Humphrey Visual Field Testing Research Articles

Quantitative Assessment of Visual Field Recovery Following Transspheniodal Pituitary Adenoma Excision and its Time Course

Background: Pituitary adenomas are a significant subset of intracranial tumors, constituting approximately 10-15% of all primary brain tumors. These benign tumors often lead to various clinical symptoms, including hormonal imbalances and visual field defects due to optic chiasm compression. The transsphenoidal approach for pituitary adenoma excision is favored for its minimal invasiveness and favorable outcomes. However, the timeline and extent of visual field recovery post-surgery remain areas of active research. Objective: This study aimed to quantitatively assess and track visual field recovery in patients following transsphenoidal pituitary adenoma excision and to identify factors influencing the recovery process. Methods: This descriptive observational study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from June 16, 2023, to March 31, 2024. Forty-six consecutive patients, aged 18-70 years, who underwent transsphenoidal pituitary adenoma excision and had documented visual field impairments, were included. Exclusion criteria were previous pituitary surgery, pre-existing visual field abnormalities not attributable to pituitary adenoma, and inability to perform visual field testing. Preoperative visual field measurements were taken within two weeks before surgery using Humphrey visual field testing. Postoperative evaluations were performed immediately after surgery (within 48 hours), and at one month, two months, and three months. Visual field indices, including mean deviation (MD) and pattern standard deviation (PSD), were recorded. Data were analyzed using SPSS version 25, with descriptive statistics for patient demographics and tumor characteristics, and inferential statistics (Student's t-test and chi-square test) for comparing visual field indices. Results: The study included 23 male and 23 female patients, with a mean age of 52.3 years (SD ± 8.7). Tumor size averaged 2.7 cm (SD ± 0.9). Non-functioning tumors comprised 65.2% of cases. Preoperative hormonal dysfunction was present in 39.1% of patients. Preoperative visual field indices showed a mean MD of -5.2 dB (SD ± 2.1). Visual field improvement was noted postoperatively, with mean MD values of -4.0 dB (SD ± 1.8) at 48 hours, -3.5 dB (SD ± 1.7) at one month, -2.8 dB (SD ± 1.5) at two months, and -2.2 dB (SD ± 1.3) at three months. Endoscopic surgery was performed in 82.6% of cases, with a gross total resection rate of 69.6%. Postoperative complications included CSF leaks (13%) and hypopituitarism (26.1%). Conclusion: The study demonstrated significant visual field recovery in patients following transsphenoidal pituitary adenoma excision, with notable improvements observed within the first three months post-surgery. These findings support the efficacy of the transsphenoidal approach in improving visual outcomes and highlight the importance of early intervention and comprehensive postoperative monitoring.

MP-3 microperimeter in early primary open angle glaucoma with a new pattern.

To investigate macular microperimetry in patients with early primary open angle glaucoma (POAG) using a new custom-made pattern, and analyze the characteristics of macular sensitivity. This case-control study included 38 patients with POAG, who were divided into pre-perimetric glaucoma (18 eyes of 18 patients), early-stage (20 eyes of 20 patients), and control (20 eyes of 20 patients) groups. All subjects underwent standard 24-2 humphrey visual field test. An MP-3 microperimeter with a new custom-made pattern (28 testing points distributed in four quadrants, covering the central 10° of the retina) was used to evaluate macular sensitivity. Ganglion cell complex (GCC) thicknesses were examined using an RS-3000 Advance OCT system. The features of structure and function were analysed per quadrant. The pre-perimetric glaucoma group had significantly lower inferior hemifield macular sensitivity compared to controls (P<0.05). The early-stage POAG group had significantly lower average, inferior hemifield, inferonasal, and inferotemporal mean sensitivities compared to the pre-perimetric glaucoma group (P<0.05), and lower macular sensitivity in all sectors compared to controls (P<0.05). Regarding GCC thickness, all sectors in the early-stage POAG group became thinner compared to those in controls (P<0.05); whereas all sectors in the early-stage POAG group, except the superonasal quadrant, became thinner compared to those in the pre-perimetric glaucoma group (P<0.05). Macular sensitivity and GCC thickness were significantly associated in each sector. The inferotemporal quadrant had the highest correlation coefficients (0.840). The structure-function relationship for the inferonasal and inferotemporal sectors was stronger compared to the corresponding superior sectors. Microperimetry reveals variations in macular sensitivity in patients with early glaucoma earlier than conventional perimetry, particularly in pre-perimetric glaucoma cases in which it might be undetectable by conventional methods. The new custom-made pattern may improve the accuracy of microperimetry by enhancing point arrangement and reducing fatigue effects. Macular sensitivity measured by MP-3 with this pattern shows statistically significant structural and functional associations with the thicknesses of the GCC.

