Severity Of Visual Field Loss Research Articles

Relationship Between Retinal Oxygen Saturation and the Severity of Visual Field Damage in Glaucoma.

Increased oxygen saturation (StO 2 ) was significantly associated with the severity of visual field (VF) damage in patients with glaucoma. To investigate the association between retinal StO 2 percentage and the severity of VF loss in glaucoma. A total of 198 eyes from 131 patients with glaucoma were included in this cross-sectional study. Participants underwent imaging using ocular oximetry (Zilia) and 24-2 Swedish Interactive Threshold Algorithm standard VF (Carl Zeiss-Meditec). StO 2 (%) was measured at 2 locations of the peripapillary optic nerve head (superotemporal, and inferotemporal). Measurements were reported as the mean of at least 5 measurements in each location. Associations between the severity of VF loss, reported as mean deviation, and StO 2 (%) were calculated. A total of 198 eyes of 131 patients (mean (95% CI) age, 71.1 (68.9,73.3) years, 68 females (51.9%), and 63 males (48.1%) were analyzed. In univariable analysis, higher StO 2 -0.06 (-0.12, 0.00) was associated with severity in all hemifields ( P = 0.047). Multivariate regression analysis showed that each 1% increase in StO 2 was associated with -0.06 (-0.12, -0.00) dB loss in mean deviation in all hemifields ( P = 0.043). In multivariate regression analysis in the superior hemifields, higher StO 2 -0.07 (-0.16, 0.01) tended to be associated with superior hemifield severity ( P = 0.09). Retinal oximetry enabled the continuous quantitative measurement of retinal StO 2. Increased StO 2 was significantly associated with the severity of VF damage in patients with glaucoma.

Impact of Demographics on Regional Visual Field Loss and Deterioration in Glaucoma.

To elucidate the impact of demographics, including gender, race, ethnicity, and preferred language, on regional visual field (VF) loss and progression in glaucoma. Multivariable linear mixed regressions were performed to determine the impact of race, ethnicity, and preferred language on regional VF loss with adjustment for age and gender. Regional VF loss was defined by pointwise total deviation values and VF loss patterns quantified by an unsupervised machine learning method termed archetypal analysis. All cross-sectional and longitudinal analyses were performed both without and with adjustment for VF mean deviation, which represented overall VF loss severity. P values were corrected for multiple comparisons. All results mentioned had corrected P values less than 0.05. Asian and Black patients showed worse pointwise VF loss than White patients with superior hemifield more affected. Patients with a preferred language other than English demonstrated worse pointwise VF loss than patients with English as their preferred language. Longitudinal analyses revealed Black patients showed worse VF loss/year compared to White patients. Patients with a preferred language other than English demonstrated worse VF loss/year compared to patients preferring English. Blacks and non-English speakers have more severe VF loss, with superior hemifield being more affected and faster VF worsening. This study furthered our understanding of racial, ethnic, and socioeconomic disparities in glaucoma outcomes. Understanding the VF loss burden in different racial, ethnic, and socioeconomic groups may guide more effective glaucoma screening and community outreach efforts. This research could help reduce vision loss and improve quality of life in disproportionately affected populations by guiding public health efforts to promote glaucoma awareness and access to care.

Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma

Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma

Structure-function relationship in glaucoma: Optical coherence tomography en face imaging vs. red-free fundus photography.

To analyse retinal nerve fibre layer (RNFL) defect measurements obtained from red-free fundus photography and optical coherence tomography (OCT) en face imaging, respectively, and to compare them for the strength of the structure-function association. Two hundred and fifty-six glaucomatous eyes of 256 patients with localized RNFL defect on red-free fundus photography were enrolled. A subgroup analysis included 81 highly myopic eyes (≤ -6.0 dioptres). Angular width of RNFL defect was compared between red-free fundus photography (i.e., red-free RNFL defect) and OCT en face imaging (i.e., en face RNFL defect). The correlation between angular width of each RNFL defect and functional outcomes, reported as mean deviation (MD) and pattern standard deviation (PSD), were assessed and compared. The angular width of en face RNFL defect was measured smaller than that of red-free RNFL defect in 91.0% eyes (mean difference, 19.98°). The association of en face RNFL defect with MD and PSD was stronger (R2 = 0.311 and R2 = 0.372, respectively) than that of red-free RNFL defect with MD and PSD (R2 = 0.162 and R2 = 0.137, respectively) (P < 0.05 for all). Especially in highly myopic eyes, the association of en face RNFL defect with MD and PSD was much stronger (R2 = 0.503 and R2 = 0.555, respectively) than that of red-free RNFL defect with MD and PSD (R2 = 0.216 and R2 = 0.166, respectively) (P < 0.05 for all). En face RNFL defect showed a higher correlation with severity of visual field loss than did red-free RNFL defect. The same dynamic was observed for highly myopic eyes.

