Motion automated perimetry identifies early glaucomatous field defects.

To evaluate the difference of the peripapillary atrophy between two eyes of unilateral visual field defect in each of patient with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). This study included 40 eyes with unilateral visual field defect in patients with POAG (20 cases) and NTG (20 cases). Color stereo optic disc photographs were morphometrically evaluated by a video camera and a computer system. The refractive range (spherical equivalent) of all these subjects was between -3.00D and +3.00D. The cup areas (CA) and cup/disc areas (CA/DA) in eyes with visual field defect were significantly larger than in eyes with normal visual field (CA: t=5.332, P<0.01; CA/DA: t=5.126, P<0.01). The alpha zone areas (alphaA) of PPA were significantly enlarged in visual field defect eyes compared with visual field normal eyes (t=3.02, P=0.0045), while there is no significant difference in beta-zone area (betaA) between two eyes. (S=13.5, P=0.426). The frequency of the PPA (alpha-zone and beta-zone) occurrence were also similar in both eyes. (alphaA: chi(2)=0.00, P=1.000; betaA: chi(2)=1.2857, P=0.2568). The results suggest that either beta-zone area or the presence of PPA is not closely correlated to the visual field defect in POAG and NTG patients with exclusion of moderate or high myopia.

To investigate the correlation between ocular pulse amplitude and visual field defects in patients with glaucoma, ocular hypertension, and glaucoma suspicion when measured with the Pascal Dynamic Contour Tonometer, and to verify if the ocular pulse amplitude is an independent predictor for visual field parameters. Seventy-seven eyes (42 patients) with glaucoma, ocular hypertension or glaucoma suspicion were examined. Ocular pulse amplitude was measured with the dynamic contour tonometer by one investigator masked to the visual field data. Visual fields were performed within three months of ocular pulse amplitude measurement by the Octopus or Humphrey Field Analyser, and were analysed with Peridata Software. Mean defect, pattern standard deviation ( radical Loss Variance) and regression analysis of those parameters (Trend Indices) were correlated with the ocular pulse amplitude for each eye. Forty-nine eyes had glaucoma, 14 had ocular hypertension, and 14 were glaucoma suspects. The mean follow-up was 46.5 (range 6-96) months. There was a significant correlation between OPA and MD and OPA and PSD, even after correction for IOP (and diagnostic group and eye): the estimated slope equals 2.68 (S.E. = 0.82, p = 0.003) and -0.86 (S.E. = 0.33, p = 0.014), respectively. There was even a weak correlation between OPA and the evolution of MD (dB/year). The slope estimate for OPA equals 0.070 (S.E. = 0.033), p = 0.037. However, after correction for IOP (and diagnostic group and eye), the strength of the relationship is reduced and the evidence disappears: the slope estimate for OPA now equals 0.039 (S.E. = 0.041), p = 0.34. There is no evidence for an association between OPA and the evolution of Trend-PSD. A small ocular pulse amplitude, as measured with a dynamic contour tonometer, is correlated with moderate to severe glaucomatous visual field loss and might be a risk factor for the development of glaucomatous visual field defects.

BackgroundExisting evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals. The following study compared the central visual field defects with the peripheral visual field defects in patients with suspect glaucoma and primary open-angle glaucoma (POAG) and investigated whether using the central visual field test alone could result in loss of clinically valuable information.MethodsIn this prospective observational study, 167 eyes from 89 patients with suspect glaucoma or POAG were first examined with static automated perimetry (SAP), followed by a peripheral visual field test on Octopus 900 perimeter (Haag-Streit, Koeniz, Switzerland). The peripheral visual field test was performed by “Auto Kinetic Perimetry” program, in which Goldmann III4e stimuli randomly moved along 16 vectors at a constant angular velocity of 5 deg/s.ResultsGlaucomatous peripheral visual field defects were seen in 18% of the eyes with a normal central visual field. In addition, 86% of glaucoma patients with moderate-to-severe central visual field defects had corresponding peripheral visual field defects in the form of localized or diffuse depression of the isopters. Furthermore, a moderate correlation was found between the central and peripheral visual fields. The median test duration was 71 s for the peripheral test and 803 s for the central test (p < 0.001).ConclusionsOur study demonstrated the diversity of glaucomatous visual field defects, as well as the possibility of losing the clinically valuable information due to focusing on the central visual field test alone. The peripheral kinetic perimetry is clinically feasible to complement the central static perimetry for a comprehensive assessment of visual function in glaucoma patients.