Pilot study comparing a new virtual reality–based visual field test to standard perimetry in children

PurposeTo assess the feasibility and performance of Vivid Vision Perimetry (VVP), a new virtual reality (VR)–based visual field platform. MethodsChildren 7-18 years of age with visual acuity of 20/80 or better undergoing Humphrey visual field (HVF) testing were recruited to perform VVP, a VR-based test that uses suprathreshold stimuli to test 54 field locations and calculates a fraction seen score. Pearson correlation coefficients were calculated to evaluate correlation between HVF mean sensitivity and VVP mean fraction seen scores. Participants were surveyed regarding their experience. ResultsA total of 37 eyes of 23 participants (average age, 12.9 ± 3.1 years; 48% female) were included. All participants successfully completed VVP testing. Diagnoses included glaucoma (12), glaucoma suspect (7), steroid-induced ocular hypertension (3), and craniopharyngioma (1). Sixteen participants had prior HVF experience, and none had prior VVP experience, although 7 had previously used VR. Of the 23 HVF tests performed, 9 (39%) were unreliable due to fixation losses, false positives, or false negatives. Similarly, 35% of VVP tests were unreliable (as defined by accurate blind spot detection). Excluding unreliable HVF tests, the correlation between HVF average mean sensitivity and VVP mean fraction seen score was 0.48 (P = 0.02; 95% CI, 0.09-0.74). When asked about preference for the VVP or HVF examination, all participants favored the VVP, and 70% were “very satisfied” with VVP. ConclusionsIn our cohort of 23 pediatric subjects, VVP proved to be a clinically feasible VR-based visual field testing, which was uniformly preferred over HVF.

Incidence of Ophthalmological Complications in NF-1 Patients Treated with MEK Inhibitors.

MEK inhibitors (MEKi) represent innovative and promising treatments for managing manifestations of neurofibromatosis type 1 (NF1). To mitigate potential ophthalmic side effects, such as MEKi-associated retinopathy (MEKAR), patients undergoing MEKi therapy routinely receive ophthalmology evaluations. Our study aims to assess the necessity of this regular screening within a predominantly pediatric NF1 population by examining the occurrence of ocular adverse events (OAE). A retrospective study evaluated 45 NF1 patients receiving MEKi. Inclusion criteria included baseline and follow-up examinations following the initiation of MEKi therapy. At each assessment, a comprehensive eye evaluation was performed, comprising a dilated fundus examination, ocular coherence tomography of the macula and nerve fiber layer, and Humphrey visual field testing. Twenty-six patients, with an average age of 13 years (range 2-23 years) and an average follow-up duration of 413 days were included in the analysis. Three different MEKi were used: selumetinib (77%), trametinib (23%), and mirdametinib (4%). None of the patients experienced retinopathy at any point during the study. Some patients had pre-existing optic neuropathies (27%), but no instances of nerve changes occurred after commencing MEKi therapy. Four patients (15%) exhibited symptoms of dry eye, all of which were effectively managed with topical lubrication.

Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial.

Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs. Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision-Control (NV-C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head-mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12-week follow-up. The final analysis included those completed the study (NV, n=40; NV-C, n=35). Efficacy measures included improved visual area (sensitivity ≥6dB) and changes in the HVF scores during the 12-week period. With a high compliance rate, NV and NV-C training improved the visual areas in the defective hemifield (>72 degrees2) and the whole field (>108 degrees2), which are clinically meaningful improvements despite no significant between-group differences. According to within-group analyses, mean total deviation scores in the defective hemifield improved after NV training (p=.03) but not after NV-C training (p=.12). The current trial suggests that VPL-based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between-group differences in therapeutic efficacy were not found as NV-C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects.

