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Relating optical coherence tomography to visual fields in glaucoma: structure-function mapping, limitations and future applications
摘要： Combining information from optical coherence tomography (OCT) imaging and visual field testing is useful in the clinical assessment and monitoring of patients with glaucoma. Measurements of retinal nerve fibre layer thickness or neuroretinal rim width taken around the optic nerve head may be related to the visual field using a structure–function map. In this review, the structure–function mapping methods in clinical use are discussed. Typical clinical maps provide a population average, ‘one size fits all’ representation, but in recent years methods for customising structure–function maps to individual eyes have been developed and these are reviewed here. In the macula, visual field stimuli stimulate photoreceptors for which associated retinal ganglion cells are peripherally displaced. Recently developed methods that relate OCT measurements to visual field test locations in the macula are therefore also reviewed. The use of structure–function maps to relate OCT measurements to localised visual field sensitivity in new applications is also explored. These new applications include the selection of visual field test locations and stimulus intensities based on OCT data, and the formal post-test combination of results across modalities. Such applications promise to exploit the structure–function relationship in glaucoma to improve disease diagnosis and monitoring of progression. Limitations in the validation and use of current structure–function mapping techniques are discussed.
关键词： optical coherence tomography,visual fields,glaucoma,perimetry
更新于2025-09-11 14:15:04
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Feasibility of Macular Integrity Assessment (MAIA) Microperimetry in Children: Sensitivity, Reliability, and Fixation Stability in Healthy Observers
摘要： PURPOSE. To assess the feasibility of macular integrity assessment (MAIA) microperimetry (MP) in children. Also to establish representative outcome measures (differential light sensitivity, ?xation stability, test–retest reliability) for children without visual impairment. METHODS. Thirty-three adults and 33 children (9–12 years) were asked to perform three monocular MAIA examinations within a single session (dominant eye only). RESULTS. Children exhibited poorer test–retest reliability than adults for measures of both mean sensitivity (95% coef?cient of repeatability [CoR95] ? 2.7 vs. 2.3 dB, P ? 0.036) and pointwise sensitivity (CoR95 ? 6.2 vs. 5.7 dB, P < 0.001). Mean sensitivity was lower in children (27.6 vs. 29.5 dB, P < 0.001), and ?xation stability was poorer (95% bivariate contour ellipse area [BCEA95] ? 4.58 vs. 1.14, P < 0.001). Mean sensitivity was negatively correlated with ?xation stability (r ? (cid:2)0.44, P < 0.001). Both children and adults exhibited substantial practice effects, with mean sensitivity improving by 0.5 dB (adults) and 0.9 dB (children) between examinations 1 and 2 (P (cid:3) 0.017). There were no signi?cant differences between examinations 2 and 3 (P ? 0.374). CONCLUSIONS. Microperimetry is feasible in 9- to 12-year-old children. However, systematically lower sensitivities mean that the classi?cation boundary for "healthy" performance should be lowered in children, pending development of techniques to improve attentiveness/?xation that may reduce or remove this difference. High measurement variability suggests that the results of multiple tests should be averaged when possible. Learning effects are a potential confound, and it is recommended that the results of the ?rst examination be discarded.
