Visual Field In Glaucoma Patients Research Articles

Influence of Trabeculectomy with Mitomycin C on Longitudinal Changes in the Visual Field in Glaucoma Patients with High Myopia.

To evaluate the effect of trabeculectomy (Trab MMC) on visual field (VF) progression in eyes with glaucoma and high myopia. Patients diagnosed with primary open-angle glaucoma or exfoliation glaucoma who underwent Trab MMC as the first glaucoma surgery along with ≥3 VF tests preoperatively and postoperatively were enrolled. High myopia was defined as an axial length ≥26.5 mm. Postoperative reductions in intraocular pressure (IOP) were assessed by survival analysis using IOP measurements obtained preoperatively. The longitudinal trends of the outcome measures were evaluated using linear mixed models. Thirty-five eyes of 32 patients were included in this study, including 22 eyes of 20 patients in non-highly myopic group and 13 eyes of 12 patients in highly myopic group. IOP decreased after Trab MMC, and the survival rate did not differ significantly in relation to axial length. Linear mixed-model analyses suggested that the inhibitory effects of Trab MMC on the rate of mean deviation (MD) changes were significant in the non-highly myopic group (-0.53 ± 0.15 dB/year preoperatively to -0.16 ± 0.13 dB/year postoperatively; P = 0.004), but not in the highly myopic group (-0.66 ± 0.19 dB/year preoperatively to -0.48 ± 0.18 dB/year postoperatively; P = 0.32). Trab MMC reduced IOP in both highly myopic and non-highly myopic eyes, and IOP reduction was very similar in both groups. The VF deterioration rate decreased in both groups, but the change was weaker and nonsignificant in the highly myopic group.

Visual field changes in glaucoma patients during the coronavirus disease 2019 pandemic in a middle-income country

ABSTRACT Background To assess the possible effect of the coronavirus disease 2019 (COVID-19) pandemic on the progression of visual field in glaucoma patients attending a charity hospital in Sao Paulo, Brazil. Research design and methods This retrospective study included all glaucoma patients attending the Glaucoma Service Santa Casa of Sao Paulo from July 2019 to October 2021. Data retrieved from the charts included intraocular pressure (IOP), information about missing appointments and non-adherence to medical treatment, mean deviation (MD), and pattern standard deviation (PSD) of Humphrey visual field. Pre- and late in-pandemic data were compared with the Wilcoxon signed-rank test. Results There was no statistically significant difference between pre- and in-pandemic values of MD, and PSD values (all P > 0.05). Fifty eyes (27.9%) of 36 patients (36%) revealed an −2 dB decrease in the MD value. Conclusions The COVID-19 pandemic did not affect visual field progression in most of patients. However, about a third of patients presented a decrease in the MD value >-2 dB in at least one eye especially those with advanced disease. As a slowly progressive optic neuropathy, the two-year time of the pandemic was possibly not long enough to impact negatively on the glaucoma progression in most of patients.

The Effect of Contact Lens-spectacle Reversed Galilean Telescope on the Visual Field of Patients with Open-angle Glaucoma.

PurposeGlaucoma causes irreversible visual field defects. This study aims to evaluate the effect of a reversed Galilean telescope on the visual field of patients with open-angle glaucoma.Methods Fifty-two glaucoma patients with a restricted visual field were recruited for this study. Central 30° visual field measurements were performed using a Humphrey visual field analyzer before and after applying the reversed Galilean telescope. To be more cosmetically acceptable, a combination of contact lens–spectacle was used as the reversed Galilean telescope.ResultsOur data analysis showed that the reversed Galilean telescope had a significant effect on all measured perimetric indices. Visual field index (VFI) improved from a basic value of 44.38 26.96 to 49.30 29.83 percent by using the reversed telescope (P 0.001). Moreover, the mean deviation (MD) was significantly improved from the initial value of –19.91 7.19 dB to a value of –18.69 7.73 dB (P 0.001). However, our results showed a significant reduction in the pattern standard deviation (PSD) comparing before (9.83 2.82) and after (8.51 3.30) values using the reversed Galilean telescope (P 0.001).ConclusionThe contact lens–spectacle combination reversed Galilean telescope significantly improved the central 30° visual field of glaucoma patients with the restricted visual field.