Development and evaluation of Order of Magnitude (OM): a virtual reality-based visual field analyzer for glaucoma detection.

This study introduces the Order of Magnitude (OM), a cost-effective, indigenous, virtual reality-based visual field analyzer designed for detecting glaucomatous visual field loss. The OM test employs a two-step supra-thresholding algorithm utilizing stimuli of 0.43°diameter (equivalent to Goldmann size III) at low and high thresholds. A comparative analysis was conducted against the Humphrey visual field (HVF) test, considered the gold standard in clinical practice. Participants, including those with glaucoma and normal individuals, underwent comprehensive eye examinations alongside the OM and HVF tests between April and October 2019. Diagnostic sensitivity and specificity of the OM test were assessed against clinical diagnoses made by specialists. We studied 157 eyes (74 glaucomatous, 83 control) of 152 participants. Results demonstrated a high level of reliability for both OM and HVF tests, with no significant difference observed (P = 0.19, Chi-square test). The sensitivity and specificity of the OM test were found to be 93% (95% CI 86-100%) and 83% (95% CI 72.4-93%), respectively, while the HVF test showed sensitivity and specificity of 98% (95% CI 93.9-100%) and 83% (95% CI 73.9-92.8%), respectively. These findings suggest that the OM test is non-inferior to the reference standard HVF test in identifying glaucomatous visual field loss.

Factors Associated With Visual Field Testing Reliability in Children With Glaucoma or Suspected Glaucoma

To evaluate Humphrey Visual Field (HVF) test reliability and its associated risk factors in children with glaucoma or glaucoma suspect. Retrospective cohort study. None. Single-center childhood glaucoma clinic. One hundred thirty-six patients aged ≤18 years with glaucoma/glaucoma suspect, and least 1 completed 24 to 2 HVF test between 2018 and 2023. Demographic and clinical characteristics including age, primary language, visual acuity (VA), and glaucoma diagnosis were extracted from electronic health records. HVF 24 to 2 testing metrics, including FP, FN, and FL. Tests were defined as reliable using manufacturer guidelines of ≤33% FP, ≤33% FN, and ≤20% FL. For each patient, a reliability score was calculated as the percentage of reliable tests among all tests completed. A multivariable logistic regression model was used to determine factors associated with test-level reliability (yes/no). A multivariable linear regression model was used to determine factors associated with patient-level reliability score. Among 634 HVFs from 136 patients (Mean ± SD age at first test 12.0 ± 3.2 years, 47.8% female), 51.3% were reliable. Older age, better baseline VA, and English as primary language were associated with greater odds of test-level reliability (P < .04). Mean ± SD patient-level reliability score was 51.7 ± 38.1%. Older age at first clinic visit, better baseline VA, and English as primary language were associated with higher reliability scores (all P < .02), and number of prior VF tests was not (P = .56). Younger age, worse visual acuity, and non-English as primary language were associated with decreased reliability and should be considered when interpreting VF testing in children. A significant learning effect was not observed with repeated testing.

Three-year efficacy and safety of omidenepag isopropyl in patients with normal tension glaucoma.

