Humphrey Perimetry Research Articles

Improvement in activities of daily living after visual training in patients with homonymous visual field defects using Goal Attainment Scaling.

Stroke is the most common cause of homonymous visual field defects (HVFDs). Yet, there is no standard protocol for composing a rehabilitation program. In this study we assess ADL gain of visual training for vision restoration in HVFD patients by means of Goal Attainment Scaling. Thirty-five patients trained two predefined regions of the visual field successively at home. In each region we compared the effects of both training rounds, one of which was thus 'directed' and the other 'undirected'. Visual fields were measured with Humphrey and Goldmann perimetry. QoL was assessed with three stroke-related questionnaires and ADL with Goal Attainment Scaling (GAS). Visual training improved the visual field for both Goldmann (ECSG = 5.82±0.94 mm; p = <0.001; n = 31) and Humphrey (0.79±0.20 dB; p = <0.001; n = 28) perimetry. All standardized stroke questionnaires were significantly improved after training (p < 0.039; n = 29), but showed no significant relation with either type of field improvement (p > 0.359). About 75% of the patients improved on their (personalized) GAS score. Interestingly, after both training rounds the GAS score increased in proportion to the extent of visual field improvement, for Goldmann border shift (p = 0.042; r = 0.38; n = 29) but not for Humphrey sensitivity increase (p = 0.337; r = 0.192; n = 28). Multiple regression revealed that GAS score was linearly related to the directed training component for Humphrey perimetry, but not for undirected training. Together these data suggest that (1) visual training aimed at vision restoration leads to visual field improvement and (2) the extent of visual field improvement is linearly related to the improvement of personal activities of daily living as evaluated by means of GAS. In conclusion, a personalized evaluation to assess treatment success showed the clinical significance of a visual training for vision restoration.

A comparison between Humphrey and frequency doubling perimetry for chiasmal visual field defects.

To evaluate and compare the diagnostic ability of frequency doubling technology perimetry (FDT) with standard automated perimetry (SAP) using Humphrey Field Analyser for the detection of visual field defects produced by chiasmal lesions. Fifteen patients with documented chiasmal disease and previously diagnosed of bitemporal hemianopia with Humphrey perimetry were prospectively evaluated. All of them underwent a new SAP (SITA 24-2) followed by FDT tests (C-20 threshold). Diagnostic criteria for hemianopia were established according to the total deviation plot and the threshold values of FDT. A patient was diagnosed with hemianopia if one or both criteria were met. Based on these criteria, FDT sensitivity was calculated. Testing time and global indexes for both perimetric strategies were compared. The sensitivity of FDT was 75.0% (18 out of 24 eyes); the criterion based on threshold values was met more often (70.83%) than the criterion based on the total deviation plot (50.0%). Linear correlation was better for the external column than for the internal column of the visual field. Testing time with FDT was 122.16 seconds shorter than with SAP (p<0.001). The mean value for mean deviation (MD) was -13.62 dB (SD 6.88) for SAP and -8.83 dB (SD 5.94) for FDT (p<0.001). Compared with standard automatic perimetry, FDT has a low sensitivity for detecting temporal hemianopias and also has more difficulty in defining the vertical limits of the defects. There f o re, it does not appear to be an adequate method for the detection of chiasmal visual field defects.

Mapping the Structure-Function Relationship in Glaucoma and Healthy Patients Measured with Spectralis OCT and Humphrey Perimetry.

