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Severe persistent visual field constriction associated with vigabatrin. Patients taking vigabatrin should have regular visual field testing.
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Visual field testing with binocular fixation.
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Red dots visual field test with blue on yellow & blue on red macula test grid.
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Artificially produced quadrantanopsia in computed visual field testing.
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Visual field testing with reduced sets of test points. A computerized analysis.
A computerized analysis of visual fields is described. In a second step these results are condensed into a 'reduced' set of test points so constructed that if testing is limited to 6-8 points nearly all defective visual fields would have been spotted with at least one defective point. The 'reduced' set involves the testing of few points several times in a session rather than spending very few trials on a great number of points. This is a new approach which merits further investigation.
The effect of ocular dominance on visual field testing.
PURPOSE: During standard automated perimetry (SAP), some patients experience visual disturbances in the tested eye while the other eye is covered with an opaque occluder. It is possible that a binocular interaction producing an inhibitory response in the nonoccluded eye, such as rivalry or Ganzfeld blankout, may be the causative factor, particularly when the dominant eye is occluded. The objective of this experiment was to determine whether subjective visual disturbances occurring during conventional perimetric test conditions were related to ocular dominance and to investigate the effect of these disturbances on measurements made during threshold visual field analysis. METHOD: Ocular dominance was determined by questioning and objective testing on 55 normal subjects. Each subject underwent program 24-2 Full Threshold SAP on a Humphrey Field Analyzer, and an opaque black patch was used to occlude the nontested eye. After testing, patients were asked to report symptoms of visual disturbance characteristic of rivalry or blankout, and the relationship between ocular dominance and visual disturbances was investigated. To determine whether symptoms of rivalry or blankout had affected visual field quantification, comparisons of short-term fluctuation, mean deviation, and false-negative errors were performed between eyes with and without visual disturbances. RESULTS: A total of 24 of 55 subjects reported visual disturbances consistent with rivalry or blankout (44%). Sixteen subjects complained of the phenomenon in one eye, and eight complained of the phenomenon in both eyes. Of the 16 experiencing disturbances in one eye only, nine cases occurred during occlusion of the dominant eye. The association between ocular dominance and visual disturbances was not found to be significant (p > 0.10). No significant differences in short-term fluctuation (p = 0.78), mean deviation (p = 0.64), or false-negative errors (p = 0.10) were found between eyes with and without visual disturbances. CONCLUSIONS: Patients undergoing standard automated perimetry with opaque patch occlusion of the nontested eye often experience visual disturbances consistent with rivalry or blankout, although these disturbances do not cause increased within-test variability or reduced sensitivity as quantified by visual field global indices. In terms of summary visual field indices, ocular dominance does not appear to affect visual field test results.
The effect of artificial tear administration on visual field testing in patients with glaucoma and dry eye.
AIM: To examine the effects of artificial tear administration on perimetry of primary open-angle glaucoma patients with dry eye. METHODS: A total of 40 patients with primary open-angle glaucoma experienced in automated perimetry with symptoms of dry eye were enrolled in this study. After their pretest visit, they were instructed to use artificial tear four times a day in both eyes for 1 week. After 1 week, patients had visual field testing. Test taking time, reliability parameters (false-positive and false-negative errors) visual field indices and number of depressed points at different probability levels (P<5%, P<2%, P<1%, P<0.5%) in both total and pattern deviation plots were compared using paired Ttest. RESULTS: We found significant improvement in reliability parameters (false-positive errors from 2.4+/-2.1 to 2.1+/-1.9, P=0.02; and false-negative errors from 7.3+/-6.4 to 4.8+/-3.6, P=0.01) and visual field indices (MD increased from 5.97+/-5.61 to 4.57+/-4.53, P=0.001; PSD from 4.67+/-2.95 to 4.13+/-2.77, P=0.04 and SF decreased from 2.24+/-1.23 to 1.83+/-0.77, P=0.04) in the second testing after artificial tear administration. Test time significantly increased from 11.66+/-2.55 min to 14.26+/-1.36, P=0.001. The number of depressed points at probability levels P<1% (P=0.03) and P<0.5% (P=0.04) at total deviation plot and P<2% (P=0.02) and P<0.5% (P=0.009) in pattern deviation plot decreased significantly. CONCLUSION: Artificial tear administration in glaucomatous patients with dry eye seems to improve significantly reliability parameters and visual field indices.