To retrospectively evaluate the 3-year efficacy and safety of single-agent omidenepag isopropyl in patients with normal tension glaucoma (NTG). Retrospective. One hundred patients (100 eyes) who had newly been administered omidenepag isopropyl were enrolled in this study. Intraocular pressure (IOP) was compared at baseline and 6, 9, 12, 18, 24, 30, and 36 months after administration. The mean deviation values at baseline and 12, 24, and 36 months measured using the Humphrey visual field test (30-2 Swedish Interactive Threshold Algorithm standard) were compared. Adverse reactions and dropouts were assessed. IOP significantly decreased from 15.5±2.7 mmHg at baseline to 13.8 ±2.3 mmHg after 6 months, 13.9± 2.3 mmHg after 12 months, 13.9±2.3 mmHg after 18 months, 13.8±2.1 mmHg after 24 months, 13.9±2.0 mmHg after 30 months, and 13.6±1.7 mmHg after 36 months (P < 0.0001). There was no significant difference in the mean deviation values at baseline (-3.66±3.49 dB), 12 months (-3.41±3.80 dB), 24 months (-3.13±3.81 dB), and 36 months (-3.06±3.30 dB). Adverse reactions occurred in 11 patients (11.0%), including conjunctival hyperemia in 6 patients. Fifty-two patients (52.0%) were excluded from the analysis because they discontinued treatment either due to IOP measurement by NCT or the use of additional drugs. After the administration of omidenepag isopropyl, IOP in patients with NTG decreased within 3 years, visual fields were maintained, and safety was satisfactory. Thus, omidenepag isopropyl can be used as the first-line treatment for patients with NTG.

Evolution of Autoimmune Retinopathy in Stiff Person Syndrome: A Case Report.

To report a case of autoimmune retinopathy (AIR) as the presenting feature of Stiff Person Syndrome (SPS) and assess its evolution. A 35-year-old man presented with progressive, chronic, vision loss. On initial examination, visual acuity measured 20/20 OD and 20/50 OS. Humphrey Visual Field testing (HVF) demonstrated decreased foveal threshold OU. Mild subfoveal ellipsoid zone loss was noted on Optical Coherence Tomography (OCT). Five years later the patient presented with painful lower extremity muscle spasms and stiffness and complained of increasing vision loss with difficulty distinguishing colors. OCT showed marked progression of ellipsoid zone loss. Scotoma were demonstrated on HVF and electroretinography demonstrated reduced responses consistent with bilateral severe maculopathy. Serum testing showed autoantibodies to the glutamic acid decarboxylase 65-kilodalton isoform (GAD65) at a high titer and a diagnosis of AIR in the setting of SPS was made. A systemic workup for malignancy was negative. The patient was treated with IVIG and transitioned to rituximab with improvement in systemic symptoms. and Importance: Unlike previous cases of AIR in the setting of SPS, vision symptoms and OCT changes presented years before the onset of muscle spasms. Etiologies such as SPS should be on the differential of unexplained retinopathy, even in the absence of systemic symptoms, especially when paraneoplastic etiologies are ruled out.

Beginners guide to perform perimetry

Background: Visual field testing is an indispensable part of assessment of glaucoma. Of paramount importance to both the practitioner and the perimetrist is the guidance on how to conduct the test to get the best results and also the interpretation of test results. Purpose: To provide procedure instructions useful for operating the Humphrey perimeter and testing the patient by monitoring the live eye monitor. Synopsis: Brief overview of how the Humphrey visual field is conducted in an easy to understand manner is presented. Highlights: This educational video is a step-by-step guide to prepare and perform Humphrey visual field test with video clips, which would be useful to the practicing ophthalmologist and optometrist, and in training programs. Video Link: https://youtu.be/YzEA8lQ9MzQ

Prediction and Detection of Glaucomatous Visual Field Progression Using Deep Learning on Macular Optical Coherence Tomography.

A deep learning model trained on macular OCT imaging studies detected clinically significant functional glaucoma progression and was also able to predict future progression. To use macular optical coherence tomography (OCT) imaging to predict the future and detect concurrent visual field progression, respectively, using deep learning. A retrospective cohort study. A pretraining data set was comprised of 7,702,201 B-scan images from 151,389 macular OCT studies. The progression detection task included 3902 macular OCT imaging studies from 1534 eyes of 828 patients with glaucoma, and the progression prediction task included 1346 macular OCT studies from 1205 eyes of 784. A novel deep learning method was developed to detect glaucoma progression and predict future progression using macular OCT, based on self-supervised pretraining of a vision transformer (ViT) model on a large, unlabeled data set of OCT images. Glaucoma progression was defined as a mean deviation (MD) rate of change of ≤ -0.5 dB/year over 5 consecutive Humphrey visual field tests, and rapid progression was defined as MD change ≤ -1 dB/year. Diagnostic performance of the ViT model for prediction of future visual field progression and detection of concurrent visual field progression using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. The model distinguished stable eyes from progressing eyes, achieving an AUC of 0.90 (95% CI, 0.88-0.91). Rapid progression was detected with an AUC of 0.92 (95% CI, 0.91-0.93). The model also demonstrated high predictive ability for forecasting future glaucoma progression, with an AUC of 0.85 (95% CI 0.83-0.87). Rapid progression was predicted with an AUC of 0.84 (95% CI 0.81-0.86). A deep learning model detected clinically significant functional glaucoma progression using macular OCT imaging studies and was also able to predict future progression. Early identification of patients undergoing glaucoma progression or at high risk for future progression may aid in clinical decision-making.

