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Vrijling ACL, de Boer MJ, Renken RJ, Marsman JBC, Grillini A, Petrillo CE, Heutink J, Jansonius NM, Cornelissen FW. Stimulus contrast, pursuit mode, and age strongly influence tracking performance on a continuous visual tracking task. Vision Res 2023; 205:108188. [PMID: 36773370 DOI: 10.1016/j.visres.2023.108188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023]
Abstract
Human observers tend to naturally track moving stimuli. This tendency may be exploited towards an intuitive means of screening visual function as an impairment induced reduction in stimulus visibility will decrease tracking performance. Yet, to be able to detect subtle impairments, stimulus contrast is critical. If too high, the decrease in performance may remain undetected. Therefore, for this approach to become reliable and sensitive, we need a detailed understanding of how age, stimulus contrast, and the type of stimulus movement affect continuous tracking performance. To do so, we evaluated how well twenty younger and twenty older participants tracked a semi-randomly moving stimulus (Goldmann size III, 0.43 degrees of visual angle), presented at five contrast levels (5%-10%-20%-40%-80%). The stimulus could move smoothly only (smooth pursuit mode) or in alternation with displacements (saccadic pursuit mode). Additionally, we assessed static foveal and peripheral contrast thresholds. For all participants, tracking performance improved with increasing contrast in both pursuit modes. To reach threshold performance levels, older participants required about twice as much contrast (20% vs. 10% and 40% vs. 20% in smooth and saccadic modes respectively). Saccadic pursuit detection thresholds correlated significantly with static peripheral contrast thresholds (rho = 0.64). Smooth pursuit detection thresholds were uncorrelated with static foveal contrast thresholds (rho = 0.29). We conclude that continuous visual stimulus tracking is strongly affected by stimulus contrast, pursuit mode, and age. This provides essential insights that can be applied towards new and intuitive approaches of screening visual function.
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Affiliation(s)
- A C L Vrijling
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands.
| | - M J de Boer
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R J Renken
- Cognitive Neuroscience Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J B C Marsman
- Cognitive Neuroscience Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - J Heutink
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Huizen, the Netherlands; Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - N M Jansonius
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F W Cornelissen
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Thepass G, Lemij HG, Vermeer KA, van der Steen J, Pel JJM. Slowed Saccadic Reaction Times in Seemingly Normal Parts of Glaucomatous Visual Fields. Front Med (Lausanne) 2021; 8:679297. [PMID: 34513866 PMCID: PMC8426641 DOI: 10.3389/fmed.2021.679297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: In eye movement perimetry, peripheral stimuli are confirmed by goal-directed eye movements toward the stimulus. The saccadic reaction time (SRT) is regarded as an index of visual field responsiveness, whereas in standard automated perimetry (SAP), the visual field sensitivity is tested. We investigated the relation between visual field sensitivity and responsiveness in corresponding locations of the visual field in healthy controls and in patients with mild, moderate and advanced glaucoma. Materials and Methods: Thirty-four healthy control subjects and 42 glaucoma patients underwent a 54-point protocol in eye movement perimetry (EMP) and a 24-2 SITA standard protocol in a Humphrey Field Analyzer. The visual field points were stratified by total deviation sensitivity loss in SAP into 6 strata. A generalized linear mixed model was applied to determine the influence of the various factors. Results: The generalized linear mixed model showed that the mean SRT increased with increasing glaucoma severity, from 479 ms in the control eyes to 678 ms in the eyes of patients with advanced glaucoma (p < 0.001). Mean SRTs significantly increased with increasing SAP sensitivity loss. Even at the locations where no sensitivity loss was detected by SAP (total deviation values greater or equal than 0 dB), we found lengthened SRTs in mild, moderate and advanced glaucoma compared to healthy controls (p < 0.05) and in moderate and advanced glaucoma compared to mild glaucoma (p < 0.05). At locations with total deviation values between 0 and −3 dB, −3 and −6 dB and −6 and −12 dB, we found similar differences. Conclusions: The lengthened SRT in areas with normal retinal sensitivities in glaucomatous eyes, i.e., planning and execution of saccades to specific locations, precede altered sensory perception as assessed with SAP. Better understanding of altered sensory processing in glaucoma might allow earlier diagnosis of emerging glaucoma.