Purpose To study the structure-function relationship in glaucoma and healthy patients assessed with Spectralis OCT and Humphrey perimetry using new statistical approaches. Materials and Methods Eighty-five eyes were prospectively selected and divided into 2 groups: glaucoma (44) and healthy patients (41). Three different statistical approaches were carried out: (1) factor analysis of the threshold sensitivities (dB) (automated perimetry) and the macular thickness (μm) (Spectralis OCT), subsequently applying Pearson's correlation to the obtained regions, (2) nonparametric regression analysis relating the values in each pair of regions that showed significant correlation, and (3) nonparametric spatial regressions using three models designed for the purpose of this study. Results In the glaucoma group, a map that relates structural and functional damage was drawn. The strongest correlation with visual fields was observed in the peripheral nasal region of both superior and inferior hemigrids (r = 0.602 and r = 0.458, resp.). The estimated functions obtained with the nonparametric regressions provided the mean sensitivity that corresponds to each given macular thickness. These functions allowed for accurate characterization of the structure-function relationship. Conclusions Both maps and point-to-point functions obtained linking structure and function damage contribute to a better understanding of this relationship and may help in the future to improve glaucoma diagnosis.

Comparison of Quality and Output of Different Optimal Perimetric Testing Approaches in Children With Glaucoma

There is limited evidence to support the development of guidance for visual field testing in children with glaucoma. To compare different static and combined static/kinetic perimetry approaches in children with glaucoma. Cross-sectional, observational study recruiting children prospectively between May 2013 and June 2015 at 2 tertiary specialist pediatric ophthalmology centers in London, England (Moorfields Eye Hospital and Great Ormond Street Hospital). The study included 65 children aged 5 to 15 years with glaucoma (108 affected eyes). A comparison of test quality and outcomes for static and combined static/kinetic techniques, with respect to ability to quantify glaucomatous loss. Children performed perimetric assessments using Humphrey static (Swedish Interactive Thresholding Algorithm 24-2 FAST) and Octopus combined static tendency-oriented perimetry/kinetic perimetry (isopter V4e, III4e, or I4e) in a single sitting, using standardized clinical protocols, administered by a single examiner. Information was collected about test duration, completion, and quality (using automated reliability indices and our qualitative Examiner-Based Assessment of Reliability score). Perimetry outputs were scored using the Aulhorn and Karmeyer classification. One affected eye in 19 participants was retested with Swedish Interactive Thresholding Algorithm 24-2 FAST and 24-2 standard algorithms. Sixty-five children (33 girls [50.8%]), with a median age of 12 years (interquartile range, 9-14 years), were tested. Test quality (Examiner-Based Assessment of Reliability score) improved with increasing age for both Humphrey and Octopus strategies and were equivalent in children older than 10 years (McNemar test, χ2 = 0.33; P = .56), but better-quality tests with Humphrey perimetry were achieved in younger children (McNemar test, χ2 = 4.0; P = .05). Octopus and Humphrey static MD values worse than or equal to -6 dB showed disagreement (Bland-Altman, mean difference, -0.70; limit of agreement, -7.74 to 6.35) but were comparable when greater than this threshold (mean difference, -0.03; limit of agreement, -2.33 to 2.27). Visual field classification scores for static perimetry tests showed substantial agreement (linearly weighted κ, 0.79; 95% CI, 0.65-0.93), although 25 of 80 (31%) were graded with a more severe defect for Octopus static perimetry. Of the 7 severe cases of visual field loss (grade 5), 5 had lower kinetic than static classification scores. A simple static perimetry approach potentially yields high-quality results in children younger than 10 years. For children older than 10 years, without penalizing quality, the addition of kinetic perimetry enabled measurement of far-peripheral sensitivity, which is particularly useful in children with severe visual field restriction.

Reduced light sensitivity due to impaired retinal perfusion in branch retinal vein occlusion.

To study the reduction in light sensitivity in areas where impaired retinal perfusion was established by fluorescein angiogram (FA) in eyes with branch retinal vein occlusion (BRVO) that recovered from retinal edema and hemorrhage. Retrospective observational case series. A study of the reduction in light sensitivity demonstrated by total deviation display of the Humphrey perimetry program 30-2 in 43 eyes from 42 patients with BRVO, whose perfusion status was assessed by FA images taken at least 6months after disease onset. Each of the 15 retinal squares in the FA images, corresponding to the 15 Humphrey test points around the fixation point in the affected vertical hemisphere, was classified as either perfused, partially perfused, or non-perfused. Correlation between light sensitivity and perfusion status was investigated by three evaluators in a total of 645 squares, 15 squares from each of the 43 subject eyes. In 459 retinal squares (71.2%) with complete agreement on the perfusion status among the three evaluators, light sensitivity was significantly different among retinal squares of perfused (median: -4.0dB, n=258), partially perfused (median: -8.0dB, n=41), and non-perfused (median: -16.0dB, n=160) (P<.000001, Kruskal-Wallis test). Light sensitivity is decreased in retinal areas exhibiting impaired perfusion, likely due to neuronal loss in the inner retinal layer in eyes with chronic BRVO.

