw sensitivity values were available for all tests, and additional descriptors were available for most tests (97.5%-100% of tests) with the exception of data variables retired by the manufacturer. Visual field data from 606 230 tests were collated into a single dataset, which is highly representative over a long period of time, for a defined population. This dataset has been linked to other administrative datasets to allow for epidemiological investigation of field of vision disorders.

Comparison of Microperimetry and Static Perimetry for Evaluating Macular Function and Progression in Retinitis Pigmentosa

To compare the usefulness of microperimetry and static automated perimetry in patients with retinitis pigmentosa (RP), using macular anatomical metrics as a reference. Prospective observational study. Forty-eight eyes of 48 patients with RP in Kyushu University Hospital who underwent microperimetry-3 (MP-3) and Humphrey Field Analyzer (HFA) 10-2 testing ≥3 times during ≥2 years were included. Macular anatomy (ellipsoid zone [EZ] length) was assessed by OCT, and macular function was assessed by MP-3 (mean retinal sensitivity at radii 2°, 4°, and 8°) and HFA10-2 program (mean retinal sensitivity at radii 2°, 4°, and 8°). Correlations between functional and anatomical parameters were analyzed cross sectionally at baseline and longitudinally by comparing the rate of progression. Correlation coefficients between anatomical and functional metrics. The mean age at baseline was 50.1±12.3 years, and the mean follow-up period was 2.8±0.7 years. At baseline, EZ length was significantly correlated with MP-3 mean retinal sensitivity at radii 2°, 4°, and 8° (Spearman's ρ=0.65, 0.84, 0.89; all P<0.005) and HFA10-2 mean retinal sensitivity at radii 2°, 4°, and 8° (Spearman's ρ=0.61, 0.73, 0.78; all P<0.005). Longitudinal analysis showed that the slope of EZ length (-88.92 μm/year) was significantly correlated with the slope of MP-3 retinal sensitivity at 8° radius (-0.62 decibels [dB]/year; Spearman's ρ=0.31, P=0.03) and the slope of HFA retinal sensitivity at 8° radius (-0.60 dB/year; Spearman's ρ=0.43, P<0.005). Both MP-3 and HFA values were cross sectionally well-correlated with EZ length in patients with patients; however, these associations became weaker in the longitudinal analysis. This highlights the need for researchers to explore additional or more sensitive parameters to better monitor RP progression. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The Correlation between Body Mass Index and Intraocular pressure, Retinal Nerve Fiber Layer Thickness and Visual Field

Abstract Background Obesity has become a world-wide medical epidemic. it constitutes an important risk for several eye diseases like cataract, diabetic retinopathy, age related macular degeneration (AMD) and glaucoma.Body mass index (BMI) is one of the most specific and objective measurement to define obesity. Obesity has recently been reported to be negatively associated with visual acuity, but the ocular conditions underlying this association and the potential implications are unclear. Amongst different eye diseases, obesity has been associated with cataract, age-related maculopathy, diabetic retinopathy, and glaucoma. Purpose To investigate the relationship between BMI and IOP and correlate it with changes in RNFL thickness and visual field. Materials and Methods 60 participants divided into three groups (normal, overweight, and obese) according to BMI, were included in this Cross-Sectional Study (pilot study). Participants underwent a complete ophthalmologic assessment, measurement of RNFL thickness and ganglion cell complex (GCC) thickness using SD-OCT, IOP with Goldmann applanation tonometry (GAT) and visual field analysis using Humphrey field analyser. Results IOP was significantly higher in obese group than those in healthy weight and overweight group. Also, IOP was statistically significant higher in overweight group compared with those healthy weight group. There were no significant differences between the three groups in average, superior, inferior, nasal, and temporal RNFL thicknesses or in GCC thickness. Yet, GCC thickness in the obese group showed significant negative correlation with BMI.There were no significant differences between the three groups in MD, and VFI. Conclusion IOP was variable according to the degree of obesity with incremental pattern with advance of BMI. BMI of overweight group had no correlation with IOP, average, superior, inferior, nasal, and temporal RNFL thicknesses. While BMI of obese group showed a significant positive correlation with IOP and negative correlation with GCC thickness.

Comparing a Head-Mounted Smartphone Visual Field Analyzer to Standard Automated Perimetry in Glaucoma: A Prospective Study.

