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Miyake M, Mori Y, Wada S, Yamada K, Shiraishi R, Numa S, Suda K, Kameda T, Ikeda H, Akagi T, Aibara T, Tamura H, Tsujikawa A. Comparison of a Novel Head-Mounted Objective Auto-perimetry (Gaze Analyzing Perimeter) and Humphrey Field Analyzer. Ophthalmol Glaucoma 2024:S2589-4196(24)00084-X. [PMID: 38823680 DOI: 10.1016/j.ogla.2024.05.003] [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: 12/19/2023] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE To evaluate the agreement between 24-2 visual field (VF) test results obtained using the gaze analyzing perimeter (GAP; Findex) and the Humphrey field analyzer (HFA; Carl Zeiss Meditec). DESIGN Cross-sectional study. PARTICIPANTS Patients underwent HFA 24-2 for suspected or confirmed VF loss and were treated at the Kyoto University Hospital between December 2022 and July 2023. METHODS Patients underwent consecutive VF tests on the same eye using HFA and GAP 24-2 tests. Bland-Altman analysis was used to compare GAP and HFA results. Examination points where the sensitivity measured using GAP was ≥ 10 dB higher than that measured using HFA were re-evaluated by referring back to the original gaze data; 2 ophthalmologists assessed whether the gaze moved linearly toward the new test target. MAIN OUTCOME MEASURES Mean deviation (MD) and elapsed time on an individual basis and sensitivity on an examination point basis. RESULTS Forty-seven eyes of 47 patients were analyzed. The correlation coefficient of the MD using HFA and GAP was 0.811 (95% confidence interval [CI]: 0.683-0.891). Bland-Altman analysis showed good agreement between HFA and GAP tests. The mean difference (95% limits of agreement) in MD between HFA and GAP results was -0.63 dB (-5.81 to 4.54 dB). Although no statistically significant differences were observed in the elapsed time (P = 0.99), measurements completed within 200 seconds were observed only in the GAP group (11 cases, 23.4%), who had significantly better HFA MD value than others (P = 0.001). On an examination point basis for sensitivity, the correlation coefficient between HFA and GAP was 0.691 (95% limits of agreement, 0.670-0.711). Original gaze data assessment revealed that the gaze moved linearly toward the new test target for 70.2% of the examination points with a sensitivity discrepancy. CONCLUSIONS The results indicate that the GAP provides VF assessment outcomes comparable to those of the HFA. The GAP exhibited advantages in terms of testing time, particularly in patients with minimal VF impairment. Furthermore, the GAP records all eye movements, enabling the objective determination of VF abnormalities based on gaze patterns and facilitating easy posthoc verification. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yuki Mori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Saori Wada
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Shogo Numa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Suda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takanori Kameda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hanako Ikeda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadamichi Akagi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Zaman N, Ong J, Waisberg E, Masalkhi M, Lee AG, Tavakkoli A, Zuckerbrod S. Advanced Visualization Engineering for Vision Disorders: A Clinically Focused Guide to Current Technology and Future Applications. Ann Biomed Eng 2024; 52:178-207. [PMID: 37861913 DOI: 10.1007/s10439-023-03379-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Head-mounted visualization technology, often in the form of virtual, augmented, and mixed reality (VAMR), has revolutionized how visual disorders may be approached clinically. In this manuscript, we review the available literature on VAMR for visual disorders and provide a clinically oriented guide to how VAMR technology has been deployed for visual impairments. The chief areas of clinical investigation with VAMR are divided include (1) vision assessment, (2) vision simulation, and (3) vision rehabilitation. We discuss in-depth the current literature of these areas in VAMR and upcoming/future applications to combat the detrimental impact of visual impairment worldwide.
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Affiliation(s)
- Nasif Zaman
- Human-Machine Perception Laboratory, University of Nevada, Reno, NV, USA
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, University of Nevada, Reno, NV, USA
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Chen YX, Meyerov J, Skalicky SE. Online Circular Contrast Perimetry via a Web-Application: Establishing a Normative Database for Central 10-Degree Perimetry. Clin Ophthalmol 2024; 18:201-213. [PMID: 38269363 PMCID: PMC10807269 DOI: 10.2147/opth.s440964] [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] [Received: 10/16/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024] Open
Abstract
Purpose To establish a normative database using a central 10-degree grid pattern for the online circular contrast perimetry (OCCP) application. Participants Fifty participants with mean age 65 ± 13 years were selected for this study. One eye from each participant that met inclusion criteria was randomly included in the cohort. Methods The web-application delivered online 52-loci perimetry in a central 10-degree pattern using circular flickering targets. These targets consist of concentric sinusoidal alternating contrast rings. Users were guided by the application to the correct viewing distance and head position using in-built blind spot localization and webcam monitoring. A spinning golden star was used as the fixation target and patients performed the test in a darkened room following standard automated perimetry (SAP). Results The reliability rates and global indices for OCCP were similar to SAP. OCCP mean sensitivity reduced with age at a similar rate to SAP. Mean sensitivity per loci of 10-degree OCCP was greater than SAP by 1.24 log units (95% CI 1.23 to 1.26) and obeyed a physiological hill of vision. Small differences existed in mean sensitivities between OCCP and SAP which increased with increasing spot eccentricity. Mean deviation (MD) displayed good agreement between the two tests. Conclusion Central 10-degree online circular contrast perimetry via a computer-based application has comparable perimetric results to standard automated perimetry in a normal cohort.
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Affiliation(s)
- Yang X Chen
- St Vincent’s Hospital Clinical School, University of Melbourne, Melbourne, VIC, Australia
| | - Joshua Meyerov
- Department of Surgery Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Simon E Skalicky
- Department of Surgery Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
- Glaucoma Investigation and Research Unit, the Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
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Lapka M, Straňák Z. The Current State of Artificial Intelligence in Neuro-Ophthalmology. A Review. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:179-186. [PMID: 38538291 DOI: 10.31348/2023/33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
This article presents a summary of recent advances in the development and use of complex systems using artificial intelligence (AI) in neuro-ophthalmology. The aim of the following article is to present the principles of AI and algorithms that are currently being used or are still in the stage of evaluation or validation within the neuro-ophthalmology environment. For the purpose of this text, a literature search was conducted using specific keywords in available scientific databases, cumulatively up to April 2023. The AI systems developed across neuro-ophthalmology mostly achieve high sensitivity, specificity and accuracy. Individual AI systems and algorithms are subsequently selected, simply described and compared in the article. The results of the individual studies differ significantly, depending on the chosen methodology, the set goals, the size of the test, evaluated set, and the evaluated parameters. It has been demonstrated that the evaluation of various diseases will be greatly speeded up with the help of AI and make the diagnosis more efficient in the future, thus showing a high potential to be a useful tool in clinical practice even with a significant increase in the number of patients.