Longitudinal Evaluation of the Structural and Functional Changes Associated with Glaucoma in Myopia.

This study ascertains that myopia is a risk factor for glaucoma progression among eyes with primary open angle glaucoma. Myopic eyes with primary open angle glaucoma may benefit from measurement and incorporation of axial length information into clinical decision making. The purpose of this study was to estimate the rate of change in retinal nerve fiber layer (RNFL) thickness and the rate of change in visual field of glaucoma patients with and without myopia. We conducted a prospective, observational cohort study where we analyzed 245 eyes of 135 glaucoma patients followed for a mean period of 6.08 years. All the subjects had RNFL imaging and standard automated perimetry performed for both eyes in the same visit every 4 months for at least 60 months. The rate of change of average RNFL thickness and visual field index (VFI) was -0.29 μm/y (95% confidence interval, -1.80 to +1.23 μm/y) and -0.30%/y (95% confidence interval, -2.24 to +1.64%/y), respectively, after adjusting for age, axial length, IOP, baseline RNFL thickness, signal strength, and correlation between fellow eyes. Axial length, as a continuous variable, was not associated with the rates of change of average RNFL thickness and VFI. However, high myopic eyes with axial lengths of ≥26.0 and ≥26.5 mm had an average rate of change of RNFL thickness of 0.15 and 0.16 μm/y faster than eyes with axial lengths of less than 26 and 26.5 mm, respectively. Similarly, myopic eyes with an axial length of ≥26.5 mm were associated with a 0.21%/y faster rate of VFI reduction. Both RNFL and visual field progression rates are faster in myopic glaucomatous eyes with an axial length of ≥26.5 mm than in eyes <26.5 mm. However, the small difference that supports high myopia as a risk factor for progression does not indicate the clinical importance or significance of axial length.

Estimating the Binocular Visual Field of Glaucoma Patients With an Adjustment for Ocular Dominance.

To investigate whether it is possible to improve estimation of the binocular visual field (VF) using monocular sensitivities on a linear scale adjusted for ocular dominance. Monocular and binocular VF measurements were evaluated using the Humphrey Field Analyzer (HFA; 24-2 Swedish Interactive Threshold Algorithm standard program) in 60 eyes of 30 patients with open angle glaucoma. Ocular dominance was measured twice in each patient and the average value was used. Measured binocular sensitivity was then predicted based on monocular measurements using the "better sensitivity" integrated visual field (IVF) method, monocular sensitivity summation methods on the dB scale, linear scale (1/Lambert), and finally monocular sensitivity summation methods on the linear scale adjusted for the ocular dominance. The absolute prediction error with the linear scale summation method (mean ± SD: 3.11 ± 4.00) was significantly smaller than the IVF method (3.15 ± 4.09; P = 0.014). Further, the absolute prediction error for the ocular dominance adjusted method (3.10 ± 3.99) was significantly smaller than the nonadjusted linear scale summation method (P = 0.014). The absolute prediction error associated with the dB scale summation method was significantly larger than any other method (8.15 ± 5.06; P < 0.0001). The most accurate estimation of binocular sensitivity was achieved using the linear monocular sensitivity summation model adjusted for ocular dominance.

Structure/function relationship between wide-scan binocular OCT images and the integrated visual field in glaucoma patients.

Structure/function relationship between wide-scan binocular OCT images and the integrated visual field in glaucoma patients.

Assessment of the Vision-specific Quality of Life Using Clustered Visual Field in Glaucoma Patients

To investigate the significance of vision-specific quality of life (QOL) in glaucoma patients based on the location of visual field defects. We examined 336 eyes of 168 patients. The 25-item National Eye Institute Visual Function Questionnaire was used to evaluate patients' QOL. Visual field testing was performed using the Humphrey Field Analyzer; the visual field was divided into 10 clusters. We defined the eye with better mean deviation as the better eye and the fellow eye as the worse eye. A single linear regression analysis was applied to assess the significance of the relationship between QOL and the clustered visual field. The strongest correlation was observed in the lower paracentral visual field in the better eye. The lower peripheral visual field in the better eye also showed a good correlation. Correlation coefficients in the better eye were generally higher than those in the worse eye. For driving, the upper temporal visual field in the better eye was the most strongly correlated (r=0.509). For role limitation and peripheral vision, the lower peripheral visual field in the better eye had the highest correlation coefficients at 0.459 and 0.425, respectively. Overall, clusters in the lower hemifield in the better eye were more strongly correlated with QOL than those in the worse eye. In particular, the lower paracentral visual field in the better eye was correlated most strongly of all. Driving, however, strongly correlated with the upper hemifield in the better eye.

