Reference Database for a Novel Binocular Visual Function Perimeter: A Randomized Clinical Trial

To evaluate menstrual cycle dependent changes on blue-on-yellow visual fields of diabetic women, and to compare the results with those of healthy women. Left eyes of 93 normally menstruating women were included in the study, comprising 45 with type-1 diabetes mellitus and severe non-proliferative diabetic retinopathy and 48 healthy controls. All subjects underwent baseline complete ocular examination and achromatic visual field analysis. Blue-on-yellow visual field tests (short-wavelength automated perimetry) were performed in both follicular (days 7-10 of the cycle) and luteal phases (days 3-6 before the bleeding) of two consecutive menstrual cycles. Visual field analyses were performed using Humphrey Field Analyser II with full threshold, central 30-2 program. Visual fields were divided into four regions: superior temporal, inferior temporal, superior nasal and inferior nasal. Visual field mean sensitivity (MS) was calculated for all regions separately. The mean ages of diabetic and control subjects were not significantly different (P > 0.05). Mean MS values of the diabetic group were significantly lower than that of the control group (P < 0.05). Control subjects did not demonstrate any menstrual cycle dependent changes in MS values (P > 0.05). However, diabetic women demonstrated a significant decrease in MS values in the luteal phase (P < 0.05). The decrease in MS was most marked in the nasal visual field (P < 0.05). Young diabetic women demonstrated a significant depression in visual field threshold sensitivity in the luteal phase of the menstrual cycle. Nasal visual fields are more prone to have menstrual cycle dependent threshold sensitivity depression. This should be taken into consideration in the clinical assessment of women with advanced diabetes who are at risk of glaucomatous optic neuropathy.

Purpose To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke. Method The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure. Results The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = −.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R 2 = .76). Conclusions The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATION Motorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand). Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand. Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Objective To evaluate the characteristics of and the association between the optical coherence tomography (OCT) results and visual field index for acute central serous chorioretinopathy (CSC).Methods Thirty patients (30 eyes) suffering acute CSC were selected randomly and fellow eyes were as normal control group.Optical coherence tomography (OCT) examination and visual field test were applied to each group:OCT for retinal macular thickness and Humphrey-750i automated perimeter for the mean sensitivity (MS),mean deviation (MD) as well as foveal sensitivity of macular (10°).The relationship between the results of macular morphology and function were analyzed by SPSS.Results The OCT scan showed that the comparison of the average retinal thickness in the central lmm diameter area,the average thickness of macula central fovea for 3mm paracentral and the average retinal thickness in the macula central fovea of 5mm pericentral between affected and fellow eyes had statistical significance (P ＜0.05).The visual field test showed that the comparison of the MS,MD and foveal sensitivity between affected and fellow eyes had statistical significance (P ＜0.05).The average retinal thickness in the central l mm diameter area affected eyes was associated with the negativeness of central light sensitivity (r =-0.546,P =0.002),and the average thickness of macula central fovea for 3mm paracentral was associated with the negativeness of MS (r =-0.631,P =0.000),also associated with the negativeness of MD (r =-0.493,P =0.007).In cross-sectional images of OCT,it can be clearly demonstrated that the morphological changes of the localized serous neuroepithelial detachment with or without the pigment epithelium detachment at macular area; visual field provides round or oval central scotoma for macular (10°) of CSC patients.Conclusions The association of OCT and visual field develops a more comprehensive evaluation for the transitions of relevant functions in structure and micro-structure changes of CSC,also can provide a better perception of changes in morphological and visual functions of acute CSC eyes. Key words: Central serous chorioretinopathy; Optical coherence tomography; Visual field

Commentary: Rethinking 10-2 visual fields in early diagnosis of glaucoma for a glided glaucoma practice: The right choice to pick up a feeble noise?

To compare rates of change between binocular and monocular visual fields. The study included 1264 visual fields from 62 normal-tension glaucoma patients with a minimum of nine pairs of visual fields for at least 5 years of follow-up. Integrated binocular visual fields (BVFs) were calculated from the two monocular visual fields using a binocular summation. Linear regression of mean deviation (MD) values was used to evaluate the rates of change of the BVFs and monocular visual fields. For each patient, the eye with the worse MD value at baseline was defined as the worse MD eye. The eye with the faster rate of change of monocular visual fields was defined as the faster-changing eye. The mean age of subjects was 61.8 years at baseline, the mean number of paired visual field tests was 10.2, and the mean follow-up was 8.1 years. The mean rate of change in the BVFs (-0.10 dB/y) was significantly slower than that of the faster-changing eyes (-0.34 dB/y) and faster than that of the slower-changing eyes (-0.06 dB/y; P < 0.001 for both comparisons). Forty-five eyes (64.5%) among the worse MD eyes at baseline were identified as faster-changing eyes at last follow-up, and having a worse MD value at baseline was a risk factor for being the faster-changing eye (P = 0.025). The rate of change in BVFs was intermediate between the rates of the faster-changing and slower-changing eyes.