Comparison of Visual Field Fluctuation Between Myopic and Emmetropic Glaucoma Patients

Background: Conflicting epidemiologic studies suggest that myopia may both increase and decrease the risk of glaucomatous visual field loss. To provide appropriate treatment to glaucoma patients, it is important to detect meaningful changes in the visual field, which requires distinguishing between visual field fluctuation and progression. Visual field fluctuation is defined as the variability between two visual field tests performed on separate days or months on the same eye that cannot be attributed to a pathologic change. We hypothesize that glaucoma patients with myopia will demonstrate more visual field fluctuation compared to emmetropic patients.&#x0D; Methods: Four or more 24-2 or 30-2 Humphrey visual field tests over several visits will be analyzed per patient. Data including the VFI plot, mean deviation, and threshold sensitivity on the glaucoma progression analysis will be collected to measure fluctuation. The sample is divided into two groups: 1. emmetropic glaucoma patients with a spherical equivalent refraction between +2 to -2 diopters and 2. high myopic glaucoma patients with a spherical equivalent refraction over -5 diopters. Bland-Altman plots, Mann-Whitney U tests, Root Mean Square Error (RMSE), intraclass correlation coefficients, and generalized estimating equation models for ordinal data will be used to analyze the collected data.&#x0D; Results: Thus far, 2,979 charts have been reviewed with data collected from 27 emmetropes and myopes who met the inclusion criteria. The recruitment goal is 78 per group and 156 total. Preliminary results for RMSE found a statistically significant p-value for mean deviation (0.0320), and no statistically significant difference for threshold sensitivity (0.5179) and VFI (0.0904).&#x0D; Conclusion and Potential Impact: This ongoing study will help establish if glaucoma patients with high myopia demonstrate greater visual field fluctuation. It is important for clinicians to have this information so that these patients can be examined carefully to prevent misdiagnoses or delayed glaucoma treatment.

Customized Visual Discrimination Digital Therapy According to Visual Field Defects in Chronic Stroke Patients.

Visual perceptual learning (VPL) may improve visual field defects (VFDs) after chronic stroke, but the optimal training duration and location remain unknown. This prospective study aimed to determine the efficacy of 8 weeks of VFD-customized visual discrimination training in improving poststroke VFDs. Prospectively enrolled patients with poststroke VFDs initially received no training for 8 weeks (no-training phase). They subsequently underwent our customized VPL program that included orientation-discrimination tasks in individualized blind fields and central letter-discrimination tasks three times per week for 8 weeks (training phase). We analyzed the luminance detection sensitivity and deviation as measured using Humphrey visual field tests before and after the no-training and training phases. The vision-related quality of life was assessed at baseline and at a 16-week follow-up using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Changes in mean total deviation (MTD) scores were greater during the training phase than during the no-training phase (defective hemifield, p=0.002; whole field, p=0.004). The MTD scores improved during the training phase (defective hemifield, p=0.004; whole field, p=0.016), but not during the no-training phase (defective hemifield, p=0.178; whole field, p=0.178). The difference between the improved and worsened areas (≥6 dB changes in luminance detection sensitivity) was greater during the training phase than during the no-training phase (p=0.009). The vision-specific social functioning subscore of the NEI-VFQ-25 improved after the 16-week study period (p=0.040). Our 8-week VFD-customized visual discrimination training protocol may effectively improve VFDs and vision-specific social functioning in chronic stroke patients.