The Impact of Neighborhood Factors on Physical Activity in Older Adults With Visual Impairment

To investigate the associations of neighborhood-level socioeconomic and environmental characteristics with physical activity in persons with glaucoma. Cross-sectional study (N=230). Home addresses were used to extract neighborhood factors (NFs): Area Deprivation Index, crime rate, and the proportion of racial and ethnic minorities, poverty, college graduates, and park area in their census tract. Participants' average number of daily steps and nonsedentary minutes were collected over 7 days using an accelerometer. Visual field (VF) loss was quantified as integrated VF sensitivity. Multivariable negative binomial regression models and additional models with an interaction term evaluated the effect of NF on physical activity and whether these relationships differed by VF loss severity. Participants were on average 70.6 years of age, 51.7% were male, and 27.8% were black. A higher Area Deprivation Index or poverty share was associated with fewer NSM (incidence rate ratio [IRR]=0.96 per 1 Area Deprivation Index decile increment, P=.01; IRR=0.92 per 10% poverty share increment, P=.02), while higher share of college graduates was associated with greater NSM (IRR=1.03 per 10% increment; P=.03). Stronger associations were noted between both high crime rate and poverty share with NSM in individuals with severe VF damage as opposed to no/mild VF damage (IRR=0.44, P=.001; IRR=0.81, P=.02). Select NFs (poverty share and crime rate) may disproportionately affect physical activity in patients with severe VF loss. Interventions to overcome activity limitations within the context of poverty and high socioeconomic disadvantage are important for addressing glaucoma-related disability, particularly in those with severe VF loss.

Genetic variants associated with glaucomatous visual field loss in primary open-angle glaucoma

Primary open-angle glaucoma (POAG) is characterized by a progressive optic neuropathy with visual field loss. To investigate the genetic variants associated with visual field loss in POAG, Japanese POAG patients (n = 426) and control subjects (n = 246) were genotyped for 22 genetic variants predisposing to POAG that can be classified into those associated with intraocular pressure (IOP) elevation (IOP-related genetic variants) and optic nerve vulnerability independent of IOP (optic nerve-related genetic variants). The genetic risk score (GRS) of the 17 IOP-related and five optic nerve-related genetic variants was calculated, and the associations between the GRS and the mean deviation (MD) of automated static perimetry as an indicator of the severity of visual field loss and pattern standard deviation (PSD) as an indicator of the focal disturbance were evaluated. There was a significant association (Beta = − 0.51, P = 0.0012) between the IOP-related GRS and MD. The severity of visual field loss may depend on the magnitude of IOP elevation induced by additive effects of IOP-related genetic variants. A significant association (n = 135, Beta = 0.65, P = 0.0097) was found between the optic nerve-related, but not IOP-related, GRS and PSD. The optic nerve-related (optic nerve vulnerability) and IOP-related (IOP elevation) genetic variants may play an important role in the focal and diffuse visual field loss respectively. To our knowledge, this is the first report to show an association between additive effects of genetic variants predisposing to POAG and glaucomatous visual field loss, including severity and focal/diffuse disturbance of visual field loss, in POAG.

