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Chen Z, Shen X, Zhang Y, Yang W, Ye J, Ouyang Z, Zheng G, Yang Y, Yu M. Development and Validation of an Internet-Based Remote Perimeter (Perimouse). Transl Vis Sci Technol 2024; 13:16. [PMID: 38506801 PMCID: PMC10959190 DOI: 10.1167/tvst.13.3.16] [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: 09/11/2023] [Accepted: 01/13/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose We sought to validate the feasibility of Perimouse, an internet-based remote perimeter that allows for natural fixation and can be performed on most computers via a web page. Methods In this cross-sectional study, Perimouse evaluated the visual field of 45 healthy people and 27 patients with primary open-angle glaucoma on a laptop. Participants used a mouse cursor to locate new dots on the screen that were determined by preset saccade vectors. A "click and confirm" strategy was used to eliminate the unwanted visual search. Dot brightness was either fixed at 12 dB in the suprathreshold program (screening program) or variable in the threshold program. We compared Perimouse outcomes with the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Testing Algorithm standard program. Results In the screening program, Perimouse showed moderate to high concordance with HFA. The intraclass coefficient ranged from 0.58 to 0.86 in different areas of Garway-Heath mapping. In the threshold program, normal subjects had threshold ranging from 19 to 16 dB, presenting sensitivity changes according to the "hill of vision". The test-retest difference was 0.09 dB. Habitual spectacle correction and environmental luminance (2-337 lux) had little impact on the central or peripheral threshold (P > 0.05). The correlation between Perimouse and HFA threshold sensitivity was strong (R = 0.950), although Perimouse mean defect was 4.40 dB higher than the HFA mean defect. Conclusions Perimouse is a reliable visual field test that correlates strongly with HFA. It shows potential for population screening and monitoring visual field defects. Translational Relevance Perimouse assesses the visual field using saccade vectors without eye trackers, enhancing its accessibility via a web page.
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Affiliation(s)
- Zidong Chen
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Xiaoyuan Shen
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Yuning Zhang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Wenxin Yang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Jiexin Ye
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Zhiqiang Ouyang
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Guifeng Zheng
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Yangfan Yang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Minbin Yu
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
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Daka Q, Mustafa R, Neziri B, Virgili G, Azuara-Blanco A. Home-Based Perimetry for Glaucoma: Where Are We Now? J Glaucoma 2022; 31:361-374. [PMID: 35394454 DOI: 10.1097/ijg.0000000000002022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To systematically summarize the current literature on home-based perimeters for glaucoma. METHODS A systematic review was conducted in accordance with the PRISMA-DTA checklist. Studies reporting portable perimeters designed for home use were retrieved from electronic databases and handsearching of reference lists of relevant publications. Studies reporting diagnostic accuracy data were evaluated with the QUADAS-2 tool and using standard automated perimetry as the reference standard. Other aspects of the technology such as detection of disease progression and patient acceptability were also included. Data were reported in a narrative and tabular format. RESULTS Of 18 included studies, 10 evaluated tablet-based perimeters, 4 evaluated web-based perimeters, and 4 evaluated head-mounted displays. Most studies used a clinic or laboratory setting. All studies reporting diagnostic accuracy data had high risk of bias in at least one domain. Across studies, sensitivity ranged from 54% in detecting mild to 91% in detecting moderate/severe glaucoma patients from controls, while specificity was between 50% and 100% for any form of glaucoma. The reported acceptability was high but had high risk of bias. CONCLUSION Several promising technologies designed for home-based perimetry have been reported. Current studies used a controlled setting in highly selected populations. There is uncertainty on the performance and value of home-based perimetry for glaucoma. Additional efforts are required to elucidate the ability of the home-based perimeters to detect glaucoma and disease progression in real life situations.