Neuro‐retinal changes evaluation in multiple sclerosis patients: 10 years follow‐up

PurposeTo analyze functional and structural changes in the retina and optic nerve (ON) in patients with multiple sclerosis (MS) compared to healthy controls (C) and after 10 years of follow‐up.MethodsFifty eyes of patients with mild‐moderate MS were evaluated and compared to 50 eyes of C at a baseline visit and at 10 years of follow‐up. The following functional parameters were evaluated: best‐corrected visual acuity (BCVA), color vision examined with the Ishihara test, and mean deviation of visual field (VF) analyzed using the Humphrey perimetry. The structural parameters of the ON were also studied using the NSITE axonal application of the optical coherence tomograph (OCT) Heidelberg Spectralis.ResultsNo differences were found in the functional parameters in MS patients compared to C, neither at 10 years of follow‐up (p &gt; 0.05). However a statistically significant decrease was observed in the structural parameters between C and MS patients at 10 years of follow‐up: mean, nasal‐inferior (NI), temporal‐inferior (TI), temporal (T), temporal‐superior (TS), papillomacular bundle and nasal/temporal (N/T) ratio thickness (p &lt; 0.001), but also in the axonal thickness, specifically in the mean, TI, T, TS, papillomacular bundle and N/T ratio thickness (p &lt; 0.001) measured with OCT in patients with MS after 10 years of disease progression. A higher functional disability using the Expanded Disability Status Scale was also recorded.ConclusionsAxonal damage can be analyzed and quantified in the retina and ON using the OCT in MS. Patients with MS showed significant decrease in the retina nerve fiber layer at 10 years of follow–up compared to C and a progressive axonal death (without outbreaks) that could be detected and quantified using the OCT, but not with the functional tests (BCVA, color and VF).

Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy.

PurposeIntraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery.Patients and methodsA comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Perioperative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery.ResultsThe average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly.ConclusionNo significant disorders in ocular structural and functional parameters were found until long after RALP.

Evaluation of a Novel Visual Field Analyzer Application for Automated Classification of Glaucoma Severity.

To describe the Glaucoma Staging Application (GSA), a new application for automated classification of visual field (VF) severity that can be used in any Humphrey perimeters. We also tested and validated its performance in staging glaucomatous VFs defects and assessed its reproducibility. The GSA is based upon the modified University of São Paulo Glaucoma Visual Field Staging System, and consists of 3 sections: severity based on the visual field index; defect location based on eccentricity; and extent of topographic damage by hemifields. We analyzed 612 VFs of 32 patients. VFs were analyzed by a glaucoma expert and then compared with the output of the GSA. To evaluate the repeatability, the same search criteria were repeated 1 week later using the same GSA. The classification given by the software was considered correct if it completely agreed in all variables (severity, location, and extent of topographic damage) with the classification performed manually by the glaucoma expert. One hundred seventy-eight eyes were classified as early VF damage, 148 moderate, and 156 severe. One hundred thirty-one VFs were classified as normal. When repeated, 1 week later, the GSA showed excellent repeatability. The automated classification agreed with the expert's grading in 100% of cases. The GSA allows an automated, fast, reproducible, and objective classification system for multiple 24-2 VFs of Humphrey perimetry. This study is a proof-of-concept that could translate into a useful tool to analyze and stage VFs more objectively and thus help detecting progression of different types of VFs defects.

