Perimetry Research Articles

Clinically functioning gonadotropin-secreting pituitary adenoma.

Gonadotroph adenomas are the most common type of nonfunctional pituitary adenomas. However, functioning gonadotroph adenomas causing clinical manifestations are rare. We present the case of a 42-year-old man with an incidental finding of a pituitary gland mass. A pituitary MRI revealed a 3 cm macroadenoma, and laboratory investigations revealed elevated follicle-stimulating hormone (FSH) and total testosterone levels. A diagnosis of functioning FSH-secreting pituitary adenoma was considered, with possible concomitant luteinizing hormone secretion, given the elevated testosterone, prompting further evaluation. Testicular ultrasound showed bilaterally enlarged testicles, and visual field testing revealed a monocular superior temporal defect. Transsphenoidal resection of pituitary adenoma was the treatment of choice. Histopathology assessment confirmed the diagnosis of gonadotroph-secreting adenoma, with positive staining for FSH. Within the 12-week postoperative period, FSH and testosterone levels normalized, and the patient experienced significant improvement in vision, along with the resolution of macroorchidism. While functional gonadotroph adenomas are rare, patients can present with a wide range of symptoms that are often unnoticeable due to their slow development. Careful evaluation can help guide multidisciplinary management to achieve full remission. Endocrine evaluation is indicated in all cases of pituitary incidentalomas to determine functional status. Clinically functioning gonadotroph adenomas, while rare, pose a diagnostic challenge and require careful clinical evaluation. Transsphenoidal surgery is the mainstay of treatment of functioning gonadotroph adenomas, with the involvement of a multidisciplinary team to achieve desirable outcomes.

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 < 0.0001), (RNFL r = −0.2754, p < 0.0001) and (GCC r = −0.2709, p < 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.

Management of glaucoma in patients with ocular surface disease

Glaucoma and ocular surface disease (OSD) are common diseases in the elderly population. As the prevalence of both conditions increases with age, they often occur together and can present in a spectrum of disease ranging from mild to severe.The management of glaucoma in patients with OSD is challenging, especially when the treatment of glaucoma, for which topical medications are usually the first choice, can further compromise the ocular surface and exacerbate the signs and symptoms of dry eye disease. In patients with glaucoma and co‐existing ocular surface disease, both need to be treated, depending on the severity of each disease and the likelihood of loss of visual function. Frequent visual field testing is required to monitor and assess the progression of glaucoma. In patients with OSD, the visual field is often unreliable and makes it difficult to diagnose and detect the progression of glaucoma.In early to moderate open‐angle glaucoma or ocular hypertension, selective laser trabeculoplasty is a good option for initial treatment as it delays the need for topical treatment. In advanced disease, the lowest number of preservative‐free eye drops should be prescribed, or glaucoma surgery should be performed.

Performance of VisuALL virtual reality visual field testing in healthy children

BackgroundVirtual reality field testing may provide an alternative to standard automated perimetry. This study evaluates a virtual reality game-based automated perimetry in a healthy pediatric population. MethodsA prospective series of pediatric patients at one institution who performed VisuALL perimetry (Olleyes Inc, Summit, NJ) using a game-based algorithm. Participants were examined by an experienced pediatric optometrist or ophthalmologist, who confirmed that there was no evidence of ocular disease expected to affect visual fields. Testing was performed binocularly, with the child wearing their spectacle correction in place. Age, refractive error, test duration, false positives, and stereoacuity were evaluated for associations with performance on VisuALL, as defined by mean deviation (MD) and pattern standard deviation (PSD). ResultsA total of 191 eyes of 97 patients (54% female) were included, with a mean age of 11.9 ± 3.1 years. Detailed patient demographics and characteristics can be found in Table 1. The average MD was −1.82 ± 3.5 dB, with a mean foveal sensitivity of 32.0 ± 4.7 dB. Fifty-nine eyes (30.9%) had MD < −2 dB. Better performance, as assessed by MD and PSD, was associated with shorter test duration (P < 0.001) and older age (P < 0.001). False positives (P = 0.442), wearing spectacles (P = 0.092), Titmus stereoacuity (P = 0.197), and refractive error (P = 0.120) did not appear to be associated with improved performance, adjusting for age as a covariate. ConclusionsVisuALL virtual reality field testing was well tolerated in this pediatric study cohort. Older age and shorter test duration were associated with better performance on field testing.

