Humphrey Visual Field Analyzer Research Articles

Combined evaluation of visual field and optical coherence tomography angiography data in multiple sclerosis patients

Aims: To evaluate Humphrey visual field analyzer (HVFA) data and optical coherence tomography angiography (OCT-A) parameters in multiple sclerosis (MS) patients with optic neuritis (ON) attacks. Methods: 34 eyes of 34 patients with MS diagnosis who had ON attacks were included in the study. After detailed ophthalmoscopic examination, OCT-A and HVFA images were taken. Spearman correlation analysis was used in statistical analysis. Results: The mean age of the participants was 31.52±10.09 years. In the correlation analysis, a moderate correlation was found between mean deviation (MD) and foveal deep blood flow (DF) (rho=0.52), and a weak correlation was found between MD and foveal superficial blood flow (SF) (rho=0.40) and optic disc head blood flow (ODF) (rho=0.38). A weak negative correlation was found between pattern standard deviation (PSD) and DF (rho=-0.37) and ODF (rho=-0.40). Conclusion: This study showed that OCTA data were affected in a manner consistent with HVFA data. More practical and quickly applicable OCTA scans may facilitate the estimation of visual field findings in MS patients.

A study on correlation between automatedperimetry and optical coherence tomography findings in glaucoma suspects

To evaluate the correlation between optic disc and retinal nerve fiber layer (RNFL) parameters of SD OCT scan of optic disc, and, visual field indices of Humphrey visual field analyzer. This is a prospective, cross-sectional study of 47 patients who are glaucoma suspects. They have been screened for glaucoma by comprehensive ophthalmic examination including visual field testing by automated perimetry and optic nerve head and retinal nerve fiber layer thickness changes assessment by optical coherence tomography. Mean age of the glaucoma suspects was 54.35 ± 10.6 years. Women were having higher (58.7%) mean age as compared to men (41.3%). Mean IOP in glaucoma suspects was 17.97 mmHg. The mean CD ratio was measured as 0.66 ± 0.11 and with significant negative correlation between the mean MD and CD ratio values (p<0.05) and similarly between MD and Vertical CDR. PSD showed significant positive correlation with CDR and also with Vertical CDR. Correlation is noted between MD and average RNFL, with significant positive correlation between MD and superior RNFL. Spectral domain OCT, when used in combination with automated perimetry helps in early diagnosis of glaucoma.SD OCT of Optic disc alone can detect changes of RNFL in patients with normal discs and visual fields. Optic Disc OCT plays a vital role in diagnosing preperimetric glaucoma patients.

Diagnostic Performance of the Offline Medios Artificial Intelligence for Glaucoma Detection in a Rural Tele-Ophthalmology Setting

PurposeThis study assesses the diagnostic efficacy of offline Medios Artificial Intelligence (AI) glaucoma software in a primary eyecare setting, using non-mydriatic fundus images from Remidio's Fundus-on-Phone (FOP NM-10). AI results were compared with tele-ophthalmologists' diagnoses and with a glaucoma specialist's assessment for those participants referred to tertiary eyecare hospital. DesignProspective, cross-sectional study Participants303 participants from 6 satellite vision centers of a tertiary eye hospital MethodsAt the vision center, participants underwent comprehensive eye evaluations, including clinical history, visual acuity measurement, slit lamp examination, intraocular pressure measurement, and fundus photography using the FOP NM-10 camera. Medios AI-Glaucoma software analysed 42-degrees disc-centric fundus images, categorizing them as normal, glaucoma, or suspect. Tele-ophthalmologists who were glaucoma fellows with a minimum of 3 years of ophthalmology and 1 year of glaucoma fellowship training, masked to AI results, remotely diagnosed subjects based on the history and disc appearance. All participants labelled as disc suspects or glaucoma by AI or tele-ophthalmologists underwent further comprehensive glaucoma evaluation at the base hospital, including clinical examination, Humphrey visual field analysis (HFA), and Optical Coherence Tomography (OCT). AI and tele-ophthalmologist diagnoses were then compared with a glaucoma specialist's diagnosis. Main Outcome MeasuresSensitivity and Specificity of Medios AI ResultsOut of 303 participants, 299 with at least one eye of sufficient image quality were included in the study. The remaining 4 participants did not have sufficient image quality in both eyes. Medios AI identified 39 participants (13%) with referable glaucoma. The AI exhibited a sensitivity of 0.91 (95% CI: 0.71 - 0.99) and specificity of 0.93 (95% CI: 0.89 - 0.96) in detecting referable glaucoma (definite perimetric glaucoma) when compared to tele-ophthalmologist. The agreement between AI and the glaucoma specialist was 80.3%, surpassing the 55.3.% agreement between the tele-ophthalmologist and the glaucoma specialist amongst those participants who were referred to the base hospital. Both AI and the tele-ophthalmologist relied on fundus photos for diagnoses, while the glaucoma specialist's assessments at the base hospital were aided by additional tools such as HFA and OCT. Furthermore, AI had fewer false positive referrals (2 out of 10) compared to the tele-ophthalmologist (9 out of 10). ConclusionMedios offline AI exhibited promising sensitivity and specificity in detecting referable glaucoma from remote vision centers in southern India when compared with teleophthalmologists. It also demonstrated better agreement with glaucoma specialist’s diagnosis for referable glaucoma participants.

