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).
...Cross-sectional study.
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.
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.
Mean deviation (MD) and elapsed time on an individual basis and sensitivity on an examination point basis.
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.
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.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Automated scotopic, mesopic, and photopic perimetry are likely to be important paradigms in the assessment of emerging treatments of retinal diseases, yet our knowledge of the photoreceptor ...mechanisms detecting targets under these conditions remains largely dependent on simian data. We therefore aimed to establish the photoreceptor/postreceptoral mechanisms detecting perimetric targets in humans under photopic, mesopic, and scotopic conditions and to make recommendations for suitable clinical testing strategies for selective perimetry.
Perimetric sensitivities within 30° of fixation were determined for eight wavelengths (410, 440, 480, 520, 560, 600, 640, and 680 nm) under scotopic, mesopic (1.3 cd.m
) and photopic (10 cd.m
) conditions. Data were fitted with vector combinations of rod, S-cone, nonopponent M+L-cone mechanism, and opponent M- versus L-cone mechanism templates.
Scotopicperimetric sensitivity was determined by rods peripherally and by a combination of rods and cones at, and immediately around, fixation. Mesopic perimetric sensitivity was mediated by M+L-cones and S-cones centrally and by M+L-cones and rods more peripherally. Photopic perimetric sensitivity was determined by an opponent M- versus L-cone, a nonopponent M+L-cone, and an S-cone mechanism centrally and by a combination of an S-cone and an M+L-cone mechanism peripherally.
Under scotopic conditions, a 480-nm stimulus provides adequate isolation (≥28 dB) of the rod mechanism. Several mechanisms contribute to mesopic sensitivity: this redundancy in detection may cause both insensitivity to broadband white targets and ambiguity in determining which mechanism is being probed with short-wavelength stimuli. M- and L-cone-derived mechanisms are well isolated at 10 cd.m
: these may be selectively probed by a stimulus at 640 nm (≥ 20 dB isolation).
In human observers, multiple mechanisms contribute to the detection of Goldmann size III and size V perimetric targets under scotopic, mesopic, and photopic conditions. The relative contribution of these mechanisms appears to differ from those found previously for macaques. Our results furthermore suggest that caution must be exercised when using microperimetric techniques, which are typically conducted under mesopic conditions and which are likely to be important in the assessment of emerging treatments for retinal disease. This is because mesopic background conditions maximize the redundancy of target detection. Furthermore, our results demonstrate that spectral manipulation of the stimulus alone cannot be used to reliably separate rod from cone responses under these conditions.
Medmont Dark-Adapted Chromatic (DAC) Perimeter enables efficient and quantifiable evaluation of rod-mediated (scotopic) vision. DAC tests rod function at multiple retinal locations, creating a ...topographical map of rod-mediated vision. These dynamic rod responses can be used as a functional marker to monitor disease progression and functional alterations in inherited retinal dystrophies, such as retinitis pigmentosa, Stargardt disease, cone-rod dystrophy, and choroideremia. In this chapter, we describe a protocol for the operation and analysis of the Medmont DAC in monitoring and assessing various retinal disorders.
Purpose: To compare the retinal sensitivities between the blue-on-yellow perimetry (BYP)/short-wavelength automated perimetry (SWAP) and green-on-yellow perimetry (GYP) among patients with and ...without nuclear sclerosis among glaucoma suspects. Methods: After ophthalmic examination, patients were subjected to two perimetric tests: BYP and GYP. The visual field (VF) parameters were compared between the two perimeters (p < 0.05 was considered significant). Results: Fifty-five eyes of 39 patients with a mean age of 60.53 ± 9.70 years were included in the study. Twenty-one eyes had clear lens or pseudophakia. Twenty-six eyes had lower grades of nuclear sclerosis (NO2NC2, NO3NC3) and eight eyes had higher grades of cataract (NO4NC4, NO5NC5). The mean retinal sensitivity (RS) in BYP was 22.08 ± 5.02 (dB) and in GYP was 23.84 ± 5.50 (dB) (p = 0.08). The mean defect in BYP was -2.56 ± 4.40 (dB) and in GYP was -3.24 ± 5.05 (dB), pattern standard deviation (PSD) in BYP was 3.65 ± 1.91 (dB) and in GYP was 3.83 ± 1.99 (dB), and foveal threshold (FT) was 24.20 ± 4.32 (dB) in BYP and 28.10 ± 4.50 (dB) in GYP. The two perimeters showed good agreement by the Bland-Altman plot for all parameters. Fourteen eyes showed perimetric changes suggestive of glaucoma by BYP. In these, GYP had a sensitivity of 92.86% (95% CI of 66.13% to 99.82%) and specificity of 95.12% (95% CI of 83.47% to 99.40%). Conclusion: BYP and GYP show good agreement. They are comparable in clear media as well as in different grades of nuclear sclerosis. GYP showed good sensitivity and specificity compared to BYP.