Detection of post-stroke visual field loss by quantification of the retrogeniculate visual pathway

Visual field loss is associated with poor post-stroke functional outcomes. However, early detection of visual field loss is often challenging in patients with disabling stroke. This study explored the association between the microstructural integrity of the retrogeniculate pathway and visual field loss in disabling stroke patients undergoing inpatient rehabilitation. Thirty patients with stroke lesions involving the retrogeniculate visual pathway were included. The degree of visual field loss was determined by the visual field index and mean deviation using automated perimetry. The fractional anisotropy (FA) values were obtained for the lateral geniculate nucleus and optic radiation; the FA laterality indices, representing the degree of degeneration, were calculated. The FA values were compared between the affected and unaffected hemispheres. The patients were categorized into complete and incomplete hemianopia groups, and their FA values were compared. The relationship between the FA laterality index and the degree of visual field loss was assessed. FA values of the lateral geniculate nucleus and optic radiation were lower on the affected side than on the unaffected side (P < 0.001 and P < 0.001, respectively). The affected optic radiation in the complete hemianopia group showed a lower FA value than in the incomplete group (P = 0.006). The FA laterality index of the optic radiation was positively correlated with the degree of visual field loss (visual field index, ρ = 0.629; mean deviation, ρ = 0.568). The quantification of the retrogeniculate visual pathway may aid in detecting post-stroke visual field loss. The microstructural integrity of the optic radiation is associated with the severity of visual field loss.

Vascular biomarkers from optical coherence tomography angiography and glaucoma: where do we stand in 2021?

Biomarkers of ocular blood flow originating from a wide variety of imaging modalities have been associated with glaucoma onset and progression for many decades. Advancements in imaging platforms including optical coherence tomography angiography (OCTA) have provided the ability to quantify vascular changes in glaucoma patients, alongside traditional measures such as retinal nerve fibre layer thickness and optic nerve head structure. Current literature on vascular biomarkers, as measured by OCTA, indicates significant relationships between glaucoma and blood flow and capillary density in the retina and ONH. The data currently available, however, are highly diverse and lack robust longitudinal data on OCTA vascular outcomes and glaucoma progression. Herein we discuss and summarize the relevant current literature on OCTA vascular biomarkers and glaucoma reviewed through March 1, 2021. Associations between OCTA vascular biomarkers and clinical structural and functional glaucoma outcomes as well as differences between glaucoma patients and healthy controls are reviewed and summarized. The available data identify significantly decreased flow density, flow index and vessel density in the ONH, peripapillary vascular layer and macula of glaucoma patients compared with controls. Whole image vessel density is also significantly decreased in glaucoma patients compared with controls, and this outcome has been found to correspond to severity of visual field loss. OCTA vascular biomarkers alongside clinical structural outcomes may aid in assessing overall risk for glaucoma in patients.

The Effect of Ametropia on Glaucomatous Visual Field Loss.

Myopia has been discussed as a risk factor for glaucoma. In this study, we characterized the relationship between ametropia and patterns of visual field (VF) loss in glaucoma. Reliable automated VFs (SITA Standard 24-2) of 120,019 eyes from 70,495 patients were selected from five academic institutions. The pattern deviation (PD) at each VF location was modeled by linear regression with ametropia (defined as spherical equivalent (SE) starting from extreme high myopia), mean deviation (MD), and their interaction (SE × MD) as regressors. Myopia was associated with decreased PD at the paracentral and temporal VF locations, whereas hyperopia was associated with decreased PD at the Bjerrum and nasal step locations. The severity of VF loss modulated the effect of ametropia: with decreasing MD and SE, paracentral/nasal step regions became more depressed and Bjerrum/temporal regions less depressed. Increasing degree of myopia was positively correlated with VF depression at four central points, and the correlation became stronger with increasing VF loss severity. With worsening VF loss, myopes have increased VF depressions at the paracentral and nasal step regions, while hyperopes have increased depressions at the Bjerrum and temporal locations. Clinicians should be aware of these effects of ametropia when interpreting VF loss.

The performance of iPad-based noise-field perimeter versus Humphrey Field Analyser in detecting glaucomatous visual field loss.