Postoperative Recovery of Light Sensitivity in Eyes with Rhegmatogenous Retinal Detachment

Purpose: To investigate whether postoperative light sensitivity recovers completely to the level prior to the development of rhegmatogenous retinal detachment (RRD) after successful surgery. Methods: We retrospectively studied 44 eyes of 44 patients with RRD who were successfully operated and who underwent Humphrey central 30-2 perimetry postoperatively. The averaged total deviation in Humphrey perimetry in the reattached retina was compared with that of the horizontal or vertical counterpart in the preoperatively non-detached retina. Results: The averaged total deviation in the reattached retina was significantly lower than in its counterpart (p < 0.0001). The averaged residual loss of light sensitivity did not correlate with postoperative visual acuity (p = 0.8047) or with its change (p = 0.1242). Conclusions: Light sensitivity in the detached retina in eyes with RRD does not completely recover after successful surgery.

Visual discrimination training improves Humphrey perimetry in chronic cortically induced blindness.

Objective:To assess if visual discrimination training improves performance on visual perimetry tests in chronic stroke patients with visual cortex involvement.Methods:24-2 and 10-2 Humphrey visual fields were analyzed for 17 chronic cortically blind stroke patients prior to and following visual discrimination training, as well as in 5 untrained, cortically blind controls. Trained patients practiced direction discrimination, orientation discrimination, or both, at nonoverlapping, blind field locations. All pretraining and posttraining discrimination performance and Humphrey fields were collected with online eye tracking, ensuring gaze-contingent stimulus presentation.Results:Trained patients recovered ∼108 degrees2 of vision on average, while untrained patients spontaneously improved over an area of ∼16 degrees2. Improvement was not affected by patient age, time since lesion, size of initial deficit, or training type, but was proportional to the amount of training performed. Untrained patients counterbalanced their improvements with worsening of sensitivity over ∼9 degrees2 of their visual field. Worsening was minimal in trained patients. Finally, although discrimination performance improved at all trained locations, changes in Humphrey sensitivity occurred both within trained regions and beyond, extending over a larger area along the blind field border.Conclusions:In adults with chronic cortical visual impairment, the blind field border appears to have enhanced plastic potential, which can be recruited by gaze-controlled visual discrimination training to expand the visible field. Our findings underscore a critical need for future studies to measure the effects of vision restoration approaches on perimetry in larger cohorts of patients.

Assessment of microperimetry on fixation stability changes in glaucomatous eyes with hemifield defect

Background Researches showed that microperimetry can exhibit more tiny visual function damage than conventional perimetry in glaucomatous eyes.However, the study on fixation stability of glaucoma is still rare until now. Objective This study was to compare the correlation between microperimetry Maia (Macular Integrity Assessment) and Humphrey perimetry, and to investigate the changes of the fixation stability in glaucoma patients with hemifield defect. Methods This study proposal was approved by Medical Ethic Committee of Peking University First Hospital.A cross-sectional study was performed under the informed consent of each subject.Thirty-five eyes of 35 glaucoma patients with hemifield defect by 24-2 Humphrey perimetry were included in Peking University First Hospital from December 2013 to March 2014, and 30 eyes of 30 normal volunteers served as controls.Both Humphery (10-2) and Maia (expert 10-2) were performed on the subjects respectively and the correlation of the results between Humphery (10-2) and Maia (expert 10-2) were analyzed.Then the patients with normal hemifield on Humphrey were assigned to Maia normal group and Maia abnormal group.Fixation stability differences were compared between glaucoma group and normal control group, and between Maia normal group and Maia abnormal group. Results The moderately positive correlation was found in the mean sensitivity between Maia microperimetry and Humphrey perimetry (r=0.403, P=0.001), and the average threshold of Maia microperimetry was moderately positive correlated with the mean defect (MD) of Humphrey perimetry in glaucoma patients (r=0.438, P=0.008). The fixation stability parameter P1 was (67±17)% and (87±10)%, and that of P2 was (70±16)% and (88±9)%; the 63% bicurve elipse area (BCEA) was (5.08±1.55)°2 and (2.21±0.60)°2, and the 95% BCEA was (14.74±6.04)°2 and (2.86±1.17)°2 in the glaucoma group and normal control group, respectively, showing significant decreases of P1 and P2 and increases of 63% BCEA and 95% BCEA in the glaucoma group compared with the normal control group (t=-5.604, -4.831, 9.885, 11.086, all at P=0.000). In Maia normal group and Maia abnormal group, the P1 was (79±8)% and (63±17)%, the P2 was (81±10)% and (67±16)%, the 63% BCEA was (3.19±0.65)°2 and (5.70±1.22)°2 and the 95% BCEA was (9.10±2.60)°2 and (19.35±5.01)°2, respectively.Compared with the Maia normal group, the P1 and P2 were significantly lower, and 63% BCEA and 95% BCEA were higher in the Maia abnormal group (t=-2.468, P=0.019; t=-2.371, P=0.024; t=5.514, P=0.000; t=5.575, P=0.000). Conclusions Maia microperimetry and Humphrey perimetry yield a good correlation for glaucomatous macular function examination.In addition, Maia microperimetry showed that fixation stability decreased in glaucoma patients with hemifield defect. Key words: Glaucoma/physiopathology; Visual field tests/instrumentation; Visual fields/physiology; Biomedical technology; Microperimetry; Fixation stability; Humans

