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At least 145 records · Page 8Linked to original sources
PubMed2004

New perimetric techniques: a comparison between rarebit and frequency doubling technology perimetry in normal subjects and glaucoma patients.

PURPOSE: To compare rarebit microdot perimetry (RB) with frequency doubling technology (FDT) perimetry in normal subjects and a group of patients with ocular hypertension or glaucoma, with age-matched controls. MATERIALS AND METHODS: : Eighty-one subjects (age 17-88 years) were examined. Twenty-seven of these were patients, aged 50 to 88 years, with ocular hypertension or suspected/manifest glaucoma in at least one eye. All subjects were examined with the RB and FDT perimetry, using the standard procedures, recommended by the respective manufacturer. RESULTS: All patients were able to perform the RB perimetry, but three patients could not perceive the strongest FDT stimulus. The concordance in RB and FDT classifications as normal/outside normal limits was 96% (Cohen's kappa = 0.90). A curvilinear (quadratic) relationship (Rsq = 0.75) was found between RB hit rate and FDT MD. All patients, who could perform both examinations, preferred the RB perimetry. CONCLUSION: In the current study, the information from the RB and FDT perimetry was almost completely equivalent. However, RB perimetry was preferred by the patients and seemed to have a larger dynamic range than FDT. The RB hit rate is apparently a straightforward and efficient measure of visual field function.

Adolescent↗
PubMed2006

Humphrey matrix frequency doubling technology perimetry and optical coherence tomography measurement of the retinal nerve fiber layer thickness in both normal and ocular hypertensive subjects.

PURPOSE: The purpose of this study was to determine by means of the Humphrey Matrix frequency doubling technology (FDT) perimetry and the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurement whether functional and/or structural differences exist between normal and ocular hypertensive (OHT) subjects. PATIENTS AND METHODS: One eye of 60 consecutive normal individuals and 60 OHT subjects was enrolled in this prospective observational comparative case series study. All subjects were examined at either the Ophthalmology Clinic, University of Chieti-Pescara, Chieti, Italy or the Department of Ophthalmology, S. Maria della Misericordia Hospital, Udine, Italy. All subjects underwent a full ophthalmic examination, including visual acuity, slit-lamp biomicroscopy, central corneal thickness ultrasound pachymetry measurement, achromatic automated perimetry, Matrix FDT perimetry, stereoscopic optic nerve head photography, and OCT. Matrix FDT perimetry mean deviation (MD), pattern standard deviation, glaucoma hemifield test, and 12 OCT RNFL thickness parameters were examined. Student t test, Bonferroni correction for multiple comparisons and receiver operator characteristics curve areas (AUROCs) were used to find any discrimination function between healthy and OHT eyes. Sensitivities at 83% and 92% specificities were reported. RESULTS: The FDT MD scores ranged from -1.10 to +3.80 decibels (db) in normal individuals and from -4.75 to +3.20 db in OHT subjects. The comparison between the average MD in the 2 groups showed a statistically significant difference (P=0.024). OCT showed a statistically significant difference between the 2 groups when examining the ratio between the inferior and the superior mean RNFL thickness (P=0.004). For OCT, the parameter with the largest AUROC for discriminating between healthy and hypertensive eyes was the ratio between the mean inferior and superior RNFL thickness (AUROC=0.85, sensitivity=75% at specificity=83%, sensitivity=67% at specificity=92%). For Matrix FDT perimetry, the parameter with the largest AUROC was MD (AUROC=0.78, sensitivity=67% at specificity=83%, sensitivity=58% at specificity=92%). CONCLUSIONS: Our results suggest that OHT eyes having a normal achromatic automated perimetry and a normal clinical disc appearance cannot be differentiated from normal eyes using conventional OCT parameters. When analyzing the ratio between inferior and superior average RNFL thickness, however, a significant difference is evident between healthy and hypertensive eyes. Using Matrix FDT perimetry, a significant difference in MD seems to exist between these 2 groups of eyes. The AUROCs confirm that OCT Iavg/Savg and Matrix FDT MD show the greatest sensitivity and specificity among the examined OCT and Matrix FDT parameters.

Adult↗
PubMed1987

A comparison of Goldmann and Humphrey automated perimetry in patients with glaucoma.