Glaucoma Rehabilitation using ElectricAI Transcranial Stimulation (GREAT)—study protocol for randomized controlled trial using combined perceptual learning and transcranial electrical stimulation for vision enhancement

BackgroundGlaucoma patients with irreversible visual field loss often experience decreased quality of life, impaired mobility, and mental health challenges. Perceptual learning (PL) and transcranial electrical stimulation (tES) have emerged as promising interventions for vision rehabilitation, showing potential in restoring residual visual functions. The Glaucoma Rehabilitation using ElectricAI Transcranial stimulation (GREAT) project aims to investigate whether combining PL and tES is more effective than using either method alone in maximizing the visual function of glaucoma patients. Additionally, the study will assess the impact of these interventions on brain neural activity, blood biomarkers, mobility, mental health, quality of life, and fear of falling.MethodsThe study employs a three-arm, double-blind, randomized, superiority-controlled design. Participants are randomly allocated in a 1:1:1 ratio to one of three groups receiving: (1) real PL and real tES, (2) real PL and sham tES, and (3) placebo PL and sham tES. Each participant undergoes 10 sessions per block (~ 1 h each), with a total of three blocks. Assessments are conducted at six time points: baseline, interim 1, interim 2, post-intervention, 1-month post-intervention, and 2-month post-intervention. The primary outcome is the mean deviation of the 24-2 visual field measured by the Humphrey visual field analyzer. Secondary outcomes include detection rate in the suprathreshold visual field, balance and gait functions, and electrophysiological and biological responses. This study also investigates changes in neurotransmitter metabolism, biomarkers, self-perceived quality of life, and psychological status before and after the intervention.DiscussionThe GREAT project is the first study to assess the effectiveness of PL and tES in the rehabilitation of glaucoma. Our findings will offer comprehensive assessments of the impact of these treatments on a wide range of brain and vision-related metrics including visual field, neural activity, biomarkers, mobility, mental health, fear of falling, and quality of life.Trial registrationClinicalTrials.gov NCT05874258. Registered on May 15, 2023.

Exploring Head-Mounted Virtual Visual Fields for Glaucoma: How do They Stack Up Against Humphrey Tests?

Abstract The integration of virtual reality (VR) technology into visual field (VF) testing has introduced innovative head-mounted perimetry devices, which offer numerous advantages over traditional methods. This review examines the features, accuracy, and reliability of commercially available head-mounted VR perimeters and compares them with the gold standard, the Humphrey Visual Field Analyzer (HFA). While traditional devices like the HFA and Goldmann Perimeter have been reliable for glaucoma management, they are limited by fixed testing environments, long testing durations, and high costs. VR-based perimetry addresses these limitations by providing portable, cost-effective, and engaging testing environments that can be conducted in various settings, including patients’ homes. Head-mounted displays (HMDs) equipped with high-resolution screens, motion sensors, and eye-tracking technology create an immersive testing experience that minimizes distractions and external light interference, potentially enhancing test accuracy. These devices also offer customizable testing protocols, improving patient comfort and compliance, especially among children and elderly patients. However, concerns remain about the reproducibility and accuracy of VR perimetry compared to established standards. Variability among VR platforms and the lack of large normative databases for visual fields pose challenges to their widespread adoption. This review highlights the need for further validation studies and the development of standardized testing protocols to ensure the reliability and accuracy of VR perimetry. Despite these challenges, the flexibility, reduced testing times, and potential for telemedicine applications make VR head-mounted perimetry a promising tool for improving glaucoma management and expanding access to VF testing in diverse clinical environments.

