Visual Field Mean Research Articles

Changes in optic nerve head microvasculature following disc hemorrhage absorption in glaucomatous eyes

This study investigated the changes in optic nerve head (ONH) microvasculature, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and visual field (VF) sensitivity following the absorption of optic disc hemorrhage (DH). Intradisc vessel density (dVD) was calculated using a 3 × 3 mm optic disc scan in 60 eyes of 60 patients with primary open angle glaucoma and DH who had undergone two or more swept-source optical coherence tomography angiography exams. Clinical parameters at the time of DH occurrence and after absorption, as well as those between the subgroups based on DH recurrence and location, were compared. Linear regression analysis was performed to identify factors associated with changes in cpRNFL thickness in the DH-affected quadrant. Mean dVD, cpRNFL thickness, and VF sensitivity significantly decreased after DH absorption (all P < 0.05). The reduction in dVD was more pronounced in eyes with recurrent DH compared to those with a single episode (P = 0.032). Eyes with DH occurring within or at the margin of the disc cup showed a greater dVD reduction than those with DH occurring outside the disc cup (P = 0.049). The reduction in cpRNFL thickness in the DH-affected quadrant correlated with dVD reduction in the same quadrant (β = 0.370, P = 0.013) and DH recurrence (β = -2.617, P = 0.033). This finding suggests that DH pathogenesis may be associated with changes in optic disc vasculature, contributing to glaucomatous progression.

Evaluation of the peripheral visual performance of DIMS spectacle lenses versus single vision lenses.

This study evaluates differences in the visual field performance when wearing the Defocus Incorporated Multiple Segments (DIMS) spectacle lens compared to wearing a conventional single vision (SV) spectacle lens. Twenty-one children aged 9-14 years with spherical equivalent refraction (SER) between -1.13D to -4.75D were recruited. Mid-peripheral near visual acuity (NVA) under room lighting condition (500 lux ±10%) was measured using DIMS and SV lenses, respectively. Automated static perimetry (Zeiss, Humphrey Visual Field HFA 750i) with SITA Fast 30-2 protocol was used to investigate the visual field sensitivity. During the test, the study lens (Plano DIMS or SV lens) were inserted into the lens holder in front of the trial lenses with each child's compensated prescription. Three children were not able to complete the reliable visual tests due to fixation losses (>20%) or high false positive rate (>15%) while 18 children successfully completed the test. The mean visual field sensitivity was 29.2 ± 3.7 decibels (dB) and 29.3 ± 3.5 dB when wearing DIMS and SV lens, respectively. The mean sensitivity differences between DIMS and SV lens among 76 locations ranged from -2.4 ± 3.9 dB to 1.6 ± 3.9 dB. No statistically significant difference in sensitivity was observed across 76 locations within the central 30o between DIMS and SV lens (Wilcoxon signed rank test with bonferroni correction for multiple comparisons, p > 0.00065). Compared to SV lens, 0.05 logarithm of minimal angle of resolution (logMAR) reduction in mid-peripheral NVA in all 4 quadrants (Superior, Temporal, Inferior and nasal, p < 0.05) was noted with the DIMS lens (N = 18). However, no statistically significant correlation was found between the mid-peripheral NVA and visual sensitivity at the specific locations. Although the mid-peripheral NVA was slightly reduced using DIMS lens, wearing DIMS lens did not change the children's visual sensitivity to detect the static stimulus within 30o visual field when compared to wearing SV lens.

Patient Experience and Barriers to the Visual Field Test for Glaucoma.

There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma. To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing. This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes. Of the 152 participants [M:F 79 (52.0%):73 (48.0%)], the age group with the highest proportion of participants was 71-80 years [n=56 (36.8%)], and most had a primary ocular diagnosis of glaucoma [n=107 (70.4%)]. The mean VAS score for visual field testing experience was 60.45 (SD=30.38). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma [55.34 (31.13) vs. 72.67 (25.04); P <0.05]. Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, sex, and mean visual field index did not influence participant experiences of visual field testing. Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Assessing Glaucoma Severity and Progression in Individuals with Asymmetric Axial Length: An Intrapatient Comparative Study