Correlation of Macular Thickness With Visual Fields in Glaucoma Patients and Suspects

To provide a quantitative comparison of the retinal thickness in the macula, with Humphrey visual field (HVF) parameters and circumpapillary retinal nerve fiber layer (RNFL) defects, in glaucoma patients and suspects. Retrospective statistical analysis of spectral domain optical coherence tomography (SD-OCT) compared with HVF mean deviation (MD) and pattern standard deviation (PSD) in 73 subjects who met the study criteria. Bivariate statistical analysis was performed. Macular thickness correlates with HVF deficits, with much worse MD (-6.8) and PSD (5.8) scores in subjects with average macular thickness <270 μm, compared with those >300 μm, (MD +0.4, PSD 1.7). Both the MD (P=0.0001) and PSD (P<0.0001) correlated with average macular thickness. In subjects with a difference of 3 or greater in the MD between the 2 eyes, there was a difference of 11 to 13 μm in average macular thickness. Asymmetry within the same eye, between the superior macula and inferior macula, correlated with a larger PSD in that eye. There was a strong correlation between RNFL defects and retinal thinning in the macula. SD-OCT measurements of retinal thickness in the macula correlate with HVF parameters and RNFL parameters in glaucoma patients and suspects. This correlation between visual field defects and macular thickness can help in confirming the existence and extent of the visual field defect.

Pupillographic evaluation of relative afferent pupillary defect in glaucoma patients

AimTo evaluate the association between the magnitude of relative afferent pupillary defect (RAPD) and the laterality of visual fields in glaucoma patients using pupillography.MethodsEvaluations were made with an RAPDx (Konan...

Parafoveal Scotoma Progression in Glaucoma: Humphrey 10-2 versus 24-2 Visual Field Analysis

To compare the performance of 10-2 versus 24-2 visual fields (VFs) in detecting progression of initial parafoveal scotoma (IPFS) in glaucomatous eyes. Retrospective, observational study. Glaucoma patients with the following criteria: (1) an IPFS (≥ 3 adjacent points with P<0.05 within the central 10° degrees of fixation, 1 point or more with P<0.01 lying at the innermost paracentral points, and no scotoma outside the central 10°) in either hemifield based on 2 reliable Humphrey 24-2 Swedish interactive threshold algorithm standard VFs, and (2) 5 or more 10-2 and 24-2 VFs. Based on threshold map sensitivities, VF progression, defined as having 1 or more significantly progressing point(s) with a slope of sensitivity of less than -1.0 dB/year at P<0.01, was evaluated using pointwise linear regression. The number of progressing eyes in 10-2 and 24-2 VF analyses. Fifty eyes (50 patients) were included (mean age ± standard deviation, 62 ± 9 years). Mean follow-up period (5.7 vs. 5.6 years) and number of VFs (7.6 vs. 7.8) were similar between 10-2 and 24-2 analyses (all P>0.3). Significantly more progressing eyes were detected in 10-2 than in 24-2 analyses (24 vs. 11 eyes; P = 0.007). This difference became greater within the central 10° (24 vs. 4 eyes; P<0.001). Four of the 11 progressing eyes in 24-2 analysis were missed in 10-2 analysis, whereas 17 of the 24 progressing eyes in 10-2 analysis were missed in 24-2 analysis. The 4 progressing eyes missed in 10-2 analysis had progressing point(s) only outside the central 10° in 24-2 analysis. The other 3 eyes with progressing point(s) only outside the central 10° in 24-2 analysis were detected as progressing in 10-2 analysis. Similar results were obtained when more stringent criteria (at least 2 significantly progressing points within the same hemifield) were used for VF progression. The 10-2 VF detects more progressing eyes than the 24-2 VF in glaucoma patients with IPFS, suggesting that closer surveillance of the central VF using testing algorithms with closely spaced grids is warranted in eyes with parafoveal scotomas. Proprietary or commercial disclosure may be found after the references.