Optical Coherence Tomography Angiography Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

Abstract Purpose: To evaluate and compare optical coherence tomography angiography (OCTA) retinal vasculature measurements in healthy, glaucoma suspect (GS), and glaucoma patients. Methods: One hundred fourteen eyes with good quality OCTA pictures were included from 38 healthy, 38 GS, 38 and primary open-angle glaucoma (POAG) participants. The information on retinal vasculature was summarized as a vessel density map and as vessel density (%), which is the fraction of the flowing vessel area over the total area examined. The superior, inferior, nasal, and temporal quadrants, as well as whole vessel density (wVD) and peripapillary vessel density (ppVD) data taken from the retinal nerve fiber layer, were studied. Global indices of the visual field were correlated with vessel density measurement. Results: Mean vessel density was significantly lower in POAG eyes compared with GSs and healthy eyes (wVD) 45.34% ± 6.64%, 50.06% ± 1.97% and 53.06% ± 2.12%, respectively (P &lt; 0.001), and ppVD 47.42% ± 7.73%, 47.42% ± 7.73% and 56.074% ± 2.71%, respectively (P &lt; 0.001). A linear relationship between vessel density (wVD and ppVD) and global indices of the visual field (mean deviation [MD] and pattern standard deviation [PSD]) shows a significant (P &lt; 0.001) relation. R 2 is 0.35, 0.36, 0.36, and 0.33 for MD and wVD, PSD and wVD, PSD and ppVD, and MD and ppVD, respectively. Conclusions: For distinguishing between healthy and glaucoma eyes, OCTA vessel density demonstrated near similar diagnostic accuracy to visual field tests. These findings imply that OCTA measurements reflect damage to tissues important in the pathogenesis of POAG.

Rapid campimetry - a novel robust kinetic approach for visual field screening in glaucoma.

To investigate the robustness and variability of a novel kinetic visual field (VF) screening method termed rapid campimetry (RC). In RC visual field (VF) screening is enabled via kinetic-based testing on any computer (10°/4.7 s at 40-cm viewing distance) and high contrast in a dark room (1 cd/cm2). In experiment (1): 30 participants [20 healthy participants (HC), 5 glaucoma patients (GLA) and 5 patients with cataract (CAT)] were included to test the intra-session variability (fatigue effect) and the following effects on RC: room illumination (140 cd/m2), ±3 D refractive errors, media opacity. In experiment (2): Inter-session variability (1-3 weeks apart) was assessed in 10 HC and 10 GLA. Since RC detects absolute scotomas, the outcome measure was the size of physiological (blindspot) and pathological (glaucoma) scotomas in degrees. A repeated measures ANOVA was employed in experiment 1 and intraclass correlation (ICC) in experiment 2. Neither the size of the blindspot nor the VF defects differed significantly between the different testing conditions. For intra-session variability, the average bias of blindspot size was -0.6 ± 2.5°, limits of agreement (LOA), in comparison to 0.3 ± 1.5° for VF defects, both with ICC of 0.86 and 0.93, respectively. For the inter-session repeatability, the average bias and LOA for blindspot size was 0.2 ± 3.85° in comparison 1.6 ± 3.1° for VF defects, both with ICC of 0.87 and 0.91, respectively. RC was robust to suboptimal testing VF conditions and showed good-to-excellent reliability between VF testing visits holding high potential for teleophthalmology.

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 Visual Acuity and Foveal Threshold by Automated Perimetry With Size V Stimulus.