Contrast sensitivity assessment using the Mars letter contrast sensitivity test

Background: Contrast sensitivity (CS) represents an individual’s ability to detect differences in luminance between two areas and is an essential component of vision. Various studies have evaluated the relevance of different charts to assess CS in ophthalmology practice. We evaluated the CS of healthy individuals using the Mars letter CS chart. Methods: In this hospital-based cross-sectional study, we consecutively recruited healthy individuals older than 18 years with unremarkable ocular examinations who attended the general outpatient clinic at Benue State University Teaching Hospital, Makurdi, Nigeria, between March 2021 and July 2022. Each participant was allocated to one of five groups with 10-year age intervals and 1:1 male-to-female ratios. All participants underwent a detailed ophthalmic examination. We tested visual fields using the 24-2 program on a Humphrey visual field analyzer with appropriate refractive correction. Monocular testing of CS with appropriate spectacle correction was performed using a Mars letter CS chart. The tribe, age, and sex of each individual, along with the best-corrected visual acuity (BCVA), intraocular pressure, mesopic pupil size, cup-to-disc ratio (C/D ratio), and mean deviation (MD) of the visual field for each eye were recorded. Results: A total of 100 eyes of 50 patients with a mean (standard deviation [SD]) age of 44.6 (12.8) years and a 1:1 male-to-female ratio were enrolled. The mean (SD) CS score for the 100 included eyes was 1.67 (0.09) log units. The mean (SD) CS score was comparable between sex groups and tribes (both P > 0.05) yet differed significantly between age groups (P < 0.001). We found a significant good inverse correlation between CS score and age (r = - 0.60; P = 0.001), a low inverse correlation with BCVA (r = - 0.29; P < 0.003), and a low direct correlation with C/D ratio (r = + 0.23; P = 0.023); however, we observed no significant correlation with tribe (r = + 0.07; P = 0.053), sex (r = + 0.16; P = 0.123), IOP (r = + 0.07; P = 0.481), mesopic pupil size (r = - 0.02; P = 0.861), and mean deviation of visual field (r = + 0.02; P = 0.873). Conclusions: We observed a progressive decline in the mean CS score in healthy eyes with each decade of increase in age. Our findings are similar to those of previous studies and could be used as reference values for the healthy population among various age groups. However, further studies with larger sample sizes are necessary to encourage clinicians to incorporate CS into routine examinations. Further studies must compare these normative values with those of disease conditions to further understand the clinical application of the CS test.

Extraction of three-dimensional shapes in glaucoma patients in response to monocular depth cues.

To assess the impact of glaucoma on perceiving three-dimensional (3D) shapes based on monocular depth cues. Clinical observational study. Twenty glaucoma patients, subjected to binocular visual-field sensitivity (binocular-VFS) tests using a Humphrey Visual Field Analyzer, and 20 age-matched healthy volunteers, underwent two tasks: identifying the nearest vertex of a 3D shape using monocular shading (3D-SfS), texture (3D-SfT), or motion (3D-SfM) cues, and distinguishing elementary one-dimensional (1D) features of these cues. The association of the visual-field index (VFI) of binocular-VFS with 3D shape perception in glaucoma patients was also examined. Glaucoma patients demonstrated reduced accuracy in distinguishing 1D luminance brightness and a larger "error-in-depth" between the perceived and actual depths for 3D-SfM and 3D-SfS compared to healthy volunteers. Six glaucoma patients with a 100% VFI for binocular-VFS exhibited a similar error-in-depth to the other fourteen glaucoma patients; they had a larger error-in-depth for 3D-SfM compared to healthy volunteers. No correlation between the error-in-depth values and the VFI values of binocular-VFS was observed. The 3D shape perception in glaucoma patients varies based on the depth cue's characteristics. Impaired 1D discrimination and larger thresholds for 3D-SfM in glaucoma patients with a 100% VFI for binocular-VFS indicate more pronounced perceptual deficits of lower-level elementary features for 3D-SfS and higher-level visual processing of 3D shapes for 3D-SfM. The effects of the location and degree of binocular visual-field defects on 3D shape perception remain to be elucidated. Our research provides insights into the 3D shape extraction mechanism in glaucoma.

Prospective Comparison of VisuALL Virtual Reality Perimetry and Humphrey Automated Perimetry in Glaucoma.

Automated perimetry plays an important role in the diagnosis and monitoring of glaucoma patients. The purpose of this study is to prospectively determine parity between Humphrey visual field analyzer (HVFA) perimetry (the current gold standard) and the VisuALL virtual reality perimeter (VRP). In this prospective fully paired diagnostic accuracy study, patients with stable, long-term HVFA visual fields (horizontal dots for ≥4 consecutive visits on progression analysis) with preperimetric, mild, moderate, or severe visual field loss were familiarized with the VRP and then tested using its proprietary software. These results were used for point-by-point comparison with a contemporaneous HVFA test. This study was approved by the Institutional Review Board (IRB) of the University of the Incarnate Word, San Antonio, Texas, United States of America (IRB approval #20-06-002). The prospective study analyzed 43 eyes of 24 glaucoma patients. Spearman's correlation of mean deviation (MD) revealed a strong correlation between HVFA and VRP with rs(41) = 0.871, p < 0.001. The overall mean difference in locus-locus sensitivity between the devices was -0.4 ± 1.5 dB but varied for different visual field locations and glaucoma severity. The parity between the VRP and HVFA was remarkably strong for mild and moderate glaucoma. Given its portability, ease of use, space efficiency, and low cost, the VRP presents a viable alternative. Automated perimetry, specifically the HVFA, has been the gold standard for visual field assessment since its introduction. The recent COVID-19 pandemic has illuminated the advantages of the VRP, allowing for safer visual assessment for both patient and clinician alike. Our study hopes to establish parity between these systems, allowing for the efficient integration of a novel head-mounted perimetry system that can safely diagnose and monitor glaucomatous progression in clinical practice. Investigation of parity between Olleyes VisuALL virtual reality perimetry (VRP) and existing standard HVFA perimetry is essential to the diagnosis and management of glaucoma. Linear correlations between the two were established from 43 glaucomatous eyes. Parity was strong for mild and moderate glaucoma, presenting VRP as a viable alternative. Griffin JM, Slagle GT, Vu TA, et al. Prospective Comparison of VisuALL Virtual Reality Perimetry and Humphrey Automated Perimetry in Glaucoma. J Curr Glaucoma Pract 2024;18(1):4-9.