Introduction: Normal Tension Glaucoma (NTG) is a spectrum of primary open angle glaucoma, characterised by optic nerve head change in the form of glaucomatous cupping, visual field defects despite Intraocular Pressure (IOP) &lt;21 mmHg. Patients remain asymptomatic until significant visual field loss occurs. An early sign of NTG is Retinal Nerve Fiber layer (RNFL) thinning. Although IOP is within normal range, further reduction can slow the disease progression. Early diagnosis of NTG is challenging due to absence of raised intraocular pressure, thus structural evaluation by optic disc, RNFL and functional evaluation by visual field indices helps in earlier diagnosis and disease progression. Aim: The aim of this study was to assess the relationship of optic nerve head and RNFL changes with visual field findings in NTG patients. Materials and Methods: The present prospective, interventional, hospital based study included 40 eyes with NTG conducted at SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu, India and duration of study was one year and six months. Thorough history, ophthalmic examination was done which includes visual acuity, anterior and posterior segment, IOP, Central Corneal Thickness (CCT), visual fields and Optical coherence Tomography (OCT). Patients started on 0.2% brimonidine eye drops twice a day and progression was tracked by repeat visual fields six months later. Data was analysed using independent samples t test and correlation was assessed using Pearson’s rank correlation. Statistical Package for Social Sciences (SPSS) software version 26 was used for the statistical analysis. Results: Forty eyes were studied. Mean age was 49.75 years with majority males 15 (56%). Average IOP was 14.825 mmHg, Average CCT was 528.58 micrometres. Correlation between IOP and Average RNFL was statistically insignificant (p=0.857). CCT had weak positive correlation with average RNFL, which was not significant statistically (p=0.659). Average CDR was 0.61. Average RNFL thickness was 81.4 μm. CDR weakly correlated to RNFL thickness (r=-0.179: p=0.269) but strongly correlated to visual field indices (Average Mean Deviation (MD) r=+0.955: p&lt;0.00001). RNFL correlated with Mean Sensitivity (MS). Followup after six months showed that only two eyes (7%) had visual field progression and was changed to latanoprost 0.005% eye drops once daily. Conclusion: CCT and Diurnal IOP variation tests play an important role in diagnosis of NTG. Hypoperfusion might be an etiological factor in NTG. OCT aids in identifying RNFL thinning even before field defects. The progression of field defects in NTG was reduced by lowering IOP.

This study was designed to assess the correlation between flow velocity, the resistive index and visual field defects in patients with chronic open angle glaucoma in comparison with a nonglaucomatous control population. Color Doppler imaging was used to study flow velocity in the central retinal artery and short posterior ciliary arteries of 76 patients with chronic open angle glaucoma and 28 normal subjects. Velocity and resistive index were correlated with visual field abnormalities. The chronic open angle glaucoma patients showed a statistically significant lowering of the end diastolic velocity and a raised resistive index in all vessels studied. The end diastolic velocity of the central retinal arteries of glaucoma patients were significantly correlated with the Mean Deviation of the visual field (right eye, p = 0.0041; left eye, p = 0.0167). The glaucoma patients showed a statistically significant lowering of the end diastolic velocity and a raised resistive index in all vessels supplying those parts of the optic disc that corresponded to visual hemifield defects. Open angle glaucoma is associated with changes in central retinal and ciliary artery flow velocity and resistive index which suggest a compromised circulation in this region.

