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Nascimento e Silva R, Kim JA, Li Y, Chen C, Chaudhry AF, Berneshawi AR, Zhang M, Villarreal A, Liu J, Shue A, Chang DS, Chang RT. Repeatability of a Virtual Reality Headset Perimeter in Glaucoma and Ocular Hypertensive Patients. Transl Vis Sci Technol 2024; 13:14. [PMID: 38899952 PMCID: PMC11193066 DOI: 10.1167/tvst.13.6.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/15/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose The VisuALL S is an automated, static threshold, virtual reality-based perimeter for mobile evaluation of the visual field. We examined same-day and 3-month repeatability. Methods Adult participants with a diagnosis of glaucoma or ocular hypertension underwent two VisuALL 24-2 Normal T- Full threshold strategy tests at baseline and one additional exam at 3 months for each eligible eye. Spearman, intraclass correlation coefficients (ICCs), and Bland-Altman plots were used to assess the correlation of individual point sensitivities and mean deviation (MD) among three tests. Results Eighty-eight eyes (44 participants) were included. Average age was 68.1 ± 14.3 years, and 60.7% were male. VisuALL MD was highly correlated between tests (intravisit: r = 0.89, intervisit: r = 0.82; P < 0.001 for both). Bland-Altman analysis showed an average difference in intravisit MD of -0.67 dB (95% confidence interval [CI], -6.04 to 4.71 dB) and -0.15 dB (95% CI, -8.04 to 7.73 dB) for intervisit exams. Eight-five percent of pointwise intravisit ICCs were above 0.75 (range, 0.63 to 0.93), and 65% of pointwise intervisit ICCs were above 0.75 (range, 0.55 to 0.91). Conclusions VisuALL demonstrated high correlation of MD between tests and good repeatability for individual point sensitivities among three tests in 3 months, except at the points around the blind spot and superiorly. Translational Relevance The preliminary reproducibility results for VisuALL are encouraging. Its portable design makes it a potentially useful tool for patients with glaucoma, enabling more frequent assessments both at home and in clinical settings.
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Affiliation(s)
| | | | - Yihao Li
- Genentech, Inc., South San Francisco, CA, USA
| | - Chen Chen
- Genentech, Inc., South San Francisco, CA, USA
| | - Anisa F. Chaudhry
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Miao Zhang
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Jocelyn Liu
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ann Shue
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dolly S. Chang
- Genentech, Inc., South San Francisco, CA, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Robert T. Chang
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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Phu J, Tan J, Kalloniatis M. Multiple (frontloaded) visual field tests increase identification of very slow mean deviation progression in glaucoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00246-6. [PMID: 37652089 DOI: 10.1016/j.jcjo.2023.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/29/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To determine the effect of frontloading (multiple) visual field (VF) tests at the same visit for detecting mean deviation (MD) change in slowly progressive glaucoma. METHODS This was a computer simulation study. Baseline MD (range, 0 to -12 dB) and progression rate (range, 0 to -0.4 dB/year, non-inclusive) were generated for 10,000 patients. Each patient had 6 simulated "stable" baseline VF tests. Then follow-up VFs (up to 10 years) were generated by incorporating progression rate and within-visit and between-visit variability. The independent variables were number of VF tests per visit (one non-frontloaded or two frontloaded), VF reliability (100%, 85%, or 70%), repeat testing because of unreliable results (yes or no), and follow-up interval (6-monthly or yearly). The outcomes were detection of progression (MD slope that was negative and significant at p < 0.05), MD at detection, and number of years to detection. RESULTS Frontloading identified more progressors (62.7%-79.2%) compared with non-frontloading (31.0%-36.7%) at 10 years (p < 0.0001). Six-monthly follow-ups led to greater detection than yearly intervals. Progressors detected by both methods were detected by the non-frontloaded method sooner (up to 0.26 years), but this was small and not clinically significant (MD difference, 0.06 dB). An increase (less severe) in MD, an increase (slower) in progression rate, and an increase in SD of baseline VFs decreased the likelihood of detecting progression. CONCLUSIONS Frontloading VF tests at 6-monthly intervals improve detection rates of MD progression in slowly progressive glaucoma patients compared with performing 1 test per visit at yearly intervals.