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Takagi Y, Yokoyama S, Yokoyama Y, Hozumi K, Kaga T. A case of functional visual loss diagnosed through bilateral randomized visual field testing with a trick method. Am J Ophthalmol Case Rep 2023; 32:101877. [PMID: 38161514 PMCID: PMC10757184 DOI: 10.1016/j.ajoc.2023.101877] [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] [Received: 12/23/2022] [Revised: 05/10/2023] [Accepted: 06/15/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To report a case of functional visual loss (FVL) diagnosed through bilateral randomized visual field testing using Imo vifa with a trick method. Observations A 27-year-old man complained of visual field abnormality in his left eye after falling from a height of 4 m. The left eye had a best-corrected visual acuity (BCVA) of 20/16 and a critical flicker frequency (CFF) of 44.5 Hz at the first visit. Commotio retinae was observed in the inferior retina of the left eye, and the pupillary light reflex was normal. Computed tomography and magnetic resonance imaging of the head revealed no abnormalities. However, the Goldmann perimeter (GP) showed constriction of visual field in the left eye. Since traumatic optic neuropathy was suspected initially; therefore, two courses of methylprednisolone pulse therapy were administered. However, the BCVA and CFF gradually worsened to 20/200 and 14 Hz, respectively. Nevertheless, his pupillary light reflex was still normal, and GP showed a spiral visual field. Thus, we suspected that this was a case of FVL and performed bilateral randomized visual field testing using Imo vifa in three steps as a trick method. In the first step, we performed the normal method for bilateral randomized visual field testing. In the second and third steps, we explained to the patient that only the right or left eye would be examined on purpose; bilateral randomized visual field testing was then performed. The results of examinations revealed left homonymous hemianopsias and normal and concentric contraction of the visual field in both eyes. These results could not be explained by organic disease, and the patient was diagnosed with FVL. Conclusions and Importance Bilateral randomized visual field testing using Imo vifa with a trick method was useful for diagnosing FVL.
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Affiliation(s)
- Yuki Takagi
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Sho Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Kenta Hozumi
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Tatsushi Kaga
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Nishida T, Weinreb RN, Arias J, Vasile C, Moghimi S. Comparison of the TEMPO binocular perimeter and Humphrey field analyzer. Sci Rep 2023; 13:21189. [PMID: 38040803 PMCID: PMC10692178 DOI: 10.1038/s41598-023-48105-5] [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: 08/21/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
This study compared between TEMPO, a new binocular perimeter, with the Humphrey Field Analyzer (HFA). Patients were tested with both TEMPO 24-2 Ambient Interactive Zippy Estimated by Sequential Testing (AIZE)-Rapid and HFA 24-2 Swedish Interactive Threshold Algorithm (SITA)-Fast in a randomized sequence on the same day. Using a mixed-effects model, visual field (VF) parameters and reliability indices were compared. Retinal nerve fiber layer (RNFL) thickness was measured using Cirrus optical coherence tomography (OCT), and coefficient of determinations for VF and OCT parameters were calculated and compared using Akaike information criteria. 740 eyes (including 68 healthy, 262 glaucoma suspects, and 410 glaucoma) of 370 participants were evaluated. No significant differences were seen in mean deviation and visual field index between the two perimeters (P > 0.05). A stronger association between VF mean sensitivity (dB or 1/L) and circumpapillary RNFL was found for TEMPO (adjusted R2 = 0.25; Akaike information criteria [AIC] = 5235.5 for dB, and adjusted R2 = 0.29; AIC = 5200.8 for 1/L, respectively) compared to HFA (adjusted R2 = 0.22; AIC = 5263.9 for dB, and adjusted R2 = 0.22; AIC = 5262.7 for 1/L, respectively). Measurement time was faster for TEMPO compared to HFA (261 s vs. 429 s, P < 0.001). Further investigations are needed to assess the long-term monitoring potential of this binocular VF test.
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Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Juan Arias
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Cristiana Vasile
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA.
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Freeman SE, De Arrigunaga S, Kang J, Zhao Y, Roldán AM, Lin MM, Elze T, Liebman D, Chang DS, Friedman DS. Participant Experience Using Novel Perimetry Tests to Monitor Glaucoma Progression. J Glaucoma 2023; 32:948-953. [PMID: 37671465 DOI: 10.1097/ijg.0000000000002296] [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: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
PRCIS Participant surveys taken after using tablet-based and smart visual function analyzer (SVFA) perimetry tests suggest that patients may prefer novel perimetry tests over traditional visual field machines. PURPOSE Compare patient experience using the IMOvifa SVFA and the tablet-based Melbourne Rapid Fields visual field (VF) tests to the Humphrey Field 24-2 Swedish Interactive Threshold Algorithm Standard. PATIENTS AND METHODS Prospective observational cohort study on adult participants with diagnoses of glaucoma suspect, ocular hypertension, or glaucoma. Participants attended 2 study visits ~3 months apart. During the first visit, participants were trained to use the 2 novel perimeters, took 1 test on both new devices and the Humphrey Field Analyzer, then were surveyed. Participants received tablets and performed weekly tablet VF tests at home between study visits. At the final study visit, participants re-took the VF tests and completed the same surveys. RESULTS Eighty-one participants were surveyed twice. At the baseline survey, participants preferred the SVFA (71.7%) and tablet tests (69.2%) over the Humphrey VF. Most were willing to perform weekly monitoring at home on the SVFA (69.1%) and tablet (75.4%). Participants generally had a "very good" overall experience when testing on the SVFA (71.6%) and tablet (90.1%). At the final visit, fewer participants were willing to test on the tablet daily (23.5% to 9.9%; P = 0.02 for change) and more were willing to test monthly (18.5% to 33.3%; P = 0.03 for change). CONCLUSION Users reported a preference for novel VF devices. Overall participant experience using these devices was positive, supporting the feasibility of home monitoring of VFs from an experience perspective.
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Affiliation(s)
- Sandra E Freeman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | | | - Joyce Kang
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | - Yan Zhao
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | - Ana M Roldán
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | - Michael M Lin
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | - Daniel Liebman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
| | - Dolly S Chang
- Genentech, Inc. South San Francisco
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
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Nomoto H, Matsumoto C, Okuyama S, Kimura S, Inoue S, Yamanaka K, Kusaka S. A new static visual field test algorithm: the Ambient Interactive ZEST (AIZE). Sci Rep 2023; 13:14945. [PMID: 37696993 PMCID: PMC10495312 DOI: 10.1038/s41598-023-42266-z] [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: 07/08/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023] Open
Abstract
Visual field (VF) test is one of the most vital tests in the diagnosis of glaucoma and to monitor the disease worsening. In the past couple of decades, the standard automated perimetry (SAP) test takes a major role in VF test for glaucoma patients. The SAP has been demanded to finish a test in short time without sacrificing accuracy. In this study, we developed and evaluated the performance of a new perimetric algorithm (ambient interactive zippy estimation by sequential testing (ZEST): AIZE) by computer simulation. AIZE is a modification of the ZEST procedure that utilizes the spatial information (weighted likelihood: WL) of neighboring test locations, which varies from the distance to the tested location, to estimate a visual threshold. Ten glaucomatous and 10 normal empirical visual field (VF) test results were simulated with five error conditions [(3% false positives (FP), 3% false negatives (FN)), (9% FP, 9% FN), (15% FP, 15% FN), (3% FP, 15% FN), (15% FP, 3% FN)]. The total number of test presentations and the root mean square error (RMSE) of the estimated visual sensitivities were compared among AIZE, the non-weighted test (WL = 0) and the fixed-weighted test (WL = 0.33). In both glaucomatous (G) and normal (N) VFs, the fixed-weighted test had the lowest number of test presentations (median G 256, N 139), followed by the AIZE (G 285, N 174) and the non-weighted test (G 303, N 195). The RMSE of the fixed-weighted test was lower (median 1.7 dB) than that of the AIZE (1.9 dB) and the non-weighted test (1.9 dB) for normal VFs, whereas the AIZE had a lower RMSE (3.2 dB) than the fixed-weighted test (4.5 dB) and the non-weighted test (4.0 dB) for glaucomatous VFs. Simulation results showed that AIZE had fewer test presentations than the non-weighted test strategy without affecting the accuracy for glaucomatous VFs. The AIZE is a useful time saving test algorithm in clinical settings.