Objective To observe the changes in visual field defect before and after treatment in patients with acute solitary occipital lobe cerebral infarction. Methods From January 2017 to May 2019, 59 patients with hemianopsia who were diagnosed as acute occipital lobe cerebral infarction in Henan Provincial People's Hospital were selected. There were 35 males (59.3%) and 24 females (40.7%); aged from 50 to 72 years, with an average age of 62.86±6.10 years. There were 23 patients of right occipital cerebral infarction and 36 patients of left occipital cerebral infarction. Lesions involved 41 patients in the striated area, 8 patients involved the occipital pole, and 23 patients involved visual radiation. All patients underwent standard medical treatment. All patients underwent visual field examination before treatment, and modified rankin scale (mRS) was used to evaluate the level of visual disability after cerebral infarction. At 1, 3, and 6 months after treatment,54 patients underwent at least one visual field examination in outpatient or inpatient follow-up visits, and 5 patients were lost to follow-up; 49 patients received repeated mRS scores. The visual field defect and mRS score of patients before and after treatment were compared and analyzed. The improvement of visual field defect in the horizontal direction exceeding 10°or the vertical direction exceeding 15°was defined as improvement, otherwise it was defined as no improvement. According to the type of visual field defect, the patients were divided into two groups: complete homonymous hemianopia and incomplete homonymous hemianopia. The cumulative visual field improvement rate of the two groups of patients was calculated. An mRS score of 0 to 2 was defined as a good prognosis, and >2 was defined as a poor prognosis. Results Before treatment, of the 59 patients, 47 were complete homonymous hemianopsia and 12 were incomplete. Of the 47 patients with complete homonymous hemianopia, 26 patients had hemianopia on the right side of both eyes, 21 patients had hemianopia on the left side of both eyes; 32 patients with macular avoidance (72.3%). Among the 12 patients of incomplete homonymous hemianopia, 10 patients of quadrant blindness included 6 patients of upper quadrant and 4 patients of lower quadrant; 2 patients of partial isotropic hemianopia on one side. Of the 54 patients reviewed after treatment, the visual field improved at the last follow-up of 25 patients (46.3%), and there was no improvement in 29 patients (53.7%). The cumulative visual field improvement rate of 47 patients with complete hemianopia hemianopia before treatment was 37.2% (16/43). The cumulative visual field improvement rate of 11 patients with incomplete isotropic hemianopia before treatment was 81.8% (9/11). There was a statistically significant difference in cumulative visual field improvement between the two groups of patients (χ2 = 7.011, P<0.05). Before treatment, 59 patients had mRS scores of 1 to 2 points in 15 patients (25.4%), and 44 patients with 2 points or more (74.6%). Of the 49 patients reviewed after treatment, 28 (57.1%) had a good prognosis and 21(42.9%) had a poor prognosis. Conclusions The visual field defect of patients with homonymous hemianopsia after acute occipital infarction may be improved after treatment. The improvement mostly occurs within 1 m after treatment, and patients with incomplete homonymous hemianopsia have more significant improvements than those with complete homonymous hemianopsia. Key words: Occipital lobe; Cerebral infarction; Visual fields; Hemianopsia

To investigate the association between asymmetry of visual field (VF) defects and optic nerve head (ONH) blood flow in patients with glaucoma using laser speckle flowgraphy. In total, 170 eyes of 85 patients with primary open-angle glaucoma were included. Intraocular pressure, VF (Humphrey 24-2, SITA program), mean blur rate in the tissue area (MBR-T) of the ONH measured by laser speckle flowgraphy, axial length, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), disc area, cup/disc area ratio, and parapapillary atrophy (PPA) area was measured in each eye. The paired eyes were divided into better and worse eyes according to the mean deviation (MD) of VF, and intereye differences of various parameters (better MD eye minus worse MD eye) were examined. Factors associated with MD difference, MBR-T difference, or cpRNFLT difference were investigated. MD of the VF in better and worse eyes were -10.2±7.3 dB and -16.8±7.4 dB, respectively. In stepwise multiple regression analysis, MBR-T differences, cpRNFLT differences and sex (male) were significantly correlated with MD differences (β, 0.26, 0.21, 0.20; P=0.01, 0.04, 0.047, respectively). MD differences were significantly associated with MBR-T differences (β, 0.28; P=0.01). For cpRNFLT differences, differences in β-PPA area and MD differences were identified as significant factors (β, -0.26, 0.22; P=0.02, 0.04, respectively). Asymmetry of ONH blood flow is significantly associated with asymmetry of visual field defects in patients with glaucoma independently of cpRNFLT.