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Affiliation(s)
- Jack Phu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Centre for Eye Health, UNSW, Sydney, NSW, Australia.
| | - Jeremy Tan
- Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
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Phu J, Kalloniatis M. Gaze tracker parameters have little association with visual field metrics of intrasession frontloaded SITA-Faster 24-2 visual field results. Ophthalmic Physiol Opt 2022; 42:973-985. [PMID: 35598152 PMCID: PMC9542222 DOI: 10.1111/opo.13006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the usefulness of Humphrey Field Analyser (HFA) SITA-Faster 24-2 gaze tracker outputs on interpreting intra-visit visual field (VF) result pairs. METHODS Analysis of 1380 right-left eye pairs and 1432 pairs of test 1-test 2 intrasession VF results of patients seen within a university-based glaucoma service was undertaken to understand gaze deviation distributions. Output gaze tracker results were aggregated into total ticks, sum of amplitudes and average amplitudes. Correlations between visual field indices (mean deviation [MD], "events" and overall hill of vision) and independent variables (age and test order) were performed using one eye from each subject. RESULTS There was no association of test order (right-left, test 1-test 2) with eye movements. There was a significant, but weak correlation between eye movements and age (r = 0.16). Correlations of eye movements with MD were driven by more severe MD values. There were no significant correlations between intrasession difference in eye movements and the change in MD, number of "events" and hill of vision, or in the root mean square of sensitivity and total deviation values. There was also no significant correlation between gaze tracker outputs and another commonly used "reliability" metric, false positive rate. CONCLUSIONS Eye movement parameters as currently reported by the HFA do not appear to be correlated with key sensitivity parameters when considering the repeatability of intrasession SITA-Faster 24-2 VF results. Thus, current gaze tracker outputs do not appear to provide clinically meaningful information for interpretation of intra-visit visual field results that cannot already be garnered using other strategies.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
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Phu J, Kalloniatis M. The Frontloading Fields Study: The Impact of False Positives and Seeding Point Errors on Visual Field Reliability When Using SITA-Faster. Transl Vis Sci Technol 2022; 11:20. [PMID: 35142783 PMCID: PMC8842500 DOI: 10.1167/tvst.11.2.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of two conventional reliability criteria (false positives [FPs] and seeding point errors [SPEs]) and the concurrent effect of low sensitivity points (≤19 dB) on intrasession SITA-Faster visual field (VF) result correlations. Methods There were 2320 intrasession SITA-Faster VF results from 1160 eyes of healthy, glaucoma suspects, and subjects with glaucoma that were separated into “both reliable” or “reliable-unreliable” pairs. VF results (mean deviation and pointwise sensitivity) were analyzed against the spectrum of FP rates and SPE, with and without censorship of sensitivity results ≤19 dB. Segmental linear regression was used to identify critical points where visual field results were significantly different between tests due to FP levels. Results There was a significant, but small (0.09 dB per 1% exceeding 12%) increase in mean deviation, and an increase in the number of points showing a >3 dB sensitivity increase (0.25–0.28 locations per 1% exceeding 12%). SPEs were almost exclusively related to a decrease in sensitivity at the primary seeding points but did not result in significant differences in other indices. Censoring sensitivity results ≤19 dB significantly improved the correlation between reliable and unreliable results. Conclusions Current criteria for judging an unreliable VF result (FP rate >15% and SPE) can lead to data being erroneously excluded, as many results do not show significant differences compared to those deemed “reliable.” Censoring of sensitivity results ≤19 dB improves intrasession correlations in VF results. Translational Relevance We provide guidelines for assessing the impact of FP, SPE, and low sensitivity results on VF interpretation.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
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Phu J, Kalloniatis M. Viability of Performing Multiple 24-2 Visual Field Examinations at the Same Clinical Visit: The Frontloading Fields Study (FFS). Am J Ophthalmol 2021; 230:48-59. [PMID: 33951444 DOI: 10.1016/j.ajo.2021.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/17/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the viability, in terms of time taken for testing and repeatability, of frontloading (performing multiple perimetric examinations) in a single clinic visit. DESIGN Reliability enhancement analysis. METHODS A total of 329 healthy glaucoma suspect and glaucoma subjects within a glaucoma clinic undergoing perimetric testing using SITA-Faster twice for each eye within the same session were included. Global indices, pointwise sensitivity and probability scores, test duration, and reliability metrics were analysed. RESULTS For both tests 9.1% of right eye and 6.7% of left eye results were unreliable, with 58.4% and 67.5% of right and left eyes achieving reliable results, respectively; 83.8% of all subjects spent less than 20 minutes performing all tests. Differences in global indices, pointwise sensitivity and probability scores showed no systematic or clinically significant difference between tests one and two for each eye. There was also no systematic difference in the number of test locations identified as defective at the P < .05 level between tests. Test results that were unreliable tended to show more instances of a failed "cluster" criterion that were not repeatable. CONCLUSIONS Frontloading using SITA-Faster was viable for obtaining sets of reliable, repeatable perimetric data in terms of conventional outputs, overcoming practical issues regarding low test reliability using singleton results and confirmation of visual field defects. Despite the need to remain cognisant of the reliability of SITA-Faster, frontloading using this algorithm may be a practical method for meeting recommendations for multiple perimetric data required to make confident inferences about glaucoma state and progression.