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Affiliation(s)
- Hiroki Nomoto
- Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan.
| | - Chota Matsumoto
- Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan
| | - Sachiko Okuyama
- Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan
| | | | | | | | - Shunji Kusaka
- Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka-sayama, Japan
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Toyokuni H, Sakamoto M, Ueda K, Kurimoto T, Yamada-Nakanishi Y, Nakamura M. Test-retest repeatability of the imo binocular random single-eye test and Humphrey monocular test in patients with glaucoma. Jpn J Ophthalmol 2023; 67:578-589. [PMID: 37392238 DOI: 10.1007/s10384-023-01007-5] [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: 11/15/2022] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To evaluate the reproducibility of the imo binocular random single-eye test (BRSET) and Humphrey Field Analyzer (HFA) monocular test in patients with glaucoma. STUDY DESIGN Retrospective observational study. METHODS We measured the visual fields (VF) of patients with glaucoma using the BRSET and HFA. All tests were repeated two months later. Mean sensitivity (MS), mean deviation (MD), sensitivity at each test location, and reliability indices were compared between the test days. Wilcoxon signed-rank test, interclass correlation coefficient (ICC), correlation coefficients, and Bland-Altman plots were generated for analysis. RESULTS We analyzed the VFs of 46 patients with glaucoma. There were no test-retest differences for MS and MD, and ICCs were > 0.9 for MS and MD in both perimeters. Inter-test correlations for MS and MD were high. The limits of agreement (LoAs) (lower, upper limit) between test days for MS were (- 3.4, 4.0) for BRSET and (-3.3, 3.0) for HFA. The LoA for MD was (- 3.3, 3.8) for BRSET and (- 3.2, 2.9) for HFA. Sensitivity at each testing location was more variable between testing days for BRSET than for HFA. For reliability indices, LoAs between testing days were wider for BRSET than for HFA. CONCLUSION The imo BRSET showed similar reproducibility to HFA in MS and MD. However, sensitivity at each test location varied more for BRSET than for HFA. Further studies are needed to verify the reproducibility of the imo BRSET.
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Affiliation(s)
| | - Mari Sakamoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Kaori Ueda
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takuji Kurimoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuko Yamada-Nakanishi
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Kang J, De Arrigunaga S, Freeman SE, Zhao Y, Lin M, Liebman DL, Roldan AM, Kim JA, Chang DS, Friedman DS, Elze T. Comparison of Perimetric Outcomes from a Tablet Perimeter, Smart Visual Function Analyzer, and Humphrey Field Analyzer. Ophthalmol Glaucoma 2023; 6:509-520. [PMID: 36918066 PMCID: PMC10495534 DOI: 10.1016/j.ogla.2023.03.001] [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: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE The tablet-based Melbourne Rapid Fields (MRF) visual field (VF) test and the IMOvifa Smart Visual Function Analyzer (SVFA) are portable perimeters that may allow for at-home monitoring and more frequent testing. We compared tablet and SVFA results with outputs from the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm Standard program. DESIGN Observational cross-sectional study. SUBJECTS Adult participants with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension seen in the Massachusetts Eye and Ear glaucoma clinic were enrolled. All participants were reliable and experienced HFA testers. METHODS Participants were tested with the SVFA and HFA. The study staff also trained participants on the MRF tablet with instructions to take weekly tests at home for 3 months. Visual field results from the 3 devices were compared. MAIN OUTCOME MEASURES Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, and point sensitivity. RESULTS Overall, 79 participants (133 eyes) with a mean age of 61 ± 13 years (range, 26-79 years) were included; 59% of the participants were female, and the mean HFA MD was -2.7 ± 3.9 dB. The global indices of MD and PSD did not significantly vary between HFA and the 2 novel devices, except that the tablet VF reported a 0.6 dB higher PSD compared with HFA. However, tablet and SVFA sensitivities significantly differed from those of the HFA at 36 and 39 locations, respectively, out of 52 locations. Relative to HFA, the tablet overestimated light sensitivity in the nasal field while underestimating the temporal field. The SVFA generally underestimated light sensitivity, but its results were more similar to HFA results compared with the tablet. CONCLUSIONS Although average MD values from the 2 novel devices suggest that they provide similar results to the HFA, point-by-point comparisons highlight notable deviations. Differences in specific point sensitivity values were significant, especially between the tablet and the other 2 devices. These differences may in part be explained by differences in the devices' normative databases as well as how MD is calculated. However, the tablet had substantial differences based on location, indicating that the tablet design itself may be responsible for differences in local sensitivities. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joyce Kang
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | | | | | - Yan Zhao
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Michael Lin
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | | | - Ana M Roldan
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Julia A Kim
- Genentech Inc., South San Francisco, California
| | - Dolly S Chang
- Genentech Inc., South San Francisco, California; Stanford University School of Medicine, Palo Alto, California
| | | | - Tobias Elze
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts.
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Nishida T, Weinreb R, Arias J, Vasile C, Moghimi S. Comparison of the TEMPO Binocular Perimeter and Humphrey Field Analyzer. RESEARCH SQUARE 2023:rs.3.rs-3283528. [PMID: 37693597 PMCID: PMC10491334 DOI: 10.21203/rs.3.rs-3283528/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This study compared between TEMPO, a new binocular perimeter, with the Humphrey Field Analyzer (HFA). Patients were tested with both TEMPO 24 - 2 AIZE-Rapid and HFA 24 - 2 SITA-Fast in a randomized sequence on the same day. Using a mixed-effects model, visual field (VF) parameters and reliability indices were compared. Retinal nerve fiber layer (RNFL) thickness was measured using Cirrus OCT, and coefficient of determinations for visual field and OCT parameters were calculated and compared using Akaike information criteria. 740 eyes (including 68 healthy, 262 glaucoma suspects, and 410 glaucoma) of 370 participants were evaluated. No significant differences were seen in mean deviation and visual field index between the two perimeters (P > 0.05). A stronger association between VF mean deviation and circumpapillary RNFL was found for TEMPO (adjusted R2 = 0.28; AIC = 5210.9) compared to HFA (adjusted R2 = 0.26; AIC = 5232.0). TEMPO had better reliability indices (fixation loss, false positive, and false negative) compared to HFA (all P < 0.05). Measurement time was faster for TEMPO compared to HFA (261sec vs. 429sec, P < 0.001). Further investigations are needed to assess the long-term monitoring potential of this binocular VF test.