Humphrey automated threshold perimetry (Program 30-2) was performed on 42 eyes of 25 patients with glaucoma to determine both the sensitivity and specificity of automated perimetry in detecting glaucomatous visual field defects. Automated perimetry sensitivity was 90.38%, while automated perimetry specificity was 91%. Fifty-two patients and a technician took part in a survey to determine their preference for either test. Patients generally preferred having Goldmann perimetry. The technician favoured Humphrey automated perimetry. Program 30-2 on the automated perimeter took 25% longer to perform than Goldmann perimetry.

Attitude of Health Personnel↗
PubMed2004

Neural losses correlated with visual losses in clinical perimetry.

PURPOSE: The validity of clinical perimetry for evaluation of the pathology of glaucoma is based on correlated losses in retinal ganglion cells and visual sensitivity, but procedures to quantify neural losses from visual field defects have not been developed. The purpose of the present study was to investigate the neural and sensitivity losses from experimental glaucoma to establish the framework for a quantitative model for the structure-function relationships of standard clinical perimetry. METHODS: Perimetry, by behavioral testing, and retinal histology data were obtained from rhesus monkeys with significant visual field defects caused by experimental glaucoma. Ganglion cell densities were obtained from sections of retina that corresponded to 16 perimetry test locations. Perimetry sensitivity as a function of ganglion cell density at corresponding retina/visual field locations was analyzed. RESULTS: The structure-function relationships were linear on log-log coordinates, with parameters that varied systematically with eccentricity. The slope value varied from 1.25 dB/dB at 4.2 degrees from fixation to a value of 2.32 dB/dB at 24 degrees from fixation, whereas the intercept value varied from -25.2 dB to -55.7 dB over the same range of eccentricities. The structure-function relationships produced a model to predict the ganglion cell density underlying a given level of visual sensitivity and location in the visual field. The model, with no free parameters, produced an accurate and relatively precise quantification of retinal ganglion cell losses caused by experimental glaucoma in monkeys. However, because the early detection of glaucoma is limited by intersubject variability, ganglion cell losses of 40% to 50% were necessary before visual sensitivity losses exceeded the normal 95% confidence limits. CONCLUSIONS: With retinal eccentricity as a factor, the neural losses from glaucoma are predictable from visual sensitivity measurements by clinical perimetry. The relationships derived from experimental glaucoma in monkeys also accurately predict the rate of age-related losses of retinal ganglion cells in humans, based on the normative perimetry data for age-related reductions in visual sensitivity. The success of the model in this study suggested that it is potentially applicable to the clinical interpretation of the state of glaucomatous optic neuropathy.

Animals↗
PubMed2003

[White-on-white, blue-on-yellow and blue-on-blue perimetry in normal subjects].

PURPOSE: To compare blue-on-blue differential contrast perimetry (BB), in accordance with E. Land "Retinex" theory, with white-on-white (WW) and blue-on-yellow (BY) perimetries on normal subjects. METHODS: An Octopus 101 perimeter was modified for BB perimetry, using a 4cd/m2 background and stimulus Goldmann size V. Fifty healthy subjects (10 per decade, from 20 to 70 years) were examined twice with each type of perimetry (WW, BB, BY) using the TOP strategy. RESULTS: The results obtained with WW, BY and BB perimetry were respectively: Reduction of sensitivity per year: 0.13, 0.27 and 0.13 dB; correlation coefficient (r) of threshold with age (and error of estimation of Y over X): -0.63 (2.24 dB), -0.70 (3.77 dB) and -0.80 (1.32 dB); threshold fluctuation: 2.21, 3.03 and 2.03 dB; percentage of points deviated more than 5dB from the expected value for the patient age: 8.1, 16.0 and 4.2%. CONCLUSIONS: Perimetric results are more stable with BB strategy than with the other two types of perimetry. BY perimetry gives the worst results: threshold reduction with age is twice higher, individual fluctuation is 50% higher and points away from the mean value are much more frequent. Overlapping between blue and yellow filters is minimal in Octopus. Therefore, an absolute threshold is examined, which is much more unstable than WW or BB differential thresholds.

Adult↗
PubMed1998

Wall perimetry in chiropractic.