Morphology‐function correlation using available clinical parameters describing retinal ganglion cells in glaucoma suspects

Aims/Purpose: To determine the morphology‐function correlation using optical coherence tomography (OCT), perimetry and photopic negative responses (PhNR) measurements in glaucoma suspects.Methods: The results of 155 patients who underwent static 24–2 Humphrey visual field test (Optopol), OCT (Optopol) and PhNR (RETeval) examinations were analysed. Patients were divided into two subgroups according to the PhNR wave implicit time, at the minimum value (n = 114) or at 72 ms (n = 41). From perimetry, the mean deviation (MD) and pattern standard deviation (PSD) were analysed. From OCT, retinal nerve fibre layer (RNFL) thickness and ganglion cell complex (GCC) thickness were considered. From the PhNR test, the amplitude of the wave obtained using RETeval was analysed. For the correlation calculations, Spearman's test was used.Results: There was a significant, moderate correlation observed between PhNR at minimum value and PSD (r = 0.2145, p = 0.0006); weak correlations observed between PhNR at minimum value and MD (r = −0.1456, p = 0.0203), RNFL (r = −0.1355, p = 0.0204), GCC (r = −0.1199, p = 0.0406). In case of PhNR at 72 ms, significant moderate correlations were observed for PhNR at 72 ms and PSD (r = 0.2863, p &lt; 0.0001), (RNFL r = −0.2754, p &lt; 0.0001) and (GCC r = −0.2709, p &lt; 0.0001); weak correlation was observed for PhNR at 72 ms and MD (r = −0.1662, p = 0.0219).Conclusions: Based on our analysis, it seems that PhNR at 72 ms correlates better with Retinal Ganglion Cells morphological measures in OCT (GCC and RNFL) and PhNR at minimum value correlates selectively with visual function measured with perimetric PSD exclusively, thus PhNR at minimum value may be more accurate coefficient to be used as a substitute of perimetric parameters.

Saccadic movements during an exploratory visual search task in patients with glaucomatous visual field loss.

To evaluate the saccadic movements of patients with visual field loss due to primary open-angle glaucoma. Thirteen patients with good visual acuity (0.2 logMAR or better) (seven patients with primary open-angle glaucoma 65 ± 13 years) and six controls (51 ± 6 years) yielded a comprehensive ophthalmological examination, including Humphrey Visual Field tests (SITA-Standard 24-2), and performed a monocular, exploratory digital visual search task that quantifies the duration for finding the number "4" on a random array of digits distributed on the screen. After individual adjustments of the angle and distance positioning, the screen was spatially matched with the 24-2 visual field, and divided into five areas for analysis. During the task, saccades were simultaneously recorded in the same eye with a video-based eye tracker. The patients with primary open-angle glaucoma showed a significantly higher number of saccades/screen (median ± interquartile range, 59.00 ± 29.00 vs. 32.50 ± 19.75 saccades (p=0.027) and visual search time per screen (38.50 ± 60.14 vs. 23.75 ± 8.90 seconds (p=0.035) than the controls did. Although the univariate analysis indicated a significant correlation with visual field mean deviation (coefficient=26.19 (p=0.02), only the visual search time/screen was significantly associated with the number of saccades/screen in the multivariate regression model (coefficient=0.55 (p<0.001). Overall, no significant correlation was observed between the sectorial number of saccades and the sensitivity of the five visual field areas. The patients with primary open-angle glaucoma show impaired search performance and showed a higher number of saccades needed to find stimuli when performing the exploratory visual task.