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Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Robert Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Juan Arias
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Cristiana Vasile
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
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12
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Johnson C, Sayed A, McSoley J, Durbin M, Kashem R, Nicklin A, Lopez V, Mijares G, Chen M, Shaheen A, Segarra S, Rady N, Duque CA, Opoku-Baah C, Abou Shousha M. Comparison of Visual Field Test Measurements With a Novel Approach on a Wearable Headset to Standard Automated Perimetry. J Glaucoma 2023; 32:647-657. [PMID: 37311012 PMCID: PMC10414153 DOI: 10.1097/ijg.0000000000002238] [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: 07/29/2022] [Accepted: 04/30/2023] [Indexed: 06/15/2023]
Abstract
PRCIS This study of inter-test comparability of a novel visual field application installed on an augmented-reality portable headset and Humphrey field analyzer Swedish interactive thresholding algorithm (SITA) Standard visual field test demonstrates the excellent correlation of mean deviation (MD) and mean sensitivity (MS). PURPOSE To determine the correlation between visual field testing with novel software on a wearable headset versus standard automated perimetry. PATIENTS AND METHODS Patients with and without visual field defects attributable to glaucoma had visual field testing in one eye of each patient with 2 methods: re:Imagine Strategy (Heru, Inc.) and the Humphrey field analyzer (Carl Zeiss Meditec, Inc.) SITA Standard 24-2 program. Main outcome measures included MS and MD, which were evaluated by linear regression, intraclass correlation coefficient (ICC), and Bland Altman analysis for assessment of the mean difference and limits of agreement. RESULTS Measurements from 89 eyes of 89 patients (18 normal and 71 glaucomas) were compared with both instruments. Linear regression analysis demonstrated an excellent Pearson correlation coefficient of r = 0.94 for MS and r = 0.95 for MD. ICC analysis demonstrated high levels of concordance (ICC = 0.95, P < 0.001 for MS and ICC = 0.94, P < 0.001 for MD). Bland-Altman analysis determined a small mean difference between the two devices (Heru minus Humphrey) of 1.15 dB for MS and 1.06 dB for MD. CONCLUSIONS The Heru visual field test correlated well with SITA Standard in a population of normal eyes and eyes with glaucoma.
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Affiliation(s)
- Catherine Johnson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Ahmed Sayed
- Heru, Inc., Miami, FL
- Biomedical Engineering Department, Helwan University, Cairo, Egypt
- EECS Department, MSOE University, Milwaukee, WI
| | - John McSoley
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | | | - Rashed Kashem
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Heru, Inc., Miami, FL
| | | | | | - Georgeana Mijares
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | | | - Abdulla Shaheen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Steven Segarra
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nadine Rady
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Christian Andres Duque
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Heru, Inc., Miami, FL
| | | | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Heru, Inc., Miami, FL
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13
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Portengen BL, Porro GL, Bergsma D, Veldman EJ, Imhof SM, Naber M. Effects of Stimulus Luminance, Stimulus Color and Intra-Stimulus Color Contrast on Visual Field Mapping in Neurologically Impaired Adults Using Flicker Pupil Perimetry. Eye Brain 2023; 15:77-89. [PMID: 37287993 PMCID: PMC10243349 DOI: 10.2147/eb.s409905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose We improve pupillary responses and diagnostic performance of flicker pupil perimetry through alterations in global and local color contrast and luminance contrast in adult patients suffering from visual field defects due to cerebral visual impairment (CVI). Methods Two experiments were conducted on patients with CVI (Experiment 1: 19 subjects, age M and SD 57.9 ± 14.0; Experiment 2: 16 subjects, age M and SD 57.3 ± 14.7) suffering from absolute homonymous visual field (VF) defects. We altered global color contrast (stimuli consisted of white, yellow, cyan and yellow-equiluminant-to-cyan colored wedges) in Experiment 1, and we manipulated luminance and local color contrast with bright and dark yellow and multicolor wedges in a 2-by-2 design in Experiment 2. Stimuli consecutively flickered across 44 stimulus locations within the inner 60 degrees of the VF and were offset to a contrasting (opponency colored) dark background. Pupil perimetry results were compared to standard automated perimetry (SAP) to assess diagnostic accuracy. Results A bright stimulus with global color contrast using yellow (p= 0.009) or white (p= 0.006) evoked strongest pupillary responses as opposed to stimuli containing local color contrast and lower brightness. Diagnostic accuracy, however, was similar across global color contrast conditions in Experiment 1 (p= 0.27) and decreased when local color contrast and less luminance contrast was introduced in Experiment 2 (p= 0.02). The bright yellow condition resulted in highest performance (AUC M = 0.85 ± 0.10, Mdn = 0.85). Conclusion Pupillary responses and pupil perimetry's diagnostic accuracy both benefit from high luminance contrast and global but not local color contrast.
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Affiliation(s)
- Brendan L Portengen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marnix Naber
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
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14
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Arai K, Nishijima E, Ogawa S, Hosaka D, Itoh Y, Noro T, Okude S, Okada S, Yoshikawa K, Nakano T. A Novel Visual Field Screening Program for Glaucoma With a Head-Mounted Perimeter. J Glaucoma 2023; 32:520-525. [PMID: 36847662 DOI: 10.1097/ijg.0000000000002199] [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: 10/21/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
PRCIS A novel visual field screening program with a head-mounted perimeter 'imo' could detect glaucoma at all stages in a short time with high accuracy. PURPOSE The present study aimed to examine the accuracy and availability of a novel glaucoma visual field screening program using a head-mounted visual perimeter 'imo.' PARTICIPANTS AND METHODS Eyes of 76 non-glaucoma participants and 92 glaucoma patients were examined. All patients underwent visual field tests using the Humphrey Visual Field Analyzer (30-2 or 24-2 Swedish Interactive Thresholding Algorithm standard program) and imo (the visual field screening program). We evaluated five visual field screening program indicators: sensitivity, specificity, positive predictive value, negative predictive value, and testing time. We also evaluated the ability of this visual field screening program to differentiate between glaucoma patients and normal controls using the receiver operating characteristic curves and areas under the receiver operating characteristic curves. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of the visual field screening program were 76%-100%, 91%-100%, 86%-89%, and 79%-100%, respectively. The visual field screening program test time was 46±13 seconds for normal controls and 61±18, 82±21, and 105±16 econds, respectively for mild, moderate, and advanced-stage patients. The areas under the receiver operating characteristic curves were 0.77, 0.97, and 1.0 in the mild, moderate, and advanced stages, respectively. CONCLUSIONS Visual field screening using a head-mounted perimeter 'imo' detected glaucoma at all stages in a short time with high accuracy.