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Xu P, Lesmes LA, Yu D, Lu ZL. Mapping the Contrast Sensitivity of the Visual Field With Bayesian Adaptive qVFM. Front Neurosci 2020; 14:665. [PMID: 32733188 PMCID: PMC7358309 DOI: 10.3389/fnins.2020.00665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Current clinical evaluation, which focuses on central vision, could be improved through characterization of residual vision with peripheral testing of visual acuity, contrast sensitivity, color vision, crowding, and reading speed. Assessing visual functions in addition to light sensitivity, a comprehensive visual field map (VFM) would be valuable for detecting and managing eye diseases. In a previous study, we developed a Bayesian adaptive qVFM method that combines a global module for preliminary assessment of the VFM's shape and a local module for assessment at individual retinal locations. The method was validated in measuring the light sensitivity VFM. In this study, we extended the qVFM method to measure contrast sensitivity across the visual field. In both simulations and psychophysics, we sampled 64 visual field locations (48 x 48 deg) and compared the qVFM method with a procedure that tested each retinal location independently (qFC; Lesmes et al., 2015). In each trial, subjects were required to identify a single optotype (size: 2.5 x 2.5 deg), one of 10 filtered Sloan letters. To compare the accuracy and precision of the two methods, three simulated eyes were tested in 1,280 trials with each method. In addition, data were collected from 10 eyes (5 OS, 5 OD) of five normal observers. For simulations, the average RMSE of the estimated contrast sensitivity with the qVFM and qFC methods were 0.057 and 0.100 after 320 trials, and 0.037 and 0.041 after 1,280 trials [all in log10 units, represent as log(sensitivity)], respectively. The average SD of the qVFM and qFC estimates were 0.054 and 0.096 after 320 trials, and 0.032 and 0.041 after 1,280 trials, respectively. The within-run variability (68.2% HWCIs) were comparable to the cross-run variability (SD). In the psychophysics experiment, the average HWCI of the estimated contrast sensitivity from the qVFM and qFC methods across the visual field decreased from 0.33 on the first trial to 0.072 and 0.16 after 160, and to 0.060 and 0.10 after 320 trials. The RMSE between the qVFM and qFC estimates started at 0.26, decreased to 0.12 after 160 and to 0.11 after 320 qVFM trials. The qVFM provides an accurate, precise, and efficient mapping of contrast sensitivity across the entire visual field. The method might find potential clinical applications in monitoring vision loss, evaluating therapeutic interventions, and developing effective rehabilitation for visual diseases.
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Affiliation(s)
- Pengjing Xu
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Luis A. Lesmes
- Adaptive Sensory Technology, Inc., San Diego, CA, United States
| | - Deyue Yu
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, United States
- NYU-ECNU Institute of Brain and Cognitive Science at NYU Shanghai, Shanghai, China
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Abstract
Measuring visual functions such as light and contrast sensitivity, visual acuity, reading speed, and crowding across retinal locations provides visual-field maps (VFMs) that are extremely valuable for detecting and managing eye diseases. Although mapping light sensitivity is a standard glaucoma test, the measurement is often noisy (Keltner et al., 2000). Mapping other visual functions is even more challenging. To improve the precision of light-sensitivity mapping and enable other VFM assessments, we developed a novel hybrid Bayesian adaptive testing framework, the qVFM method. The method combines a global module for preliminary assessment of the VFM's shape and a local module for assessing individual visual-field locations. This study validates the qVFM method in measuring light sensitivity across the visual field. In both simulation and psychophysics studies, we sampled 100 visual-field locations (60° × 60°) and compared the performance of qVFM with the qYN procedure (Lesmes et al., 2015) that measured light sensitivity at each location independently. In the simulations, a simulated observer was tested monocularly for 1,000 runs with 1,200 trials/run, to compare the accuracy and precision of the two methods. In the experiments, data were collected from 12 eyes (six left, six right) of six human subjects. Subjects were cued to report the presence or absence of a target stimulus, with the luminance and location of the target adaptively selected in each trial. Both simulations and a psychological experiment showed that the qVFM method can provide accurate, precise, and efficient mapping of light sensitivity. This method can be extended to map other visual functions, with potential clinical signals for monitoring vision loss, evaluating therapeutic interventions, and developing effective rehabilitation for low vision.