关键词： test-retest reliability,MAIA,microperimetry,visual ?elds,differential light sensitivity,perimetry,children
更新于2025-09-11 14:15:04
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Effects of Cataract Extraction on the Outcomes of Automated Perimetry and Retinal Nerve Fiber Layer Thickness Measurements by Optical Coherence Tomography in Primary Angle Closure Glaucoma
摘要： Objective: To evaluate the effect of cataract extraction on both visual field and retinal nerve fiber layer thickness measurements in primary angle closure glaucoma (PACG) eyes. Methods: Retrospective cohort study on 30 PACG eyes underwent cataract extraction. Changes in RNFL thickness and visual field parameters including mean deviation (MD), visual field index (VFI) and pattern standard deviation (PSD) were analyzed within 6 months before and after cataract extraction. Results: Overall, MD (p=0.003) and VFI (p=0.004) improved significantly after cataract extraction, whereas PSD showed no significant change (p=0.6). In the 10 eyes with MD worse than -20 dB, mean MD improved by 3.4 ± 3.56 dB (from -24.36 ± 3.06 dB to -20.96 ± 5.06 dB, p=0.01) and mean VFI improved by 16.25 ± 15.66% (from 23.38 ± 9.65% to 39.63 ± 20.83%, p=0.02). PSD showed no significant change after cataract extraction (p=0.07). In the 20 eyes with MD better than -20 dB, MD and VFI also improved postoperatively, but the changes did not reach statistical significance: mean MD improved by 1.64 ± 3.65 dB (from -11.57 ± 5.57 dB to -9.92 ± 5.36 dB, p=0.05) whilst mean VFI improved by 4.57 ± 12.29% (from 74.95 ± 17.95% to 79.52 ± 17.26%, p=0.07). RNFL thickness did not show any significant changes after cataract extraction (p=0.13). Conclusions: Both MD and VFI improved after cataract extraction, especially in eyes with pre-operative MD worse than -20 dB. PSD and RNFL thickness showed no significant change after cataract extraction.
关键词： Perimetry,Visual field,Extraction,Retinal nerve fiber layer thickness,Optical coherence tomography,Primary angle closure glaucoma,Cataract
更新于2025-09-10 09:29:36
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Evaluation of Structure-Function Relationships in Longitudinal Changes of Glaucoma using the Spectralis OCT Follow-Up Mode
摘要： The detection of glaucoma progression is an essential part of glaucoma management. Subjectivity of standard automated perimetry (SAP) prevents the accurate evaluation of progression, thus the detection of structural changes by optical coherence tomography (OCT) is attracting attention. Despite its objectivity, there is controversy about the appropriateness of the use of OCT, because many previous studies have indicated OCT results may not reflect the deterioration of visual field. A reason for this dissociation may be the test-retest variability of OCT, a major cause of which is misplacement of the measurement location. Recent advantages of spectral-domain OCT (SD-OCT), especially Spectralis OCT with an eye-tracking system (follow-up mode) enable measurement at approximately the same location as previous examinations. In addition to utilizing Spectralis follow-up mode, we introduced structure-function relationship map and nonlinear relationship between SAP and OCT results in considering structure-function relationship in longitudinal changes. The introduction of these two ideas in our study population improved the correlation between the SAP and OCT (R = 0.589 at most). The results of this study support the practical use of OCT in glaucoma progression but also stress the importance of focus on the corresponding focal changes and the consideration of disease severity.
关键词： longitudinal study,standard automated perimetry,optical coherence tomography,structure-function relationship,glaucoma progression
更新于2025-09-10 09:29:36
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Variability in monocular and binocular fixation during standard automated perimetry
摘要： The aim of this cross-sectional study was to use standard automated perimetry to compare fixation variability among the dominant eye fixation, non-dominant eye fixation, and binocular fixation conditions. Thirty-five eyes of 35 healthy young participants underwent standard automated perimetry (Humphrey 24–2 SITA-Standard) in dominant eye fixation, non-dominant eye fixation, and binocular fixation conditions. Fixation variability during foveal threshold and visual field measurement, which was recorded using a wearable eye-tracking glass and calculated using the bivariate contour ellipse area (deg2), was compared among the three fixation conditions. Further, the association of bivariate contour ellipse area with ocular position and fusional amplitude during binocular fixation was analysed. There were no significant differences in bivariate contour ellipse area during foveal threshold measurement among the dominant eye fixation (1.75 deg2), non-dominant eye fixation (1.45 deg2), and binocular fixation (1.62 deg2) conditions. In contrast, the bivariate contour ellipse area during visual field measurement in binocular fixation (2.85 deg2) was significantly lower than the bivariate contour ellipse area in dominant eye fixation (4.62 deg2; p = 0.0227) and non-dominant eye fixation (5.24 deg2; p = 0.0006) conditions. There was no significant difference in bivariate contour ellipse area during visual field measurement between dominant eye fixation and non-dominant eye fixation conditions. There was no significant correlation between bivariate contour ellipse area and either ocular position or fusional amplitude during both foveal threshold and visual field measurements. Thus, fixation variability might be improved in binocular fixation conditions during a long-duration test, such as visual field measurement.