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Affiliation(s)
- Kota Arai
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
- Department of Ophthalmology, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Euido Nishijima
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
| | - Shumpei Ogawa
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
| | - Daisuke Hosaka
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
- Department of Ophthalmology, Machida Municipal Hospital
| | - Yoshinori Itoh
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
| | - Takahiko Noro
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
| | - Sachiyo Okude
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
| | - Satomi Okada
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
| | - Keiji Yoshikawa
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
- Yoshikawa Eye Clinic, Machida, Tokyo
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Nishishimbashi
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15
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Terracciano R, Mascolo A, Venturo L, Guidi F, Vaira M, Eandi CM, Demarchi D. Kinetic Perimetry on Virtual Reality Headset. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:413-419. [PMID: 37027637 DOI: 10.1109/tbcas.2023.3249045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
OBJECTIVE We present a portable automatic kinetic perimeter based on a virtual reality (VR) headset device as an innovative and alternative solution for the screening of clinical visual fields. We compared the performances of our solution with a gold standard perimeter, validating the test on healthy subjects. METHODS The system is composed of an Oculus Quest 2 VR headset with a clicker for participant response feedback. An Android app was designed in Unity to generate moving stimuli along vectors, following a standard Goldmann kinetic perimetry approach. Sensitivity thresholds are obtained by moving centripetally three different targets (V/4e, IV/1e, III/1e) along 24 or 12 vectors from an area of non-seeing to an area of seeing and then transmitted wirelessly to a PC. A Python real-time algorithm processes the incoming kinetic results and displays the hill of vision in a two-dimensional map (isopter). We involved 21 subjects (5 males and 16 females, age range 22-73 years) for a total of 42 eyes tested with our proposed solution, and results were compared with a Humphrey visual field analyzer to test reproducibility and efficacy. RESULTS isopters generated with the Oculus headset were in good agreement with those acquired with a commercial device (Pearson's correlation values r > 0.83 for each target). CONCLUSIONS we demonstrate the feasibility of VR kinetic perimetry by comparing performances between our system and a clinically used perimeter in healthy subjects. SIGNIFICANCE proposed device leads the way for a portable and more accessible visual field test, overcoming challenges in current kinetic perimetry practices.
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16
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Labkovich M, Warburton AJ, Ying S, Valliani AA, Kissel N, Serafini RA, Mathew R, Paul M, Hovstadius SM, Navarro VN, Patel A, Reddy H, Chelnis JG. Virtual Reality Hemifield Measurements for Corrective Surgery Eligibility in Ptosis Patients: A Pilot Clinical Trial. Transl Vis Sci Technol 2022; 11:35. [PMID: 36282119 DOI: 10.1167/tvst.11.10.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis. Methods In a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients' Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities. Results VR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = -0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P < 0.05; MCHT P < 0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P < 0.01), speed (P < 0.001), and overall experience (P < 0.01). Conclusions This pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment. Translational Relevance In this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.
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Affiliation(s)
- Margarita Labkovich
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew J Warburton
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Ying
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aly A Valliani
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas Kissel
- Department of Statistics & Data Science, Carnegie Mellon, Pittsburgh, PA, USA
| | - Randal A Serafini
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Nash Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj Mathew
- Department of Medical Education, SUNY Downstate, Brooklyn, NY, USA
| | - Megan Paul
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Malin Hovstadius
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vicente N Navarro
- Department of Uro Onc Research, Weill Cornell Medicine, New York, NY, USA
| | - Aashay Patel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harsha Reddy
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James G Chelnis
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Chen YT, Yeh PH, Cheng YC, Su WW, Hwang YS, Chen HSL, Lee YS, Shen SC. Application and Validation of LUXIE: A Newly Developed Virtual Reality Perimetry Software. J Pers Med 2022; 12:1560. [PMID: 36294698 PMCID: PMC9605009 DOI: 10.3390/jpm12101560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2023] Open
Abstract
PURPOSE To report the application of LUXIE and validate its reliability by comparing the test results with those of Humphrey Field Analyzer 3 (HFA3). METHODS In this pilot study, we prospectively recruited participants who had received HFA3 SITA standard 30-2 perimetry and tested them with LUXIE on the same day. LUXIE is a software designed for visual field testing cooperating with HTC Vive Pro Eye, a head-mounted virtual reality device with an eye-tracking system. The test stimuli were synchronized with eye movements captured by the eye-tracking system to eliminate fixation loss. The global, hemifields, quadrants, glaucoma hemifield test (GHT) sectors, and point-by-point retinal sensitivities were compared between LUXIE and HFA3. All participants were asked to fill out a post-test user survey. RESULTS Thirty-eight participants with 65 eyes were enrolled. LUXIE demonstrated good correlations with HFA3 in global (r = 0.81), superior hemifield (r = 0.77), superonasal, superotemporal, and inferonasal quadrants (r = 0.80, 0.78, 0.80). The user survey showed that participants were more satisfied with LUXIE in operating difficulty, comfortability, time perception, concentration, and overall satisfaction. CONCLUSIONS LUXIE demonstrated good correlations with HFA3. Fixation loss could be eliminated in LUXIE with the eye-tracking system. The application of virtual reality devices such as the HTC Vive Pro Eye makes telemedicine and even home-based self-screening visual field tests possible. KEY MESSAGES 1. Virtual reality perimetry is a developing technology that has the potential in telemedicine, and home self-screening visual field tests. 2. LUXIE demonstrated good correlations with Humphrey Field Analyzer 3 in visual field retinal sensitivities.
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Affiliation(s)
- Yen-Ting Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Po-Han Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Yu-Chun Cheng
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Wen Su
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Henry Shen-Lih Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yung-Sung Lee
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Su-Chin Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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18
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Sakamoto M, Sawamura H, Aihara M, Goseki T, Ikeda T, Ishikawa H, Nakamura M. Agreement in the detection of chiasmal and postchiasmal visual field defects between imo binocular random single-eye test and Humphrey monocular test. Jpn J Ophthalmol 2022; 66:413-424. [PMID: 35972588 DOI: 10.1007/s10384-022-00935-y] [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: 02/08/2022] [Accepted: 06/23/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare the ability of imo binocular random single-eye test (BRSET) to detect visual field (VF) defects due to chiasmal and postchiasmal lesions (C/PCLs) with a Humphrey Field Analyzer (HFA) monocular test. STUDY DESIGN Prospective multicenter study METHODS: This study enrolled 40 patients with C/PCLs and measured their VFs using both imo BRSET and HFA monocular test. The VFs were classified into three groups using the cluster criterion: 1) bitemporal group, 2) homonymous group, and 3) others. The agreement and correlation of VF results between imo and HFA were analyzed using the Bland-Altman plot and Spearman correlation coefficient. RESULTS The VFs of 34 patients were analyzed and classified. There were 13 patients in the bitemporal, 6 in the homonymous, and 15 in the others group. BRSET showed a significantly shorter test duration than HFA. The imo systematically yielded a lower sensitivity than HFA. The average sensitivity at each test location correlated well between the perimeters in all groups, with the correlation coefficients ranging from 0.89 to 0.98. Bland-Altman plots showed wider limits of agreement in the affected quadrants compared to the unaffected quadrants in the bitemporal and homonymous groups. The fixation loss rate did not differ between the perimeters, but there were significant differences in the false positive and false negative rates between perimeters. CONCLUSION BRSET detected VF defects due to C/PCLs as accurately as the HFA monocular test with a shorter test duration.