Visual acuity has been shown to correlate with foveal threshold as determined by automated perimetry. Although automated perimetry with size V stimulus is commonly used in neuro-ophthalmology practice, the relationship between the visual acuity and the foveal threshold with this larger stimulus is not well known. Retrospective study of patients who had undergone neuro-ophthalmology evaluation and visual field testing with automated perimetry using size V stimulus. Healthy controls were also recruited. Using visual acuity and foveal threshold, Pearson correlation coefficients were calculated, and basic foveal threshold statistics were stratified by visual acuity. Prediction intervals for visual acuities by various foveal threshold were also calculated. A total of 106 unique eyes were included. The final Pearson correlation coefficient between visual acuities was -0.795 for the right eye and -0.578 for the left eye, with a pooled correlation coefficient of -0.751 (P < 0.001). A foveal threshold of at least 34 dB was present in 94.4% of eyes with 20/20 visual acuity, and a foveal threshold of greater than 35 dB was not observed in eyes with visual acuity of 20/40 or worse. Foveal threshold as determined by automated perimetry using size V stimulus has moderate-to-strong correlation with visual acuity in patients undergoing neuro-ophthalmology evaluation.

Peripapillary and macular vascular densities in healthy, ocular hypertensive, and different stages of glaucomatous eyes.

To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography (OCTA) in the early diagnosis of glaucoma. Glaucoma patients and healthy controls (n=29 eyes) were investigated in this cross-sectional comparative study. Glaucoma patients were grouped as ocular hypertension (n=44 eyes), preperimetric glaucoma (PPG; n=32 eyes), early glaucoma (EG; n=35 eyes), moderate stage glaucoma (MG; n=36 eyes), and advanced glaucoma (AG; n=35 eyes). Peripapillary and macular vascular densities (VDs) of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness (RNFLT), ganglion cell analysis (GCA), and visual field (VF) tests were evaluated. Area under the receiver operation characteristic curves (AUC) of the peripapillary and macular VD parameters were obtained. VD values decreased with the progression of glaucoma. Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls (P<0.001). There was no significant difference in RNFLT between the PPG and EG groups, but most peripapillary and macular VDs were found to be lower in EG group than in PPG group (P<0.05). In most disease group, VDs were significantly correlated with OCT parameters (P<0.001) and VF index (P<0.05). There were no significant correlations between VF and RNFLT indices in the AG group, but significant correlations were found between VF and VD values (P<0.05). AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD (AUC: 0.865, 0.929, and 0.986, respectively in EG, MG, and AG groups). OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease. In cases where limitations or suspicions in structural and functional tests are present, OCTA can be used as a supportive diagnostic test, both in EG and AG.

Effect of ERM on RNFL, GCIPL and Macular Thickness According to the Severity of Glaucoma

Purpose: To investigate the effect of an epiretinal membrane (ERM) on peripapillary retinal nerve fiber layer thickness (pRNFLT), macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and macular thickness (MT) in relation to glaucoma severity using swept-source optical coherence tomography (SS-OCT).Methods: In total, 105 eyes of 105 glaucoma patients with ERM were matched at a 1:1 ratio with glaucoma patients without ERM according to age, sex, cataract surgery, axial length and mean deviation based on visual field tests. The differences in pRNFLT, mGCIPLT and MT between the two groups were assessed using SS-OCT. Furthermore, the patients were divided into three glaucoma-severity groups, and the differences in pRNFLT, mGCIPLT and MT were compared between glaucoma patients with and without ERM in each group.Results: In all patients, including those with early, moderate, and advanced glaucoma, those with ERM had greater average, temporal quadrant, and 7, 8, 9, 10, and 11 o’clock pRNFLT values compared to those without ERM. Additionally, mGCIPLT and MT were thicker in glaucoma patients with ERM in all groups. The difference in pRNFLT at the 7 and 11 o’clock positions between glaucoma patients with and without ERM was significantly more pronounced in the moderate glaucoma group than in the early glaucoma group (&lt;i&gt;p&lt;/i&gt; = 0.043 and &lt;i&gt;p&lt;/i&gt; = 0.012, respectively).Conclusions: ERM has notable effects on the pRNFLT, mGCIPLT and MT. Furthermore, the magnitude of its effect on pRNFLT varies with glaucoma severity.