Homonymous hemianopia due to cerebral venous thrombosis: A case report

Rationale: Diagnosing cerebral venous thrombosis (CVT) can be difficult because of nonspecific symptoms, such as headache and homonymous hemianopia (HH). Herein, we present a case of delayed CVT diagnosis due to nonspecific neurological symptoms and nonprominent lesions in a patient with HH. Patient concern: A 65-year-old woman presented with a sudden onset headache accompanied by right HH that lasted for 1 day. Brain computed tomography and magnetic resonance imaging were initially performed due to suspicion of ischemic lesions or hemorrhage in the left postchiasmal visual pathway; however, no remarkable acute brain lesions were detected. Ophthalmological examinations revealed no notable findings, except for a definite field defect in the Humphrey visual field test. The headaches then waxed and waned but recurred 3 days after the initial symptom. A repeat brain magnetic resonance imaging was performed, which revealed left sectoral gyral swelling and vascular enhancement in the occipital lobe. To further evaluate venous drainage, additional 3-dimensional cerebral computed tomography angiography and 4-vessel angiography were conducted, revealing a partial filling defect in the left transverse sinus and superior venous drainage impairment. These findings suggested the presence of venous thrombosis in the left transverse sinus. Diagnosis: The patient was diagnosed with thrombosis of the left transverse sinus, which subsequently caused the right HH. Intervention: Anticoagulation therapy with parenteral heparin was started as soon as the diagnosis of CVT was confirmed. Eventually, the patient was solely managed with oral warfarin administration. Outcomes: Following 3 days of treatment, her headache resolved, and a subsequent visual field testing conducted 2 weeks later revealed a definite improvement in the field defect. Lessons: Despite its favorable prognosis, CVT can be challenging to diagnose. CVT should be considered as a differential diagnosis when diagnosing patients who present with headaches accompanied by HH without prominent brain lesions.

Correlation between Residual Sensitivity in the Central Inferior Nasal Visual Field and Visual Function in Chronic Leber Hereditary Optic Neuropathy Patients

Introduction: Leber hereditary optic neuropathy (LHON) is a maternally inherited, acute or subacute, optic neuropathy. The typical symptoms include reduced visual acuity and central scotoma. Despite the presence of deep central scotoma, some patients with LHON are able to perform daily activities. This study aimed to investigate the correlation between the residual visual field and visual acuity, critical flicker frequency, and fixation ellipse in patients with chronic LHON. Methods: Residual visual function (defined as sensitivity points where patients sensed the size V stimulus) of both eyes was evaluated in 10 patients with LHON carrying the m.11778 mitochondrial DNA mutation and with median age of onset and disease duration of 29 and 16.5 years, respectively. The central visual field was measured as static perimetry using the Humphrey visual field testing 30-2 program with the size III or V stimulus. Moreover, best-corrected visual acuity, critical flicker frequency, and the correlation between fixation ellipse and residual central visual fields were determined. The analysis was performed through a linear mixed-effects model. Results: The residual visual sensitivity in the inferior nasal visual field was significantly correlated with the logMAR (p < 0.05). The fixation ellipse fell within the residual visual field region with higher sensitivity. Conclusions: Patients with chronic LHON tended to retain the sensitivity detectable with the size V stimulus at the central inferior nasal visual field regions, where the fixation ellipse fell. Visual acuity, which influences daily activity, was spatially correlated with residual visual sensitivity.

Performance of virtual reality game–based automated perimetry in patients with childhood glaucoma

To evaluate VisuALL, a game-based automated perimetry device, utilizing virtual reality (VR) goggles, in a cohort of patients with childhood glaucoma. In this prospective series, the results of consecutive patients with childhood glaucoma performing both VisuALL VR field (VRF) and Humphrey visual field (HVF) 24-2 testing were compared. A masked ophthalmologist graded both VRF and HVF tests for field defects (three clustered abnormal points in total or pattern deviation plot). VRF testing was performed binocularly and with the child's own spectacles. The two devices were assessed with respect to agreement of (1) global indices, such as mean deviation (MD) and pattern standard deviation (PSD), (2) point-by-point sensitivity, and (3) the ability to detect visual field defects determined by a grader. A total of 39 children (77 eyes) were enrolled, with mean age 14.1 ± 3.6 years; 3 patients (5 eyes) could not complete the HVF. Average HVF MD was -6.3 ± 6.4 dB. There was strong correlation between VRF and HVF for MD (R = 0.68, P < 0.001), PSD (R=0.78, P < 0.001), and point-by-point sensitivity (R = 0.63, P < 0.001). Bland Altman analysis showed no systematic difference between VRF and HVF in assessing MD and PSD. Of 72 eyes having results for both modalities, 63 (87.5%) had agreement between VRF and HVF with respect to the presence/absence of any field defect, and 52 (72.2%) had agreement regarding the presence/absence of fixation-threatening field loss. VRF is comparable to the gold standard HVF in both identification and quantification of visual field deficits in pediatric glaucoma patients and may offer a valuable supplement or alternative to standard automated perimetry.