Glaucoma awareness, anxiety and its impact on patients undergoing visual field testing and optical coherence tomography.

To assess the effect of Glaucoma awareness, knowledge, and anxiety on patients under visual field analysis by Humphrey's visual field analyzer (HFA) and optical coherence tomography(OCT). This prospective comparative cohort study included glaucoma patients undergoing HFA (Group A)(n = 150) and OCT(Group B) (n = 150). Each group consisted of 75 newly diagnosed patients and 75 patients who were on follow-up. Participants completed State trait anxiety inventory form Y2(STAI) before and after the test to assess pre-test and intra-test anxiety. Another validated and structured questionnaire was used to assess patient awareness and knowledge of glaucoma. Anxiety scores were used to make correlations and comparisons between the two groups and also against visual field reliability indices. The impact of awareness on anxiety scores and its correlation with reliability indices were also determined. Overall pretest and intratest anxiety scores in patients undergoing HFA were 52.39(9.5) and 52.45(8.6)and OCT 53.04(8.0) and 53.83(8.2) respectively.Pretest anxiety was less in follow-up patients of both groups(Group A-51.04,Group B-52.72).There was no statistically significant difference between the groups(pretest p = 0.52,Intratest p = 0.15). Anxiety score was found to be significantly high in female participants(54.07,p = 0.01)and those without awareness(p < 0.001). Patients with education of graduation and above in group B had significantly lower anxiety scores(p = 0.007). Anxiety levels induced by both diagnostic modalities HFA and OCT appear to be similar and it does not affect the reliability indices.Anxiety score was higher in female participants and participants lacking disease awareness.

Correlations between Steady-State Pattern Electroretinogram and Humphrey Visual Field Analyzer Global Indices and Their Associations with Retinal Ganglion Cell Layer-Inner Plexiform Layer Thickness in Glaucoma Suspects.

The purpose of this study was to investigate the utility of steady state pattern electroretinogram (ss-PERG) in detecting retinal ganglion cell (RGC) dysfunction in glaucoma suspects (GS) who had normal 24-2 Humphrey Visual Fields (HFA). This was a prospective cohort study of GS patients who were identified based on optic disc appearance with normal HFAs. Patients received a complete eye examination, standard automated perimetry (SAP), optical coherence tomography (OCT), and ss-PERG measurements. The ss-PERG parameters, Magnitude (Mag), Magnitude D (MagD), and MagD/Mag ratio, were examined, along with their relationships between HFA and OCT measurements. Twenty-five patients were included in this study, with a total of 49 eyes. Fifteen eyes had abnormal ss-PERG parameters and when compared to GS eyes with normal ss-PERG parameters, there were significant differences in HFA 24-2, retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer and inner plexiform layer (GCL + IPL) thickness. All ss-PERG parameters were significantly correlated with 24-2 VF mean deviation (MD) and visual field index (VFI), as well as 10-2 VF MD after controlling for age, sex, intraocular pressure, central corneal thickness, and spherical equivalent. When controlled for age, spherical equivalent, and IOP, MagD/Mag ratio significantly contributed to the variance in average GCL + IPL thicknesses, whereas 24-2 VF MD and 10-2 VF MD did not. MagD/Mag ratio also significantly accounted for variance in all macular GCL + IPL sectors, while 10-2 VF MD did not. ss-PERG has significant correlations with HFA global indices and was predictive of GCL + IPL thickness in GS patients. Clinical Significance. ss-PERG may serve as a useful functional tool for detecting and measuring RGC dysfunction in GS. It appears to be more sensitive than HFA in the detection of early changes in GCL + IPL thicknesses and may be helpful to use in conjunction with current diagnostic studies to improve the ability of monitoring GS progression.