Patterns of Binocular Visual Field Loss Derived from Large-Scale Patient Data from Glaucoma Clinics

To evaluate the presence, duration and magnitude of a learning effect in serial visual field (VF) testing, using the commercially available frequency doubling technology (FDT) instrument. 21 healthy adults with no prior VF experience underwent 6 serial VF tests, using the full-threshold C-20 program of the Zeiss-Humphrey FDT analyzer, on one randomly chosen eye. Tests were spaced at least two days apart. The average mean sensitivity was 32.37 +/- 2.6 dB; the average mean deviation (MD) was 1.22 +/- 1.8 dB. The MD at the first examination (0.28 +/- 2.1 dB) was significantly poorer than at any of the other testing sessions (p<0.003). Similarly, the mean sensitivity at the first examination (31.16 +/- 3.0 dB) was significantly lower than any other testing session (p<0.004). The proportion of improvement from the first to the second session was 63% and 65% of the total improvement, for mean sensitivity and MD, respectively. Mean test duration showed a modest reduction, from 4.40 +/- 0.3 minutes in the first session to 4.17 +/- 0.4 minutes in the last session (p = 0.023). A sub-analysis comparison of the different VF segments showed a more prominent learning effect in the peripheral and nasal visual segments (p<0.0001). Baseline measurements should best rely on the second testing session, since MD and mean sensitivity are somewhat poorer when subjects with no prior VF experience are first tested on the FDT instrument. This may be especially true for the purpose of following patients over time.

Combined average visual field index (VFI) is a simple, novel tool for binocular visual field which agrees with the existing binocular integrated visual field (IVF) model, as well as patient reported activity limitation in glaucoma. The aim was to determine the correlation between novel models of binocular visual field with the existing IVF and glaucoma activity limitation (GAL-9). IVFs were calculated from the monocular visual fields of 58 patients with primary glaucoma and the novel binocular visual field models termed binocular summation visual field index (BiSumVFI) and combined average visual field index (CaVFI) were derived from the VFIs of both fields. GAL-9 questionnaire was administered to the patients. The relationship between IVF and the 2 newer models of binocular fields were determined and the correlation of IVF, BiSumVFI, and CaVFI with GAL-9 was estimated. A very strong correlation was seen between IVF and BiSumVFI (r=-0.913, P<0.001, confidence interval: -0.958 to -0.821) and also between IVF and CaVFI (r=-0.896, P<0.001, confidence interval: -0.947 to -0.802). Linear regression analysis showed a significant R2 of 0.902 (P<0.001) to predict IVF from BiSumVFI and R2 of 0.847 (P<0.001) to predict IVF from CaVFI. IVF, BiSumVFI, and CaVFI correlated moderately and significantly with GAL-9 with correlation coefficients of 0.481, -0.499, and -0.505, respectively. The binocular summation VFI and combined average VFI models of binocular visual field are good predictors of IVF in glaucoma. They correlate well with the existing IVF model in estimating patients' perception of activity limitation in glaucoma.