PurposeTo investigate whether there is a difference in inter-eye glaucoma severity and progression in patients with asymmetric axial length DesignLong-term observational study ParticipantsPatients over 20 years of age who had been diagnosed with glaucoma at Seoul National University Hospital, Seoul, Korea, between 2010 and 2020. MethodsPatients diagnosed with glaucoma in both eyes with an axial length difference of more than 1.0 mm were included. Each individual’s eyes were classified into “longer eye” and “shorter eye,” and the baseline and follow-up clinical data were analyzed using the paired test. Main Outcome MeasuresDifferences in clinical characteristics in patients with asymmetric axial length ResultsA total of 190 eyes of 95 glaucoma patients with asymmetric axial length were included in the study. The patients’ mean age was 51.2 ± 12.3 years, and the mean follow-up period was 10.1 ± 3.9 years. There was no difference in the baseline intraocular pressure (IOP) or central corneal thickness (CCT) between longer eyes and shorter eyes. Among the baseline disc parameters, ovality index, beta-zone and gamma-zone parapapillary atrophy (PPA) area were larger in the longer eyes. In the baseline OCT data, the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness were thinner in the longer eyes. According to a baseline visual field (VF) test, the mean deviation (MD) and visual field index (VFI) values were significantly lower in the longer eyes. Based on an analysis of glaucoma progression, the rate of change of superior GCIPL (longer eyes : -0.65 μm/yr, shorter eyes : -0.40 μm/yr) , MD (longer eyes : -0.40 dB/yr, shorter eyes : -0.21 dB/yr) , and VFI (longer eyes : -0.92 %/yr, shorter eyes : -0.46 %/yr) were larger in the longer eyes. The greater the difference between the mean IOP and beta-zone PPA area between inter-eyes, the greater the difference in the rate of change of RNFL and GCIPL. Additionally, the greater the difference in IOP fluctuation, the greater the difference in the rate of change between MD and VFI. ConclusionsWhen there was an axial length difference of more than 1.0 mm, glaucoma tended to be more severe and to progress faster in the longer eyes. The inter-eye difference in glaucoma progression rate is related to both mean IOP and IOP fluctuation.

Clinical value of cognitive behavioral nursing model to patients with congenital glaucoma.

There have been studies on the use of cognitive behavioral nursing intervention (CBNI) but the main subjects were patients with secondary glaucoma and there are fewer studies on the care of congenital glaucoma. To explore the clinical value of cognitive behavioral nursing model in patients with congenital glaucoma. One hundred and fifty-three postoperative patients with congenital glaucoma treated in our hospital between January 2021 and December 2022 were prospectively selected for the study and randomly divided into a control group (n= 77) and an observation group (n= 76). The control group was given routine nursing, and the observation group was given cognitive behavioral nursing mode on the basis of the control group. Anxiety self-assessment scale (SAS), depression self-assessment scale (SDS), Connor-Davidson toughness scale, and treatment adherence evaluation scale were used to evaluate the psychological state, mental toughness, treatment adherence, treatment effect and nursing care satisfaction in the two groups before and after 2 weeks of intervention. The efficacy of the treatment was also assessed by determining the visual acuity (VA), intraocular pressure (IOP), and mean defective (MD) value of the visual field of the two groups of patients. After nursing, the SDS score (46.33 ± 6.16 versus 53.21 ± 5.94) and SAS score (44.41 ± 5.6 versus 52.82 ± 6.31) in the observation group were lower than those in the control group (P< 0.05). The scores of optimism (11.55 ± 1.90 versus 8.20 ± 1.95), self-improvement (22.05 ± 3.60 versus 17.60 ± 4.30), tenacity (37.45 ± 3.10 versus 28.90 ± 4.55) and total score (71.35 ± 8.00 versus 56.85 ± 8.50) in the observation group were higher than those in the control group (P< 0.05). After care, the VA of the observation group (0.95 ± 0.22) was greater than that of the control group (0.84 ± 0.16), and the IOP (14.25 ± 0.58 versus 15.89 ± 0.67) and the MD (5.42 ± 0.46 versus 6.68 ± 0.49) of the observation group were less than that of the control group. The difference between the two groups was statistically significant (P< 0.05). The compliance (96.05% versus 85.71%) and nursing satisfaction (96.10% versus 85.71%) of the observation group were higher than those of the control group (P< 0.05). Cognitive-behavioural nursing care for glaucoma patients can improve patients' mental toughness, improve visual acuity, reduce intraocular pressure and mean visual field defect values, and have a positive effect on enhancing patients' treatment adherence and nursing satisfaction.