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Affiliation(s)
- Pengjing Xu
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | | | - Deyue Yu
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China.,Center for Neural Science and Department of Psychology, New York University, New York, NY, USA.,NYU-ECNU Institute of Cognitive Neuroscience at NYU Shanghai, Shanghai, China
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8
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Phu J, Khuu SK, Agar A, Kalloniatis M. Clinical Evaluation of Swedish Interactive Thresholding Algorithm-Faster Compared With Swedish Interactive Thresholding Algorithm-Standard in Normal Subjects, Glaucoma Suspects, and Patients With Glaucoma. Am J Ophthalmol 2019; 208:251-264. [PMID: 31470001 DOI: 10.1016/j.ajo.2019.08.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/06/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the visual fields results obtained using the Swedish interactive thresholding algorithm-Standard (SS) and the Swedish interactive thresholding algorithm-Faster (SFR) in normal subjects, glaucoma suspects, and patients with glaucoma and to quantify potential time-saving benefits of the SFR algorithm. DESIGN Prospective, cross-sectional study. METHODS One randomly selected eye from 364 patients (77 normal subjects, 178 glaucoma suspects, and 109 patients with glaucoma) seen in a single institution underwent testing using both SS and SFR on the Humphrey Field Analyzer. Cumulative test time using each algorithm was compared after accounting for different rates of test reliability. Pointwise and cluster analysis was performed to determine whether there were systematic differences between algorithms. RESULTS Using SFR had a greater rate of unreliable results (29.3%) compared with SS (7.7%, P < .0001). This was mainly because of high false positive rates and seeding point errors. However, modeled test times showed that using SFR could obtain a greater number of reliable results within a shorter period of time. SFR resulted in higher sensitivity values (on average 0.5 dB for patients with glaucoma) that was greater under conditions of field loss (<19 dB). Cluster analysis showed no systematic patterns of sensitivity differences between algorithms. CONCLUSIONS After accounting for different rates of test reliability, SFR can result in significant time savings compared with SS. Clinicians should be cognizant of false positive rates and seeding point errors as common sources of error for SFR. Results between algorithms are not directly interchangeable, especially if there is a visual field deficit <19 dB.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales.
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales
| | - Ashish Agar
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales; Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales
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Phu J, Kalloniatis M, Wang H, Khuu SK. Optimising the Structure-Function Relationship at the Locus of Deficit in Retinal Disease. Front Neurosci 2019; 13:306. [PMID: 31024235 PMCID: PMC6467237 DOI: 10.3389/fnins.2019.00306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Technologies such as optical coherence tomography have facilitated the visualization of anatomical tissues such as that of the retina. The availability of in vivo retinal anatomical data has led to the hypothesis that it may be able to accurately predict visual function from anatomical information. However, accurate determination of the structure-function relationship has remained elusive in part due to contributions of non-retinal sources of variability, thus imposing potential limitations in the fidelity of the relationship. Furthermore, differences in manifestation of functional loss due to different retinal loci of change (inner retina or outer retinal elements) have also been the subject of debate. Here, we assessed the application of a novel, more objective psychophysical paradigm to better characterize the relationship between functional and structural characteristics in the eye. Using ocular diseases with known loci of anatomical change (glaucoma, inner retinal loss; and retinitis pigmentosa, outer retinal loss), we compared conventional more subjective psychophysical techniques that may be contaminated by the presence of non-retinal sources of variability with our more objective approach. We show that stronger correlations between underlying retinal structure and visual function can be achieved across a breadth of anatomical change by using a more objective psychophysical paradigm. This was independent of the locus of structural loss (at the ganglion cells for glaucoma or photoreceptors for retinitis pigmentosa), highlighting the role of downstream retinal elements to serve as anatomical limiting factors for studying the structure-function relationship. By reducing the contribution of non-retinal sources of variability in psychophysical measurements, we herein provide a structure-function model with higher fidelity. This reinforces the need to carefully consider the psychophysical protocol when examining the structure-function relationship in sensory systems.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, NSW, Australia
| | - Henrietta Wang
- Centre for Eye Health, The University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Kensington, NSW, Australia