BACKGROUND: Wall perimetry is a method of examination that led to the initial appreciation of the "tunnel vision information." The visual field loss that wall perimetry indicates generally defines the overall characteristics of the dysfunction associated with 'tunnel vision.' Wall perimetry is an inexpensive, yet sensitive, preliminary screening test for perception abnormality in the outermost periphery of vision. OBJECTIVE: To describe wall perimetry. The term "wall perimetry" denotes a simple preliminary method of examining the visual fields of chiropractic patients. DISCUSSION: The test is described with reference to photographs. The patient stands 1 m from the corner of a room and is instructed to look directly at the junction of the walls, with the head remaining still and gaze fixed. Standing behind the patient, the examiner projects a target of light onto the wall and moves it until it is seen by the subject. CONCLUSION: Chiropractors are encouraged to test appropriate patients by wall perimetry before spinal manipulation therapy. On the basis of existing experience, detection of patients with visual field loss is to be expected. From that point, formal examination of the visual fields using kinetic or static perimetry apparatus is recommended to further verify the "tunnel vision" discovery.

Chiropractic↗
PubMed1998

Influence of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on short-wavelength and conventional automated perimetry.

The aim of the study was to determine the effect of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on macular visual function as assessed by conventional and short-wavelength automated static threshold perimetry. The sample comprised 24 patients who required laser photocoagulation for clinically significant DMO (mean age 59.75 years, range 45-75 years). One eye of each patient was selected for the study. Patients underwent conventional and short-wavelength perimetry using programme 10-2 of the Humphrey Field Analyser on two separate occasions prior to treatment and subsequently within 1 week of, and at 1, 2, 4 and 12 weeks after, treatment. The pointwise pattern deviation plot was analysed for conventional perimetry and a pointwise horizontal and vertical hemifield asymmetry analysis was derived for short-wavelength perimetry (thereby negating the influence of pre-receptoral absorption). The extent of sensitivity loss was determined by counting the number of stimulus locations with statistical probability levels of p less than 0.05. Group mean log minimum angle of resolution (logMAR) visual acuity was largely unchanged over the course of the study. Conventional perimetry showed an increase in the group mean number of abnormal contiguous stimulus locations from 2.4 (SD 4.3, range 0-14) immediately prior to treatment, to 12.4 (SD 7.8, range 0-30) within 1 week of treatment; at 3 months post-treatment, the group mean number of abnormal contiguous stimulus locations was 8.1 (SD 6.5, range 0-20). A similar but less pronounced change was found for short-wavelength perimetry. The spatial position of the post-treatment localised sensitivity loss corresponded with the area of retinal photocoagulation. Despite proven benefit in the stabilisation of visual acuity, laser photocoagulation for clinically significant DMO invariably results in a localised loss of perimetric sensitivity within 10 degrees eccentricity of the fovea. Evidence for the value of laser therapy for clinically significant DMO must be re-examined.

Aged↗
PubMedDate not supplied

Recovery of reliability by retest after a 5-minute interval in frequency doubling technology perimetry.

PURPOSE: In frequency doubling technology (FDT) perimetry, the incidence of tests classified as unreliable is higher in the second-tested left eye than in the first-tested right eye when perimetry is performed without a rest period. The purpose of this study was to determine whether the incidence of unreliable results was reduced when the retest began after a 5-min rest period. METHODS: The subjects were 978 residents of Miyoshi City, Japan, who underwent FDT perimetry during a medical checkup. FDT perimetry was always performed first on the right eye and then on the left eye without a rest interval. When the results were determined to be unreliable, FDT perimetry was repeated after a 5-min rest interval. RESULTS: The perimetric results were determined to be unreliable in one eye of 119 subjects; the results of the first-tested right eye were unreliable in 24 (20.2%), and the results of the second-tested left eye were unreliable in 95 (79.8%) subjects. This difference in the incidence of reliability was significant (P<0.001). After a 5-min rest interval, the percentage of eyes with reliable results recovered to 92% of the right eyes and to 86% of the left eyes. CONCLUSIONS: The incidence of unreliable results in FDT perimetry of the second-tested left eye was higher than that of the first-tested right eye when tests were performed without a rest interval. However, the incidence of unreliability in the eye was decreased when the retest was performed after a 5-min rest interval.

Adult↗
PubMedDate not supplied

Automated perimetry: background, instruments and methods.