THE EFFECT OF SERUM 25-HYDROXY VITAMIN D ON VISUAL FIELDS IN MODERATE - HIGH MYOPIA

Introduction &amp; ObjectivesMyopia is a visual impairment problem that constantly increases, causing global health problemsand economic burdens. Previous studies have concluded that vitamin D deficiency is associated withdecreased visual acuity and visual function. To determine the relationship between serum 25(OH)Dlevels and visual fields in moderate to high myopia&#x0D; MethodsThis study was an observational analytic study with a cross-sectional design. Visual function testsperformed were visual acuity test, Humphrey visual field analyzer, and ELISA test for serum25(OH)D.&#x0D; ResultsThe study consisted of 50 subjects with moderate to high myopia with 39 subjects was females (60%)and mean age of 26.62±3.70 years. The distribution of moderate myopia and high myopia was 30%and 20% with a mean spherical equivalent of -5.11±1.54 D. Twenty four subjects (48%) had serum25(OH)D deficiency, 1 subject (2%) had insufficiency of serum 25(OH)D with an average level of44.56±41.45 ng/ml. Fischer's Exact analysis on the right eye revealed 7 subjects (29.2%) had serum25(OH)D deficiency and insufficiency with visual field defect (p=0.001). On the left eye, 6 subjects(25%) had serum 25(OH)D deficiency and insufficiency with visual field defect (p=0.132).&#x0D; ConclusionThere was statistically significant relationship between serum 25(OH)D levels and visual field inmoderate to high myopia in one eye.

Retinal Ganglion Cell Functional Recovery after Intraocular Pressure Lowering Treatment Using Prostaglandin Analogs in Glaucoma Suspects: A Prospective Pilot Study.

To evaluate the ability of pattern electroretinogram (PERG) to detect improvement of retinal ganglion cell (RGC) function in glaucoma suspects (GS) after medically reducing intraocular pressure (IOP) using prostaglandin analog drops. Six subjects (eight eyes) received topical IOP lowering treatment based on their clinical examination and were observed at Manhattan Eye, Ear & Throat Hospital over an average of 3.1 ± 2.2 months. During this time, participants underwent a full ophthalmologic exam and were evaluated with a Humphrey visual field analyzer (HFA) 24-2 [24-2 mean deviation (MD), 24-2 pattern standard deviation (PSD), and 24-2 visual field indices (VFI)], Diopsys NOVA PERG optimized for glaucoma [magnitude (Mag), magnitudeD (MagD), and magnitudeD/magnitude ratio (MagD/Mag ratio)] and optical coherence tomography (OCT)-derived average retinal nerve fiber layer thickness (avRNFLT) and average ganglion cell layer + inner plexiform layer (avGCL + IPL) thicknesses at baseline visit (pretreatment) and 3 months later (posttreatment). Goldman applanation tonometry was used to measure IOP at each visit. Paired sample t-tests were conducted to determine the statistical significance of the change in IOP, HFA indices, PERG parameters, and OCT thickness measurements between the two visits. Lowering IOP by 22.29% resulted in a significant increase (32.98 and 15.49%) in MagD [t (7) = -3.174, 95% confidence interval (CI) = -0.53, -0.08, p = 0.016] and MagD/Mag ratio [t (7) = -3.233, 95% CI = -0.20, -0.03, p = 0.014], respectively. There was a positive percentage change for all variables of interest, however, 24-2 MD, Mag, avRNFLT, and GCL+ IPLT did not reach statistical significance. After reducing IOP by 22.29% for a duration of 3.1 months, the PERG parameters, MagD and MagD/Mag ratio, significantly improved by 32.98 and 15.49%, respectively. Pattern electroretinogram (PERG) may be a crucial tool for clinicians to locate a window of opportunity in which degenerating yet viable RGCs could be rescued from irreversible damage. We suggest consideration of PERG as a tool in early retinal ganglion cell (RGC) dysfunction detection as well as for monitoring IOP lowering treatment. Tirsi A, Gliagias V, Sheha H, et al. Retinal Ganglion Cell Functional Recovery after Intraocular Pressure Lowering Treatment Using Prostaglandin Analogs in Glaucoma Suspects: A Prospective Pilot Study. J Curr Glaucoma Pract 2023;17(4):178-190.

New methods for detection of early loss of rapid flicker, spatial vision, and chromatic sensitivity in glaucoma