Head Turn During Visual Field Testing to Minimize the Influence of Prominent Facial Anatomy.

Facial contour naturally decreases the visual field. Peripheral visual field defects caused by facial anatomy and ocular pathology can be missed in a routine standard of care. Mathematically calculating the true angle for turning the head to optimize the peripheral visual field has not been studied to date. The purpose of this study was to explore the utility of turning the head during perimetry to maximize the testable visual field. Six healthy study participants aged 18-52 were enrolled, prospectively; the dominant eye of each participant was tested. In total, 60-4 visual fields were obtained from each participant's dominant eye with the head in primary position. Then, the 60-4 tests were repeated with the head turned prescribed degrees toward and away from the tested eye ("manual method"). Based on a photograph of the participant's face, a convolutional neural network (CNN) was used to predict the optimal head turn angle for maximizing the field, and the test was repeated in this position ("automated method"). Maximal visual field exposure was found at a head turn of 15° away from the tested eye using the manual method and was found at an average head turn of 12.6° using the automated method; maximum threshold values were similar between manual and automated methods. The mean of threshold in these subjects at the standard direction and the predicted optimum direction was 1,302, SD = 69.35, and 1,404, SD = 67.37, respectively ( P = 0.02). Turning the head during perimetry maximizes the testable field area by minimizing the influence of prominent facial anatomy. In addition, our CNN can accurately predict each individual's optimal angle of head turn for maximizing the visual field.

Progressive Retinopathy in a Patient with Mucopolysaccharidosis Type II undergoing Enzyme Replacement Therapy: A Case Report.

To report the changing fundus autofluorescence (FAF) and ocular coherence tomographic (OCT) findings through time in a patient with mucopolysaccharidosis type II being treated with idursulfase, an enzyme replacement therapy (ERT). Case report with clinical photography. We report the case of a 27-year old male patient with mucopolysaccharidosis type II whom we followed from 2019-2023. Throughout follow-up we noticed a slow increase of parafoveal outer retinal atrophy centripetally which is reflected in a smaller hyper-auto-fluorescent ring and increasing ring scotoma on visual field testing. The patient remains asymptomatic.Discussion/Conclusion: Despite continuing long-term enzyme replacement treatment with idursulfase the retinopathy associated with mucopolysaccharidosis type II progressed in our patient.

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.

Central Visual Field Testing in Early Glaucoma: A Report by the American Academy of Ophthalmology

To evaluate the current published literature on the utility of the 10-2 visual field (VF) testing strategy for the evaluation and management of early glaucoma, defined here as mean deviation (MD) better than -6 decibels (dB). A search of the peer-reviewed literature was last conducted in June 2023 in the PubMed database. Abstracts of 986 articles were examined to exclude reviews and non-English-language articles. After inclusion and exclusion criteria were applied, 26 articles were selected, and the panel methodologist rated them for strength of evidence. Thirteen articles were rated level I, and 8 articles were rated level II. The 5 level III articles were excluded. Data from the 21 included articles were abstracted and reviewed. The central 12 locations on the 24-2 VF test grid lie within the central 10 degrees covered by the 10-2 VF test. In early glaucoma, defects detected within the central 10 degrees generally agree between the 2 tests. Defects within the central 10 degrees of the 24-2 VF test can predict defects on the 10-2 VF test, although the 24-2 may miss defects detected on the 10-2 VF test. In addition, results from the 10-2 VF test show better association with findings from OCT scans of the macular ganglion cell complex. Modifications of the 24-2 test that include extra test locations within the central 10 degrees improve detection of central defects found on 10-2 VF testing. Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma. However, early 10-2 VF testing may provide sufficient additional information for some patients, particularly those with a repeatabledefect within the central 12 locations of the standard 24-2 VF test or who have inner retinal layer thinning on OCT scans of the macula. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Which glaucoma patients benefit from 10-2 visual field testing? Proposing the functional vulnerability zone framework