Wang et al compare an FDA-registered head-mounted smartphone device (PalmScan VF2000) with standard automated perimetry (SAP) in glaucoma patients and find that the head-mounted device may not fully recapitulate SAP testing. This study prospectively compared visual field testing using the PalmScan VF2000 Visual Field Analyzer, a head-mounted smartphone device, with standard automated perimetry (SAP). Patients with glaucoma undergoing Humphrey Field Analyzer SAP testing were asked to complete in-office PalmScan testing using a Samsung S5 smartphone in a virtual reality-style headset. Glaucoma severity was defined as SAP mean deviation (MD) >-6 dB for mild, between -6 and -12 dB for moderate, and <-12 dB for severe. Global parameters MD and pattern SD from PalmScan and SAP were compared using t -tests and Bland-Altman analyses. Bland-Altmann analyses of PalmScan and SAP MD were conducted for the superonasal, superotemporal, inferonasal, and inferotemporal visual field quadrants. The repeatability of PalmScan was assessed using Spearman's correlations and intraclass correlation coefficients (ICCs). Fifty-one patients (51 eyes) completed both SAP and PalmScan testing and met the criteria for analysis. Compared with SAP, global MD and pattern SD measurements from PalmScan differed by an average of +0.62±0.26 dB (range: -3.25 to +4.60 dB) and -1.00±0.24 dB (range: -6.03 to +2.77 dB), respectively, while MD scores from individual visual field quadrants differed by as much as -6.58 to +11.43 dB. The agreement between PalmScan and SAP in classifying glaucoma severity was 86.3% across all eyes. PalmScan and SAP identified the same quadrant as having the worst visual field defect in 66.7% of eyes. Despite advantages in cost and accessibility, the PalmScan head-mounted perimetry device may not be able to fully recapitulate SAP testing.

Comparison of a Novel Head-Mounted Objective Auto-perimetry (Gaze Analyzing Perimeter) and Humphrey Field Analyzer

To evaluate the agreement between 24-2 visual field (VF) test results obtained using the gaze analyzing perimeter (GAP; FINDEX, Tokyo, Japan) and the Humphrey field analyzer (HFA; Carl Zeiss Meditec, Dublin, CA, USA). Cross-sectional study PARTICIPANTS: Patients who underwent HFA 24-2 for suspected or confirmed VF loss and were treated at the Kyoto University Hospital between December 2022 and July 2023. Patients underwent consecutive VF tests on the same eye using HFA and GAP 24-2 tests. Bland-Altman analysis was used to compare GAP and HFA results. Examination points where the sensitivity measured using GAP was ≥10 dB higher than that measured using HFA were reevaluated by referring back to the original gaze data; two ophthalmologists assessed whether the gaze moved linearly toward the new test target. Mean deviation (MD) and elapsed time on an individual basis and sensitivity on an examination point basis. Forty-seven eyes of 47 patients were analyzed. The correlation coefficient of the MD using HFA and GAP was 0.811 (95% confidence interval [CI]: 0.683-0.891). Bland-Altman analysis showed good agreement between HFA and GAP tests. The mean difference (95% limits of agreement [LOA]) in MD between HFA and GAP results was -0.63 dB (-5.81 to 4.54 dB). Although no statistically significant differences were observed in the elapsed time (P = 0.99), measurements completed within 200 s were observed only in the GAP group (11 cases, 23.4%), who had significantly better HFA MD value than others (P=0.001). On an examination point basis for sensitivity, the correlation coefficient between HFA and GAP was 0.691 (95% LOA, 0.670-0.711). Original gaze data assessment revealed that the gaze moved linearly toward the new test target for 70.2% of the examination points with a sensitivity discrepancy. The results indicate that the GAP provides VF assessment outcomes comparable to those of the HFA. The GAP exhibited advantages in terms of testing time, particularly in patients with minimal VF impairment. Furthermore, the GAP records all eye movements, enabling the objective determination of VF abnormalities based on gaze patterns and facilitating easy post-hoc verification.