BackgroundTo conduct a preliminary evaluation of the feasibility of visual field fast (VFF), a free iPad-based noise-field perimeter, in detecting glaucomatous scotomas versus the clinical-standard Humphrey visual field (HVF) test. VFF confronts subjects with a screen of flickering stimulus, allowing the immediate perception of scotomas.MethodsThis was a cross-sectional observational study of 66 glaucoma patients (66 eyes) and 30 healthy controls (30 eyes). All patients had no other visual field disorders. VFF was compared against HVF in terms of whole field and quadrants for the following: (1) correspondence in scotoma detection. (2) Agreement and correlation of the scotoma size (percentage of abnormal visual field area). (3) Test duration. Other domains tested included: (1) correlation of VFF scotoma area with the severity of visual field loss on HVF (mean deviation, MD; visual field index, VFI). (2) Repeatability of VFF. (3) Patient descriptors of scotomas.ResultsUsing HVF pattern deviation plot as a reference, VFF detected 52/57 (91.2%) of glaucoma subjects with 1 false-positive (control) (kappa = 0.86). 146/184 (79.3%) of abnormal quadrants (visual field defect present) were localized and 23/157 (14.6%) healthy quadrants were falsely identified as abnormal (kappa = 0.61). VFF underestimated scotoma area as compared to HVF (21.0% versus 44.0%, p < 0.01) but correlated positively (r = 0.268, p = 0.044) with HVF area and negatively with VFI (r = −0.340, p = 0.01) and MD (r = −0.398, p < 0.01). Using HVF total deviation plot as reference, VFF’s glaucoma detection rate remained unchanged (kappa = 0.86) with similar quadrant detection (kappa = 0.68). However, a greater underestimation of scotoma area was observed (21.0% versus 85.4%, p < 0.01). VFF’s quantitative repeatability was excellent for whole field (intraclass correlation coefficient, ICC: 0.96; p < 0.0001) and quadrants (ICC: 0.82–0.96; all p < 0.001). Qualitatively, 35/37 (94.6%) of subjects reported reduced luminance and flicker in scotomas, with similar morphologies on retests. VFF is faster than HVF SITA-Standard in glaucoma (3.60 ± 1.85 min versus 6.92 ± 1.12 min, p < 0.01) and control (1.12 ± 0.486 min versus 5.16 ± 0.727 min, p < 0.01).ConclusionThis early model of VFF accurately detected scotomas with high repeatability. However, its accuracy in localizing and quantifying the scotoma can be improved. Considering its portability and cost-effectiveness, VFF demonstrated potential as a general screening tool for moderate-to-severe glaucoma.

Macular vessel density, branching complexity and foveal avascular zone size in normal tension glaucoma

The aim of this study was to investigate the relationship between glaucoma severity and perifoveal vessel density (pfVD), branching complexity, and foveal avascular zone (FAZ) size in normal tension glaucoma (NTG). 31 patients with NTG washed out of glaucoma medications were subjected to tests including; intraocular pressure measurement; standard automated perimetry; optical coherence tomography (OCT) measurement of macular ganglion cell complex (mGCC), inner macular thickness (IMT) and circumpapillary retinal nerve fibre layer (cpRNFL); and OCT angiography measurement of pfVD, FAZ perimeter and multispectral fractal dimensions (MSFD). Eyes with more severe glaucoma had significantly thinner mGCC and cpRNFL and lower pfVD. MD decreased by 0.4 dB (95% CI 0.1 to 0.6 dB, P = 0.007) for every 1% decrease in pfVD. Lower MSFD was observed in eyes with lower pfVD and in patients with systemic hypertension. Multivariable analysis, accounting for age and OCTA quality, found lower pfVD remained significantly associated with thinner IMT, thinner mGCC and worse MD but not with MSFD. pfVD was reduced in NTG and was diminished in eyes with worse MD. Macular vessel branching complexity was not related to severity of visual field loss but was lower in patients with systemic hypertension.