The goal of automated perimetry is to reduce perimetrist involvement and testing time while maintaining standardized test conditions. Proper calibration of the perimeter background luminance and target intensity is important so that results can be compared between examinations and machines. Three testing procedures may be used alone or in combination: kinetic, threshold static and suprathreshold static perimetry. The Octopus and the Perimetron are fully automated perimeters. The former uses threshold static perimetry while the latter uses kinetic and suprathreshold static perimetry. They are operated by small-sized microprocessors using miniature silicone chip circuitry. They are accurately calibrated, fulfilling the specifications deemed necessary by visual psychophysicists. Although data display and plotting problems still exist, automated perimetry is ready for thorough comparisons with Goldmann and Tübinger manual perimetry.

Computers↗
PubMed1995

Random dot motion perimetry in patients with glaucoma and in normal subjects.

PURPOSE: To determine whether patients with primary open-angle glaucoma have an increase in size thresholds, prolongation of reaction times, and greater localization errors to random dot motion stimuli than normal subjects. METHODS: Motion perimetry, a computer graphics method of visual field testing, quantitates a subject's ability to detect a correlated shift in position of dots within a defined circular area against a background of fixed dots. We measured motion thresholds, the smallest detectable circular dot motion target, at the Humphrey 24-2 test loci. By using the subject's light-pen responses to the location of the targets, we computed motion size threshold, reaction times, and localization errors (number of pixels from where the subject touched the monitor to the target center). With motion perimetry and conventional automated perimetry, we tested one eye in each of 25 patients with primary open-angle glaucoma and 25 age-matched control subjects. We then generated total deviation pointwise probability plots for the patients with primary open-angle glaucoma. RESULTS: Patients with primary open-angle glaucoma had increased mean motion size threshold (P < .001) and increased localization errors (P < .002), compared with the control subjects. With the probability plot analysis, there was good correlation of the visual field defects between the two perimetry tests. Additionally, motion perimetry identified nerve fiber bundle-like defects in 12 patients that were not detected with conventional automated perimetry. CONCLUSIONS: Patients with primary open-angle glaucoma had abnormal motion perception with an increase in spatial localization error.

Adult↗
PubMedDate not supplied

An automated measuring system for fundus perimetry.

PURPOSE: In order to automate fundus perimetry, which is usually laborious because of the many manual operations and the frequent eye movements, we developed a new fundus perimeter with an automated measuring system using computer technology. METHODS: This fundus perimeter consists of an infrared fundus camera, a fundus-pursuit unit, and a target-display unit. Both units are personal computers operating on Windows. After presetting the measuring points on the fundus, perimetry is automatically performed. The fundus-pursuit unit recognizes and pursues the fundus reference region while calculating its coordinates in real time during perimetry. The target-display unit corrects the stimulus coordinates with data from the fundus-pursuit unit and even if eye movement occurs, automatically displays the stimulus targets at the correct retinal point that had been preset. RESULTS: Fundus perimetry can be automatically and precisely performed with this automated measuring system. It shortens the duration of the examination and frees the operator from the lengthy and laborious manual operations during perimetry. CONCLUSIONS: This automated measuring system will make fundus perimetry easier for the operator, as well as more popular for clinical use.

Adult↗
PubMed2002

Assessment of optic disc anatomy and nerve fiber layer thickness in ocular hypertensive subjects with normal short-wavelength automated perimetry.

PURPOSE: To compare optic disc topography and nerve fiber layer thickness in ocular hypertensive eyes and normal subjects. DESIGN: Prospective, case-controlled study. PARTICIPANTS AND CONTROLS: One eye in each of 20 normal and 27 ocular hypertensive patients was enrolled. METHODS: Consecutive normal and ocular hypertensive patients were enrolled. Each patient underwent complete ophthalmic examination, achromatic automated perimetry, short-wavelength automated perimetry, confocal scanning laser ophthalmoscopy, confocal scanning laser polarimetry, and optical coherence tomography. The intraocular pressure was 21 mmHg or less for normal subjects and at least 25 mmHg on two separate occasions in ocular hypertensive eyes. Structural parameters were compared between the two groups. Eyes with evidence of glaucomatous optic neuropathy, achromatic visual field loss, or evidence of focal visual field injury during short-wavelength automated perimetry were excluded. MAIN OUTCOME MEASURES: Optic nerve head topography and nerve fiber layer thickness. RESULTS: The three imaging technologies could not detect differences in optic disc or nerve fiber layer anatomy between the two groups. Ocular hypertensive eyes had a greater corrected pattern standard deviation than normal eyes during short-wavelength automated perimetry (P = 0.04). CONCLUSIONS: Ocular hypertensive eyes with normal achromatic automated perimetry and short-wavelength automated perimetry could not be distinguished from normal subjects with confocal scanning laser ophthalmoscopy, confocal scanning laser polarimetry, and optical coherence tomography.