Hypometabolism in the Posteromedial Temporal and Medial Occipital Cortex on Preoperative 2-Deoxy-2-(18F) Fluoro-D-Glucose Positron Emission Tomography Suggests Exacerbation of Visual Field Defects After Surgery for Temporal Lobe Epilepsy: A Retrospective Long-Term Follow-Up Study

ObjectiveSurgery is a good treatment option for drug-resistant temporal lobe epilepsy (TLE). 2-deoxy-2-(18F) fluoro-D-glucose (FDG) positron emission tomography (PET) is used to detect epileptic foci as hypometabolic lesions in presurgical evaluation. Visual field defects (VFDs) in the contralateral homonymous upper quadrant are common postoperative complications in TLE. This study aimed to quantify VFDs using pattern deviation probability plots (PDPPs) and examine the effect of hypometabolism in FDG-PET on VFDs. MethodsThis study included 40 patients. Both visual fields were assessed using the Humphrey field analyzer (HFA) preoperatively and 3 months and 2 years postoperatively. PDPPs with <0.5% confidence level counted in the contralateral homonymous upper quadrant. FDG-PET results were compared between groups with (15 patients) and without (24 patients) hypometabolism in the optic radiation. ResultsAll 40 patients were evaluated by HFA at 3 months postoperatively and 39 at 2 years postoperatively. The incidence of VFDs 3 months postoperatively was 35/40 (87.5%), and 17/40 (42.5%) patients had severe VFDs. In cases of surgery on the left temporal lobe, ipsilateral eyes appeared to be more significantly affected than contralateral eyes. VFDs were more severe in patients with FDG hypometabolism than in those without hypometabolism in posteromedial temporal and medial occipital cortex (P < 0.01); however, 85% of patients with FDG hypometabolism had a reduced VFD 2 years postoperatively. ConclusionPDPP counting is useful for quantifying VFDs. Preoperative dysfunction indicated by preoperative FDG-PET in the posteromedial temporal and medial occipital cortex could enhance VFDs early after TLE surgery.

Subjective perception of visual field defects using random noise-moving images in patients with glaucoma: A comparison of computer graphics and analog noises.

Random noise-moving images (noises) can make glaucoma patients with no subjective symptoms aware of visual field abnormalities. To explore this concept, we developed a noise using computer graphics (CG) and investigated the difference in the subjective perception of visual field abnormalities between CG and conventional analog noises. We enrolled individuals with glaucoma (205 eyes), preperimetric glaucoma (PPG; 19 eyes), and normal eyes (35 eyes). For a CG noise, a series of still images was made by randomly selecting five monochromatic tones on 2-mm square dots, and these images were drawn at 60 frames per second (fps) to create a noise-moving image. The participants were asked to describe their perceived shadows on a paper. The results were categorized as follows based on the pattern deviation probability map of the Humphrey field analyzer (HFA): "agreement," "partial agreement," "disagreement," and "no response." The glaucoma stage was classified into four stages, from M1 to M4, based on the HFA's mean deviation. The detection rates (agreement and partial agreement) were 80.5% and 65.4% for the CG and analog noises, respectively, with CG noise showing a significantly higher detection rate in all glaucoma eyes (P < 0.001). The detection rates tended to increase as the glaucoma stage progressed, and in Stage M3, these were 93.9% and 78.8% for the CG and analog noises, respectively. The PPG eyes did not exhibit subjective abnormalities for both noises. The specificity values were 97.1% and 100% for the CG and analog noises, respectively. The CG noise is more effective than the analog noise in evaluating the subjective perception of visual field abnormalities in patients with glaucoma.

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.

The Impact of Social Vulnerability on Structural and Functional Glaucoma Severity, Worsening, and Variability

To determine the associations between social vulnerability index (SVI) and baseline severity, worsening, and variability of glaucoma, as assessed by visual field (VF) and OCT. Retrospective longitudinal cohort study. Adults with glaucoma or glaucoma suspect status in 1 or both eyes. Visual fields were derived from 7897 eyes from 4482 patients, while OCTs were derived from 6271 eyes from 3976 patients. All eyes had a minimum of 5 tests over follow-up using either the Humphrey Field Analyzer or the Cirrus HD-OCT. Social vulnerability index, which measures neighborhood-level environmental factors, was linked to patients' addresses at the census tract level. Rates of change in mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness were computed using linear regression. The slope of the regression line was used to assess worsening, while the standard deviation of residuals was used as a measure of variability. Multivariable linear mixed-effects models were used to investigate the impact of SVI on baseline, worsening, and variability in both MD and RNFL. We further explored the interaction effect of mean intraocular pressure (IOP) and SVI on worsening in MD and RNFL. Glaucoma severity defined based on baseline MD and RNFL thickness. Worsening defined as MD and RNFL slope. Variability defined as the standard deviation of the residuals obtained from MD and RNFL slopes. Increased (worse) SVI was significantly associated with worse baseline MD (β=-1.07 dB, 95% confidence interval [CI]: [-1.54, -0.60]), thicker baseline RNFL (β=2.46 μm, 95% CI: [0.75, 4.17]), greater rates of RNFL loss (β=-0.12 μm, 95% CI: [-0.23, -0.02]), and greater VF variability (β=0.16 dB, 95% CI: [0.07, 0.24]). Having worse SVI was associated with worse RNFL loss with increases in IOP (βinteraction=-0.07, 95% CI: [-0.12, -0.02]). Increased SVI score is associated with worse functional (VF) loss at baseline, higher rates of structural (OCT) worsening over time, higher VF variability, and a greater effect of IOP on RNFL loss. Further studies are needed to enhance our understanding of these relationships and establish their cause. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