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

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

Comparison of intraocular pressure profiles during the water drinking test and the modified diurnal tension curve

ObjectivesTo compare intraocular pressure (IOP) during the water drinking test (WDT) and modified diurnal tension curve (mDTC) in open-angle glaucoma (OAG) patients, using multimodal, observer-masked tonometry.MethodsOpen-angle glaucoma subjects were prospectively enroled, excluding those who had undergone glaucoma filtration or laser surgery. Two-hourly mDTC Goldmann applanation (GAT) and rebound tonometry (RT) was performed between 8:00 and 16:00, and every 15 min for 45 min after ingestion of 800mls of water. Blood pressure, heart rate, pupillometry measurements, and optical coherence tomography (AS-OCT) were also recorded.ResultsForty-two subjects’ right eyes were included. 48% were using topical glaucoma medication. Mean baseline IOP was 14.9 ± 4.52 mmHg, with mean visual field mean deviation (±SD) −5.05 ± 5.45 dB. Strong association was found between maximum IOP during mDTC and WDT (r = 0.90, 95% CI 0.82–0.95 p < 0.0001) with agreement (mDTC-WDT) bias −0.82 mmHg, 95% LoA −1.46 to −0.18. During the WDT, mean systolic blood pressure (±SD) increased from 140.0 ± 20.0 to 153.3 ± 24.0 mmHg (p < 0.0001), mean heart rate ( ± SD) reduced from 69.5 ± 11.3 bpm to 63.6 ± 10.0 bpm (p < 0.0001), and temporal iridocorneal angle increased from 29.2 ± 6.0° to 29.6 ± 5.2° (p = 0.04).ConclusionThis study presents repeated, observer-masked IOP data showing strong correlation between maximum IOP during mDTC and WDT using multimodal tonometry. This supports WDT as a meaningful alternative to mDTC when investigating diurnal IOP characteristics in clinic, with reduced time requirements and associated costs.

Peripapillary Atrophy Area as an Indicator of Glaucomatous Structural and Functional Progression.

To determine whether peripapillary atrophy (PPA) area is an indicator of glaucomatous structural and functional damage and progression. In this retrospective longitudinal analysis from ongoing prospective study we qualified 71 eyes (50 subjects) with glaucoma. All subjects had a comprehensive ophthalmic examination, visual field (VF), and spectral-domain optical coherence tomography (OCT) testing in at least three visits. PPA was manually delineated on en face OCT optic nerve head scans, while observing the corresponding cross-sectional images, as the hyper-reflective area contiguous with the optic disc. The mean follow-up duration was 4.4 ± 1.4years with an average of 6.8 ± 2.2 visits. At baseline, PPA area was significantly associated only with VF's mean deviation (MD; P = 0.041), visual field index (VFI; P = 0.041), superior ganglion cell inner plexiform layer (GCIPL; P = 0.011), and disc area (P = 0.011). Longitudinally, PPA area was negatively and significantly associated with MD (P = 0.015), VFI (P = 0.035), GCIPL (P = 0.009), superior GCIPL (P = 0.034), and disc area (P = 0.007, positive association). Longitudinal change in PPA area is an indicator of glaucomatous structural and functional progression but PPA area at baseline cannot predict future progression. Longitudinal changes in peripapillary atrophy area measured by OCT can be an indicator of structural and functional glaucoma progression.

Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

Background/aimWhile intraocular pressure (IOP) remains the only modifiable risk factor for glaucoma progression, the ultimate goal of glaucoma management is to preserve patients’ functional vision and quality of life. To...