Purpose: To examine whether ocular hypertension and early glaucoma cause measurable changes in spatial vision, rapid flicker sensitivity and red/green and yellow/blue colour vision.Methods: We examined subjects aged 40 to 78 years with ocular hypertension (OHT), primary open angle glaucoma (POAG), normal tension glaucoma (NTG), and age matched controls. Monocular best corrected visual acuity (BCVA) was tested using EDTRS charts.VA and Functional Contrast Sensitivity (FCS) with Landolt ring stimuli of both positive and negative contrast were also measured monocularly with the Acuity‐Plus test. Red/green (RG) and yellow/blue (YB) colour thresholds were measured with the Colour Assessment and Diagnostics (CAD) test. Photopic (cone‐enhanced) and mesopic (rod‐enhanced) rapid flicker thresholds were measured at the fovea (0°) and at an eccentricity of 5° in each of the four quadrants using the Flicker‐Plus test. All subjects had their visual fields measured using the Humphrey visual field analyser (24–2 SITA standard protocol). Peripapillary retinal nerve fibre layer thickness (pRNFLT) and macular retinal layer thicknesses were measured using the Heidelberg Spectralis OCT.Results: The mean, logMAR BCVA for OHT patients was 0.00 and for POAG and NTG patients was −0.10 and 0.10, respectively. For control participants, mean logMAR BCVA was 0.00. Mean pRNFL thickness was significantly reduced for glaucoma patients (59.5 ± 7.7 μm) as compared to control subjects (94.6 ± 5.13 μm) and OHT patients (115.5 ± 3.5 μm). POAG and NTG patients showed significantly higher colour thresholds (mean red/green threshold 4.97, blue/yellow 5.28 CAD units) compared to control subjects (mean red/green threshold 2.07, blue/yellow 1.62 CAD units). One OHT patient showed acquired loss of blue/yellow colour vision (3.23 CAD units), with normal VA. The Acuity‐Plus test which employs briefly presented stimuli, also revealed significant loss of VA (3.78 and 3.64 min of arc) and FCS (141.32% and 100%) in an NTG patient, with results outside normal limits for both positive and negative contrast, respectively. Central FCS was higher and outside the normal age limits for POAG patients (73.41% and 89.27%) as compared to age matched controls (61.27% and 33.63%). OHT patients, on the other hand, produced FCS thresholds within normal limits. Flicker modulation thresholds were higher for both rod and cone enhanced stimulus conditions in glaucoma and OHT patients, when compared to control subjects.Conclusion: The results reveal non‐uniform, losses that can affect selectively each of the visual attributes examined in this study. These preliminary findings suggest that in addition to VA and FCS tests, colour vision and rapid flicker sensitivity should also be examined in patients with optic nerve pathologies like glaucoma.

Visual field loss patterns in dominant and recessive optic atrophy based on OPA1 archetypes

Aims/Purpose: Identification and quantification of visual field loss patterns of dominant optic atrophy forms (ACO2 and AFG3L2 mutations) and recessive optic atrophy form (WFS1 mutation, Wolfram Syndrome, WS) based on machine learning‐obtained archetypes for OPA1‐Dominant Optic Atrophy (DOA).Methods: Five patients affected by hereditary optic neuropathies carrying ACO2 gene mutations, 5 with AFG3L2 mutations, and 20 with WFS1 mutations were enrolled. Visual field (VF) tests performed by SITA standard 30–2 or 24–2 Humphrey VF analyzer (Carl Zeiss Meditec, Dublin, CA, USA) were collected for these patients. The VFs of these rare mutations (30% WFS1, 10% ACO2 and 3% AFG3L2 [1]) were decomposed and quantified according to the archetypes (AT) obtained in the unsupervised machine learning model developed for the OPA1 mutation.Results: The archetype analysis (AA)‐model developed for the DOA‐OPA1 mutation is composed of twelve ATs, with the central, the ceco‐central, and the para‐central as the most significant ones. For WS patients, the VF‐decomposition was mostly made up of ATs resembling more severe abnormalities, while for the ACO2 and AFG3L2‐affected patients the most important ATs were similar to the OPA1 cases.Conclusions: The developed AA‐model based on OPA1‐DOA affected patients enabled the decomposition of VFs of more rare optic atrophy mutations. The association of weights to the different ATs for patient‐specific VFs showed to be a possible option to identify and quantify the most important patterns of visual field loss in such particular cases of autosomal dominant or recessive optic neuropathies. A pattern‐specific visual field loss might strengthen the differential diagnosis between OPA1 and other mutations and support future clinical and therapeutic trials.

Archetypal analysis for dominant optic atrophy visual field loss

Aims/Purpose: Identification of the characteristic visual field loss patterns of dominant optic atrophy (DOA) employing the Archetypal Analysis (AA) machine learning algorithm and further relation with patient‐specific parameters.Methods: For 64 patients affected by molecularly confirmed DOA with OPA1 heterozygous mutation, binocular visual field (VF) tests performed by SITA standard 30–2 or 24–2 Humphrey VF analyser (Carl Zeiss Meditec, Dublin, CA, USA) were collected. For patients that had multiple VF tests, several VFs were collected to enlarge the dataset. Resorting to Python 3.8 (Anaconda) an AA model was developed to determine and quantify the DOA underlying patterns of visual loss. After a careful analysis involving different linear and non‐linear machine Learning models and algorithms, the different archetypes (AT) were related to parameters such as age and visual acuity.Results: Considering 229 VF test, employing the AA, twelve archetypes were detected for the characterization and quantification of visual loss in DOA. Central, ceco‐central, and para‐central ATs revealed to be the most significant ones, matching the common characteristic scotomas for DOA patients, followed by quadrantanopia, altitudinal, and nasal step ATs.Younger patients were related to less severe visual loss representative ATs, while patients with lower visual acuity were related to more severe visual loss representative ATs.Conclusions: Archetypal analysis shows to be a potential powerful tool to support clinicians in the identification of DOA patients by identifying and quantifying visual loss patterns characteristic of this disease. Relation with other patient‐specific parameters might strengthen the differential DOA diagnosis.