CORRELATION OF STRUCTURE AND FUNCTIONAL DEFECT WITH QUALITY OF LIFE IN PATIENT WITH GLAUCOMA

Introduction: Glaucoma damage generally produces a characteristic change in the morphology of the optic nerve, runs progressively and permanently that cause visual changes, decreased vision, and blindness. Blindness will affect one’s dependence to get help in their daily activities. This paper investigate the correlation between VFI, BCVA, MD and RNFL thickness with the quality of life of people with glaucoma using Glaucoma Quality of Life-15 (GQL-15). Methods: A cross-sectional study conducted at the Sardjito Eye Center in April 2021. Purposive sampling used to recruit glaucoma patients who had BCVA, Visual Field examination (Humphrey Field Analyzer (HFA) 3 Carl Zeiss Meditec Inc.), and OCT ONH (Cirrus HD-OCT 5000, Carl Zeiss). Glaucoma Quality of Life-15 (GQL-15) questionnaire were used to interview the patients. Results: Eight (32%) normotension glaucoma and 17 (68%) open angle glaucoma patients were included. Fifteen (60%) patients aged 17-40 y.o, 7 (28%) aged 41-60 y.o and 3 (12%) aged &gt; 60 y.o were included. Majority of the samples 6 of them were unemployed (24%), 5 entrepreneurs 5 (20%) and 5 students (20%). GQL-15 score was significantly correlated with respondent's BCVA r= -0.39 (p= 0.05). However, there was no correlation between GQL-15 with RNFL r= 0.01 (p=0.94), VFI r= -0.21 (p= 0.29) and MD with r=0.09 (p= 0.66) respectively. It showed that VFI and GQL-15 has negative correlation with a correlation coefficient of -0.21 (p=0.29). Subscale score related to central and near was significantly correlated with VFI (p= 0,05) and MD (p= 0,03). Conclusion: There was a significant correlation between GQL-15 subscale score of central and near vision with VFI and MD. Subjects with lower VFI and MD tend to have worse problem with central and near vision. Total GQL-15 score has a weak negative correlation with BCVA and MD. There was no correlation between GQL-15 with VFI and RNFL.

Development and Validation of an Internet-Based Remote Perimeter (Perimouse).

We sought to validate the feasibility of Perimouse, an internet-based remote perimeter that allows for natural fixation and can be performed on most computers via a web page. In this cross-sectional study, Perimouse evaluated the visual field of 45 healthy people and 27 patients with primary open-angle glaucoma on a laptop. Participants used a mouse cursor to locate new dots on the screen that were determined by preset saccade vectors. A "click and confirm" strategy was used to eliminate the unwanted visual search. Dot brightness was either fixed at 12dB in the suprathreshold program (screening program) or variable in the threshold program. We compared Perimouse outcomes with the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Testing Algorithm standard program. In the screening program, Perimouse showed moderate to high concordance with HFA. The intraclass coefficient ranged from 0.58 to 0.86 in different areas of Garway-Heath mapping. In the threshold program, normal subjects had threshold ranging from 19 to 16dB, presenting sensitivity changes according to the "hill of vision". The test-retest difference was 0.09dB. Habitual spectacle correction and environmental luminance (2-337 lux) had little impact on the central or peripheral threshold (P > 0.05). The correlation between Perimouse and HFA threshold sensitivity was strong (R = 0.950), although Perimouse mean defect was 4.40dB higher than the HFA mean defect. Perimouse is a reliable visual field test that correlates strongly with HFA. It shows potential for population screening and monitoring visual field defects. Perimouse assesses the visual field using saccade vectors without eye trackers, enhancing its accessibility via a web page.