Glaucomatous visual fields and neurocognitive function are independently associated with poor lane maintenance during driving simulation

BackgroundDriving simulators are a safe alternative to on-road vehicles for studying driving behavior in glaucoma drivers. Visual field (VF) loss severity is associated with higher driving simulator crash risk, though mechanisms explaining this relationship remain unknown. Furthermore, associations between driving behavior and neurocognitive performance in glaucoma are unexplored. Here, we evaluated the hypothesis that VF loss severity and neurocognitive performance interact to influence simulated vehicle control in glaucoma drivers.MethodsGlaucoma patients (n = 25) and suspects (n = 18) were recruited into the study. All had > 20/40 corrected visual acuity in each eye and were experienced field takers with at least three stable (reliability > 20%) fields over the last 2 years. Diagnosis of neurological disorder or cognitive impairment were exclusion criteria. Binocular VFs were derived from monocular Humphrey VFs to estimate a binocular VF index (OU-VFI). Montreal Cognitive Assessment (MoCA) was administered to assess global and sub-domain neurocognitive performance. National Eye Institute Visual Function Questionnaire (NEI-VFQ) was administered to assess peripheral vision and driving difficulties sub-scores. Driving performance was evaluated using a driving simulator with a 290° panoramic field of view constructed around a full-sized automotive cab. Vehicle control metrics, such as lateral acceleration variability and steering wheel variability, were calculated from vehicle sensor data while patients drove on a straight two-lane rural road. Linear mixed models were constructed to evaluate associations between driving performance and clinical characteristics.ResultsPatients were 9.5 years older than suspects (p = 0.015). OU-VFI in the glaucoma group ranged from 24 to 98% (85.6 ± 18.3; M ± SD). OU-VFI (p = .0066) was associated with MoCA total (p = .0066) and visuo-spatial and executive function sub-domain scores (p = .012). During driving simulation, patients showed greater steering wheel variability (p = 0.0001) and lateral acceleration variability (p < .0001) relative to suspects. Greater steering wheel variability was independently associated with OU-VFI (p = .0069), MoCA total scores (p = 0.028), and VFQ driving sub-scores (p = 0.0087), but not age (p = 0.61).ConclusionsPoor vehicle control was independently associated with greater VF loss and worse neurocognitive performance, suggesting both factors contribute to information processing models of driving performance in glaucoma. Future research must demonstrate the external validity of current findings to on-road performance in glaucoma.

Afro‐Caribbean patients have a lower disc vascular density than European patients: a cross‐sectional study

AbstractPurposeTo determine if there are racial differences in disc vascular density between Afro‐Caribbean and European patients, and the relationship with disease severity in glaucoma.DesignCross‐sectional study.Participants50 eyes from 32 Afro‐Caribbean glaucoma patients, 35 eyes from 22 European glaucoma patients, 23 eyes from 14 Afro‐Caribbean normal controls, 24 eyes from 12 European normal controls.MethodsAll patients underwent a complete ophthalmic examination. Disc vascular density was measured using OCT angiography. We compared the disc vascular density of Optic head nerve and peripapillary between Afro‐Caribbean and European patients in normal controls and glaucoma patients. We evaluate superficial vascular complex and matched the severity of glaucoma between the two groups using mean deviation from Humphrey visual field 24‐2 test. We also performed Spearman correlation between the disc vascular density and mean deviation, visual acuity, intraocular pressures, central corneal thickness and cup‐disc ratio.Main Outcome MeasuresDisc vascular density.ResultsAfro‐Caribbean normal controls had a lower mean disc vascular density (42.4 ± 0.8 [SEM]) than European normal controls (46.2 ± 0.2; p &lt; 0.0001). We matched the severity of visual field loss in 32 eyes from Afro‐Caribbean glaucoma patients (MD = 5.97 ± 0.75) and 32 eyes from European glaucoma patients (MD = 4.17 ± 0.73; p = 0.090). Afro‐Caribbean glaucoma patients also had a lower mean disc vascular density (33.26 ± 6.60 [SEM]) than European glaucoma patients (36.68 ± 5.28; p = 0.022). There was a moderate correlation between disc vascular density and mean deviation (r = −0.70, p &lt; 0.0001) in the Afro‐Caribbean glaucoma patients. We found no correlation between disc vascular density and mean deviation (r = −0.31, p = 0.070) in the European glaucoma patients.ConclusionsAfro‐Caribbean patients have lower disc vascular density than European patients in normal controls but not subgroup mild, moderate or advanced glaucoma.

Scleral pits represent degeneration around the posterior ciliary arteries and are signs of disease severity in choroideremia.