Diagnostic capability of ganglion cell complex thickness in primary open angle glaucoma

Background Glaucoma is characterized by loss of retinal ganglion cells (RGCs) followed by visual field defects.Spectral domain OCT(SD-OCT) enabled more precise and quantitative assessments of macular ganglion cell complex (GCC) thickness. Objective This study was to evaluate the diagnostic ability of GCC thickness in identifying primary open angle glaucoma (POAG). Methods A prospective study was performed.Seventy POAG patients and 30 healthy volunteers were enrolled in Beijing Tongren Hospital from November 2015 to April 2016.Macular GCC thickness and peripapillary retinal nerve fiber layer (RNFL) thickness were measured with RTVue SD-OCT, and Humphrey perimetry was performed on the eyes.The patients were assigned to the early stage POAG group, advanced POAG group and later stage POAG group based on the mean defect (MD) of visual field.The average, superior, inferior GCC and RNFL, focal loss volume (FLV), and global loss volume (GLV) were measured and compared among the groups.The correlations between GCC thickness or RNFL thickness with MD were evaluated in the POAG eyes.The discrimination capabilities of GCC thickness or RNFL thickness were assessed and compared by using areas under the receiver operating characteristic (ROC) curves (AUC). Results Compared with the normal control group, the average, superior, inferior GCC thickness and RNFL values were evidently reduced, the FLV and GLV were significantly increased in the early stage POAG group, advanced POAG group and later stage POAG group (all at P 0.05). Conclusions Inferior GCC is more susceptible to glaucomatous damage.FLV and GLV from GCC pattern parameters are sensitive indicators for diagnosis of POAG.GCC thickness could be a valid structural parameter for detecting glaucoma and can be used as a marker in glaucoma assessment. Key words: Glaucoma/diagnosis; Tomography, optical coherence; Retinal nerve fiber layer; Ganglion cell complex; Receiver operating characteristic curves

Flat Anterior Chamber after Trabeculectomy in Secondary Angle-Closure Glaucoma with BEST1 Gene Mutation: Case Series.