A Noninvasive Clinical Method to Measure in Vivo Mechanical Strains of the Lamina Cribrosa by OCT

To measure mechanical strain of the lamina cribrosa (LC) after intraocular pressure (IOP) change produced 1 week after a change in glaucoma medication. Cohort study. Adult glaucoma patients (23 eyes, 15 patients) prescribed a change in IOP-lowering medication. Noninvasive OCT imaging of the eye. Deformation calculated by digital volume correlation of OCT scans of the LC before and after IOP lowering by medication. Among 23 eyes, 17 eyes of 12 persons had IOP lowering ≥ 3 mmHg (reduced IOP group) with tensile anterior-posterior Ezz strain= 1.0% ± 1.1% (P= 0.003) and compressive radial strain (Err)=-0.3% ± 0.5% (P= 0.012; random effects models accounting inclusion of both eyes in some persons). Maximum in-plane principal (tensile) strain and maximum shear strain in the reduced-IOP group were as follows: Emax= 1.7% ± 1.0% and Γmax= 1.4% ± 0.7%, respectively (both P < 0.0001 vs. zero). Reduced-IOP group strains Emax and Γmax were significantly larger with greater % IOP decrease (P < 0.0001 and P < 0.0001, respectively). The compliances of the Ezz, Emax, and Γmax strain responses, defined as strain normalized by the IOP decrease, were larger with more abnormal perimetric mean deviation or visual field index values (all P ≤ 0.02). Strains were unrelated to age (all P ≥ 0.088). In reduced-IOP eyes, mean LC anterior border posterior movement was only 2.05 μm posteriorly (P= 0.052) and not related to % IOP change (P= 0.94, random effects models). Only Err was significantly related to anterior lamina depth change, becoming more negative with greater posterior LC border change (P= 0.015). Lamina cribrosa mechanical strains can be effectively measured by changes in eye drop medication using OCT and are related to degree of visual function loss in glaucoma. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The impact of COVID‐19 on the wait times and severity of surgical glaucoma cases evaluated at a tertiary eye center

Aims/Purpose: COVID‐19 has caused shortages in health services worldwide. In Canada, this led to a relocation of medical staff, which paradoxically acted as potential barriers to access to care when considering the significant delays reported in elective surgeries. The purpose of this study was to assess the effect of pandemic related delays on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec, Canada.Methods: In this retrospective cohort study, 182 and 201 eyes of patients who underwent glaucoma surgery at Hôpital Saint‐Sacrement, Quebec City, between the periods of March 1 to June 30, 2019 (pre‐pandemic) and 2021 (pandemic), were included. Severity data included mean visual field deficit, intraocular pressure (IOP), number of drops, and preoperative best corrected visual acuity (BCVA). The times from referral to surgery (referral time) and from listing date to surgery (listing time) were calculated.Results: Visual field deficit was −11.6 ± 7.7 dB in 2019 versus −11.6 ± 7.5 dB in 2021 (p = 0.92). Mean preoperative IOP was 21.1 ± 9.70 mmHg in 2019 versus 20.0 ± 9.52 mmHg in 2021 (p = 0.25). The mean MAVC in the affected eye was 0.60 ± 0.72 LogMAR in 2019 versus 0.55 ± 0.73 LogMAR (p = 0.07). The mean number of preoperative drop classes was 3 ± 1 in both groups (p = 0.56). The mean number of patients referred with oral glaucoma medication increased from 45 to 70 in 2019 and 2021 respectively (p = 0.03). Time to consultation was 122 ± 120 days in 2019 versus 144 ± 136 days in 2021 (p = 0.17), whereas time to list was 48 ± 57 days in 2019 versus 38 ± 43 days in 2021 (p = 0.05).Conclusions: There were no statistically significant differences in the severity of surgical glaucoma cases operated on during the pandemic. Waiting list time decreased, possibly secondary to the prioritization of more urgent glaucoma cases over other ophthalmic surgeries. These reassuring data suggest that the barriers of the pandemic did not lead to a severe worsening of access to care for surgical glaucoma patients.ReferencesFelfeli, Tina et al. The ophthalmic surgical backlog associated with the COVID‐19 pandemic: a population‐based and microsimulation modelling study. CMAJ Open. vol.9 (4) 1063–1072. 23 Nov. 2021, https://doi.org/10.9778/cmajo.20210145

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.

