1
|
Glassman AR, Elmasry MA, Baskin DE, Brigell M, Chong V, Davis Q, Lesmes L, Levin LA, Maddess T, Taylor LJ, Wenzel A. Visual Function Measurements in Eyes With Diabetic Retinopathy: An Expert Opinion on Available Measures. OPHTHALMOLOGY SCIENCE 2024; 4:100519. [PMID: 38881606 PMCID: PMC11179417 DOI: 10.1016/j.xops.2024.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 06/18/2024]
Abstract
Clinical Relevance Visual function impairment from diabetic retinopathy can have a considerable impact on patient's quality of life. Best-corrected visual acuity (BCVA) is most commonly used to assess visual function and guide clinical trials. However, BCVA is affected late in the disease process, is not affected in early disease, and does not capture some of the visual disturbances described by patients with diabetes. The goal of this report is to evaluate the relationship between diabetic retinal disease (DRD) and visual function parameters to determine which if any of them may be used in a future DRD staging system. Methods The visual functions working group was 1 of 6 areas of DRD studied as part of the DRD staging system update, a project of the Mary Tyler Moore Vision Initiative. The working group identified 12 variables of possible interest, 7 of which were judged to have sufficient preliminary data to suggest an association with DR to warrant further review: microperimetry, static automated perimetry, electroretinogram (ERG) oscillatory potentials, flicker ERG, low luminance visual acuity (LLVA), contrast sensitivity (CS), and BCVA. The objective field analyzer (OFA) was added after subsequent in-person workshops. Results Currently, the only visual function test available for immediate use is BCVA; the remaining tests are either promising (within 5 years) or have potential (>5 years) use. Besides BCVA, most visual function tests had a limited role in current clinical care; however, LLVA, CS, flicker ERG, and OFA demonstrated potential for screening and research purposes. Conclusions Although current visual function tests are promising, future prospective studies involving patients with early and more advanced retinopathy are necessary to determine if these tests can be used clinically or as endpoints for clinical studies. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
| | - Mohamed Ashraf Elmasry
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Boston, Massachusetts
| | - Darrell E Baskin
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | | | - Luis Lesmes
- Adaptive Sensory Technology, San Diego, California
| | - Leonard A Levin
- Departments of Ophthalmology & Visual Sciences and Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Laura J Taylor
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andreas Wenzel
- Roche Pharma Research & Early Development, F. Hoffmann - La Roche Ltd, Basel, Switzerland
| |
Collapse
|
2
|
Rai BB, Sabeti F, Carle CF, Maddess T. Visual Field Tests: A Narrative Review of Different Perimetric Methods. J Clin Med 2024; 13:2458. [PMID: 38730989 PMCID: PMC11084906 DOI: 10.3390/jcm13092458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
Visual field (VF) testing dates back to fifth century B.C. It plays a pivotal role in the diagnosis, management, and prognosis of retinal and neurological diseases. This review summarizes each of the different VF tests and perimetric methods, including the advantages and disadvantages and adherence to the desired standard diagnostic criteria. The review targets beginners and eye care professionals and includes history and evolution, qualitative and quantitative tests, and subjective and objective perimetric methods. VF testing methods have evolved in terms of technique, precision, user-friendliness, and accuracy. Consequently, some earlier perimetric techniques, often still effective, are not used or have been forgotten. Newer technologies may not always be advantageous because of higher costs, and they may not achieve the desired sensitivity and specificity. VF testing is most often used in glaucoma and neurological diseases, but new objective methods that also measure response latencies are emerging for the management of retinal diseases. Given the varied perimetric methods available, clinicians are advised to select appropriate methods to suit their needs and target disease and to decide on applying simple vs. complex tests or between using subjective and objective methods. Newer, rapid, non-contact, objective methods may provide improved patient satisfaction and allow for the testing of children and the infirm.
Collapse
Affiliation(s)
- Bhim Bahadur Rai
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
- Faculty of Health, School of Optometry, University of Canberra, Canberra, ACT 2601, Australia
| | - Corinne Frances Carle
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
| |
Collapse
|
3
|
Carle CF, Chain AYH, Kolic M, Maddess T. The structure-function relationship between multifocal pupil perimetry and retinal nerve fibre layer in glaucoma. BMC Ophthalmol 2024; 24:159. [PMID: 38600474 PMCID: PMC11008001 DOI: 10.1186/s12886-024-03402-z] [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: 08/22/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Multifocal pupillographic objective perimetry (mfPOP) is a novel method for assessing functional change in diseases like glaucoma. Previous research has suggested that, in contrast to the pretectally-mediated melanopsin response of intrinsically photosensitive retinal ganglion cells, mfPOP responses to transient onset stimuli involve the extrastriate cortex, and thus the main visual pathway. We therefore investigate the correlation between peripapillary retinal nerve fibre layer (pRNFL) thickness and glaucomatous visual field changes detected using mfPOP. Parallel analyses are undertaken using white on white standard automated perimetry (SAP) for comparison. METHODS Twenty-five glaucoma patients and 24 normal subjects were tested using SAP, 3 mfPOP variants, and optical coherence tomography (OCT). Arcuate clusters of the SAP and mfPOP deviations were weighted according to their contribution to published arcuate divisions of the retinal nerve fibre layer. Structure-function correlation coefficients (r) were computed between pRNFL clock-hour sector thickness measurements, and the local visual field sensitivities from both SAP and mfPOP. RESULTS The strongest correlation was observed in the superior-superotemporal disc sector in patients with worst eye SAP MD < -12 dB: r = 0.93 for the mfPOP LumBal test (p < 0.001). Correlations across all disc-sectors were strongest in these same patients in both SAP and mfPOP: SAP r = 0.54, mfPOP LumBal r = 0.55 (p < 0.001). In patients with SAP MD ≥ -6 dB in both eyes, SAP correlations across all sectors were higher than mfPOP; mfPOP correlations however, were higher than SAP in more advanced disease, and in normal subjects. CONCLUSIONS For both methods the largest correlations with pRNFL thickness corresponded to the inferior nasal field of more severely damaged eyes. Head-to-head comparison of mfPOP and SAP showed similar structure-function relationships. This agrees with our recent reports that mfPOP primarily stimulates the cortical drive to the pupils.
