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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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Jones L, Callaghan T, Campbell P, Jones PR, Taylor DJ, Asfaw DS, Edgar DF, Crabb DP. Acceptability of a home-based visual field test (Eyecatcher) for glaucoma home monitoring: a qualitative study of patients' views and experiences. BMJ Open 2021; 11:e043130. [PMID: 33820785 PMCID: PMC8030466 DOI: 10.1136/bmjopen-2020-043130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. DESIGN Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. SETTING Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. PARTICIPANTS Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). RESULTS All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. CONCLUSIONS Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma.
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Affiliation(s)
- Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Jones PR, Campbell P, Callaghan T, Jones L, Asfaw DS, Edgar DF, Crabb DP. Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months. Am J Ophthalmol 2021; 223:42-52. [PMID: 32882222 PMCID: PMC7462567 DOI: 10.1016/j.ajo.2020.08.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023]
Abstract
Purpose To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma. Design Prospective longitudinal feasibility and reliability study. Methods Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye). Results All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320). Conclusions Home monitoring of VFs is viable for some patients and may provide clinically useful data.
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK; Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Dekker TM, Farahbakhsh M, Atkinson J, Braddick OJ, Jones PR. Development of the spatial contrast sensitivity function (CSF) during childhood: Analysis of previous findings and new psychophysical data. J Vis 2020; 20:4. [PMID: 33275663 PMCID: PMC7718811 DOI: 10.1167/jov.20.13.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although the contrast sensitivity function (CSF) changes markedly during infancy, there is no consensus regarding whether, how, and why it continues to develop in later childhood. Here, we analyzed previously published data (N = 1928 CSFs), and present new psychophysical findings from 98 children (4.7–14.8 years) and 50 adults (18.1–29.7 years), in order to answer the following questions: (1) Does the CSF change during childhood? (2) How large is the developmental effect size? (3) Are any changes uniform across the CSF, or frequency-specific? and (4) Can some or all of the changes be explained by “non-visual” (i.e. procedural/cognitive) factors, such as boredom or inattentiveness? The new data were collected using a four-alternative forced-choice (4AFC) Gabor-detection task, with two different psychophysical procedures (Weighted Staircase; QUEST+), and suprathreshold (false-negative) catch trials to quantify lapse rates. It is shown that from ages 4 to 18 years, the CSF improves (at an exponentially decaying rate) by approximately 0.3 log10 units (a doubling of contrast sensitivity [CS]), with 90% of this change complete by 12 years of age. The size of the effect was small relative to individual variability, with age alone explaining less than one sixth of variability (16%), and most children performing as well as some adults (i.e. falling within the 90% population limits for adults). Development was frequency-specific, with changes occurring primarily around or below the CSF peak (≤ 4 cpd). At least half — and potentially all — of the changes observed could be explained by non-visual factors (e.g. lapses in concentration), although possible biological mechanisms are discussed.
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Affiliation(s)
- Tessa M Dekker
- Child Vision Lab, Institute of Ophthalmology, University College London (UCL), London, UK.,Division of Psychology and Language Sciences, University College London (UCL), London, UK.,
| | - Mahtab Farahbakhsh
- Child Vision Lab, Institute of Ophthalmology, University College London (UCL), London, UK.,
| | - Janette Atkinson
- Faculty of Brain Sciences, University College London (UCL), London, UK.,
| | - Oliver J Braddick
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,
| | - Pete R Jones
- Child Vision Lab, Institute of Ophthalmology, University College London (UCL), London, UK.,NIHR Moorfields Biomedical Research Centre, London, UK.,Division of Optometry and Visual Science, City, University of London, London, UK.,
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Elfadaly D, Abdelrazik ST, Thomas PBM, Dekker TM, Dahlmann-Noor A, Jones PR. Can Psychophysics Be Fun? Exploring the Feasibility of a Gamified Contrast Sensitivity Function Measure in Amblyopic Children Aged 4-9 Years. Front Med (Lausanne) 2020; 7:469. [PMID: 32984366 PMCID: PMC7480072 DOI: 10.3389/fmed.2020.00469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/13/2020] [Indexed: 12/04/2022] Open
Abstract
Routine assessments of the Contrast Sensitivity Function [CSF] could be useful for the diagnosis and monitoring of amblyopia. However, current CSF measures are not clinically practical, as they are too slow, too boring, and too uncomfortable to sustain a young child's interest. Here we assess the feasibility of a more gamified approach to CSF testing, in which a maximum likelihood psychophysical algorithm (QUEST+) is combined with a largely unconstrained user interface (no fixation target, head restraints, or discrete trials). Twenty-five amblyopes (strabismic, anisometropic, or mixed) aged 4.0–9.2 years performed the gamified CSF assessment monocularly (once per eye). The test required the child to “pop” (press) grating stimuli as they “bounced” around a tablet screen. Head tracking via the tablet's front-facing camera was used to adjust for variations in viewing distance post hoc. CSFs were fitted for each eye, and Area Under the CSF (AUCSF) computed as a summary measure of sensitivity. The results showed that AUCSF measurements were able to separate moderately and severely amblyopic eyes from fellow eyes (case-control effect), and to distinguish individuals with varying degrees of vision loss (dose effect). Even the youngest children exhibited no difficulties completing the test or comprehending what to do, and most children appeared to find the test genuinely enjoyable. Informal feedback from a focus group of older children was also positive, although potential shortcomings with the present design were identified. This feasibility study indicates that gamified, child-friendly vision assessments have promise as a future means of pediatric clinical assessment. Such measures could be particularly valuable for assessing children outside of conventional eye-care facilities (e.g., home-monitoring, school screening).
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Affiliation(s)
- Doaa Elfadaly
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Peter B M Thomas
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Tessa M Dekker
- Child Vision Laboratory, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Annegret Dahlmann-Noor
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Pete R Jones
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.,Child Vision Laboratory, Institute of Ophthalmology, University College London (UCL), London, United Kingdom.,Division of Optometry and Visual Sciences, City, University of London, London, United Kingdom
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