Efficacy of Smoothing Algorithms to Enhance Detection of Visual Field Progression in Glaucoma

To evaluate and compare the effectiveness of nearest neighbor (NN)- and variational autoencoder (VAE)-smoothing algorithms to reduce variability and enhance the performance of glaucoma visual field (VF) progression models. Longitudinal cohort study. 7150 eyes (4232 patients), with ≥ 5 years of follow-up and ≥ 6 visits. Vsual fieldthresholds were smoothed with the NN and VAE algorithms. The mean total deviation (mTD) and VF index rates, pointwise linear regression (PLR), permutation of PLR (PoPLR), and the glaucoma rate index were applied to the unsmoothed and smoothed data. The proportion of progressing eyes and the conversion to progression were compared between the smoothed and unsmoothed data. A simulation series of noiseless VFs with various patterns of glaucoma damage was used to evaluate the specificity of the smoothing models. The mean values of age and follow-up time were 62.8 (standard deviation: 12.6) years and 10.4 (standard deviation: 4.7) years, respectively. The proportion of progression was significantly higher for the NN and VAE smoothed data compared with the unsmoothed data. VF progression occurred significantly earlier with both smoothed data compared with unsmoothed data based on mTD rates, PLR, and PoPLR methods. The ability to detect the progressing eyes was similar for the unsmoothed and smoothed data in the simulation data. Smoothing VF data with NN and VAE algorithms improves the signal-to-noise ratio for detection of change, results in earlier detection of VF progression, and could help monitor glaucoma progression more effectively in the clinical setting. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Usher Syndrome on the Island of Ireland: A Genotype-Phenotype Review.

Usher syndrome (USH) is a genetically heterogeneous group of autosomal recessive (AR) syndromic inherited retinal degenerations (IRDs) representing 50% of deaf-blindness. All subtypes include retinitis pigmentosa, sensorineural hearing loss, and vestibular abnormalities. Thorough phenotyping may facilitate genetic diagnosis and intervention. Here we report the clinical/genetic features of an Irish USH cohort. USH patients were selected from the Irish IRD registry (Target 5000). Patients were examined clinically (deep-phenotyping) and genetically using a 254 IRD-associated gene target capture sequencing panel, USH2A exon, and whole genome sequencing. The study identified 145 patients (24.1% USH1 [n = 35], 73.8% USH2 [n = 107], 1.4% USH3 [n = 2], and 0.7% USH4 [n = 1]). A genetic diagnosis was reached in 82.1%, the majority (80.7%) being MYO7A or USH2A genotypes. Mean visual acuity and visual field (VF) were 0.47 ± 0.58 LogMAR and 31.3° ± 32.8°, respectively, at a mean age of 43 years. Legal blindness criteria were met in 40.7%. Cataract was present in 77.4%. ADGRV1 genotypes had the most VF loss, whereas USH2A patients had greater myopia and CDH23 had the most astigmatism. Variants absent from gnomAD non-Finnish Europeans and ClinVar represented more than 20% of the variants identified and were detected in ADGRV1, ARSG, CDH23, MYO7A, and USH2A. USH is a genetically diverse group of AR IRDs that have a profound impact on affected individuals and their families. The prevalence and phenotype/genotype characteristics of USH in Ireland have, as yet, gone unreported. Understanding the genotype of Irish USH patients may guide clinical and genetic characterization facilitating access to existing/novel therapeutics.

Comparison of perimetric 24-2 and 30-2 test patterns in detecting visual field defects in patients with tumours in the pituitary region.

Automated perimetry provides a standardized method of measuring the visual field. The Humphrey Field Analyser (HFA) uses the 24-2 test pattern to cover 24 degrees centrally or the 30-2 test pattern to cover a slightly broader region of 30 degrees. The aim of this study was to determine whether the 24-2 test pattern provides comparable information to the 30-2 test pattern in detecting visual field defects in patients with tumours in the pituitary region. A retrospective cohort study was carried out on patients with tumours in the pituitary region and radiologically confirmed compression of the visual pathway. Included patients (79 of 133) had been examined using the Humphrey 30-2 visual field test, after which the 30-2 test patterns were reduced into corresponding 24-2 test patterns. The location of visual field defects, visual acuity and the perimetric parameters mean deviation (MD) and visual field index (VFI) were also recorded. No patient was classified differently when evaluated with the 24-2 test pattern, compared to the 30-2 test pattern. Interestingly, although the majority of patients had visual field defects located in the temporal visual field of each eye, a significant minority did not. In addition, it was found that a large proportion of patients had normal visual acuity (≥0.8). The use of the HFA 24-2 test pattern reliably detected visual field defects in patients with tumours in the pituitary region. The present study indicates that MD and VFI are not reliable parameters for evaluating visual field defects due to compression.