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Affiliation(s)
- Mari Sakamoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Hiromasa Sawamura
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan.,International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Tetsuya Ikeda
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan.,Sanno Hospital, Tokyo, Japan
| | - Hitoshi Ishikawa
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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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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20
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Ong J, Tavakkoli A, Strangman G, Zaman N, Kamran SA, Zhang Q, Ivkovic V, Lee AG. Neuro-ophthalmic Imaging and Visual Assessment Technology for Spaceflight Associated Neuro-ocular Syndrome (SANS). Surv Ophthalmol 2022; 67:1443-1466. [DOI: 10.1016/j.survophthal.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
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22
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Nakai Y, Bessho K, Shono Y, Taoka K, Nakai Y. Comparison of imo and Humphrey field analyzer perimeters in glaucomatous eyes. Int J Ophthalmol 2021; 14:1882-1887. [PMID: 34926203 DOI: 10.18240/ijo.2021.12.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the imo perimeter, a new portable head-mounted perimeter unit that enables both eyes to be examined quickly and simultaneously, with the Humphrey field analyzer (HFA) perimeter to investigate correlations and their diagnostic ability in glaucomatous eyes. METHODS The performance of the equipment in 128 glaucomatous eyes and 40 normal eyes were tested. We investigated the correlations of mean deviation, pattern standard deviation, visual field index, and the sensitivity. RESULTS Measurements of mean deviation (r=0.886, P<0.001), pattern standard deviation (r=0.814, P<0.001), and visual field index (r=0.871, P<0.001) in both perimeters were strongly and positively correlated. The sensitivities in the imo perimeter were 80.5% for mean deviation, 81.2% for pattern standard deviation, and 80.5% in visual field index; those in the HFA were 63.3% for mean deviation, 74.5% for pattern standard deviation, and 80.5% for visual field index. Both perimeters demonstrated high diagnostic ability. CONCLUSION The parameters by the imo and HFA in glaucomatous eyes show strong positive correlations with favorable sensitivity, specificity, and diagnostic ability. However, the difference between imo and HFA results increases with the increase in visual field disturbance.
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Affiliation(s)
| | - Kyoko Bessho
- Tokai Eye Clinic, 399-Hadokoro-cho, Tsu 514-0009, Japan
| | - Yuko Shono
- Tokai Eye Clinic, 399-Hadokoro-cho, Tsu 514-0009, Japan
| | - Kaori Taoka
- Tokai Eye Clinic, 399-Hadokoro-cho, Tsu 514-0009, Japan
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Wu Y, Szymanska M, Hu Y, Fazal MI, Jiang N, Yetisen AK, Cordeiro MF. Measures of disease activity in glaucoma. Biosens Bioelectron 2021; 196:113700. [PMID: 34653715 DOI: 10.1016/j.bios.2021.113700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness globally which significantly affects the quality of life and has a substantial economic impact. Effective detective methods are necessary to identify glaucoma as early as possible. Regular eye examinations are important for detecting the disease early and preventing deterioration of vision and quality of life. Current methods of measuring disease activity are powerful in describing the functional and structural changes in glaucomatous eyes. However, there is still a need for a novel tool to detect glaucoma earlier and more accurately. Tear fluid biomarker analysis and new imaging technology provide novel surrogate endpoints of glaucoma. Artificial intelligence is a post-diagnostic tool that can analyse ophthalmic test results. A detail review of currently used clinical tests in glaucoma include intraocular pressure test, visual field test and optical coherence tomography are presented. The advanced technologies for glaucoma measurement which can identify specific disease characteristics, as well as the mechanism, performance and future perspectives of these devices are highlighted. Applications of AI in diagnosis and prediction in glaucoma are mentioned. With the development in imaging tools, sensor technologies and artificial intelligence, diagnostic evaluation of glaucoma must assess more variables to facilitate earlier diagnosis and management in the future.
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Affiliation(s)
- Yue Wu
- Department of Surgery and Cancer, Imperial College London, South Kensington, London, United Kingdom; Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom.
| | - M Ihsan Fazal
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - M Francesca Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom; The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom; Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom.
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Ahmed Y, Pereira A, Bowden S, Shi RB, Li Y, Ahmed IIK, Arshinoff SA. Multicenter Comparison of the Toronto Portable Perimeter with the Humphrey Field Analyzer: A Pilot Study. Ophthalmol Glaucoma 2021; 5:146-159. [PMID: 34358734 DOI: 10.1016/j.ogla.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the agreement between glaucomatous 24-2 visual field (VF) testing performed with the Toronto Portable Perimeter (TPP; VEM Medical Technologies) and the Humphrey Field Analyzer (HFA; Carl Zeiss Meditec). DESIGN Multicenter prospective cohort analysis. PARTICIPANTS Patients with suspected or confirmed glaucoma treated at Prism Eye Institute (Oakville, Canada), York Finch Eye Associates (North York, Canada), or the Ontario Mobile Medical Eye Care Unit (Cochrane, Canada) between March 2019 and March 2020. METHODS Patients underwent consecutive VF tests on the same eye using the HFA Swedish Interactive Threshold Algorithm Standard 24-2 test and TPP Standard 24-2 test in randomized order. Bland-Altman analysis and paired t tests were used to compare VF results obtained by the TPP and the HFA. Participants completed a 5-question validated questionnaire after completing both testing methods. MAIN OUTCOME MEASURES Mean difference and degree of agreement in mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and test duration between VF modalities. RESULTS One hundred fifty eyes from 91 patients were included in analysis. Average MD of the overall cohort using HFA and TPP VF testing was -4.32 ± 5.47 dB and -4.53 ± 5.22 dB, respectively (P = 0.74). Bland-Altman analysis showed good agreement between HFA and TPP tests. The mean differences (95% limits of agreement) between HFA and TPP for MD, PSD, VFI, and test duration were 0.21 dB (-4.25 to 4.67 dB), -0.13 dB (-3.72 to 3.47 dB), 0.66% (-10.94% to 12.26%), and 0.65 seconds (-97.51 to 98.81 seconds), respectively. No statistically significant mean difference was found between HFA and TPP tests for MD, PSD, VFI, or test duration. Mean deviation (R2 = 0.830) and VFI (R2 = 0.866) were correlated strongly with both modalities. Questionnaire results demonstrated that patients significantly preferred the TPP over the HFA for VF testing (P < 0.001). CONCLUSIONS Mean deviation, PSD, and VFI outcomes measured by the TPP were statistically similar to corresponding parameters obtained with the HFA. Test time duration did not differ significantly between the TPP and HFA, and patients significantly preferred the TPP to the HFA examination experience. These pilot results suggest that the TPP may offer an accessible alternative to HFA VF testing.
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Affiliation(s)
- Yusuf Ahmed
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Austin Pereira
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sylvie Bowden
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Runjie B Shi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yan Li
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute, Oakville, Ontario, Canada
| | - Steve A Arshinoff
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; York Finch Eye Associates, Toronto, Ontario, Canada.