Assessment of the Vision-Specific Quality of Life Using Binocular Esterman Visual Field in Glaucoma Patients

Assessment of the Vision-Specific Quality of Life Using Binocular Esterman Visual Field in Glaucoma Patients

Stopping Progression of Optic Disk Damage and Preserving Visual Fields in Glaucoma Patients

Stopping Progression of Optic Disk Damage and Preserving Visual Fields in Glaucoma Patients

Visual Field Protective Effect of Erigeron breviscapus (vant.) Hand. Mazz. Extract on Glaucoma with Controlled Intraocular Pressure

Objective: To evaluate the visual field protective effect of Erigeron breviscapus (vant.) Hand. Mazz. (EBHM) extract on glaucoma with controlled intraocular pressure (IOP).Methods: Forty patients (40 eyes) with primary open-angle glaucoma, visual field defects and a postsurgical IOP of <18mmHg were enrolled. The EBHM and placebo tablets were given orally according to the randomized and double-blind principle. Two tablets (of either EBHM or placebo) were taken three times a day for a period of 6 months. Patients were examined every 2 months after treatment commenced. At the end of the study, the results were given to the drug manufacturer.Results: All patients completed the prospective, randomized, double-blind, clinical trial. No obvious adverse effects were found in patients during the treatment period. In the placebo group, no significant difference was found in mean defect (MD) or mean sensitivity (MS) between the values at pretreatment and after 2, 4, and 6 months of treatment. After 6 months of EBHM treatment, the MD was significantly decreased and the MS was significantly increased compared with pre-treatment (p < 0.05). In the patients with moderate and late glaucoma, the MD was significantly decreased and the MS was significantly increased after 2, 4, and 6 months of EBHM treatment compared with pre-treatment.Conclusion: EBHM extract may have a partial protective effect on the visual field of glaucoma patients with controlled IOP. Further studies are needed to determine the safety and effectiveness of long-term EBHM treatment.

Visual Field Protective Effect of Erigeron breviscapus (vant.) Hand. Mazz. Extract on Glaucoma with Controlled Intraocular Pressure

Objective: To evaluate the visual field protective effect of Erigeron breviscapus (vant.) Hand. Mazz. (EBHM) extract on glaucoma with controlled intraocular pressure (IOP). Methods: Forty patients (40 eyes) with primary open-angle glaucoma, visual field defects and a postsurgical IOP of <18mmHg were enrolled. The EBHM and placebo tablets were given orally according to the randomized and double-blind principle. Two tablets (of either EBHM or placebo) were taken three times a day for a period of 6 months. Patients were examined every 2 months after treatment commenced. At the end of the study, the results were given to the drug manufacturer. Results: All patients completed the prospective, randomized, double-blind, clinical trial. No obvious adverse effects were found in patients during the treatment period. In the placebo group, no significant difference was found in mean defect (MD) or mean sensitivity (MS) between the values at pretreatment and after 2, 4, and 6 months of treatment. After 6 months of EBHM treatment, the MD was significantly decreased and the MS was significantly increased compared with pre-treatment (p < 0.05). In the patients with moderate and late glaucoma, the MD was significantly decreased and the MS was significantly increased after 2, 4, and 6 months of EBHM treatment compared with pre-treatment. Conclusion: EBHM extract may have a partial protective effect on the visual field of glaucoma patients with controlled IOP. Further studies are needed to determine the safety and effectiveness of long-term EBHM treatment.

Classifying Patterns of Localized Glaucomatous Visual Field Defects on Automated Perimetry

To classify the classic patterns of glaucomatous visual field defects on automated perimetry and to study their proximity to fixation. Cross-sectional observational study. About 1120 full threshold 30-2 reliable visual fields of glaucoma patients were analyzed by 2 glaucomatologists. Classically described patterns of visual field defects were identified on the pattern deviation plot and definitions proposed. Interreader agreement between 3 independent (not involved in the classification) readers was determined. Proximity to fixation of the different patterns was assessed. Interreader agreement with 3 readers was found to be 93% or more between any 2 readers using the present system of classification. Central fixation was seen to be involved in 45% of the glaucomatous visual field defects studied overall. The proposed definitions of topographical glaucomatous field defects based on the pattern deviation probability plot are simple to use in clinical practice with good interreader agreement.