Influence of Refractive Error on Circumpapillary Structure-function vs. Vessel Density-function Relationships in Open-angle Glaucoma.

In Japanese OAG eyes correlation of 30-degree visual field MD and VFI with circumpapillary vessel density is systematically stronger than that with circumpapillary RNFLT, and is preserved in myopia and high myopia. To investigate the influence of refractive error on the relationship between circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and circumpapillary vessel density (cpVD), respectively, and global visual field parameters in Japanese open-angle glaucoma (OAG) eyes. One eye of 81 Japanese OAG patients (spherical equivalent refractive error: +3.0 to -9.0 D) underwent 360-degree cpRNFLT and cpVD measurements with Cirrus HD 5000-AngioPlex optical coherence tomography and 30-2 Humphrey visual field testing for mean deviation [MD] and visual field index [VFI] within 1 month. Correlations were determined for the whole population and each refractive error subgroups, separately: emmetropia/hyperopia (n=24), mild (n=18), moderate (n=20), and high myopia (n=19). For the total population, significant strong to very strong correlations were found between MD, VFI, and both cpRNFLT and cpVD, respectively, with consistently higher r-values for cpVD (highest r-values: 0.532 for cpRNFLT, P<0.001; 0.722 for cpVD, P<0.001). Of the refractive subgroups, statistically significant correlations between cpRNFLT and the visual field parameters were maintained only in the hyperopia/emmetropia and moderate myopia groups. In contrast, statistically significant, strong to very strong correlations between cpVD and both MD and VFI, always exceeding the corresponding r-values found for cpRNFLT were found in all refractive subgroups, with r-values ranging between 0.548 (P=0.005) and 0.841 (P<0.001). Our results suggest that in Japanese OAG eyes the relationship of MD and VFI with cpVD is strong. It is systematically stronger than that with cpRNFLT, and preserved in each conventional refractive error category including high myopia.

Microvascular quantitative metrics in retinitis pigmentosa using optical coherence tomography angiography

AimsTo describe the changes in vessel density (VD) using optical coherence tomography angiography (OCTA) of the different sectors in the macular area between retinitis pigmentosa (RP) patients and controls. MethodsObservational case-control study. We initially included 22 patients with RP and 21 controls. We obtained 6 × 6 OCTA images of the macular area using Angio-OCT SS-DRI-Triton 1.22 (Topcon, Japan), together with visual acuity, biomicroscopy, visual field and optical coherence tomography examination. We compared the VD values in both groups for both superficial (SVP) and deep vascular plexus (DVP). Correlation between VD and macular thickness was also calculated. ResultsThe mean visual field index (VFI) in the RP group was 26.11% (±17.29). VD was significantly lower in the RP group compared with healthy controls in all sectors of the DVP (Superior 43.48 ± 3.79 vs 48.86 ± 2.62, P < .0001; Nasal 40,52 ± 4.30 vs 46,01 ± 3.23, P = .0002; Inferior 42.76 ± 5.26 vs 50.10 ± 3.36, P < .0001; Temporal 40.42 ± 4.46 vs 46.09 ± 2.91, P = .0001) and in all but nasal sector in the SVP (Superior 39.86 ± 4.46 vs 46.47 ± 2.61, P < .0001; Nasal 40.35 ± 4.56 vs 44.09 ± 2.87, P = .0067; Inferior 40.74 ± 4.61 vs 46.58 ± 3.26, P = .0002; Temporal 39.98 ± 5.07 vs 44.78 ± 3.28, P = .0024). Correlation between VD and macular thickness was positive and significant (RP: r = 0.59, P = .043; controls r = 0.51, P = .018). ConclusionsPatients with advanced forms of RP have less vessel density in the macular area than healthy subjects. These differences are present in all four quadrants in the DVP and three in the SVP.