Choroideremia is an X-linked recessive condition characterized by progressive chorioretinal degeneration. Recently, peculiar scleral ectasias, termed scleral "pits" and "tunnels," have been described as a novel finding in patients with choroideremia, but little is known regarding their etiology or their evolution over time. This is a retrospective chart review of consecutive patients with molecularly-confirmed choroideremia and related female carriers seen at a university-based tertiary referral center from January 2010 to July 2016. Multimodal imaging was evaluated for the evolution of scleral pits on fundus photography and scleral tunnels on optical coherence tomography (OCT). The presence of scleral pits and tunnels was correlated with markers of disease severity including age, visual acuity, and severity of visual field loss. Thirty patients (21 affected males, 9 female carriers) were included in the study. Scleral pits were seen in 38.1% (8/21) of affected males and found to occur at insertion sites of the posterior ciliary arteries. Those with scleral pits were older, had poorer visual acuity, and more severe visual field loss than those without (p ≤ 0.05). Scleral tunnels were common (68.4%, 13/19 affected males with available OCT imaging), but no statistically-significant associations with disease severity were seen. The development of new scleral pits and tunnels was observed on longitudinal imaging in 4 and 2 affected males, respectively. No scleral pits or tunnels were visualized in any female carriers. Scleral pits represent degeneration around the posterior ciliary arteries and may be useful as clinical markers of disease severity in choroideremia.

Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

ABSTRACTPurpose: To compare severity of visual field (VF) loss at first presentation in glaucoma clinics in England and Tanzania.Methods: Large archives of VF records from automated perimetry were used to retrospectively examine vision loss at first presentation in glaucoma clinics in Tanzania (N = 1,502) and England (N = 9,264). Mean deviation (MD) of the worse eye at the first hospital visit was used as an estimate of detectable VF loss severity.Results: In Tanzania, 44.7% {CI95%: 42.2, 47.2} of patients presented with severe VF loss (< −20 dB), versus 4.6% {4.1, 5.0} in England. If we consider late presentation to also include cases of advanced loss (-12.01 dB to -20 dB), then the proportion of patients presenting late was 58.1% {55.6, 60.6} and 14.0% {13.3, 14.7}, respectively. The proportion of late presentations was greater in Tanzania at all ages, but the difference was particularly pronounced among working-age adults, with 50.3% {46.9, 53.7} of 18–65-year-olds presenting with advanced or severe VF loss, versus 10.2% {9.3, 11.3} in England. In both countries, men were more likely to present late than women.Conclusions: Late presentation of glaucoma is a problem in England, and an even greater challenge in Tanzania. Possible solutions are discussed, including increased community eye-care, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids.

Rapid Central Visual Field Progression Rate in Eyes with Open-Angle Glaucoma and Choroidal Microvasculature Dropout

Central visual field (CVF) loss has been linked to poorer vision-related quality of life in eyes with open-angle glaucoma (OAG) and can occur even in early-stage OAG eyes. The present study investigated whether the detection of choroidal microvasculature dropout (CMvD) during follow-up, which may be a sign of perfusion deficiency in the optic nerve head, is associated with rapid rate of CVF loss in early-stage OAG eyes. This study included 44 Korean OAG eyes with CMvD, identified by optical coherence tomography angiography, and 44 Korean OAG eyes without CMvD matched for age and severity of visual field loss at initial presentation. The rates of mean threshold changes in global and CVF were compared in eyes with and without CMvD using a linear mixed model. Clinical variables associated with rapid rate of CVF progression were also identified using a linear mixed model. The CVF progression rate was significantly higher in eyes with CMvD than in those without CMvD (−0.584 dB/year vs. −0.190 dB/year; P < 0.001) and detection of CMvD during follow-up was an independent predictor of rapid CVF progression rate. The presence of CMvD may aid in identification of high-risk patients who may show faster CVF progression and require more aggressive treatment.

Head and Gaze Behavior in Retinitis Pigmentosa.