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Phu J, Kalloniatis M, Wang H, Khuu SK. Differences in Static and Kinetic Perimetry Results are Eliminated in Retinal Disease when Psychophysical Procedures are Equated. Transl Vis Sci Technol 2018; 7:22. [PMID: 30280007 PMCID: PMC6166892 DOI: 10.1167/tvst.7.5.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose We tested the hypothesis that clinical statokinetic dissociation (SKD, defined as the difference in sensitivity to static and kinetic stimuli) at the scotoma border in retinal disease is due to individual criterion bias and that SKD can be eliminated by equating the psychophysical procedures for testing static and kinetic stimulus detection. Methods Six subjects with glaucoma and six with retinitis pigmentosa (RP) were tested. Clinical procedures (standard automated perimetry [SAP] and manual kinetic perimetry [MKP]) were used to determine clinical SKD and the region of interest for laboratory-based testing. Two-way Method of Limits (MoL) was used to establish the isocontrast region at the scotoma border in glaucoma and RP subjects. Method of Constant Stimuli (MoCS) and a two-interval forced choice (2IFC) procedure then were used to present static or kinetic (inward or outward) stimuli at different eccentricities within the isocontrast region. The results were fitted with psychometric functions to determine threshold eccentricities. Results Clinical SKD was found in glaucoma and RP subjects, with variable magnitude among subjects, but significantly exceeding expected typical measurement variability. The resultant psychometric functions when using MoCS and 2IFC showed equal sensitivity to static and kinetic targets, thus eliminating SKD. Conclusions Clinical SKD found using clinical techniques is due to methodologic differences and criterion bias, and is eliminated by using an equated and more objective psychophysical task, similar to normal subjects. Translational relevance Eliminating SKD using a psychophysical approach minimizing criterion bias suggests that it is not useful to distinguish between normal and diseased fields.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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Barboni MTS, Szepessy Z, Ventura DF, Németh J. Individual Test Point Fluctuations of Macular Sensitivity in Healthy Eyes and Eyes With Age-Related Macular Degeneration Measured With Microperimetry. Transl Vis Sci Technol 2018; 7:25. [PMID: 29696099 PMCID: PMC5914506 DOI: 10.1167/tvst.7.2.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To establish fluctuation limits, it was considered that not only overall macular sensitivity but also fluctuations of individual test points in the macula might have clinical value. Methods Three repeated measurements of microperimetry were performed using the Standard Expert test of Macular Integrity Assessment (MAIA) in healthy subjects (N = 12, age = 23.8 ± 1.5 years old) and in patients with age-related macular degeneration (AMD) (N = 11, age = 68.5 ± 7.4 years old). A total of 37 macular points arranged in four concentric rings and in four quadrants were analyzed individually and in groups. Results The data show low fluctuation of macular sensitivity of individual test points in healthy subjects (average = 1.38 ± 0.28 dB) and AMD patients (average = 2.12 ± 0.60 dB). Lower sensitivity points are more related to higher fluctuation than to the distance from the central point. Fixation stability showed no effect on the sensitivity fluctuation. The 95th percentile of the standard deviations of healthy subjects was, on average, 2.7 dB, ranging from 1.2 to 4 dB, depending on the point tested. Conclusion Point analysis and regional analysis might be considered prior to evaluating macular sensitivity fluctuation in order to distinguish between normal variation and a clinical change. Translational Relevance Statistical methods were used to compare repeated microperimetry measurements and to establish fluctuation limits of the macular sensitivity. This analysis could add information regarding the integrity of different macular areas and provide new insights into fixation points prior to the biofeedback fixation training.
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Affiliation(s)
- Mirella Telles Salgueiro Barboni
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.,Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Brazil
| | - Zsuzsanna Szepessy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.,Bionic Innovation Center, Budapest, Hungary
| | - Dora Fix Ventura
- Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Brazil
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.,Bionic Innovation Center, Budapest, Hungary
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Phu J, Kalloniatis M, Khuu SK. Reducing Spatial Uncertainty Through Attentional Cueing Improves Contrast Sensitivity in Regions of the Visual Field With Glaucomatous Defects. Transl Vis Sci Technol 2018; 7:8. [PMID: 29600116 PMCID: PMC5868861 DOI: 10.1167/tvst.7.2.8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/21/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Current clinical perimetric test paradigms present stimuli randomly to various locations across the visual field (VF), inherently introducing spatial uncertainty, which reduces contrast sensitivity. In the present study, we determined the extent to which spatial uncertainty affects contrast sensitivity in glaucoma patients by minimizing spatial uncertainty through attentional cueing. Methods Six patients with open-angle glaucoma and six healthy subjects underwent laboratory-based psychophysical testing to measure contrast sensitivity at preselected locations at two eccentricities (9.5° and 17.5°) with two stimulus sizes (Goldmann sizes III and V) under different cueing conditions: 1, 2, 4, or 8 points verbally cued. Method of Constant Stimuli and a single-interval forced-choice procedure were used to generate frequency of seeing (FOS) curves at locations with and without VF defects. Results At locations with VF defects, cueing minimizes spatial uncertainty and improves sensitivity under all conditions. The effect of cueing was maximal when one point was cued, and rapidly diminished when more points were cued (no change to baseline with 8 points cued). The slope of the FOS curve steepened with reduced spatial uncertainty. Locations with normal sensitivity in glaucomatous eyes had similar performance to that of healthy subjects. There was a systematic increase in uncertainty with the depth of VF loss. Conclusions Sensitivity measurements across the VF are negatively affected by spatial uncertainty, which increases with greater VF loss. Minimizing uncertainty can improve sensitivity at locations of deficit. Translational Relevance Current perimetric techniques introduce spatial uncertainty and may therefore underestimate sensitivity in regions of VF loss.