Estudio de densidad vascular en pacientes con retinitis pigmentosa por medio de angiografía por tomografía de coherencia óptica

AimsTo describe the changes in vessel density (VD) using optical coherence tomography angiography (OCTA) of the different sectors in the macular area between retinitis pigmentosa (RP) patients and controls. MethodsObservational case-control study. We initially included 22 patients with RP and 21 controls. We obtained 6x6 OCTA images of the macular area using Angio-OCT SS-DRI-Triton 1.22 (Topcon, Japan), together with visual acuity, biomicroscopy, visual field and optical coherence tomography examination. We compared the VD values in both groups for both superficial (SVP) and deep vascular plexus (DVP). Correlation between VD and macular thickness was also calculated. ResultsThe mean visual field index (VFI) in the RP group was 26.11% (±17.29). VD was significantly lower in the RP group compared with healthy controls in all sectors of the DVP (Superior 43.48±3.79 vs 48.86±2.62, P<.0001; Nasal 40,52±4.30 vs 46,01±3.23, P=.0002; Inferior 42.76±5.26 vs 50.10±3.36, P<.0001; Temporal 40.42±4.46 vs 46.09±2.91, P=.0001) and in all but nasal sector in the SVP (Superior 39.86±4.46 vs 46.47±2.61, P<.0001; Nasal 40.35±4.56 vs 44.09±2.87, P=.0067; Inferior 40.74±4.61 vs 46.58±3.26, P=.0002; Temporal 39.98±5.07 vs 44.78±3.28, P=.0024). Correlation between VD and macular thickness was positive and significant (RP: r=.59, P=.043; controls r=.51, P=.018). ConclusionsPatients with advanced forms of RP have less vessel density in the macular area than healthy subjects. These differences are present in all four quadrants in the DVP and three in the SVP.

Analysis of the influence of corneal properties and densitometry on applanation and rebound tonometry in primary open angle glaucoma

To evaluate the influence of corneal densitometry on portable applanation (Perkins) and rebound (iCare ic100 and PRO) tonometry. A secondary goal was to assess if there was a relationship between various corneal properties and the severity of primary open angle glaucoma (POAG). Seventy-five eyes of 75 patients with primary open angle glaucoma were studied, divided by severity into 3 groups: 25 mild, 25 moderate and 25 advanced. Intraocular pressure (IOP) was measured 3 times in each participant with a Perkins applanation tonometer (PAT), a handheld version of the Goldman applanation tonometer (GAT), an iCare PRO and an iCare ic100. Mean values were then calculated. Corneal topography with the Pentacam HR (Oculus, Wetzlar, Germany) was also performed in all individuals. Mean age and sex were comparable in all groups, as were densitometry values (P>0.05). The mean visual field defect (MD) was 2.85 (±1.23) dB in the mild glaucoma group, 8.26 (±1.90) dB in the moderate group and 15.66 (±3.46) dB in the advanced group. Three multivariate regression analyses were performed. The first and second calculations assessed the effect of IOP obtained with iCare ic100 and PAT as dependent variables with age, sex, CCT and mean keratometry (Km) within the glaucoma subgroups and the global sample. The third analysis was carried out to assess the relationship between corneal densitometry as the dependant variable and the aforementioned corneal parameters among the glaucoma groups. In the first multivariate regression analysis, a statistically significant correlation was found between ic100 rebound tonometry and CCT in the POAG global sample (coef. 0.117; IC [-0.21-(-0.01)]; P=0.025). No statistically significant correlation was found in the subgroup analyses. In the second multivariate analysis, no significant correlation was found between PAT and CCT, Km, age or sex (P>0.05). In the third analysis, densitometry was correlated with age in all glaucoma subgroups (P<0.001) and with CCT in the moderate glaucoma subgroup (coef. -0.037; IC [-0.67-(-0.01)]; P=0.021). Tonometry appeared to be minimally influenced by corneal densitometry, with a mild positive linear correlation seen (R=0.03). IOP values were similar with 3 of the tonometers: PAT 16.07 (±3.18) mmHg, PRO 16.27 (±3.42) mmHg and ic100 15.17 (±4.28) mmHg. There was, however, a significant underestimation of IOP with ic100 (-0.89mmHg) compared to PAT (P=0.007). Corneal densitometry did not show significant differences between glaucoma severity groups. A positive correlation was seen with CCT and both corneal densitometry and age. No correlation was found with keratometry or severity of glaucoma. The influence of corneal densitometry on IOP measurements appears weak, with little clinical relevance identified.

Effects of socioeconomic status on baseline values and outcomes at 24 months in the Treatment of Advanced Glaucoma Study randomised controlled Trial

Background/aimsSocioeconomic status (SES) is associated with late disease presentation and poorer outcomes. We evaluate the effect of SES on treatment outcomes and report the correlation between SES and baseline characteristics...