Adult↗
PubMed2006

[I have tested for you. Automated kinetic perimetry].

We compared the kinetic perimetry of the Humphrey Field Anayzer and the Haag Streit Octopus 101 and assessed their use in relation to Goldmann perimetry. The Humphrey kinetic perimetry comes close to Goldmann perimetry and the Octopus shows clear advantages, notably in terms of ergonomics and its more sophisticated software. The Goldmann requires a high level of skill; examination time with the Humphrey and the Octopus is at least double the time required by a skilled Goldmann operator. The examiner can to a certain degree be passive during the static visual field examination, but is entirely active during the kinematic visual field examination. Therefore, contrary to static perimetry, the examination can only be performed by a physician. The future of automated kinematic perimetry depends on simplification of the software.

Humans↗
PubMed1999

Localized scotomata detected with temporal modulation perimetry in central serous chorioretinopathy.

AIM: Flicker deficits have been reported in various maculopathies, including age-related macular degeneration. We test whether flicker losses exist in patients with central serous chorioretinopathy (CSC) and whether the size and flicker frequency of the target is important in detecting such losses. METHODS: We examined four CSC patients with temporal modulation (flicker perception) perimetry using the Medmont auto-flicker module (Medmont Pty Ltd, Melbourne, Vic. Australia), as well as static perimetry and colour vision. One case was examined using sophisticated laboratory equipment to precisely measure their temporal contrast sensitivity function (temporal CSF or de Lange curve) using larger targets to consider the effect of target frequency and size. Two patients were followed longitudinally and tested after resolution of the maculopathy. We compared our patients with an age-matched control group of 11 people. RESULTS: Temporal modulation perimetry detected larger and more localized defects in all cases of active CSC compared with static perimetry. There appeared to be size and frequency tuning to the deficit, with greatest loss being found at 16 Hz with small (0.5 degree) targets. The losses resolved in one case where the retina recovered in 4 weeks, but remained to a lesser degree in another case who suffered a 2 year long fluctuating course before the CSC subsided. CONCLUSIONS: Temporal modulation perimetry detects a loss of flicker sensitivity in patients with CSC. Deeper and more clearly defined scotomata are found with a flickering stimulus compared with a steady state one. The greatest losses of flicker sensitivity are found with 16 Hz modulation and with small targets located directly over the lesion. The duration of the disease may be important for recovery of flicker sensitivity. Temporal modulation perimetry appears to be a valuable tool for the confirmation of functional loss due to CSC.

Adult↗
PubMed2004

Vigabatrin-associated loss of vision: rarebit perimetry illuminates the dose-damage relationship.

PURPOSE: The utility of vigabatrin in the treatment of epilepsy is partially offset by its retinal toxicity. The relationship between dosage and damage is obscure. This may be due to perimetric shortcomings. The new technique of rarebit ('microdot') perimetry might be more informative. METHODS: Twelve patients who had been treated with vigabatrin for various durations were examined by manual, kinetic perimetry and by rarebit perimetry. RESULTS: Rarebit results differed significantly between patients and normal controls and rarebit deficits were directly proportional to cumulated vigabatrin doses (correlation coefficients were - 0.92 in the nasal field and - 0.82 in the temporal field). Manual perimetry results were less clearly related to dosage (r = - 0.54 and r = - 0.73, respectively). CONCLUSION: Rarebit perimetry indicates that each treated subject will develop visual loss and that visual loss will be proportional to the accumulated dose. Conventional perimetry is less well suited to detecting and quantifying vigabatrin-associated visual loss.

Adult↗
PubMed2001

[Evaluation of extensive visual field defects with computer-assisted kinetic perimetry].