[Screening visual field test considering priori probability].
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Oculokinetic perimetry: a simple visual field test for use in the community.
A method of visual field examination is described which enables an unsupervised person to carry out self-assessment using only a paper test chart, a record sheet, and a pencil. It is entitled 'oculokinetic perimetry' because it is the subject's eye that moves and not the test target. By providing non-ophthalmic health care workers with a simple means of performing perimetry in the community, and by allowing susceptible people to carry out self-assessment of the visual fields at home, this test should facilitate the detection and management of glaucoma, especially in underdeveloped countries.
Continuous visual field test supervision may not always be necessary.
OBJECTIVE: To assess the effect of supervision on computerized visual field (VF) performance and to determine what patient characteristics predict poor unsupervised performance. DESIGN: Randomized, crossover, cross-sectional, clinical trial. PARTICIPANTS: Two hundred unselected patients with definite or suspect glaucoma or neuro-ophthalmic VF indication participated. INTERVENTION: All patients completed two 30-2 tests of one eye on a Humphrey perimeter, one with continuous active technician supervision and one without supervision after the initial 2 minutes of the test. MAIN OUTCOME MEASURES: Visual field reliability and global VF indices were measured. RESULTS: Supervision had a positive effect on overall reliability (P = 0.04) but not on individual reliability parameters or any of the global VF indices. There was no difference between Humphrey Field Analyzers I and II in the need for supervision. Predictors of need for supervision were low educational level and a prior test result with false-positive responses. Predictors of an unreliable test were advanced age and a prior test with a high proportion of fixation losses. CONCLUSION: Supervision is necessary for those with risk factors for unsatisfactory perimetry such as advanced age, low level of formal education, and prior test results with false-positive responses or high fixation losses; in the remainder, omission of supervision can be considered.
Introduction to formal visual field testing: Goldmann and Humphrey perimetry.
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The learning effect in visual field testing of healthy subjects using frequency doubling technology.
PURPOSE: To evaluate the presence, duration and magnitude of a learning effect in serial visual field (VF) testing, using the commercially available frequency doubling technology (FDT) instrument. PATIENTS AND METHODS: 21 healthy adults with no prior VF experience underwent 6 serial VF tests, using the full-threshold C-20 program of the Zeiss-Humphrey FDT analyzer, on one randomly chosen eye. Tests were spaced at least two days apart. RESULTS: The average mean sensitivity was 32.37 +/- 2.6 dB; the average mean deviation (MD) was 1.22 +/- 1.8 dB. The MD at the first examination (0.28 +/- 2.1 dB) was significantly poorer than at any of the other testing sessions (p<0.003). Similarly, the mean sensitivity at the first examination (31.16 +/- 3.0 dB) was significantly lower than any other testing session (p<0.004). The proportion of improvement from the first to the second session was 63% and 65% of the total improvement, for mean sensitivity and MD, respectively. Mean test duration showed a modest reduction, from 4.40 +/- 0.3 minutes in the first session to 4.17 +/- 0.4 minutes in the last session (p = 0.023). A sub-analysis comparison of the different VF segments showed a more prominent learning effect in the peripheral and nasal visual segments (p<0.0001). CONCLUSION: Baseline measurements should best rely on the second testing session, since MD and mean sensitivity are somewhat poorer when subjects with no prior VF experience are first tested on the FDT instrument. This may be especially true for the purpose of following patients over time.