The standard automated perimetry (SAP) 24-2 test cannot adequately test the paracentral region because test points are located sparsely in macular area where is crowded with retinal ganglion cells (RGCs), even though paracentral scotoma is clinically related to a risk of losing visual function. More sensitive visual field (VF) tests are needed to assess paracentral VF defects precisely. We investigated the structure–function relationship on the SAP 10-2 test and the frequency doubling technology (FDT) 24-2 test as well as the SAP 24-2 test in glaucoma with parafoveal scotoma (PFS). Glaucoma patients with PFS (134 patients) were included in this cross-sectional study. Sub-analysis was performed with isolated PFS (51 patients). Global and sectoral mean sensitivities (MS) were evaluated using SAP 24-2, 10-2, and FDT 24-2 program. MS was analyzed as dB or unlogged 1/lambert (SAP) or 1/Michelson contrast (FDT). Ganglion cell-inner plexiform layer (GCIPL) thickness was measured using spectral domain optical coherence tomography. Topographic relationships between the structure and the function were analyzed. In the total PFS group, good structure–function correlations were found in all zones with SAP 24-2, 10-2, and FDT 24-2 test. For glaucoma with isolated PFS, average GCIPL thickness was significantly correlated with central cluster MS (dB) using the SAP 10-2 test (r = 0.279, P = .047) and the FDT 24-2 test (r = 0.289, P = .039), but not the SAP 24-2 test (r = 0.264, P = .061). Topographically, the FDT 24-2 test showed significant correlations in all sectors between sectoral MS and corresponding GCIPL thickness. With regard to the SAP 10-2 test, there was significant topographical structure–function correlations for the superotemporal, inferotemporal, and inferonasal sectors. For SAP 24-2, only inferonasal GCIPL thickness was correlated with the corresponding VF sensitivity. Topographical structure–function on the macula was better with the SAP 10-2 test (superotemporal sector) and the FDT 24-2 test (superotemporal sector) than with the SAP 24-2 test in glaucoma with isolated PFS. In conclusion, FDT 24-2 and SAP 10-2 tests performed more favorably than the SAP 24-2 test in the structure–function relationship of glaucoma patients with isolated paracentral scotoma. FDT 24-2 tests can be another good option for detecting and monitoring RGC loss on the macular area while not missing VF defects outside the central 10°.

目的 研究准分子激光原位角膜磨镶术(laser in situkemtomileusis,LASIK)对患者视野的影响.方法 用Octo-pusl01全自动视野计G2程序的TOP/BY分程序对LASIK手术的近视患者于术前、术后6个月行视野检查.结果 术后视野的平均敏感度(mean sensitivity,MS)与术前比较,差异无显著性(P＞0.05).术后视野的指数平均缺损(mean defeet,MD)与术前比较,差异有显著性(P＜0.01).手术前、手术后视力与手术前后各自视野MS、MD均无显著相关性(P＞0.05).手术前后MS和MD平均差值与术前屈光度数、角膜切削百分比、激光切削时间、负压吸引时间、瞳孔直径、年龄、性别等行Spearman相关分析显示均无相关性(P＞0.05).结论 手术对视网膜和视神经结构和功能影响还不足以导致临床上明显的功能损伤,没有表现出有临床意义的功能改变.LASIK手术前后视野无明显变化,蓝/黄视野计与标准白色视野计检测的视野结果一致,说明两者检测敏感性相当。

Purpose: To evaluate the accuracy of confrontation visual field testing with regard to the density of the visual field defect and its location in the peripheral visual field. Methods: A prospective comparison of confrontation visual field testing with fullthreshold Humphrey automated static perimetry C24-2 or C30-2 was conducted at a university eye center over a 3-month period. Seventy-two patients with a variety of neurologic and ophthalmologic conditions underwent confrontation visual field testing and automated perimetry as a part of their evaluation. One visual field from each patient was analyzed for this study. Results: Confrontation visual field testing yielded an overall sensitivity for detecting an abnormal visual field (full-field analysis) of 63%, when sensitivity of confrontation testing rested on the detection of just one abnormal quadrant. The sensitivity of confrontation testing varied depending on the type of visual field loss present: 51 % for arcuate scotomas, 67% for visual field constriction, 78% for attitudinal scotomas, and 90% for hemianopias. The sensitivity of detecting abnormal visual field quadrants, rather than the full-field analysis, was, however, poor at 38%. The sensitivity of confrontation testing was lower for superior quadrant defects and higher for inferior quadrant defects. The estimated probability of detecting an abnormal visual field quadrant occurring at a —26-decibel sensitivity loss from age-matched healthy patients for superior quadrant defects and a —19-decibel sensitivity loss for inferior quadrant defects was 50%. The increased sensitivity noted for visual field defects and for inferior quadrant defects appears to be related, in part, to the density of the visual field loss present. Conclusion: Confrontation visual field testing is relatively insensitive unless a moderate to dense defect is present, and as such is a poor screening test. However, when visual field defects are identified with confrontation visual field testing, the defects often are real as per the high specificity (97%)and high positive predictive value (96%).