Korrelation zwischen glaukomatösen Halbfeldskotomen in der Weiß-Weiß-Perimetrie und in der Blau-Gelb-Perimetrie am Oculus-Twinfield-Perimeter

The "Twinfield Perimeter" can be used for white-on-white and blue-on-yellow perimetry. Since the normative database which is used fort the calculation of the visual field indices for both strategies is based on data from white-on-white perimetric evaluations of normal persons using the "Tübinger Automatikperimeter", the validity of this approach may be questioned. In the study presented here we compared the correlation of white-on-white (W/W) and blue-on-yellow (B/Y) visual fields in glaucoma patients with a hemifield scotoma. One eye each from 40 normal persons and from 40 glaucoma patients was included in the study. Both W/W-perimetry and B/Y-perimetry was performed using the "Twinfield Perimeter" (Oculus, Modell 56 900, Wetzlar, Germany). From the sensitivity values determined with the 30/2 strategy, we calculated the mean sensitivity (MS), mean deviation (MD) of the total field and of both hemifields (HMS bzw. HMD) separately. Normal values derived from the normal persons of the present study were compared with the normal values used by the Twinfield Perimeter. To determine the strength of the association of B/Y- and W/W-hemifield scotoma, we calculated the linear correlation coefficient (Pearson's R) between the HMD of B/Y und W/W-hemifields. MS of both glaucoma patients and normal persons were determined to be significantly higher for B/Y visual fields (14.17 +/- 4.15 and 20.97 +/- 3.56) when compared with W/W-visual fields (10.70 +/- 3.19 or 15.98 +/- 3.3). When normal values from the Twinfield Perimeter were applied, the MD for normal persons was calculated to be - 4.69 +/- 3.22 compared with 0 +/- 3.6 when the MD was calculated with the normal values from the study. For both normal values we confirm a strong correlation between HMD-values of W/W- and B/Y-visual fields. Since the mean sensitivity of B/Y visual fields is higher than the mean sensitivity of W/W visual fields, calculations of the MD of B/Y visual fields of glaucoma patients should be based on normative databases which are derived from B/Y visual fields of normal persons.

Evaluating several sources of variability for standard and SWAP visual fields in glaucoma patients, suspects, and normals

Purpose To quantify factors affecting test-retest variability of threshold measurements over a series of 3 serial visual fields (VF). Design Prospective comparative observational study. Participants Forty-one normals, 10 suspects and 35 stable glaucoma patients. Methods All subjects performed 3 standard and 3 short-wavelength automated perimetry (SWAP) VFs. At each VF location, severity (defined as age-corrected total deviation) and test-retest variability (TRV), defined as the standard deviation of 3 serial threshold values, were calculated. A multiple regression model (constructed separately for standard VF and SWAP) incorporated 13 factors: severity, location, eccentricity, study group, diagnosis, superior versus inferior hemifield, nasal versus temporal hemifield, one-versus-two thresholds, age, mean pupil size, pupil size variability, between-subject variation, and residual variation. Main outcome measures Variability in threshold sensitivity VF values. Results Mean TRV (± standard deviation) for normal, suspect and glaucoma eyes, respectively, was: 1.28 ± 0.87, 1.53 ± 1.04 and 2.20 ± 1.79 dB for standard VF, and 1.87 ± 1.35, 1.86 ± 1.24 and 2.68 ± 1.85 dB for SWAP. The contribution of each factor to the model for standard VF and SWAP (SWAP in parentheses) were: severity 15.5% (6.9%); location 2.7% (4.1%); eccentricity 1.1% (0.64%); diagnosis 2.9% (5.9%); “superior versus inferior” hemifield 0.17% (1.7%); “nasal versus temporal” hemifield 0.06% (0.02%); one-versus-two thresholds 0.04% (0.16%); age 0.1% (0.06%); mean pupil size 0.59% (0.1%); pupil size variability 3.2% (2.8%); between-subject 8.0% (13.5%) and residual variation 61.0% (66.6%). Excluding between-subject and residual variation, the 11-factor model was able to account for less than one third of the variability seen in both standard VF and SWAP. Conclusions Severity of defect and between subject variation exerted the largest effect on TRV. However, even if all 11 factors could be adjusted for, it would reduce the magnitude of TRV by only 30%. More work is needed to reduce the remaining variability inherent in psychophysical testing and to better understand the intrinsic physiological variability present both in healthy and diseased eyes. It is possible that a larger number of VFs used for the calculation of TRV might further reduce the magnitude of the remaining variability found in this study.