ABSTRACTClinical relevanceA method for determining 10-2 deployment in glaucoma with the goal of detecting additional visual field sensitivity for the purpose of functional monitoring is proposed.BackgroundTo provide a pilot method for determining when to deploy the 10-2 visual field (VF) test grid in glaucoma by characterising the ‘functional vulnerability zone’.MethodsThe cross-sectional 24-2 (central 12 locations) and 10-2 VF results from 133 eyes of 133 glaucoma subjects were used to describe the central Hill of Vision using VF sensitivity. The ‘volume’ (defined using arbitrary units, A.U.) under the Hill was calculated. A greater A.U. on the 10-2 indicated a functional vulnerability zone (FVZ), signifying additional clinical dynamic range for potential future monitoring. The main outcome measures were calculated A.U. and 24-2 factors which were significantly related to A.U. differences between 24-2 and 10-2.ResultsOver 55% of patients had an FVZ (A.U. greater using 10-2). Several 24-2 features (worse mean deviation, worse central 24-2 mean defect, and a higher proportion of defective locations) were significant in the FVZ cohort compared to non-FVZ. 24-2 mean deviation levels at which 10-2 may be favoured were low at −3.16 to −3.62 dB. Specifically, 5 or more defective central 24-2 test locations were associated with an FVZ. Subjects exhibiting a less severe defect on the 10-2 were more likely to have an FVZ, indicating its potential for future VF monitoring.ConclusionsThe authors propose several clinical markers, focussing on the 24-2, which can guide clinicians on when the 10-2 may have utility in glaucoma assessment. The authors provide a pilot reference spreadsheet for clinicians to visualise the likelihood of 10-2 utility in the context of an FVZ.

Role of Electrophysiologal Studies for Detection of Simulation and Aggravation in Ophthalmology

Abstract Objective To present the importance of the electrophysiological studies for detection of malingering and aggravation in ophthalmology. Materials and methods Six eyes of three patients underwent a complete clinical examination, fundus-autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT), visual field testing, electrophysiological (EF) studies – full-field, multifocal and pattern electroretinography (ffERG, mfERG and PERG) and visual evoked potentials (VEPs), for detection of simulation or aggravation. Results After the electrophysiological studies’ results, which are objective and non-manipulable, we purposefully reviewed and repeated some of the tests already done, which allowed a comprehensive interpretation of the results. It turned out that discrete changes in targeted search can be detected in several of the studies performed, which greatly facilitates the correct diagnosis. Conclusion EF studies are objective methods for studying the visual analyzer’s function, that can not be manipulated, which makes them indispensable for detecting simulation and aggravation in ophthalmology. A detailed extensive study of the degree of simulation and aggravation among the ophthalmological patients is needed, which will enrich our knowledge and make us more precise in our expertise.

Impact of Single Compared to Dual Sensory Loss in People with Dementia on Care Partner Outcomes

AbstractBackgroundBoth hearing and vision loss impact significantly on outcomes in people with dementia as well as their care partners. The study aimed to compare the impact on care partner outcomes of hearing loss alone and dual sensory (both hearing and vision) loss in people with dementiaMethodsThe study sample includes data from the SENSE‐Cog Trial (www.sense‐cog.eu). Care partner psychological distress was ascertained using the 12‐item General Health Questionnaire and the Hospital Anxiety and Depression Scale. Caregiving intensity was assessed using the care partner items of the RUD Lite. Dementia symptoms were assessed with the MOCA, the 12‐item Neuropsychiatric Inventory and the Bristol Activities of Daily Living scale. Vision loss was defined by the presence of binocular visual acuity of not more than 6/9.5 and greater than 6/60 in Snellen metric using the Portable Eye Examination Kit (PEEK) vision tool and visual field greater than 10° using confrontation visual field test. Hearing loss was defined by a bilateral hearing difficulty, indicated by failure of a pure tone hearing screening test in both ears. Statistical analyses included comparison between groups with different sensory losses (hearing‐ vs. dual loss) and regression analyses.ResultsData of dyads of people with dementia and either hearing loss (N = 150) or dual sensory loss (N = 92) and their care partners (female 72.5%; male 27.5%) were considered. Participants had Alzheimer’s dementia (65%), vascular dementia (16%) or mixed dementia (19%), with mean MOCA score 16.6 (range 10 – 28). 73% of patients lived with partner or family and 24% alone. Higher caregiving intensity and higher psychological distress were observed in care partners of patients with dual sensory loss compared to care partners of people with hearing loss only after controlling for the impact of cognitive deficits, neuropsychiatric symptoms, performance on activities of daily living and demographic characteristics.ConclusionsDual sensory loss in people with dementia increases care partner distress and caregiving intensity compared to single hearing loss. Shedding light on sensory loss in dementia may pave new ways towards more effective symptom management and higher quality of life of both patients and their care partners.