PurposeTrabeculectomy has been regarded as a mainstay of initial treatment in eyes of angle closure glaucoma (ACG) with peripheral anterior synechia > 180° in the Chinese population while its efficacy in secondary ACG with BEST1 gene mutation remains unclear. We set out to investigate the treatment outcome of trabeculectomy for secondary ACG in a group of patients with autosomal recessive bestrophinopathy (ARB).MethodsIn this retrospective case series study, 8 secondary ACG patients with ARB and their 4 recruited family members underwent a thorough ophthalmic examination including best-corrected visual acuity, Goldmann applanation tonometry, gonioscopy, and fundus examinations. Ultrasound biomicroscopy, optical coherence tomography (OCT), ultrasound A-scan, B-scan, electro-oculography (EOG), Humphrey perimetry, fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were also performed. Blood samples were obtained in the patients and their available family members to analyze the variants of the BEST1 gene. Trabeculectomy was performed in the 8 patients (15 eyes).ResultsThe age of onset varied from 13 to 38 years. The average axial length (AL) of the affected eyes was 21.82 ± 0.92 mm and the average anterior chamber depth (ACD) was 2.19 ± 0.29 mm. There was marked axial shallowing of the anterior chamber in all 15 eyes after trabeculectomy, and was not improved with potent mydriatics. The IOP was elevated in 3 eyes. Variable degree of yellowish subretinal deposits was observed in the posterior retina. The FFA showed punctuate or patched hyperfluorescence suggesting retinal pigment epithelium impairment. The ICGA demonstrated dilatation of choroidal vessels. The OCT revealed diffused neuroretinal detachment in the posterior and midperipheral retina, with intraretinal fluid collections, and hyperreflective subretinal accumulations. The average subfoveal choroidal thickness of the patients was 382.36 ± 80.09 μm. All the patients and enrolled family members carried mutation in BEST1 gene.ConclusionsARB is a rare condition with fundus manifestations mimicking various diseases. Careful discrimination should be taken to exclude any secondary causes for ACG before treatment. Concerning the high incidence of postoperative shallow anterior chamber, selection of filtering surgery should be very careful in these patients.

Relationship between Choroidal Thickness and Visual Field Impairment in Acute Zonal Occult Outer Retinopathy

Purpose To evaluate sequential changes in choroidal thickness at the affected area in patients with acute zonal occult outer retinopathy (AZOOR). Methods This retrospective observational case series included 14 affected eyes and 6 unaffected fellow eyes from 10 AZOOR patients with impaired macular area. Using enhanced depth imaging optical coherence tomography, choroidal thicknesses at the subfovea and at nasal and temporal sites 1000 μm away from the fovea were manually measured at baseline and 3 and 6 months thereafter. Changes in the choroidal thicknesses and the average threshold at the affected area on Humphrey perimetry were compared during the 6-month follow-up. Results In AZOOR eyes, the average threshold at the affected area significantly increased over time, while outer retinal structure ameliorated. The mean choroidal thicknesses at all the sites measured significantly decreased at 3 and 6 months compared with baseline values in AZOOR eyes, but not in fellow eyes. There was an inverse correlation between the changing rates of the average threshold and the subfoveal choroidal thickness at 6 months from baseline. Conclusion The current data suggest that choroidal thickness at AZOOR-affected area significantly decreased with regression of AZOOR and this anatomical change correlated with the functional recovery.

Diagnostic ability of Humphrey perimetry, Octopus perimetry, and optical coherence tomography for glaucomatous optic neuropathy.

PurposeTo evaluate and compare the diagnostic accuracy of the Humphrey Field Analyzer (HFA), Octopus perimetry, and Cirrus OCT for glaucomatous optic neuropathy.MethodsEighty-eight healthy individuals and 150 open-angle glaucoma patients were consecutive and prospectively selected. Eligibility criteria for the glaucoma group were intraocular pressure ≥21 mm Hg and glaucomatous optic nerve head morphology. All subjects underwent a reliable standard automated perimetry with the HFA and Octopus perimeter, and were imaged with the Cirrus OCT. Receiver-operating characteristic (ROC) curves were plotted for the threshold values and main indices of the HFA and Octopus, the peripapillary retinal nerve fiber layer thicknesses, and the optic nerve head parameters. Sensitivities at 85 and 95% fixed-specificities were also calculated. The best areas under the ROC curves (AUCs) were compared using the DeLong method.ResultsIn the glaucoma group, mean deviation (MD) was -5.42±4.6 dB for HFA and 3.90±3.6 dB for Octopus. The MD of the HFA (0.966; P<0.001), mean sensitivity of the Octopus (0.941; P<0.001), and average cup-to-disc (C/D) ratio measured by the Cirrus OCT (0.958; P<0.001) had the largest AUCs for each test studied. There were no significant differences among them. Sensitivities at 95% fixed-specificity were 82% for pattern standard deviation of the HFA, 81.3% for average C/D ratio of OCT, and 80% for the MD of the Octopus.ConclusionsHFA, Octopus, and Cirrus OCT demonstrated similar diagnostic accuracies for glaucomatous optic neuropathy. Visual field and OCT provide supplementary information and thus these tests are not interchangeable.