The Relationship between Transcranial Doppler Ultrasonography and Visual Field Test Results in Glaucoma and Glaucoma Suspect Patients.

To evaluate the relationships between parameters of transcranial ultrasonography and results of visual field tests in patients with open angle glaucoma or suspected of having glaucoma. This retrospective study was based on data from medical records of patients who visited the Department of Ophthalmology in __________ Hospital from January 1, 2016 to October 17, 2019 and underwent transcranial Doppler ultrasonography as part of a routine health examination. Ophthalmic data were visual acuity, intraocular pressure, optical coherence tomography (OCT), and Humphrey visual field test results. Retinal nerve fiber layer defect was confirmed by a glaucoma specialist. Patients' ophthalmic data, such as average ganglion cell layer thickness, visual field index (VFI), pattern standard deviation (PSD), and mean deviation (MD), were divided into quartiles. Each ophthalmic artery parameter from transcranial Doppler ultrasonography was compared between quartiles. A total of 162 patients were reviewed. There was no difference in Doppler ophthalmic artery (OA) parameters between patients with or without retinal nerve fiber layer defect. None of the quartile groups of average ganglion cell layer thickness showed significant difference in any OA parameters. Patients in the low-VFI quartile showed significant low peak systolic velocities of OAs when adjusted for age, gender, and presence of diabetes mellitus or hypertension (p = 0.016). A higher PSD showed lower peak systolic velocity (p = 0.046). There was no significant tendency between any other OA parameter and MD value. Our study suggests that hemodynamic parameters of ophthalmic arteries might be associated with visual field status of patients. Further large-population studies are needed in order to better understand the relationship between visual function and ocular blood flow.

Effect of presbyopic correction lens on humphrey visual field testing in patients with multifocal intraocular lens.

Most previous studies on the effects of multifocal intraocular lenses (MIOL) on Humphrey visual field (HVF) used presbyopic corrective lens (PC). There has been insufficient data from patients with MIOL performing HVF with and without PC. This study aimed to determine the effect of PC on HVF testing in patients with MIOL. This was a prospective, comparative crossover study at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University between June 2015 and July 2018. Early-stage glaucomatous and non-glaucomatous pseudophakic patients with 2 models of MIOL completed HVF testing with and without PC. Mean deviation (MD), pattern standard deviation (PSD), and reliability indices (fixation losses, false positives, and false negatives) were compared. Ninety-four eyes of 59 patients were enrolled. After excluding patients with confirmed unreliable visual field, 82 eyes of 51 patients (male, 22; female, 29) with a mean age of 65.4 years were included in the study. Forty-nine eyes were non-glaucoma and 33 eyes were early-stage glaucoma. Forty-four eyes received TECNIS ZM900 and 38 eyes received Acrysof IQ ReSTOR SN6AD1. The overall MD standard deviation was -3.5 (2.1) with PC and -3.1 (2.1) without PC (P = .01). The overall PSD standard deviation was 2.8 (1.5) with PC and 2.7 (1.5) without PC (P = .93). The reliability indices were not statistically significantly different with and without PC. There was a good intraclass correlation (ICC) of MD (ICC = 0.87) and PSD (ICC = 0.88) with and without PC. Eyes with TECNIS ZM 900 had significantly better MD when performing HVF without PC (mean difference -0.7, P < .01), but not with Acrysof IQ ReSTOR SN6AD1 (mean difference -0.1, P = .74). Pseudophakic eyes with MIOL may not require PC during HVF testing regardless of the MIOL model. Although eyes with TECNIS ZM900 performed HVF without PC resulted in a significantly better MD value compared with PC, the difference was not clinically significant.