The relationship between visual disability and visual field in patients with glaucoma

Purpose To evaluate the relationship between visual disability and the remaining visual field in glaucoma patients. Design Prospective noncomparative survey. Participants One hundred forty-seven Japanese patients with glaucoma were examined. Methods Using a previously developed questionnaire, we assessed the relationship between visual disability indices and both the visual field examined using program 30-2 of the Humphrey Field Analyzer and visual acuity. Main outcome measures Pearson’s correlation coefficients between visual disability indices and the 22 visual field and 2 visual acuity measurements were calculated. Multiple regression analysis with stepwise variable selection identified factors significantly contributing to visual disability. Results We identified a significant correlation between visual disability and both the visual field and visual acuity measurements collected. Of the factors examined, retinal sensitivity in the lower hemifield within 5° of the fixation and visual acuity in the better eye significantly contributed to all the item and total disability indices (DIs), measurements of the degree of visual disability as evaluated by the questionnaire; visual acuity in the worse eye contributed to two of the seven item DIs, as well as the total DI. The R value for total DI ( R = 0.87, P < 0.0001) indicated that approximately 76% of the visual disability could be explained by these factors. Conclusions The Japanese glaucoma patients’ visual disability is explained primarily by retinal sensitivity in the lower hemifield within 5° of the fixation and visual acuity in the better eye and secondarily by visual acuity in the worse eye.

Localised changes in glaucomatous visual fields after trabeculectomy.

Modern techniques of automated perimetry have shown that surgical reduction of intraocular pressure (IOP) may have a beneficial effect on the glaucomatous visual field. The purpose of the present study was to analyse and quantify the changes in the visual fields of glaucoma patients after trabeculectomy. Octopus visual fields of twenty-seven glaucoma patients were analysed. Change in visual field mean sensitivity (MS) was calculated to detect total field changes. A clinical and a statistical analysis of small clusters of test points were used to define whether local changes had occurred. MS in the operated eyes improved significantly from 16.4+/-5.6 to 18.2+/-5.5 dB. The patients had on average 3.9+/-6.2 clusters where the retinal sensitivity had improved at least 5 dB and only 0.4+/-0.9 clusters where sensitivity had deteriorated at least 5 dB after trabeculectomy. 17 patients had more improved than deteriorated clusters postoperatively. Statistically significant improvement was seen in the MS, but improvement was also found in small local areas of the visual fields after trabeculectomy.

The Effectiveness of Glaucomatous Visual Field Test Using a Size I Stimulus

Perimetry using size I and III targets was conducted on glaucoma patients. The detectability of the visual field defects using a size I target and abnormal spatial summation was investigated. Subjects were 14 eyes of 11 glaucoma patients with mild to moderate visual field defects and 11 eyes of 11 normal persons. Program 24-2 of the Humphrey Field Analyzer was applied to each subject. Based on the mean sensitivity and standard deviation at each coordinate in normal persons, the Z-score was calculated in the visual fields of glaucoma patients (absolute scotomas were excluded). The mean Z-score of retinal sensitivity, was less for size III than for size I in abnormal lesions, and less for size I than for size III in normal lesions (paired t-test, p < 0.01). Pathological spatial summation was found more frequently in normal lesions than in abnormal lesions. In mild visual field defects, size I detects abnormalities with greater sensitivity than size III. Perimetry using the size I target can be effective as a supplementary diagnostic method to detect and follow the early glaucomatous visual field.