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Affiliation(s)
- Gijs Thepass
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, Netherlands
| | - Hans G Lemij
- Glaucoma Service, Rotterdam Eye Hospital, Rotterdam, Netherlands
| | | | - Johannes van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Royal Dutch Visio, Huizen, Netherlands
| | - Johan J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands
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Mazumdar D, Meethal NSK, George R, Pel JJM. Saccadic reaction time in mirror image sectors across horizontal meridian in eye movement perimetry. Sci Rep 2021; 11:2630. [PMID: 33514780 PMCID: PMC7846759 DOI: 10.1038/s41598-021-81762-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023] Open
Abstract
In eye movement perimetry (EMP), the saccadic reaction time (SRT) to ‘seen’ visual stimuli are delayed in glaucoma. Evaluating SRT behaviour in hemi-field sectors could refine its clinical implication. The development phase included 60 controls retrospectively and for the test cohort in evaluation phase, another 30 healthy subjects and 30 glaucoma patients were recruited prospectively. The SRTs were used to calculate the normative limits within 5 predefined hemi-field sectors. Scores were assigned to probabilities for SRT at the level of 5%, 2.5% 1% and 0.5%. Per sector pair, a probability score limit (PSL) was calculated at each of the four levels and were compared with the scores obtained from the test cohort. The classification accuracy ‘normal versus abnormal’ was assessed for PSL in EMP and compared with glaucoma hemi-field test in standard automated perimetry. We found no statistically significant differences in SRTs between the mirror sectors in healthy subjects. The PSL at 2.5% had moderate classification accuracy with a specificity of 77% and sensitivity 70%. This could be suggestive of an SRT delay in the overall visual field in glaucoma.
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Affiliation(s)
- Deepmala Mazumdar
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.,Medical and Vision Research Foundation, Chennai, India
| | - Najiya S Kadavath Meethal
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.,Medical and Vision Research Foundation, Chennai, India
| | - Ronnie George
- Medical and Vision Research Foundation, Chennai, India
| | - Johan J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands. .,Department of Neuroscience, Room EE 1453, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Visual Field Plots: A Comparison Study Between Standard Automated Perimetry and Eye Movement Perimetry. J Glaucoma 2020; 29:351-361. [PMID: 32108671 DOI: 10.1097/ijg.0000000000001477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PRéCIS:: This eye movement perimetry (EMP) study describes the development of saccadic reaction time (SRT)-based visual field plots, which could effectively display the presence, location, and extent of glaucomatous defects and support clinical decision-making. PURPOSE EMP is capable of discriminating normal from glaucomatous visual field defects on the basis of average delays in SRTs. To classify the presence and extent of age-corrected visual field defects, it is required to create SRT-based probability maps. AIM The aim of this study was to create visual field probability plots based on SRTs and to evaluate their clinical applicability by 2 glaucoma specialists. MATERIALS AND METHODS The development phase included 95 controls segregated into 5 age-bins to estimate normative limits of SRT. Next, for the testing phase, a set of 28 healthy subjects and 24 glaucoma patients were recruited who underwent standard automated perimetry (SAP) and EMP visual field testing. Fifty-two SAP and EMP plots were presented to 2 glaucoma specialists to classify them as normal or abnormal and to identify the defect location and pattern as 1 or more of 7 predefined categories. RESULTS The glaucoma specialists showed a sensitivity of 100% and a specificity of 93% and 96% for identifying normal versus abnormal visual field. For specialists 1 and 2, 85% and 92%, respectively, of EMP reports were assigned to the same category as SAP. The reports that did not agree with SAP were graded to a higher defect pattern. The intermethod agreement for specialists 1 and 2 was κ 0.92 and 0.96, respectively. CONCLUSION SRT-based visual field probability plots provided a comprehensive summary of an individual's visual field status and showed comparable clinical applicability to that of SAP plots.