Collapse
Affiliation(s)
- Corinne F Carle
- Neuroscience, The John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra ACT, 2601, Australia.
| | - Allan Y H Chain
- Neuroscience, The John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra ACT, 2601, Australia
| | - Maria Kolic
- CERA Retinal Gene Therapy Unit, University of Melbourne, Melbourne Vic, Australia
| | - Ted Maddess
- Neuroscience, The John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra ACT, 2601, Australia
| |
Collapse
|
4
|
Sabeti F, van Kleef JP, Iyer RM, Carle CF, Nolan CJ, Chia RH, Maddess T. Discriminating early-stage diabetic retinopathy with subjective and objective perimetry. Front Endocrinol (Lausanne) 2024; 14:1333826. [PMID: 38264290 PMCID: PMC10804944 DOI: 10.3389/fendo.2023.1333826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction To prevent progression of early-stage diabetic retinopathy, we need functional tests that can distinguish multiple levels of neural damage before classical vasculopathy. To that end, we compared multifocal pupillographic objective perimetry (mfPOP), and two types of subjective automated perimetry (SAP), in persons with type 2 diabetes (PwT2D) with either no retinopathy (noDR) or mild to-moderate non-proliferative retinopathy (mmDR). Methods Both eyes were assessed by two mfPOP test methods that present stimuli within either the central ±15° (OFA15) or ±30° (OFA30), each producing per-region sensitivities and response delays. The SAP tests were 24-2 Short Wavelength Automated Perimetry and 24-2 Matrix perimetry. Results Five of eight mfPOP global indices were significantly different between noDR and mmDR eyes, but none of the equivalent measures differed for SAP. Per-region mfPOP identified significant hypersensitivity and longer delays in the peripheral visual field, verifying earlier findings. Diagnostic power for discrimination of noDR vs. mmDR, and normal controls vs. PwT2D, was much higher for mfPOP than SAP. The mfPOP per-region delays provided the best discrimination. The presence of localized rather than global changes in delay ruled out iris neuropathy as a major factor. Discussion mfPOP response delays may provide new surrogate endpoints for studies of interventions for early-stage diabetic eye damage.
Collapse
Affiliation(s)
- Faran Sabeti
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
- Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Joshua P. van Kleef
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Rakesh M. Iyer
- Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia
| | - Corinne F. Carle
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Christopher J. Nolan
- Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Rong Hui Chia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Ted Maddess
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
5
|
Rai BB, van Kleef JP, Sabeti F, Vlieger R, Suominen H, Maddess T. Early diabetic eye damage: Comparing detection methods using diagnostic power. Surv Ophthalmol 2024; 69:24-33. [PMID: 37797701 DOI: 10.1016/j.survophthal.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
It is now clear that retinal neuropathy precedes classical microvascular retinopathy in diabetes. Therefore, tests that underpin useful new endpoints must provide high diagnostic power well before the onset of moderate diabetic retinopathy. Hence, we compare detection methods of early diabetic eye damage. We reviewed data from a range of functional and structural studies of early diabetic eye disease and computed standardized effect size as a measure of diagnostic power, allowing the studies to be compared quantitatively. We then derived minimum performance criteria for tests to provide useful clinical endpoints. This included the criteria that tests should be rapid and easy so that children with type 1 diabetes can be followed into adulthood with the same tests. We also defined attributes that lend test data to further improve performance using Machine/Deep Learning. Data from a new form of objective perimetry suggested that the criteria are achievable.
Collapse
Affiliation(s)
- Bhim B Rai
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia.
| | - Joshua P van Kleef
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; School of Optometry, Faculty of Health, 2 University of Canberra, Canberra, ACT, Australia
| | - Robin Vlieger
- ANU School of Computing, Australian National University, Canberra, ACT, Australia
| | - Hanna Suominen
- ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia; ANU School of Computing, Australian National University, Canberra, ACT, Australia; University of Turku, Turku, Finland
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia
| |
Collapse
|