Reviving the Role of Optical Coherence Tomography and Visual Field Analysis as Investigative Tools for Diagnosis of Primary Open-Angle Glaucoma in Rural Tertiary Care Centre

Background: Glaucoma is the second most common cause of blindness globally and is characterised by raised intraocular pressure, optic disc cupping, and visual field defects. However, advanced imaging modalities such as optical coherence tomography (OCT) can pick up early changes. Our study aims to examine the role of OCT for the early diagnosis of primary open-angle glaucoma (POAG), its correlation with standard automated perimetry, and the diagnostic efficiency of both in POAG patients at a rural tertiary care centre in the Chengelpet District. Materials and Methods: This was a prospective observational study comparing the quantitative measurement of RNFL using OCT with functional loss analysed using the Automated Perimetry Humphrey Visual Field Analyzer in patients with POAG visiting the tertiary health centre in the Chengelpet district in Tamil Nadu. The study was conducted in 92 eyes of 50 patients diagnosed with POAG for 15 months from March 2022 to May 2023. Results: Of the 92 eyes of 50 patients, 26 were male patients and 24 were female patients. In total, 21 eyes had no demonstrable visual field defect, 49 eyes had single hemifield defect and 22 eyes had both hemifield defect. The area under the receiver operator characteristic curve for OCT RNFL layer measurement in patients diagnosed with visually confirmed ONH changes was 1.00, which was highly significant (P value = 0.01) and correlated well with the type of visual field defect with Humphrey's automated perimetry, suggesting significant correlation between the two. OCT-RNFL measurements are better diagnostic tests than standard automated perimetry for the early detection of glaucoma. Conclusion: Both OCT RNFL and Humphrey's automated visual field analysis play a most crucial role as an investigative modality for early diagnosis of POAG; however, OCT has an added advantage of detecting early glaucoma changes even without visible field changes and hence useful for very early detection of POAG in a tertiary care centre.

Pattern visual evoked potential and foveal sensitivity in amblyopia.

Amblyopic eyes show impaired visual functions such as poor visual acuity and reduced foveal sensitivity. The purpose of this study was to determine the association between foveal threshold and visual evoked potentials (VEP) in strabismic and anisometropic amblyopia. Forty-five subjects (age range: 7-28years, 43.3% female) including 15 strabismic and 15 anisometropic amblyopes, and 15 age-similar control subjectsparticipated in this study. Each subject had pattern visual evoked potentialsand foveal threshold recorded in each eye using RetiScan (Roland Consult, Germany) and Humphrey Visual Field Analyzer II (HFA II; Carl Zeiss Meditec Inc., Dublin, CA), respectively. These outcomes were comparedamong the amblyopic eyes, their fellow eyes, and the control eyes. Compared to the amblyopic eyes (Mean ± SD: 33.4 ± 3.48dB), the foveal threshold was higher in fellow eyes (37.0 ± 2.04dB, p = 0.0002) and incontrol eyes (38.7 ± 0.96dB, p < 0.0001). Strabismic amblyopes had a lower foveal threshold than anisometropic amblyopes (31.8 ± 3.86 vs. 35.0 ± 2.17dB, p = 0.005). Relative to the P100 peak time in fellow eyes (1°checks:116.1 ± 9.00ms; 0.25°checks:118.8 ± 5.67ms), amblyopic eyes had delayed P100 peak times for both 1° (122.7 ± 11.4ms, p < 0.0001) and 0.25° (130.4 ± 11.2ms, p < 0.0001) check sizes. There were also significant differences in P100 peak time between amblyopic and control eyes (1°:122.7 ± 11.4 vs.112.4 ± 5.01ms, p = 0.15; 0.25°:130.4 ± 11.2 vs.113.9 ± 5.71ms, p < 0.0001) and between fellow and control eyes (0.25°:118.8 ± 5.67 vs.113.9 ± 5.71ms, p = 0.009). Amblyopic eyes exhibited lower N75-P100 amplitudes than fellow eyes (1°:12.6 ± 7.96 vs.15.9 ± 8.82µV, p = 0.01; 0.25°:10.6 ± 6.11 vs. 15.8 ± 10.6µV, p = 0.001) and control eyes (0.25°: p = 0.0008). Foveal threshold correlated negatively with P100 peak time (1°: r = -0.45, p = 0.002 and 0.25°: r = -0.58, p < 0.0001) and positively with N75-P100 amplitude responses (1°: r = 0.42, p = 0.004 and 0.25°: r = 0.52, p = 0.002). Amblyopic eyes showed reduced pattern VEP amplitudes and delayed peak times with significant associations with the foveal sensitivity. However, the VEP measures overlapped extensively between amblyopic and control eyes with no apparent criterion value for optimal discrimination, suggesting that foveal sensitivity might be a better discriminator of amblyopia than pattern VEP.