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Doustkouhi SM, Turnbull PRK, Dakin SC. The Effect of Simulated Visual Field Loss on Optokinetic Nystagmus. Transl Vis Sci Technol 2020; 9:25. [PMID: 32742755 PMCID: PMC7354858 DOI: 10.1167/tvst.9.3.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Assessment of functional vision across the visual field is hampered by a reliance on patients' subjective judgement of the presence of a stimulus, and the accompanying demands (time and attention) this places on them. As a first step toward determining whether an objective measure of an involuntary eye movement (optokinetic nystagmus [OKN]) could provide an objective measure of field loss, we determined how various measures of OKN depend on the extent of simulated visual field loss (SVFL). Methods We used infrared eye-tracking to measure the eye movements of 16 healthy participants viewing horizontally translating 2-dimensional noise patterns over trials of varying contrasts and different levels of SVFL. We quantified the strength of OKN by estimating the velocity of tracking eye movements compared to the stimulus (OKN gain). These measurements were made using an open-loop SVFL paradigm, where a varying amount of gaze-contingent peripheral stimuli was occluded. Results Full-field stimulation led to an average OKN gain of 0.92 ± 0.15. This value fell steadily with increasing SVFL to a value of 0.38 ± 0.20 when the periphery was not stimulated at all (i.e., the stimulus was a 5-deg. diameter foveal patch). We note considerable individual variation in OKN gain in all conditions. Conclusions Measuring the extent of visual field loss using an objective measure of OKN gain is feasible. Translational Relevance Simulated visual field loss reduces optokinetic nystagmus, but further refinement of this technique would be required to overcome individual differences and to pick up clinically relevant field defects.
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Affiliation(s)
- Soheil M Doustkouhi
- School of Optometry & Vision Science, University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Philip R K Turnbull
- School of Optometry & Vision Science, University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Steven C Dakin
- School of Optometry & Vision Science, University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.,UCL Institute of Ophthalmology, University College London, London, UK
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Mazumdar D, Meethal NSK, Panday M, Asokan R, Thepass G, George RJ, van der Steen J, Pel JJM. Effect of Age, Sex, Stimulus Intensity, and Eccentricity on Saccadic Reaction Time in Eye Movement Perimetry. Transl Vis Sci Technol 2019; 8:13. [PMID: 31388465 PMCID: PMC6670042 DOI: 10.1167/tvst.8.4.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose In eye movement perimetry (EMP), the extent of the visual field is tested by assessing the saccades using an eye tracker. The aim of the present study was to determine the effects of age and sex of the subjects, the eccentricity and intensity of the peripheral stimuli on saccadic reaction time (SRT), and the interaction between these parameters in healthy participants. Methods Healthy participants aged between 20 to 70 years underwent a complete ophthalmic examination and an EMP test. SRT was determined from detected peripheral stimuli of four intensity levels. A multilevel mixed-model analysis was used to verify the influence of subject and stimulus characteristics on SRT within the tested visual field. Results Ninety-five subjects (mean age 43.0 [15.0] years) were included. Age, stimulus intensity, and eccentricity had a statistically significant effect on SRT, not sex. SRTs were significantly faster with increasing stimulus intensity and decreasing eccentricity (P < 0.001). At the lowest stimulus intensity of 192 cd/m2, a significant interaction was found between age and eccentricity. Conclusions The current study demonstrated significant SRT dependence across the visual field measured up to 27°, irrespective of sex. The presented SRT values may serve as a first normative guide for EMP. Translational Relevance This report of SRT interaction can aid in refining its use as a measure of visual field responsiveness.