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Advanced Vision Analyzer–Virtual Reality Perimeter. OPHTHALMOLOGY SCIENCE 2021; 1:100035. [PMID: 36249304 PMCID: PMC9559955 DOI: 10.1016/j.xops.2021.100035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the Advanced Vision Analyzer (AVA; Elisar Vision Technology) and to compare pointwise threshold sensitivity and functional correlation of Elisar Standard Algorithm (ESA) with the Swedish Interactive Threshold Algorithm (SITA) of the Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Inc). Design Prospective, cross-sectional, observational case series. Participants One hundred sixty eyes (85 control participants, 75 glaucoma patients) for functional assessment, 15 eyes for test–retest variability (TRV), 107 eyes for blind spot trial (45 normal eyes, 62 glaucoma eyes) were recruited consecutively. A separate group of participants was chosen for each assessment. Methods All participants underwent ESA and SITA Standard 24-2 testing, and 1 eye of each participant was selected randomly. Intraclass correlation coefficient (ICC), Bland-Altman, linear regression, mean bias (MB), and proportional bias analyses were quantified and assessed. Threshold measurements, TRV, and blind spot location accuracy were compared with those of the HFA. Main Outcome Measures Pointwise threshold sensitivity, sectoral mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), TRV, blind spot location, average test time were computed, and data were correlated. Results The mean time required to perform a field test with the AVA was 7.08 ± 1.55 minutes and with HFA was 6.26 ± 0.54 minutes (P = 0.228). The MS difference between AVA and HFA was –2.2 ± 2.3 dB in healthy participants (P < 0.001) and –2.6 ± 3.5 dB in participants with glaucoma (P < 0.001). The correlation coefficients for pointwise threshold values were moderately to strongly correlated for both the devices (r = 0.68–0.89). For MS, the overall ICC value was 0.893 (P < 0.001) with MB of 2.48 dB and a limits of agreement (LOA) of 10.90 (range, 7.93 to –2.97). For TRV, response variability decreased with an increase in sensitivity and increased with eccentricity. Blind spot location was accurate, and global indices of testing methods correlated well. Conclusions The AVA effectively captures threshold values for each point in the visual field. Adequate functional correlation suggests substantial equivalence between the AVA (ESA) and HFA (SITA Standard), implying that AVA may allow accurate assessment of visual field.
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Muñoz-Negrete F, Moreno-Montañés J, Rebolleda G. Perimetría en domicilio. ¿Es posible? ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:285-287. [PMID: 34629693 PMCID: PMC8123935 DOI: 10.1016/j.oftal.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muñoz-Negrete FJ, Moreno-Montañés J, Rebolleda G. Home perimetry. Is possible? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:285-287. [PMID: 34092281 DOI: 10.1016/j.oftale.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; OFTARED, Madrid, Spain.
| | - J Moreno-Montañés
- OFTARED, Madrid, Spain; Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; OFTARED, Madrid, Spain
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Mine I, Shoji T, Kumagai T, Yoshikawa Y, Kosaka A, Shinoda K. Central Visual Field Sensitivity With and Without Background Light Given to the Nontested Fellow Eye in Glaucoma Patients. J Glaucoma 2021; 30:537-544. [PMID: 33350657 DOI: 10.1097/ijg.0000000000001764] [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: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
PRECIS This study showed the difference of monocular visual sensitivity between with and without background light given to the nontested fellow eyes in glaucoma patients. Monocular sensitivity measurements of the worse eyes with fellow eye's background light conditions should carefully be considered when assessing the impact of functional impairment in glaucoma patients. PURPOSE The purpose of this study was to investigate the difference between monocular sensitivities measured with and without background light given to the nontested fellow eye in glaucoma patients using a new perimeter named "imo." METHODS In this cross-sectional study, we examined 102 eyes of 51 patients (mean age, 65.1±14.9 y) with open-angle glaucoma who were affected with at least 1 significant point in the central 10 degrees. We conducted a routine ophthalmic examination and visual field testing using the Humphrey Field Analyzer 24-2 and 10-2 programs. The eyes were assigned to "better" and "worse" categories based on the visual acuity and central visual thresholding. Subsequently, we compared the central visual sensitivities with and without background light given to the nontested fellow eye. RESULTS The mean sensitivity (MS) in the central 5 points of the visual field of the worse eyes was better when measured with background light than without background light (P=0.037) given to the nontested fellow eye. No significant difference was seen among the MS in the visual field of the better eyes. After dividing the patients into low (n=25) and high sensitivity (n=26) groups, only the low sensitivity group in worse eyes had higher MS with background light than without background light (P<0.05) given to the nontested fellow eye. CONCLUSIONS Monocular sensitivities measured with background light given to the nontested fellow eye were higher than those without background light in the worse eye group of glaucoma patients. Monocular MS measurements of the worse eyes with fellow eye's background light conditions and their related indices should thus carefully be considered when assessing the impact of functional impairment in glaucoma patients.
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Affiliation(s)
- Izumi Mine
- Department of Ophthalmology, Saitama Medical University, Iruma, Saitama Prefecture, Japan
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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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Prea SM, Kong GYX, Guymer RH, Vingrys AJ. Uptake, Persistence, and Performance of Weekly Home Monitoring of Visual Field in a Large Cohort of Patients With Glaucoma. Am J Ophthalmol 2021; 223:286-295. [PMID: 33221287 DOI: 10.1016/j.ajo.2020.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE This study examines the short-term uptake, compliance, and performance of a tablet device used for home monitoring of visual field (VF-Home) by glaucoma patients. DESIGN Single-center, observational, longitudinal, compliance study. METHODS Participants who were glaucoma suspects or had stable glaucoma in at least one eye were recruited during a regular clinic review. Baseline in-clinic visual field (VF) was recorded with the Humphrey Field Analyser (HFA, SITA standard) and repeated at 6 months. Participants were tasked with performing 6 VF examinations from home, at weekly intervals, using a loaned iPad tablet. Uptake was defined as returning at least 1 test from home. Reliability and global indices from VF-Home were compared to in-clinic outcomes. Data are shown as either mean ± [standard deviation] or median [quartile 1-3 range], and group comparisons were achieved with bootstrap. RESULTS We recruited 186 eyes of 101 participants. VF-Home uptake was excellent, with 88% of participants successfully completing ≥1 home examination and 69% completing all 6 examinations. The median duration between tests was 7.0 [7.0-8.0] days. Barriers to uptake and compliance involved information technology (IT) logistical reasons, lack of motivation, or competing life demands. VF-Home gave greater fixation loss but a similar level of False Positives (FP) as the HFA. A high correlation was found for the mean defect between in-clinic and at-home outcomes (R = 0.85). CONCLUSIONS VF-Home can return a high level of short-term compliance and results comparable to those found by in-clinic testing. IT logistical reasons and lack of motivation are barriers to uptake and compliance.
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Affiliation(s)
- Selwyn M Prea
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - George Y X Kong
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Robyn H Guymer
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia.