Mean rate of progression of visual fields in patients with primary open-angle glaucoma and ocular hypertension attending a tertiary care center in South India - A prospective cohort study using FORUM® Glaucoma Workplace software.

To find out the mean rate of progression (MROP) of visual fields (VF) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) using FORUM® Glaucoma Workplace. Two hundred and one eyes of 105 patients were included in this prospective cohort study. Patients with POAG and OHT were recruited, and VF analysis with 24-2 and or 10-2 was done using SITA standard strategy in Zeiss Humphrey Visual Field Analyzer (HFA). All the previous VFs were identified from FORUM software, and the baseline indices were recorded from the first reliable VF analysis. The present VF analysis was compared to the previous one using FORUM software, and the rate of progression (ROP) in VF was obtained by Guided Progression Analysis. MROP of VF in the POAG group was - 0.085 dB/year, ranging from -2.8 to 2.8 dB/year with a standard deviation (SD) of 0.69. In the OHT group, the MROP of VF was -0.003 dB/year, ranging from - 0.8 to 0.5 dB/year with an SD of 0.27. The MROP of VF in medically treated eyes with POAG was -0.14 dB/year with an SD of 0.61 and in surgically treated eyes was -0.02 dB/year with an SD of 0.78. The overall baseline mean VF index (VFI) was 83.19% and the final mean VFI was 79.80%. There was a statistically significant decrease in the mean VFI value from baseline to the final visit (P-value 0.0005). The mean ROP of VF in the POAG group was -0.085 dB/year and in the OHT group was - 0.003 dB/year.

Kinetic Perimetry on Virtual Reality Headset.

We present a portable automatic kinetic perimeter based on a virtual reality (VR) headset device as an innovative and alternative solution for the screening of clinical visual fields. We compared the performances of our solution with a gold standard perimeter, validating the test on healthy subjects. The system is composed of an Oculus Quest 2 VR headset with a clicker for participant response feedback. An Android app was designed in Unity to generate moving stimuli along vectors, following a standard Goldmann kinetic perimetry approach. Sensitivity thresholds are obtained by moving centripetally three different targets (V/4e, IV/1e, III/1e) along 24 or 12 vectors from an area of non-seeing to an area of seeing and then transmitted wirelessly to a PC. A Python real-time algorithm processes the incoming kinetic results and displays the hill of vision in a two-dimensional map (isopter). We involved 21 subjects (5 males and 16 females, age range 22-73 years) for a total of 42 eyes tested with our proposed solution, and results were compared with a Humphrey visual field analyzer to test reproducibility and efficacy. isopters generated with the Oculus headset were in good agreement with those acquired with a commercial device (Pearson's correlation values r > 0.83 for each target). we demonstrate the feasibility of VR kinetic perimetry by comparing performances between our system and a clinically used perimeter in healthy subjects. proposed device leads the way for a portable and more accessible visual field test, overcoming challenges in current kinetic perimetry practices.

The Comparison of Foveal Sensitivity Between Diabetic and Non-diabetic Patients by Using Standard Automated Perimetry 10-2 Protocol: A Cross-Sectional Study.

Purpose The purpose of the study is to assess whether standard automated perimetry (SAP) was capable of detecting early neuroretinal changes by comparing foveal sensitivity in diabeticand non-diabetic subjects. Settings and design This is an observational and cross-sectional study that compared foveal sensitivity between a case group of 47 subjects with no or mild-to-moderate diabetic retinopathy (DR) without maculopathy and a control group of 43 healthy subjects. Materials and Methods After a thorough ocular examination, all patients were put through tests using a Humphrey visual field analyzerwith the Swedish interactive threshold algorithm (SITA) standard system (10-2 software). The primary indicator of success was the age-adjusted foveal awareness-esteem difference. Mean deviation (MD) and pattern standard deviation (PSD) readings were the supplementary performance indicators. Results The mean age of the case and control group was 50.76 ± 13.20 years and 49.90 ± 12.20 years, respectively. The probability of cataract development was higher in the case group (p< 0.0001). In the control group, 95.3% had best-corrected visual acuity (BCVA) in the category of good visual acuity (VA) (p < 0.0001). The mean foveal sensitivity in the case group was 28.57 ± 7.54 and 32.16 ± 7.09 for the control group, and the difference was statistically significant (p < 0.023). The mean of MD in the case group was -6.05 ± 7.93, whereas in the control group, it was -3.28 ± 1.70, which was found significant (p = 0.027). There was no difference in PSD between the study groups. Conclusions Foveal sensitivity decreased in diabetics, even without maculopathy, so SAP helps identify a patient at risk of future vision loss.