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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Hirooka K, Misaki K, Nitta E, Ukegawa K, Sato S, Tsujikawa A. Comparison of Macular Integrity Assessment (MAIA ™), MP-3, and the Humphrey Field Analyzer in the Evaluation of the Relationship between the Structure and Function of the Macula. PLoS One 2016; 11:e0151000. [PMID: 26974468 PMCID: PMC4790949 DOI: 10.1371/journal.pone.0151000] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/21/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose This study was conducted in order to compare relationships between the macular visual field (VF) mean sensitivity measured by MAIATM (Macular Integrity Assessment), MP-3, or Humphry field analyzer (HFA) and the ganglion cell and inner plexiform layer (GCA) thicknesses. Methods This cross-sectional study examined 73 glaucoma patients and 19 normal subjects. All subjects underwent measurements for GCA thickness by Cirrus HD-OCT and static threshold perimetry using MAIATM, MP-3, or HFA. VF and OCT in the retinal view were used to examine both the global relationship between the VF sensitivity and GCA thickness, and the superior hemiretina and inferior hemiretina. The relationship between the GCA thickness and macular sensitivity was examined by Spearman correlation analysis. Results For each instrument, statistically significant macular VF sensitivity (dB) and GCA thickness relationships were observed using the decibel scale (R = 0.547–0.687, all P < 0.001). The highest correlation for the global (R = 0.682) and the superior hemiretina (R = 0.594) GCA thickness-VF mean sensitivity was observed by the HFA. The highest correlation for the inferior hemiretina (R = 0.687) GCA thickness-VF mean sensitivity was observed by the MP-3. Among the three VF measurement instruments, however, no significant differences were found for the structure-function relationships. Conclusions All three VF measurement instruments found similar structure-function relationships in the central VF.
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Affiliation(s)
- Kazuyuki Hirooka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750–1 Ikenobe, Miki, Kagawa 761–0793, Japan
- * E-mail:
| | - Kana Misaki
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750–1 Ikenobe, Miki, Kagawa 761–0793, Japan
| | - Eri Nitta
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750–1 Ikenobe, Miki, Kagawa 761–0793, Japan
| | - Kaori Ukegawa
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750–1 Ikenobe, Miki, Kagawa 761–0793, Japan
| | - Shino Sato
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750–1 Ikenobe, Miki, Kagawa 761–0793, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750–1 Ikenobe, Miki, Kagawa 761–0793, Japan
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Lee JP, Park IW, Chung YS. The volume of tumor mass and visual field defect in patients with pituitary macroadenoma. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:37-41. [PMID: 21350693 PMCID: PMC3039193 DOI: 10.3341/kjo.2011.25.1.37] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 09/05/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. METHODS We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. RESULTS Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). CONCLUSIONS In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.
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Affiliation(s)
- Jung Pil Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Kasten E, Wuest S, Sabel BA. Variability of stimulus detection, form discrimination, and color recognition with suprathreshold campimetry in brain-damaged patients. Neuroophthalmology 2009. [DOI: 10.1076/noph.20.4.161.3932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Lee PP, Walt JW, Rosenblatt LC, Siegartel LR, Stern LS. Association between intraocular pressure variation and glaucoma progression: data from a United States chart review. Am J Ophthalmol 2007; 144:901-907. [PMID: 17919446 DOI: 10.1016/j.ajo.2007.07.040] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 07/25/2007] [Accepted: 07/30/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate whether greater intraocular pressure (IOP) variation between visits was associated with higher likelihood of glaucoma progression. DESIGN Cohort study. METHODS A five-year minimum of data (June 1, 1990 through January 22, 2002) was collected on 151 patients (302 eyes) from 12 United States specialty centers. A post hoc analysis of visual field (VF) progression, glaucoma medication, intraocular pressure (IOP), and other ocular data was conducted for two nonmutually exclusive cohorts based on retrospective data abstracted well after actual patient visits. Mean IOP and standard deviations (SD) were calculated before treatment (medication or surgery) or progression, whichever occurred first, and before progression regardless of treatment. IOP variables were assessed in a univariate fashion; Cox proportional hazards models evaluated glaucoma progression as an outcome measure and IOP SD as a main predictor, controlling for covariates. RESULTS In cohort 1 (55 patients; 84 eyes), mean age was 63 years (range, 37 to 85 years), 58% were female, and 19% of eyes underwent VF progression. In cohort 2 (129 patients; 251 eyes), mean age was 66 years (range, 19 to 88 years), 55% were female, and 27% of eyes underwent VF progression. Mean IOP was 16.5 mm Hg (IOP SD, 2.0 mm Hg), and 16.4 mm Hg (IOP SD, 2.7 mm Hg) in cohorts 1 and 2, respectively. Controlling for age, mean IOP, VF stage, and other covariates, each unit increase in IOP SD resulted in a 4.2 times and 5.5 times higher risk of glaucoma progression for cohort 1 (95% confidence interval [CI], 1.3 to 12.9) and cohort 2 (95% CI, 3.4 to 9.1), respectively. CONCLUSIONS IOP variability is an important predictor of glaucoma progression; SD is a convenient measure of variability to assess glaucoma progression risk.