Glaucoma remains one of the leading causes of acquired blindness worldwide (Thylefors & Negrel, 1994; Quigley & Broman, 2006). Open-angle glaucoma (OAG) including primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG), is the most common type of glaucoma and is just a representative chronic disease such as hyptertension and diabetes mellitus (Schwartz & Quigley, 2008; Quigley, 2011). Because the ultimate goal of glaucoma treatment is to maintain long-term visual function, glaucomatous patients require essentially lifelong follow-up. Thus, we need an approach to glaucoma management that considers patients’ present visual functions as well as their future prognosis. The pathogenesis of glaucomatous optic neuropathy as well as the details of its long-term progression have not beeen clered yet. Many clinical trials have confirmed the importance of intraocular pressure (IOP) in the development and progression of OAG (Kass et al., 2002; Gordon et al, 2002; Heijl et al. 2002; 2003; Leske et al, 1999; 2003; Collaborative normaltension glaucoma study group, 1998; 2001; Anderson et al, 2003; The AGIS Investigators, 1994; 2000; Katz, 1999; Musch et al, 2009; Parrish et al, 2009; Chauhan et al, 2008). These studies have shown that lowering IOP reduces the risk of developing OAG and slows its progression. The aim of current glaucoma treatment approaches is to maintain patients’ visual function for as long as possible by reducing IOP. In addition to visual function, of course, we monitor patients’ IOP, optic discs, and retinal changes. Since preservation of visual fields is the final outcome in glaucoma management, ongoing evaluation of patients’ visual fields must be the most important activity in clinical practice. Recently, the morphological evaluation of optic disc cupping, retinal nerve fiber layer defects, and the retinal ganglion cell complex by imaging systems such as optical coherence tomography (OCT) has become popular (Wollstein et al, 2005; Tan O et al, 2009). After all these systems provide only the ability to reliably and safely detect or predict glaucoma progression beside monitering visual field and visual acuity (Hood & Kordon, 2007; Harwerth et al, 2010; Parrish et al, 2009). Standard automated perimetry (SAP) is used to examine and evaluate visual fields, but the technique is difficult to perform and have still has many problems. Furthermore, there is

Purpose. To evaluate the relationships among the optic nerve head (ONH) area, macular ganglion cell complex (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and visual field defects in patients with primary open angle glaucoma (POAG). Methods. This retrospective study included 90 eyes of 90 patients with POAG. The ONH area, rim area, mGCC thickness, and cpRNFL thickness were measured using optical coherence tomography. Mean deviation (MD) was measured using standard automated perimetry. The relationships among clinical factors including age, refraction, the ONH area, the rim area, the mGCC thickness, the cpRNFL thickness, and MD were evaluated using correlation coefficients and multiple regression analyses. Results. The significant correlation of the ONH area with refraction (r = 0.362, P < 0.001), the mGCC thickness (r = 0.225, P = 0.033), and the cpRNFL thickness (r = 0.253, P = 0.016) was found. Multiple regression analysis showed that the ONH area, rim area, and MD were selected as significant contributing factors to explain the mGCC thickness and cpRNFL thickness. No factor was selected to explain MD. Conclusions. The ONH area, in other words, the disc size itself may affect the mGCC thickness and cpRNFL thickness in POAG patients.

Recent work using computerised perimetry has documented predictable visual field defects in patients with choroidal melanoma. Despite the higher frequency of occurrence of choroidal metastases, relatively little is known about their exact effects on visual performance, specifically with respect to visual field. This study is a pilot retrospective analysis of the results of automated perimetry testing in patients with choroidal metastatic disease. The Humphrey field analyser was used to perform visual field tests on 15 eyes in 11 patients diagnosed with choroidal metastases. All 11 primary tumours were carcinomas originating in the breast (seven), lung (one), kidney (one), stomach (one), and prostate (one). All patients had either central 30 and/or peripheral 30-60 threshold strategies. Each of the 15 eyes tested had a demonstrable visual field defect. Eight eyes (53%) had absolute scotomas and seven (43%) had relative scotomas; the defects did not consistently correspond in size or location to the tumour as depicted by ophthalmoscopy or ultrasonography. This is in contradistinction to automated perimetry results in patients with choroidal melanoma. Three of the four eyes (75%) which were retested after treatment of the metastases showed improvement of the visual field. Seven of nine eyes (77%) that initially had reduced visual acuity had improvement after treatment. This clinical improvement corresponded well to tumour shrinkage and resolution of subretinal fluid. These findings may be useful in the decision to initiate treatment for symptomatic choroidal metastatic disease and in explaining to patients and their referring physicians what improvement could be expected from such treatment. A prospective evaluation of patients with choroidal metastases seems appropriate based on this pilot experience and may elucidate if the differences noted between visual field performance of these patients and those with choroidal melanoma may be useful in some diagnostically difficult cases.

Association of CAV1/CAV2 Genomic Variants with Primary Open-Angle Glaucoma Overall and by Gender and Pattern of Visual Field Loss

Background/aimsTo determine the accuracy of an innovative paper-based, low-cost, easily accessed, portable method of evaluating the visual field (VF).MethodsTwo groups of consecutive patients with glaucoma and controls were enrolled. Both...