Comparison of Peristat Online Perimetry with the Humphrey Perimetry in a Clinic-Based Setting.

PurposeWe determined the receiver operating characteristic (ROC) curves for Peristat online perimetry at detecting varying degrees of glaucoma and the correlation between Peristat online perimetry and Humphrey visual field.MethodsA prospective, comparative study of Peristat online perimetry (an achromatic static computer threshold testing program) and Humphrey visual field (HVF) 24-2 SITA standard testing was performed by 63 glaucoma patients and 30 healthy controls in random order. The number of total adjacent abnormal test points were identified for each test, and compared with Spearman correlation. Receive operating characteristic curves were generated for Peristat online perimetry detection of mild and moderate-severe glaucoma patients using contrast sensitivity thresholds of −16.7, −21.7, and −26.7 dB.ResultsThe area under the ROC curve for glaucoma detection ranged from 0.77 to 0.81 for mild disease (mean deviation [MD], >−6 dB on HVF) and 0.85 to 0.87 for moderate to severe disease (MD, <−6 dB on HVF) depending on contrast threshold. Peristat online perimetry and Humphrey visual field abnormal points were highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all P < 0.001).ConclusionsPeristat online perimetry exhibits a reasonable ROC curve without specialized equipment and exhibited significant correlation with the conventional 24° Humphrey visual field test.Translational RelevanceLow cost widely available internet-based visual fields may complement traditional office-based visual field testing.

Comparison of Three Visual Field Tests in Children: Frequency Doubling Test, 24-2 and 30-2 SITA Perimetry

ABSTRACTBackground: To investigate the reliability of FDT and 24-2 and 30-2 Humphrey perimetry in children. Methods: We retrospectively reviewed the records corresponding to 274 eyes of children aged 6–12 years, who underwent FDT and 30-2 and 24-2 Humphrey visual field testing from January 2011 through March 2013. Each test group was divided into two subgroups: a normal visual acuity subgroup (> 0.8 Snellen, group 1) and a low visual acuity subgroup (≤0.8 Snellen, group 2). Reliability indexes such as fixation losses, test duration, and the number and rate of false-positive errors were analyzed. Results: In both subgroups, test duration was shortest for 24-2 perimetry (group 1: p < 0.0001; group 2: p < 0.0001). FDT was associated with lower rates of fixation loss, false positive errors, and false negative errors than 30-2 perimetry. However, the fixation loss rate of FDT was only significantly lower under the subgroup analysis. The normal visual acuity subgroup had a higher MD score on FDT vs. 30-2 perimetry (P = 0.028). However, the PSD was similar for all tests. Conclusion: This reliability study showed that FDT perimetry is superior to 30-2 SITA perimetry. There was no significant difference in the reliability indexes for FDT and 24-2 SITA perimetry; thus, when considering test duration and reliability, 24-2 SITA perimetry appears to be the optimal choice in pediatric patients.