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Affiliation(s)
- Paul P Lee
- Duke University Eye Center, Durham, NC, USA
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Sasaoka M, Hara H, Nakamura K. Comparison between monkey and human visual fields using a personal computer system. Behav Brain Res 2005; 161:18-30. [PMID: 15904706 DOI: 10.1016/j.bbr.2005.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Accepted: 02/03/2005] [Indexed: 11/16/2022]
Abstract
To use monkeys as models for eye diseases that may lead to blindness, we need to develop a method to precisely measure its visual field and to understand similarities and differences in visual field properties between monkeys and humans. The visual field of monkey was not measured precisely although the necessity. We established a new system with personal computers for precise measurement of the monkey visual field. Four monkeys and three humans served as subjects. The luminance-contrast sensitivity of the central 24 degrees field was measured while the subject was fixating a small spot. During the measurement, we continuously recorded the eye position, and discarded the data when fixation was broken. Reliability indices demonstrated high and stable behavioral performance by both monkeys and humans. The luminance-contrast sensitivity was highest around the fovea, and declined as eccentricity increased. The blind spot was clearly detected 15 degrees temporally. The overall sensitivity was higher in humans than in monkeys and the sensitivity dropped more sharply in the periphery in monkeys than in humans. We recommend this system as a convenient and reliable way to measure visual functions in monkeys in basic ophthalmologic research or in assessment of the drug effects on the visual field.
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Affiliation(s)
- Masaaki Sasaoka
- Department of Behavioral and Brain Sciences, Primate Research Institute, Kyoto University, Aichi, Japan
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Mansberger SL, Johnson CA, Cioffi GA, Choi D, Krishnadas SR, Srinivasan M, Balamurugan V, Kim U, Smith SD, Wilkins JH, Gritz DC. Predictive Value of Frequency Doubling Technology Perimetry for Detecting Glaucoma in a Developing Country. J Glaucoma 2005; 14:128-34. [PMID: 15741814 DOI: 10.1097/01.ijg.0000151883.07232.54] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the feasibility and diagnostic precision of Frequency Doubling Technology (FDT) perimetry as a method to detect glaucoma in rural villages of a developing country. DESIGN Cross-sectional study. METHODS Testing included FDT perimetry (C-20-5 screening protocol), tonometry, anterior segment biomicroscopy, and dilated ophthalmoscopy in 296 rural, non-English speaking residents of Southern India over 35 years old. Participants repeated the FDT if they had a location with reduced sensitivity or an unreliable result. We defined an abnormal FDT as one location of reduced sensitivity present on both the initial and repeat examination. We determined the diagnostic precision of FDT separately for a glaucomatous optic disc, a cup to disc ratio (C/D) > or = 0.7, and a C/D > or = 0.8. RESULTS Ninety-three percent of subjects were able to complete the test satisfactorily. With repeat FDT testing, 37% of eyes with abnormal FDT results subsequently converted to normal and 67% of eyes with unreliable results subsequently became reliable. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for a glaucomatous optic disc were 7%, 87%, 13%, 76%, and 69%, respectively; for a C/D > or = 0.7, they were 0%, 87%, 0%, 91%, and 81%, respectively; and for a C/D > or = 0.8, they were 0%, 87%, 0%, 99%, and 87%, respectively. CONCLUSION Clinicians can use FDT perimetry to rapidly screen for glaucoma in rural villages of a developing country. FDT testing had high specificity and negative predictive value, but low sensitivity and positive predictive value. The low sensitivity suggests that FDT has limited applicability as the sole test for glaucoma screening in this population. Repeat testing of FDT results that are unreliable or suspected of being abnormal is beneficial for this screening procedure.