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Affiliation(s)
- Qëndresë Daka
- Department of Pathophysiology, Medical Faculty, University of Prishtina
- University Clinical Centre of Kosova, Prishtinë, Kosovo
| | - Rona Mustafa
- Department of Pathophysiology, Medical Faculty, University of Prishtina
| | - Burim Neziri
- Department of Pathophysiology, Medical Faculty, University of Prishtina
- University Clinical Centre of Kosova, Prishtinë, Kosovo
| | - Gianni Virgili
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Eye Clinic, Department NERUOFARBA, University of Florence, Florence, Italy
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Hannen T, El-Khoury S, Patel R, Ngounou F, Preußner PR. Comparison of the Automated Pattern-Noise (PANO) Glaucoma Test with the HFA, an FDT Stimulus, and the Fundus Area Cup-to-disk Ratio. J Curr Glaucoma Pract 2021; 15:132-138. [PMID: 35173395 PMCID: PMC8807941 DOI: 10.5005/jp-journals-10078-1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM AND OBJECTIVE To compare the results of a new automated glaucoma test-Pattern-Noise (PANO)-to the Humphrey Visual Field Analyzer-II (HFA), the fundus area cup-to-disk ratio (CDR), and a frequency doubling technology (FDT) stimulus. MATERIALS AND METHODS This was a prospective study performed in the West-Region of Cameroon. Two hundred and nineteen eyes of 122 adult patients were included with a clinical suspicion of normal-tension or primary open-angle glaucoma and no other major ocular pathology. Eyes were examined with PANO, HFA (24-2 SITA standard), and FDT-stimulus in a randomized order followed by clinical assessment of the CDR. RESULTS Parametric correlation of the mean contrast threshold of PANO with the mean contrast threshold of FDT-stimulus, total deviation of HFA, and area CDR was 0.94, -0.85, and 0.62, respectively (p < 0.001 for all values). Spatial distribution of sensitivity thresholds is highly correlated (p < 0.001) at all points in the visual field between PANO and HFA. With cut-off values of 3 ± 1 dB for HFA mean deviation and 4 ± 1 for PANO mean contrast threshold and after eliminating borderline cases, PANO's sensitivity was 95% and specificity 60%. The mean patient age was 45.2 ± 15.8 years. Mean thresholds of PANO and FDT-stimulus decreased with increasing age. Mean examination time was 7.1 ± 1.8 minutes for PANO, 5.9 ± 1.3 minutes for HFA, and 4.7 ± 1.3 minutes for FDT-stimulus. The mean percentage of false-positives per examination was 4.95% for PANO, 4.62% (p = 0.025) for FDT-stimulus, and 2.10% for HFA. CONCLUSION The results showed that PANO was successful in suspecting the presence of glaucoma. Pattern-Noise examination led to findings that were significantly correlated to HFA, FDT stimulus, and area CDR. Some patterns of defect were also correlated. Furthermore, PANO showed a reasonable examination time and error rate. CLINICAL SIGNIFICANCE Affordable and robust visual field devices are lacking in large parts of the developing world. Comparing them to established methods is a prerequisite to their clinical use. HOW TO CITE THIS ARTICLE Hannen T, El-Khoury S, Patel R, et al. Comparison of the Automated Pattern-Noise (PANO) Glaucoma Test with the HFA, an FDT Stimulus, and the Fundus Area Cup-to-disk Ratio. J Curr Glaucoma Pract 2021;15(3):132-138.
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Affiliation(s)
- Thomas Hannen
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstraße 1, Mainz, Germany
| | - Sylvain El-Khoury
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstraße 1, Mainz, Germany; Department of Pediatrics and Retina, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Rajesh Patel
- Department of Ophthalmology, Presbyterian Eye Hospital, Bafoussam, Cameroon
| | - Faustin Ngounou
- Department of Ophthalmology, Presbyterian Eye Hospital, Bafoussam, Cameroon
| | - Paul-Rolf Preußner
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstraße 1, Mainz, Germany
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Olsen AS, Cour M, Damato B, Kolko M. Detection of visual field defects by opticians - with Damato Multifixation Campimetry Online. Acta Ophthalmol 2019; 97:577-582. [PMID: 30593721 DOI: 10.1111/aos.14005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 11/23/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To study Damato Multifixation Campimetry Online (DMCO), an inexpensive online visual field test, used for screening at optician shops in Denmark. METHODS This was an evaluation of a diagnostic test and customers were included if minimum 50 years old, with a visual acuity of minimum 0.5 and with less myopia than 6 D. Standard equipment was a computer, a wireless mouse and a computer monitor. We used the 'DMCO STANDARD 4,5' algorithm for screening. DMCO results were electronically transmitted to the authors. Customers with a positive DMCO test received an eye examination including the reference standard Humphrey Visual Field Analyzer 30-2 SITA Fast test. A subset of control participants with a negative DMCO test received the same examination in order to estimate the number of false and true negatives. DMCO specificity and sensitivity were estimated according to five reference standards with 95% confidence intervals. RESULTS The population comprised 627 individuals, 381 women and 246 men, from 13 optician shops. Mean age was 62 years (SD 7.4). DMCO was positive in 32 individuals and 27 individuals were classified as 'true positives' with diagnoses such as glaucoma, cataract and neurological visual field defects. Of the 595 individuals with a negative DMCO test, 110 were examined and nine individuals were classified as 'false negatives' according to diagnoses. Depending on reference the specificity was 97-99% and sensitivity was 14-69%. CONCLUSION Screening with DMCO demonstrated high specificity, whereas sensitivity was unsatisfactory. Future studies with enough power to estimate the true sensitivity is needed.