Idiopathic Acquired Temporal Wedge Visual Field Defects

ABSTRACTOur aim is to report 13 unusual cases of acquired, temporal sectoral scotomas. Such stationary “wedge” field defects have been reported previously in cases of presumed congenital nasal hypoplasia of the optic disc and as a complication of vitreoretinal surgery. To our knowledge, the literature provides no reports of similar defects occurring spontaneously. This is a descriptive clinical case series of 13 patients presenting with sub-acute monocular temporal visual field loss. All were clinically assessed and investigated with Goldmann perimetry, automated Humphrey visual fields, retinal optical coherence tomography, orbital ultrasound, and standard and multi-focal electroretinography. Cases were followed with serial perimetry for a mean of 3.9 years (range: 6 months to 10 years). Goldmann and Humphrey perimetry both demonstrated “wedge”-shaped defects extending temporally from an apex contiguous with, or lateral to, the blind spot. There was no evidence of optic disc drusen, glaucoma, disc hypoplasia, or focal retinitis. Sectoral optic disc swelling was not present in any patient at presentation. In all cases, the visual field defect remained stable. One patient developed a similar defect in the fellow eye after an interval of 5 years. Here we describe 13 cases of acquired, stationary temporal wedge scotomas, novel in the literature. Although the aetiology is uncertain, we propose damage to the nasal rim of the optic disc as a likely mechanism.

Visual Rehabilitation in Chronic Cerebral Blindness: A Randomized Controlled Crossover Study.

The treatment of patients suffering from cerebral blindness following stroke is a topic of much recent interest. Several types of treatment are under investigation, such as substitution with prisms and compensation training of saccades. A third approach, aimed at vision restitution is controversial, as a proper controlled study design is missing. In the current study, 27 chronic stroke patients with homonymous visual field defects were trained at home with a visual training device. We used a discrimination task for two types of stimuli: a static point stimulus and a new optic flow-discontinuity stimulus. Using a randomized controlled crossover design, each patient received two successive training rounds, one with high contrast stimuli in their affected hemifield (test) and one round with low-contrast stimuli in their intact hemifield (control). Goldmann and Humphrey perimetry were performed at the start of the study and following each training round. In addition, reading performance was measured. Goldmann perimetry revealed a statistically significant reduction of the visual field defect after the test training, but not after the control training or after no intervention. For both training rounds combined, Humphrey perimetry revealed that the effect of a directed training (sensitivity change in trained hemifield) exceeded that of an undirected training (sensitivity change in untrained hemifield). The interaction between trained and tested hemifield was just above the threshold of significance (p = 0.058). Interestingly, reduction of the field defect assessed by Goldmann perimetry increases with the difference between defect size as measured by Humphrey and Goldmann perimetry prior to training. Moreover, improvement of visual sensitivity measured by Humphrey perimetry increases with the fraction of non-responsive elements (i.e., more relative field loss) in Humphrey perimetry prior to training. Reading speed revealed a significant improvement after training. Our findings demonstrate that our training can result in reduction of the visual field. Improved reading performance after defect training further supports the significance of our training for improvement in daily life activities.

Changes in visual field defects during 10-year follow-up for indocyanine green-assisted macular hole surgery.

To determine whether the visual field defects detected within 3months of indocyanine green (ICG)-assisted inner-limiting membrane (ILM) peeling continue to worsen over longer periods. This was a retrospective observational case series. Four eyes with visual field defects that developed within 3years of ICG-assisted ILM peeling for a macular hole (MH) were examined yearly for 10years. The main outcome measures were the degree of mean deviation (MD) determined by Humphrey perimetry with the 30-2 SITA-Fast program and the best-corrected visual acuity (BCVA). Four patients were examined yearly for more than 10years, with a mean duration of follow-up of 139.5months (11.6years) and a range of follow-up of 137-156months (11.4-13years). The mean (±standard deviation) preoperative MD value was -4.99±3.26dB, and the mean postoperative MD values were -12.9±1.29dB after 1year, -14.1±0.75dB after 3years, and -12.73±2.65dB after 10years. The mean preoperative BCVA was 0.65±0.26 logarithm of the minimal angle of resolution (logMAR) units, and the postoperative BCVA was 0.21±0.07 logMAR units at 1year, 0.28±0.21 logMAR units at 3years, and 0.14±0.06dB logMAR units at 10years. The visual field defects detected soon after ICG-assisted ILM peeling continued to worsen for 3years, but not thereafter.