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Schimiti RB, Avelino RR, Kara-José N, Costa VP. Full-threshold versus Swedish Interactive Threshold Algorithm (SITA) in normal individuals undergoing automated perimetry for the first time. Ophthalmology 2002; 109:2084-92; discussion 2092. [PMID: 12414419 DOI: 10.1016/s0161-6420(02)01253-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the full-threshold (FT) and Swedish Interactive Threshold Algorithm standard (SS) strategies in normal individuals undergoing automated perimetry for the first time. DESIGN Randomized, comparative, observational case series. PARTICIPANTS Eighty perimetrically naive normal individuals. METHODS All individuals underwent computerized visual field examinations (30-2, Humphrey 750, Humphrey-Zeiss, Dublin, CA) with both FT and SS strategies. One eye of each individual was tested. Test order between strategies was randomized. MAIN OUTCOME MEASURES The following variables were compared: test time, foveal threshold, fixation losses, false-positive and false-negative errors, mean deviation, pattern standard deviation, glaucoma hemifield test, and number of depressed points deviating at P < 5%, P < 2%, P < 1%, and P < 0.5% on the total and pattern deviation probability maps. Initially, we compared the results of all FT and SS tests, regardless of the order in which they were applied. Next, patients undergoing SS as the first examination were compared with those undergoing FT as the first test. Finally, the SS and FT results obtained in the second test were compared. Anderson's criteria were applied to define abnormal examinations, allowing for the calculation of the specificity of the SS and FT strategies. RESULTS When the results of all FT and SS tests were analyzed, the number of significantly depressed points deviating at P < 5%, P < 2%, and P < 1% on the pattern deviation probability maps was higher with the SS strategy (P < 0.05); the specificity was 50% for SS and 72.5% for FT (P < 0.01). When only first examinations were compared, the number of significantly depressed points deviating at P < 5%, P < 2%, and P < 1% on both the total and pattern deviation probability maps was higher with the SS strategy (P < 0.05); the specificity was 38.1% and 63.2% for the SS and FT strategies, respectively (P = 0.04). When only the second examinations were compared, there were no significant differences either between the number of depressed points or between the specificities of both strategies (73.7% for SS and 71.4% for FT) (P = 0.98). CONCLUSIONS Normal individuals with no perimetric experience may present more significantly depressed points on the pattern deviation probability map when the SS strategy is used, reducing the test specificity in comparison with FT. These findings are probably due to a lower interindividual variability observed with SS. However, these differences disappeared in a second examination, suggesting that both strategies perform similarly in perimetrically experienced individuals.
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Affiliation(s)
- Rui Barroso Schimiti
- Glaucoma Service, Department of Ophthalmology, University of Campinas, Campinas, Sao Paulo Brazil
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Vesti E, Spry PGD, Chauhan BC, Johnson CA. Sensitivity differences between real-patient and computer-stimulated visual fields. J Glaucoma 2002; 11:35-45. [PMID: 11821688 DOI: 10.1097/00061198-200202000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors sought to verify computer simulation of visual fields by comparing thresholds of real and corresponding simulated visual fields. METHODS Four patients with stable glaucomatous visual fields and three patients with progressing glaucomatous visual fields were chosen for the study. Visual fields had been recorded at 6-month intervals for 5 to 7.5 years. A previously described computer simulation program was used to generate a corresponding simulated visual field for each of the real fields. Twenty different levels of response variability and long-term variability were used in the simulations. Pointwise sensitivity differences between real and simulated fields were calculated. The average difference and 95% interval of the differences were analyzed for the different simulation conditions, for the pointwise sensitivities in the real patient fields, and to determine whether the field was stable or progressing. RESULTS In almost all simulation conditions, the average pointwise sensitivity differences ranged from -1 to 1 dB and were not significantly different among different simulation conditions. The 95% interval of the average difference increased significantly with response variability, whereas long-term variability failed to show any apparent effect. Average pointwise differences and the 95% intervals were greatest in locations where the real-patient field had reduced sensitivity of 14 dB or worse. CONCLUSION The simulation program provided good estimates of visual field sensitivities. Increasing amounts of response, but not long-term variability, produced a linear increase in the variability of threshold sensitivities. This finding implies that short-term rather than long-term fluctuation is the most important factor determining the variability of thresholds.
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Affiliation(s)
- Eija Vesti
- Department of Ophthalmology, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
PURPOSE To quantify automated visual field defects seen at entry in the Optic Neuritis Treatment Trial (ONTT) to determine whether particular areas of the field are preferentially affected and to determine the extent of visual field involvement in patients having "localized" field defects. METHODS Review of Humphrey 30-2 Visual Field (Allergan-Humphrey, Inc, San Leandro, CA) data from the involved and fellow eyes of 440 patients who were enrolled in the ONTT. Field defects were evaluated by comparing the involved eye to the fellow eye. RESULTS Patients with diffuse visual field defects had a relatively equal diminution of visual threshold throughout the tested 30-2 field. Patients with localized central and cecocentral scotomas had their greatest depression of threshold centrally; however, even those patients with mild defects (mean defect, <6 dB) had diminution of visual threshold throughout the entire tested 30-degree field. Patients with moderate (mean defect, 6 to 20 dB) and severe (mean defect, >20 dB) central and cecocentral defects had even greater peripheral depression. Patients with altitudinal or quadrant defects had involvement of the "unaffected" field that also varied with the mean defect. The overall average depression of visual threshold for all patients averaged 36%+/-4% and was relatively uniform throughout the tested field. CONCLUSIONS Optic neuritis affects the entire central 30-2 field, even in patients who appear to have localized depression of visual threshold. Optic neuritis does not appear to have a predilection for any particular area of the visual field.
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Affiliation(s)
- J P Fang
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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