Peripheral visual field loss (PVFL) due to retinitis pigmentosa (RP) decreases saccades to areas of visual defect, leading to a habitually confined range of eye movement. We investigated the relative contributions of head and eye movement in RP patients and normal-sighted controls to determine whether this reduced eye movement is offset by increased head movement. Eye-head coordination was examined in 18 early-moderate RP patients, 4 late-stage RP patients, and 19 normal-sighted controls. Three metrics were extracted: the extent of eye, head, and total gaze (eye+head) movement while viewing a naturalistic scene; head gain, the ratio of head movement to total gaze movement during smooth pursuit; and the customary oculomotor range (COMR), the orbital range within which the eye is preferentially maintained during a pro-saccade task. The late-stage RP group had minimal gaze movement and could not discern the naturalistic scene. Variance in head position in early-moderate RP was significantly greater than in controls, whereas variance in total gaze was similar. Head gain was greater in early-moderate RP than in controls, whereas COMR was smaller. Across groups, visual field extent was negatively correlated with head gain and positively correlated with COMR. Accounting for age effects, these results demonstrate increased head movement at the expense of eye movement in participants with PVFL. RP is associated with an increased propensity for head movement during gaze shifts, and the magnitude of this effect is dependent on the severity of visual field loss.

Illness perceptions in people newly diagnosed with glaucoma and ocular hypertension

Background/aimsTo determine whether self-reported illness perceptions in newly diagnosed patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) are more negative compared with peers who have lived with their...

Locations, Circumstances, and Outcomes of Falls in Patients With Glaucoma

To characterize the locations, circumstances, and outcomes of falls in patients with varying degrees of glaucoma. Prospective cohort study. Patients with suspected or diagnosed glaucoma completed monthly calendars reporting falls. After each fall, a 30-item questionnaire was administered to determine fall location, circumstances, and injury. Mean deviation on visual field (VF) testing was used to categorize glaucoma severity. Main outcome measures were fall locations, circumstances, and outcomes. One-hundred forty-two patients experienced 330 falls. Falls were most likely to occur in/around the home (71%), and this likelihood did not vary significantly with severity of VF damage (P > .2). The most commonly cited fall circumstances were tripping (43.6%), slipping (31.3%), uneven flooring (23.5%), and poor vision (15.9%). The circumstances related to falls did not vary by severity of VF damage (P > .2), except for poor vision, which was more frequently cited in individuals with more advanced VF damage (P= .001). Forty-three percent of falls resulted in some injury; and the likelihood of injury did not vary by severity of VF loss (P= .60) or any other factor except floor type and number of comorbidities (P<.05 for all). Falls in persons with more severe glaucoma were more likely to result in a fracture (9.4%) or an emergency room visit (18.8%), though these associations did not persist in multivariable models (P > .5 for all). Glaucoma patients fall mostly in/around the home and demonstrate similar fall circumstances across the spectrum of disease severity, suggesting that current fall prevention interventions, particularly those emphasizing home modification, may be an adequate starting point to prevent falls in this high-risk-group.

Choroidal Microvasculature Dropout Is Associated With Parafoveal Visual Field Defects in Glaucoma

To determine whether the frequency of parafoveal visual field (VF) damage differs according to the presence of choroidal microvasculature dropout (CMvD) in open-angle glaucoma (OAG) and to assess correlations between the angular circumference of CMvD and the severity of VF defects. Retrospective case-control study. This study enrolled 88 eyes of 88 consecutive OAG patients (44 with CMvD and 44 without CMvD matched for age [≤5 years], axial length [≤1mm], and the severity of VF loss [≤1 dB]). Angular circumference of CMvD was determined from choroidal layer images obtained from optical coherence tomography angiography. Demographic and ocular characteristics, including the presence of parafoveal VF defects and VF mean sensitivity (MS), were compared between OAG eyes with CMvD and those without. Logistic regression analyses were performed to derive the clinical factors associated with parafoveal VF defects. The relationships between CMvD angular circumference and global/regional VF defect severity were assessed. Parafoveal VF defects were observed in 96% (42/44) of eyes with CMvD but only in 39% (17/44) of eyes without CMvD. OAG eyes with CMvD showed significantly lower superior parafoveal VF MS compared to those without. A significant association was found between parafoveal VF defects and CMvD in OAG eyes, and CMvD angular circumference was significantly correlated with the severity of VF defects. The involvement of parafoveal VF defects was significantly associated with the presence of CMvD. Among eyes with CMvD, CMvD angular circumference had significant correlations with the severity of VF defects.