BACKGROUND: Conventional kinetic perimetry is of especial use in case of advanced scotoma. However, examiner dependency is a major drawback. Purpose of this study was to evaluate the clinical feasibility and intraindividual scatter of computer-assisted kinetic perimetry in monitoring advanced visual field defects of various origins. METHODS: Examinations were carried out with the Tuebingen Computer Campimeter (background lumincance 10 cd/m2). In an initial session, the localization of the scotoma border is estimated with conventional manual kinetic perimetry. In the subsequent computer assisted kinetic mode, an individually adjusted set of vectors is designed. Each vector crosses the manually assessed visual field defect border almost perpendicularly, starting approximately 3 degrees within the scotoma. Each individual set of vectors can be stored and recalled for follow-up. Stimuli move along these vectors with identical characteristics as in manual kinetic perimetry. Stimulus presentations are repeated six times in a randomized order. Patients' responses are recorded and additionally corrected for mean individual reaction time. A "local kinetic threshold" (mean) and a related parameter for dispersion (standard deviation) are assessed. RESULTS: Four subjects with advanced visual field loss of various origin (retinitis pigmentosa, vigabatrin-associated visual field defect, glaucomatous nerve fibre layer defect, and postgeniculate visual pathway defect) participated in this study. Maximal difference between manual-kinetic and automated kinetic thresholds reaches from 1.7 degrees to 5 degrees. Local scatter (standard deviation) of kinetic threshold, assessed by computer-assisted perimetry, varies between 0.1 degree and 3.0 degrees. CONCLUSION: Computer assisted kinetic perimetry is a new, useful, examiner-independent, reliable method for effective evaluation and monitoring of advanced visual field loss.

Adult↗
PubMed1994

[15 years automated perimetry--where does the path lead?].

15 years ago the first fully automated perimeter became available, the Octopus 201, developed by Fankhauser in Bern. Some of the objections which were raised in those days against automated perimeters have turned out true, many, however, not. From todays perspective automated perimetry has brought tremendous advantages for clinical routine diagnosis. The essential power of automated perimetry is its ability to obtain quantitative data which can be processed statistically. The examination of the central visual field may be performed in a much more sophisticated way than by manual kinetic testing. Automated perimetry, however, also has its draw-backs, which are mostly due to mistakes or errors by the examiner, not so much to the method itself. For routine light-sense perimetry the upcoming years will give us faster and optimized testing strategies. Procedures for automated interpretation of visual field data will be developed. The interest in more complex perimetric test criteria goes on one hand into the direction of independence of disturbancies of the optical media (e.g. temporal criteria), on the other hand into the differentiation of various cell populations in the visual system (Blue/Yellow-Perimetry; Motion-Defined-Form etc.). For objective perimetry a powerful system for pattern-ERG and pattern-VECP with a spatial resolution comparable to standard perimetric tests is available. Also in these fields of perimetry the coming years will bring interesting and revolutionary new developments which will open new diagnostic dimensions.

Electroretinography↗
PubMed1984

[Threshold-adjusted supraliminal pattern perimetry with the Goldmann perimeter].

This paper describes a method of supraliminal pattern perimetry for use with a Goldmann perimeter. In this method, the stimuli are adjusted in stages in accordance with the normal physiological sensitivity gradient. The threshold is determined on four meridians located 10 degrees and 30 degrees from the center. These threshold values are used to define three different levels of brightness which exceed the threshold by approximately the same amounts in three sectors of the field of vision extending from 2 degrees to 10 degrees, 10 degrees to 20 degrees and 20 degrees to 30 degrees. The points arranged in a rectangular pattern at intervals of 3 1/3 degrees are used to check for relative and absolute defects in the patient's field of vision. Supraliminal pattern perimetry can be performed manually on the Goldmann perimeter in a manner similar to automatic supraliminal perimetry to detect small defects in the field of vision. Manual perimetry, though, allows the physician to use his clinical experience directly and also makes it possible to combine screening and detection into a single procedure, since it is then possible to alter pattern density and to switch from supraliminal pattern perimetry to kinetic and free static threshold determination during the actual course of the examination. The flexibility of the manual method may well save both physician and patient time and effort, especially in difficult cases. With automatic perimetry, however, such flexibility is hampered by the fact that programs must be run through in succession (with the exception of the Octopus Program 4).

Computers↗