Converting to SITA-standard from full-threshold visual field testing in the follow-up phase of a clinical trial.
PURPOSE: To evaluate the impact of converting from Humphrey 24-2 full-threshold (FT) visual field (VF) testing to SITA-Standard (SS) VF testing during the follow-up phase of a clinical trial. METHODS: VF data were obtained from 243 patients in the Collaborative Initial Glaucoma Treatment Study (CIGTS) who had follow-up visits in 2004. FT and SS VF tests were performed in random order on the same day. RESULTS: The average duration of the SS test (6.3 minutes) was shorter (P < 0.0001, paired t-test) than the FT test (11.8 minutes). The mean deviation did not differ between SS and FT testing. A small difference was found in the pattern SD (PSD) (P = 0.02). The mean CIGTS score from the FT test (4.5) was significantly lower (P < 0.0001) than the mean CIGTS score from the SS test (6.0). Although the two tests yielded identical Glaucoma Hemifield Test (GHT) results in 179 patients (76%), 16 patients had a normal GHT result on FT testing and an SS test result that was outside normal limits. Six patients had the reverse finding. The most significant factor associated with an increased (positive) difference between the CIGTS VF score generated from SS and FT testing was conducting the FT test first (P < 0.0001). CONCLUSIONS: Although SS and FT testing yielded very similar mean deviation results, the CIGTS VF score and GHT differed between SS and FT tests. Changing the approach used to measuring a study's primary VF outcome should be accompanied by a critical evaluation of the change's impact.
A system of visual field testing and recording using a parabolic projection.
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Visual field testing in glaucoma Medicare beneficiaries before surgery.
OBJECTIVE: The standard of care for progressive glaucoma that requires medical or surgical intervention includes visual field (VF) testing at least annually. This study aims to assess how commonly ophthalmologists perform VF testing before planned glaucoma surgery in the Medicare population, and whether variations in conformance occur across demographic and clinical subgroups. DESIGN: Retrospective, observational, population-based analysis. PARTICIPANTS: Thirteen thousand seven hundred fifty-three Medicare beneficiaries. METHODS: Data were obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States from 1995 to 1999. The proportion of patients with evidence of at least 1 VF examination in the year before glaucoma surgery was determined. MAIN OUTCOME MEASURE: Rate of VF testing in the year before glaucoma surgery. RESULTS: Overall, 70% of patients had at least 1 VF test in the year preceding glaucoma surgery. This rate was significantly lower (P<0.001) in patients > or =85 years (56%), blacks (64%), patients with race other than white or black (66%), patients with diabetic retinopathy (60%), and patients with bilateral blindness (47%). CONCLUSIONS: The use of VF testing before surgery in glaucoma Medicare beneficiaries is suboptimal relative to the recommended standard of care. Underutilization is of particular concern in blacks, who are at increased risk of glaucomatous damage. Quality-of-care initiatives are needed to facilitate appropriate preoperative evaluations of glaucoma Medicare beneficiaries for glaucoma surgery.
[Reproducibility of central visual field testing using kinetic or computerized static perimetry (author's transl)].
Under controlled conditions the differences between duplicated examinations with the Goldmann kinetic perimeter and the Krakau/Heijl static computerized perimeter were evaluated. Kinetic visual fields were obtained independently by two well trained examiners and duplicate examinations were performed by computer perimetry. The differences between the two examinations were statistically evaluated using quantitative criteria. The agreement between first and second examination--based on normal and pathologic findings--was 72% for the Goldmann and 88% for the computer perimeter. The greater reproducibility of central visual field testing with the computer perimeter is most probably due to the subjectivity of the observer in the kinetic manual technique. The computer obviously represents a standardized observer using a constant strategy with a fixed time course. The computerized perimeter was easy to operate and did not require a specially trained technician. All the patients in whom kinetic visual field testing was possible were able to undergo computerized perimetry.
Visual field testing of driving license applicants.
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