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Comparison of the Performance of a Novel, Smartphone-based, Head-mounted Perimeter (GearVision) With the Humphrey Field Analyzer. J Glaucoma 2021; 30:e146-e152. [PMID: 33596021 DOI: 10.1097/ijg.0000000000001797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
PRECIS The agreement between a head-mounted perimeter [GearVision (GV)] and Humphrey field analyzer (HFA) for total threshold sensitivity was a mean difference of -1.9 dB (95% limits of agreement -5 to 1). GV was the preferred perimeter in 68.2% of participants. PURPOSE The purpose of this study was to compare reliability indices and threshold sensitivities obtained using a novel, smartphone-based, head-mounted perimeter (GV) with the HFA in normal, glaucoma suspect and glaucoma patients. A secondary objective was to evaluate the subjective experience participants had with both perimeters using a questionnaire. METHODS In a prospective, cross-sectional study; 107 eyes (34 glaucoma, 18 glaucoma suspect, and 55 normal) of 54 participants underwent HFA and GV in random order. The main outcome measure was the agreement of threshold sensitivities using Bland and Altman analysis. Participants also completed a questionnaire about their experience with the devices. RESULTS Median false-positive response rate for GV was 7% (4% to 12%), while for HFA it was 0% (0% to 6%, P<0.001). Median false-negative response rate was similar for both tests. In all, 84 eyes with reliable HFA and GV results were included in the final analysis. Median threshold sensitivity of all 52 points on HFA was 29.1 dB (26.5 to 30.7 dB) and for GV was 30.6 dB (29.1 to 32.6 dB; P<0.001). Mean difference (95% limits of agreement) in total threshold sensitivity between HFA and GV was -1.9 dB (-5 to 1 dB). The 95% limits of agreement were fairly narrow (-8 to 2 dB) across the 6 Garway-Heath sectors. Most participants preferred to perform GV (68.2%) if required to repeat perimetry compared with HFA (20.6%, P<0.001). CONCLUSIONS There was fairly good agreement between the threshold sensitivities of GV and HFA. GV was also preferred by most patients and could potentially supplement HFA as a portable or home perimeter.
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Razeghinejad R, Gonzalez-Garcia A, Myers JS, Katz LJ. Preliminary Report on a Novel Virtual Reality Perimeter Compared With Standard Automated Perimetry. J Glaucoma 2021; 30:17-23. [PMID: 32941320 DOI: 10.1097/ijg.0000000000001670] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/22/2020] [Indexed: 11/26/2022]
Abstract
PRECIS The VisuALL head-mounted perimetry in normal subjects and glaucoma patients had a moderate to strong correlation with the Humphrey Field Analyzer (HFA). PURPOSE Visual field testing has a vital role in diagnosing and managing glaucoma. The current clinical practice relies on large, table-based testing units. This study investigated the performance of a novel virtual reality head-mounted visual perimetry device (VisuALL), in normal and glaucoma patients. METHODS This prospective observational study was conducted on 50 eyes of 25 healthy subjects (normal group) and 52 eyes of 26 patients with a controlled mild or moderate stage of glaucoma (glaucoma group). All participants had visual field testing with VisuALL and the HFA (24-2, Swedish Interactive Threshold Algorithm). The mean sensitivity of the whole visual field and each quadrant were compared between both machines and the receiver operating characteristic was used to compare the diagnostic abilities and the Bland-Altman plot to evaluate the agreement of the 2 perimeters. RESULTS The global mean sensitivity of the VisuALL and the HFA correlated significantly in both normal (r=0.5, P=0.001) and glaucoma (r=0.8, P<0.001) groups. The mean sensitivity of all quadrants also correlated significantly in both groups. The VisuALL mean sensitivity had a greater (0.98) receiver operating characteristic curve than HFA (0.93) mean sensitivity (P=0.06) in discriminating normal versus glaucoma. CONCLUSION There was an excellent correlation between the VisuALL and the Standard Automated Perimetry in normal and glaucoma patients and VisuALL showing high diagnostic performance.
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Affiliation(s)
| | | | | | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA
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Age-dependent changes in visual sensitivity induced by moving fixation points in adduction and abduction using imo perimetry. Sci Rep 2020; 10:21175. [PMID: 33273620 PMCID: PMC7713232 DOI: 10.1038/s41598-020-78147-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Visual field (VF) testing has usually been performed with the central gaze as a fixed point. Recent publications indicated optic nerve head deformations induced by optic nerve traction force can promote the progression of optic neuropathies, including glaucoma. We generated a new static test protocol that adds 6° adduction and abduction to gaze position (fixation points) movement. The aim of this study was to investigate both whether quantifying VF sensitivities at lateral horizontal gaze positions is feasible and whether horizontal gaze positions change sensitivities differently in subjects of different ages. Healthy adult eyes from 29 younger (≤ 45 years) and 28 elderly (> 45 years) eyes were examined in this cross-sectional study. After VF testing with central gaze as a fixation point using 24 plus (1) imo static perimetry, subjects underwent VF testing with 6° adduction and 6° abduction as fixation points. The average mean sensitivities with central gaze, adduction, and abduction were 29.9 ± 1.0, 29.9 ± 1.3, and 30.0 ± 1.2 decibels (dB) in younger subjects and 27.7 ± 1.2, 27.5 ± 1.7, and 28.1 ± 1.3 dB in elderly subjects, respectively. Visual sensitivity in young healthy subjects was similar among the three fixation points, whereas visual sensitivity in elderly healthy subjects was significantly better with abduction as a fixation point than with central gaze and adduction (both p < 0.05). We expect this test protocol to contribute to our understanding of visual function during horizontal eye gaze movement in various eye diseases.
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Kumagai T, Shoji T, Yoshikawa Y, Mine I, Kanno J, Ishii H, Saito A, Ishikawa S, Kimura I, Shinoda K. Comparison of central visual sensitivity between monocular and binocular testing in advanced glaucoma patients using imo perimetry. Br J Ophthalmol 2020; 104:1258-1534. [PMID: 32152139 PMCID: PMC7587224 DOI: 10.1136/bjophthalmol-2019-315251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM This study aimed to compare central visual sensitivity under monocular and binocular conditions in patients with glaucoma using the new imo static perimetry. METHODS Fifty-one consecutive eyes of 51 patients with open-angle glaucoma who were affected with at least one significant point in the central 10° were examined in this cross-sectional study. Monocular and binocular random single-eye tests were performed using the imo perimeter and the Humphrey field analyser (HFA) 24-2 and 10-2 tests. The eyes were assigned to 'better' and 'worse' categories based on the visual acuity and central visual thresholding. Central visual sensitivity results obtained by monocular, binocular random single-eye tests and binocular simultaneous both eye test were compared. RESULTS The average mean deviation with the HFA 24-2 was -5.5 (-1.5, -14.6) dB (median, (IQR)) in the better eyes and -18.0 (-12.9, -23.8) dB in the worse eyes. The mean sensitivity in the central 4 points of the visual field (VF) of the worse eyes was lower when measured under the binocular eye condition than under the monocular condition. Conversely, this value of the better eyes was greater when measured under the binocular eye condition than under the monocular condition. CONCLUSIONS The central sensitivity of the better eyes was better and that of the worse eyes poorer with binocular testing than with monocular testing in patients with glaucoma. Although monocular VF testing is still the most straightforward means to monocularly monitor glaucoma at clinical settings, binocular testing, such as provided with imo perimetry, may be a useful clinical tool to predict the effect of VF impairments on a patient's quality of visual life.
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Affiliation(s)
- Tomoyuki Kumagai
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Takuhei Shoji
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Yuji Yoshikawa
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Izumi Mine
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Junji Kanno
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Hirokazu Ishii
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Akane Saito
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Sho Ishikawa
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
| | - Itaru Kimura
- Department of Ophthalmology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Kei Shinoda
- Department of Ophtalmology, Saitama Medical University, Iruma, Saitama, Japan
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