Comparison of the TEMPO binocular perimeter and Humphrey field analyzer

This study compared between TEMPO, a new binocular perimeter, with the Humphrey Field Analyzer (HFA). Patients were tested with both TEMPO 24–2 Ambient Interactive Zippy Estimated by Sequential Testing (AIZE)-Rapid and HFA 24–2 Swedish Interactive Threshold Algorithm (SITA)-Fast in a randomized sequence on the same day. Using a mixed-effects model, visual field (VF) parameters and reliability indices were compared. Retinal nerve fiber layer (RNFL) thickness was measured using Cirrus optical coherence tomography (OCT), and coefficient of determinations for VF and OCT parameters were calculated and compared using Akaike information criteria. 740 eyes (including 68 healthy, 262 glaucoma suspects, and 410 glaucoma) of 370 participants were evaluated. No significant differences were seen in mean deviation and visual field index between the two perimeters (P > 0.05). A stronger association between VF mean sensitivity (dB or 1/L) and circumpapillary RNFL was found for TEMPO (adjusted R2 = 0.25; Akaike information criteria [AIC] = 5235.5 for dB, and adjusted R2 = 0.29; AIC = 5200.8 for 1/L, respectively) compared to HFA (adjusted R2 = 0.22; AIC = 5263.9 for dB, and adjusted R2 = 0.22; AIC = 5262.7 for 1/L, respectively). Measurement time was faster for TEMPO compared to HFA (261 s vs. 429 s, P < 0.001). Further investigations are needed to assess the long-term monitoring potential of this binocular VF test.

Estimating functions for visual field progression in newly diagnosed exfoliation glaucoma patients in Sweden.

This study aimed to determine whether glaucoma progression was linear or not in newly diagnosed exfoliation glaucoma patients. A total of 96 patients with newly diagnosed exfoliation glaucoma were included. These patients were required to undergo at least seven visual field tests within 3years (± 1month), and all were treated at the time of inclusion. The study was a non-randomized, prospective cohort study. The outcome of the study was visual field progression. Progression was assessed based on mean deviation (MD), visual field index (VFI), and "Guided Progression Analysis". The MD and VFI values were plotted against time, and distribution and curve fit were calculated. The results showed that the general rate of progression of the cohort was - 3.84 (± 2.61) dB for the MD values and 9.66 (± 6.25)% for the VFI values over 3years. The best-fitted curve for MD and VFI values in the 36months period was significant for both linear and exponential curves (p ≤ 0.001; p ≤ 0.001). However, in the MD group, the F and the R2 values were higher for exponential than for linear function (linear: F = 42.60, R2 = 0.059; exponential: F = 53.26, R2 = 0.073). The opposite results were found among VFI values. The F and the R2 values were slightly better for linear than for exponential (linear: F = 37.22, R2 = 0.052; exponential: F = 35.55, R2 = 0.050). In conclusion, the study found that visual field progression between diagnosis and 18months seemed to be exponential. However, after 18months, the IOP reduction effects probably ameliorated progression, making the curve linear.