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Affiliation(s)
- Deepmala Mazumdar
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, the Netherlands.,Medical and Vision Research Foundation, Chennai, India
| | - Najiya S Kadavath Meethal
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, the Netherlands.,Medical and Vision Research Foundation, Chennai, India
| | - Manish Panday
- Medical and Vision Research Foundation, Chennai, India
| | - Rashima Asokan
- Medical and Vision Research Foundation, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Gijs Thepass
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, the Netherlands
| | | | - Johannes van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, the Netherlands.,Royal Dutch Visio, Huizen, the Netherlands
| | - Johan J M Pel
- Medical and Vision Research Foundation, Chennai, India
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Meethal NSK, Pel JJM, Mazumdar D, Asokan R, Panday M, van der Steen J, George R. Eye Movement Perimetry and Frequency Doubling Perimetry: clinical performance and patient preference during glaucoma screening. Graefes Arch Clin Exp Ophthalmol 2019; 257:1277-1287. [PMID: 30944987 DOI: 10.1007/s00417-019-04311-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the screening accuracy of an Eye Movement Perimetry (EMP) in comparison with Frequency Doubling Perimetry (FDP) and to investigate the patient preference and perception towards these visual field screening methods. METHODS A total of 104 healthy subjects (mean age (SD) of 48 (14) years) and 73 glaucoma patients (mean age (SD) of 52 (13) years) were recruited. All the participants underwent a comprehensive ophthalmic evaluation including the 24-2 SITA standard protocol on the Humphrey Field Analyzer (HFA). This was followed by the 26-point protocol in EMP and the C-20-1 protocol in FDP. During EMP, all subjects were instructed to fixate a central target and to look at the detected peripheral target, followed by refixation of the central target and Saccadic Reaction Time (SRT) towards each of the "seen" stimuli was calculated. Next, a questionnaire was administered to evaluate the patient preference and perception towards the perimetry techniques. Mean SRTs and Robin scores were used to plot Receiver Operating Characteristics (ROC) curves to determine the screening accuracies. From the questionnaire survey, the frequency distributions of the responses were calculated. RESULTS Robin score and SRT were significantly increased in glaucoma patients in comparison with the age-matched healthy subjects (p < 0.001). The ROC analysis revealed comparable Area Under the Curve (AUC) values (0.95, p = 0.81) with a specificity of 95.2% for FDP and 96.2% for EMP with a sensitivity of 87.7%. Thirty-seven percent of the older age group (≥ 40 years) and 65% of severe glaucoma patients showed preference for EMP over FDP. CONCLUSIONS This study results indicate that the customized protocol in EMP provides efficient and rapid means of screening visual field defects in glaucoma, which compared well with FDP. Elderly healthy participants and patients with moderate and severe glaucomatous defects preferred EMP as it permitted natural reflexive eye movements thereby resembling a real-life test setting.
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Affiliation(s)
- Najiya Sundus Kadavath Meethal
- Department of Neuroscience, Vestibular and Ocular Motor Research Group, Erasmus MC, 2040, 3000, CA, Rotterdam, The Netherlands.,Medical and Vision Research Foundation, Chennai, India
| | - Johan J M Pel
- Department of Neuroscience, Vestibular and Ocular Motor Research Group, Erasmus MC, 2040, 3000, CA, Rotterdam, The Netherlands
| | - Deepmala Mazumdar
- Department of Neuroscience, Vestibular and Ocular Motor Research Group, Erasmus MC, 2040, 3000, CA, Rotterdam, The Netherlands.,Medical and Vision Research Foundation, Chennai, India
| | | | - Manish Panday
- Medical and Vision Research Foundation, Chennai, India
| | - Johannes van der Steen
- Department of Neuroscience, Vestibular and Ocular Motor Research Group, Erasmus MC, 2040, 3000, CA, Rotterdam, The Netherlands.,Royal Dutch Visio, Huizen, The Netherlands
| | - Ronnie George
- Medical and Vision Research Foundation, Chennai, India.
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