The use of MRI-tractography to explore the human neuroretina is yet to be reported. Track-weighted imaging (TWI) was recently introduced as a qualitative tractography-based method with high anatomical contrast. To explore the human retina in healthy volunteers and patients with anterior ischemic optic neuropathy (AION) using TWI reconstructions. Prospective. Twenty AION patients compared with 20 healthy volunteers. 3.0T MRI diffusion-weighted imaging (DWI) with b-value of 1000 s/mm2 and 60 diffusion-weighting noncollinear directions. We performed constrained spherical deconvolution from the diffusion-weighted signal and volumetric tractography method, whereby 10 million streamlines are initiated from seed points randomly distributed throughout the orbital area. We then reconstructed TWI maps with isotropic voxel size of 300 μm. We tested the effect of the number of diffusion-weighting directions, ocular laterality, and ocular dominance on healthy retinal fascicles distribution. We then performed factorial analysis of variance to test the effects of the presence/absence of the fascicles on the visual field defect in patients. In healthy volunteers, we found more temporal fascicle in right eyes (P = 0.001), more superior fascicles in dominant eyes (P = 0.014), and fewer fascicles with tractography maps based on 30 directions than those based on 45 directions (P = 9 × 10-8 ) and 60 directions (P = 6 × 10-7 ). Eight out of 20 AION patients presented with complete absence of neuroretinal fascicle, side of the disease, which was correlated with visual field mean deviation at the 6-month visit [F(1,17) = 6.97, P = 0.016]. Seven patients presented with a temporal fascicle in the injured eye; this fascicle presence was linked to visual field mean deviation at the 6-month visit [F(1,17) = 8.43, P = 0.009]. In AION patients, the presence of the temporal neuroretinal fascicle in the affected eye provides an objective outcome radiological sign correlated with visual performance. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

The incidence was determined of visual field defects in patients in the Prescription-Event Monitoring (PEM) study, treated for > or =6 months with the antiepileptic drug vigabatrin. Questionnaires were sent to the general practitioners of the 7228 patients in the PEM study, treated with vigabatrin for > or =6 months, to ascertain whether any serious adverse events, including changes in vision, had occurred. Ophthalmologists were asked to give the results of the perimetry tests and their opinion of the cause of the visual field defect for those patients referred to them. 6793 (94%) of the 7228 questionnaires were returned. 5090 (75%) contained clinical data. 328 patients were deceased. Seventy seven cases identified from the 4762 surviving patients, are being followed up with ophthalmologists. To date, 2 weeks after posting, 12 cases of visual field defect have been confirmed by formal perimetry tests. Ten of these 12 were considered to be probably or possibly related to vigabatrin use, giving an incidence of 2.0 per 1000 patients compared with 0.4 per 1000 patients in the original PEM cohort. These interim results show a substantial increase in the incidence of visual field defects associated with long term use of vigabatrin and demonstrate that PEM can be used to assess long latency adverse events.

BackgroundOpen-angle glaucoma is a common ophthalmic disease, which has a great impact on the vision of middle-aged and elderly people. Medication plays an important role in the treatment of glaucoma, so finding effective drug treatment is of great significance to improve the quality of life of glaucoma patients.ObjectiveTo explore the curative effect of nimodipine combined with latanoprost in the treatment of open-angle glaucoma and its effect on ocular hemodynamics and visual field defects.MethodsThis study retrospectively analyzed the clinical data of 87 patients with open-angle glaucoma who came to the Shanxi Province Fenyang Hospital and The First Affiliated Hospital of Shanxi Datong University for treatment from January 2019 to January 2021. According to different treatment plans, the patients were divided into two groups: an observation group (n = 46) treated with nimodipine combined with latanoprost, and a control group (n = 41) treated by latanoprost monotherapy. Treatment efficacy, hemodynamics, visual field defects, 24-hour peak intraocular pressure, binocular optic disc parameters, adverse reactions and quality of life were recorded and compared between two groups of patients.ResultsThe overall therapeutic effect of the observation group was significantly better than that in the control group. After treatment, ocular hemodynamics, visual field defects, 24-hour peak intraocular pressure, binocular optic disc parameters and life quality of both groups were obviously improved compared to those before treatment, with more significant improvements in the observation group. In addition, there was no significant difference in the incidence of adverse reactions between the two groups.ConclusionNimodipine combined with latanoprost eye drops is effective in the treatment of primary open-angle glaucoma, which could effectively improve the ocular hemodynamics and visual field defects of patients with fewer adverse reactions and higher safety. Therefore, it can be further promoted and used in clinical practice.