Purpose
To explore the mechanisms of cone sensitivity loss in retinitis pigmentosa by combining two‐colour perimetry with threshold versus intensity (tvi) testing.
Methods
Seven subjects with ...autosomal recessive retinitis pigmentosa and 10 normal subjects were recruited and underwent perimetric testing of one eye using 480‐ and 640‐nm Goldman size V targets presented under scotopic conditions (no background illumination) and against a white background ranging in luminance from −1.5 to 2 log cd m−2 in 0.5 log cd m−2 steps. Data were fitted with tvi functions of the form logT = logT0 + log ((A + A0)/A0)n, where T is the threshold, T0 is the absolute threshold, A is the background intensity, A0 is the ‘dark–light’ constant and n is a gain constant.
Results
Reliable tvi functions could not be obtained within the region of the visual field corresponding to loss of the ellipsoid zone on optical coherence tomography. At fixation, changes in both T0 and A0 were observed, consistent with a d1 mechanism loss, which resulted in an upwards and rightwards shift of the tvi function. Losses at ±3°, ±3° demonstrated changes in T0, consistent with a d3 mechanism loss, resulting in an upwards translation of the tvi curve.
Conclusions
Although the absolute cone threshold was elevated at each location, shifts in the tvi function (so‐called d1 mechanism loss) at fixation minimise threshold elevation in the presence of white adapting backgrounds, such as those typically employed in standard two‐colour perimetry. At more peripheral testing locations, changes in threshold occurred independent of background luminance (so‐called d3 mechanism loss). These findings suggest that backgrounds which selectively adapt rods while maintaining cones at, or near, absolute threshold may be preferable to conventional two‐colour perimetry for assessing loss of cone sensitivity, especially at the point of fixation.
Abstract Glaucoma is a leading cause of irreversible blindness worldwide and poses a significant public health challenge. Primary open-angle glaucoma (POAG) is the most common form of glaucoma and is ...marked by progressive optic nerve damage and peripheral visual field loss. Early detection and management of glaucoma are essential to prevent severe vision impairment. Perimetry measures visual field sensitivity and is a crucial tool for diagnosing and the progression of glaucoma. However, traditional perimetry devices are bulky, expensive, and require specialized settings, thereby limiting their accessibility. Studies indicate the evolving role of portable and home-based visual field testing, where the efficacy of virtual reality (VR) devices such as the VisuALL against traditional perimetry tools. Apple Vision Pro’s integration into glaucoma management could address the limitations of conventional perimetry, and thus making monitoring more feasible and less burdensome. In this manuscript, we explore the potential of Apple Vision Pro’s technology as a head-mounted perimetry device for glaucoma. The Apple Vision Pro headset leverages advances in augmented reality and wearable computing to offer a portable, cost-effective solution for visual field testing. Its compact design enables patients to perform tests at home, thus reducing the need for clinical visits and improving adherence to monitoring protocols. This portability is also particularly beneficial in space environments, such as on the International Space Station, where regular monitoring of visual health of astronauts is critical.
False Positive Responses in Standard Automated Perimetry Heijl, Anders; Patella, Vincent Michael; Flanagan, John G. ...
American journal of ophthalmology,
January 2022, 2022-01-00, 20220101, 2022, Letnik:
233
Journal Article
Recenzirano
Odprti dostop
To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results.
Prospective multicenter cross-sectional study.
One hundred twenty-six patients ...with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH).
Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6%-1.4%). Only small parts of intervisit differences were explained by FP (r2 values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r2 values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP.
Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results, except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.
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