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Affiliation(s)
- Ane Sophie Olsen
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet – Glostrup Glostrup Denmark
| | - Morten Cour
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet – Glostrup Glostrup Denmark
| | - Bertil Damato
- Department of Ophthalmology University of California San Francisco California USA
| | - Miriam Kolko
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet – Glostrup Glostrup Denmark
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
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Nordfang M, Uhre V, Robotham RJ, Kerry SJ, Frederiksen JL, Starrfelt R. A free and simple computerized screening test for visual field defects. Scand J Psychol 2019; 60:289-294. [PMID: 31131452 DOI: 10.1111/sjop.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
About 30-40% of stroke patients suffer from visual field defects following injury. These can interfere with the standard neuropsychological assessment and complicate the interpretation of tests that use visual materials. However, information about the integrity of a patient's central visual field is often unavailable. We, therefore, designed a screening tool, the computerized visual field test (c-VFT), specifically targeted at providing easily available, but rough, information about patients' central visual field. c-VFT was tested in two samples of stroke patients. Eleven patients were tested on c-VFT and on the Esterman test. Five patients were tested on c-VFT and the Humphrey Visual Field Analyzer (HFA), central 10-2. Criterion validity of the c-VFT was investigated by calculating quadrantwise intraclass correlation for both comparisons. For the HFA comparison, we also calculated point-to-point intraclass correlation, sensitivity, and specificity. Analyses revealed moderately good correspondence between c-VFT and the Esterman test, and between c-VFT and HFA 10-2, respectively. When looking specifically at test points within one degree of visual angle apart in the two tests, intraclass correlation increased. For these points, the sensitivity of c-VFT was 0.89 and specificity was 0.97. While the c-VFT is not designed to be diagnostic nor to replace the detailed visual field analysis, this study shows that it provides a reasonable screening of the central visual field. The test can easily be used and will be made freely available to neuropsychological clinicians and researchers.
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Affiliation(s)
- Maria Nordfang
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
| | - Valdemar Uhre
- Danish Research Center for Magnetic Resonance, Hvidovre, Denmark.,Research Unit, Child and Adolescent Mental Health Centre, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Ro Julia Robotham
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sheila J Kerry
- Institute Cognitive Neuroscience, University College London, UK
| | - Jette Lautrup Frederiksen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Randi Starrfelt
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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El-Khoury S, Hannen T, Dragnea DC, Ngounou F, Preußner PR. Pattern noise (PANO): a new automated functional glaucoma test. Int Ophthalmol 2017; 38:1993-2003. [PMID: 28815393 DOI: 10.1007/s10792-017-0690-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To present a newly developed visual field device (pattern noise: PANO) designed to be sensitive to glaucoma defects, cost-effective, material-practical and easy to repair and therefore particularly suited for low-income countries, where glaucoma can be highly prevalent (e.g. sub-Saharan Africa). METHODS This is primarily a descriptive paper, but it also includes a prospective matched case-control pilot study. Hardware, stimulus, target configuration, testing strategy and result sheet are described. The main outcome measure is the contrast level (range 2-64). Targets are composed of bright/dark pixels flickering with 18 Hz and have a size of 5°. Pixel size is approximated to the hill of vision. Average luminance of targets is constant and equals background luminance.The study was performed in the West Region in Cameroon. Twenty eyes of 20 newly presenting patients with glaucomatous optic disc cupping on funduscopy were compared with 20 eyes of 20 normal patients matched in age and laterality of eye. RESULTS Mean age was 32.9 ± 18.8 years for glaucoma patients and 32.2 ± 15.6 years for healthy subjects. Mean contrast threshold was significantly higher in eyes with abnormal disc (16.2 ± 14.3 vs. 4.4 ± 0.8, P = 0.002). Correlation of mean contrast thresholds and cup-to-disc ratio was significant (r = 0.59; P = 0.006). Average examination time was significantly longer for glaucoma eyes compared to healthy eyes (8.2 vs. 6.1 min, P < 0.001), whereas error rate did not differ (4.8 ± 2.5% vs. 4.1 ± 1.8%, P = 0.33). CONCLUSION PANO demonstrated visual field defects in patients with glaucomatous optic disc. Defects correlated significantly with glaucomatous optic nerve head morphological alterations. Healthy eyes obtained normal results. More studies are needed to establish PANO.
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Affiliation(s)
- Sylvain El-Khoury
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Thomas Hannen
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Diana Carmen Dragnea
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | | | - Paul-Rolf Preußner
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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