Hemianopias can have a severe impact on functional ability and quality of life (QoL). Binocular visual field (VF) analysis is clinically more relevant to visual function than monocular VF. The aim is to analyze the binocular VF of patients with hemianopias and its association with the monocular VF and to assess the QoL of these patients through questionnaires specifically related to vision compared with healthy controls. The case-control study included patients with hemianopias and controls. Sex, age, general history, etiology, location of the lesion, and time since the lesion appeared were recorded. Monocular VF and Esterman binocular VF were performed. VF defect, mean defect (MD), and Esterman scores were recorded. Visual Activities Questionnaire (VAQ-33) and Visual Function Questionnaire (VFQ-25) questionnaires were administered. Twenty patients with hemianopia and 22 healthy controls were included. The Esterman score in homonymous hemianopia patients (n = 17) correlated with best eye MD (r = -0.62, P = 0.01), worst eye MD (r = -0.70, P = 0.002), and average MD (r = -0.68, P = 0.003). Compared with healthy control subjects, patients with homonymous hemianopia had significantly lower VFQ-25 score and in 10/12 subscales (all P < 0.001). VAQ-33 scores revealed lower overall and subscales scores with the exception of light/dark adaptation (P = 0.08). Correlations were found between monocular and binocular VF scores and general vision (r = -0.55), peripheral vision (on both questionnaires, r-range -0.75 to 0.47), VFQ-25 and VAQ-33 overall scores (r = -0.59, -0.49 and 0.50), and glare disability (r = 0.53 and 0.67). Hemianopic VF defects involve a major alteration in the patients' vision-related QoL.

To examine whether automated visual field (VF) testing may exert a short-term influence on subsequent intraocular pressure (IOP) measurement during the same visit. We reviewed patients with primary open-angle glaucoma whose most recent visit occurred at a major academic institution from July to December 2009 and who had 3 visits without intervening changes in glaucoma management within the previous 5 years. Exclusion criteria were patient admittance of nonadherence with medical therapy and documented difficulty of IOP measurement. One hundred nine right eyes from 109 patients were included. IOP obtained within 30 minutes after VF testing was compared with IOP from the previous and next visits without VF testing. Subgroup analyses included the role of reliability of VF test performance, surgical versus medical IOP control, and different topical medications. The average IOP measured after VF testing was 14.9 ± 4.7 mm Hg, higher than both the previous (13.7 ± 4.4 mm Hg, P < 0.001) and next visits without VF examination (13.8 ± 4.4 mm Hg, P < 0.001). A total of 22.9% of patients experienced a more than 20% increase of IOP. Eyes with surgical control had less IOP elevation than eyes with medical control (3.1% ± 15.9% vs. 11.7% ± 17.4%, P = 0.009). Users of β-blockers or α-2-agonists had less IOP elevation than eyes controlled with prostaglandins or carbonic anhydrase inhibitors (0.9% ± 15.1% vs. 9.0% ± 12.3%, P = 0.030). This retrospective study suggests that patients with primary open-angle glaucoma experience a small and transient increase in IOP after VF testing and that this effect may be lower after surgical pressure control.

Aim: To investigate which visual field testing strategy yields more reliable and tolerable field analysis in a normal pediatric population. Material and Methods: 68 healthy children aged 6–13 years with no ocular or systemic diseases were included in the study. One randomly selected eye of each child underwent standard achromatic visual field analysis using a Model 750 Humphrey Field Analyzer II (Carl Zeiss Meditec, Dublin, Calif., USA). We evaluated the reliability criteria (false negative, false positive and fixation loss scores) and the duration of the visual field tests performed by Fastpac (with stimulus sizes III and V, respectively) and SITA Fast with stimulus size III. Moreover, subjects underwent Goldmann perimetry testing with stimulus V. Ability to complete the perimetry tests was also scored. Perimetric analysis was stopped before the end if signs of fatigue appeared. Mean sensitivity, mean defect and pattern standard deviation were recorded for automated tests. Results: All subjects but 8 successfully completed each of four tests. The mean duration of the tests was 4.23, 5.46, 6.35 and 11.06 min for SITA Fast with stimulus size III, Fastpac with stimulus size V, Size III and Goldmann perimetry, respectively (p < 0.001). Both false-negative and false-positive test scores were found to be significantly lower for SITA Fast with stimulus size III compared to the other automated tests (p < 0.01). Children older than 8 years (n = 35) achieved significantly higher test reliability scores (p < 0.01). Conclusion: As early detection of structural and functional visual abnormalities may be of utmost importance in the pediatric population considering many potentially serious neurological and ocular problems met with, accurate and reproducible visual field testing is vital. To achieve this goal, visual field testing with SITA Fast algorithm seemed to be a promising strategy for a pediatric population in a typical clinical setting.

Assessment of the Reliability of Standard Automated Perimetry in Regions of Glaucomatous Damage