关键词： binocular fixation,standard automated perimetry,monocular fixation,fixation variability,bivariate contour ellipse area
更新于2025-09-09 09:28:46
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Frequency-doubling technology perimetry and multifocal visual evoked potential in glaucoma, suspected glaucoma, and control patients
摘要： The gold standard in functional glaucoma evaluation is standard automated perimetry (SAP). However, SAP depends on the reliability of the patients’ responses and other external factors; therefore, other technologies have been developed for earlier detection of visual field changes in glaucoma patients. The frequency-doubling perimetry (FDT) is believed to detect glaucoma earlier than SAP. The multifocal visual evoked potential (mfVEP) is an objective test for functional evaluation. Objective: To evaluate the sensitivity and specificity of FDT and mfVEP tests in normal, suspect, and glaucomatous eyes and compare the monocular and interocular mfVEP. Methods: Ninety-five eyes from 95 individuals (23 controls, 33 glaucoma suspects, 39 glaucomatous) were enrolled. All participants underwent a full ophthalmic examination, followed by SAP, FDT, and mfVEP tests. Results: The area under the curve for mean deviation and pattern standard deviation were 0.756 and 0.761, respectively, for FDT, 0.564 and 0.512 for signal and alpha for interocular mfVEP, and 0.568 and 0.538 for signal and alpha for monocular mfVEP. This difference between monocular and interocular mfVEP was not significant. Conclusion: The FDT matrix was superior to mfVEP in glaucoma detection. The difference between monocular and interocular mfVEP in the diagnosis of glaucoma was not significant.
关键词： electrophysiology,glaucomatous eyes,standard automated perimetry
更新于2025-09-09 09:28:46
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Assessing the GOANNA Visual Field Algorithm Using Artificial Scotoma Generation on Human Observers
摘要： Purpose: To validate the performance of a new perimetric algorithm (Gradient-Oriented Automated Natural Neighbor Approach; GOANNA) in humans using a novel combination of computer simulation and human testing, which we call Artificial Scotoma Generation (ASG). Methods: Fifteen healthy observers were recruited. Baseline conventional automated perimetry was performed on the Octopus 900. Visual field sensitivity was measured using two different procedures: GOANNA and Zippy Estimation by Sequential Testing (ZEST). Four different scotoma types were induced in each observer by implementing a novel technique that inserts a step between the algorithm and the perimeter, which in turn alters presentation levels to simulate scotomata in human observers. Accuracy, precision, and unique number of locations tested were measured, with the maximum difference between a location and its neighbors (Max_d) used to stratify results. Results: GOANNA sampled significantly more locations than ZEST (paired t-test, P < 0.001), while maintaining comparable test times. Difference plots showed that GOANNA displayed greater accuracy than ZEST when Max_d was in the 10 to 30 dB range (with the exception of Max_d = 20 dB; Wilcoxon, P < 0.001). Similarly, GOANNA demonstrated greater precision than ZEST when Max_d was in the 20 to 30 dB range (Wilcoxon, P < 0.001). Conclusions: We have introduced a novel method for assessing accuracy of perimetric algorithms in human observers. Results observed in the current study agreed with the results seen in earlier simulation studies, and thus provide support for performing larger scale clinical trials with GOANNA in the future. Translational Relevance: The GOANNA perimetric testing algorithm offers a new paradigm for visual field testing where locations for testing are chosen that target scotoma borders. Further, the ASG methodology used in this paper to assess GOANNA shows promise as a hybrid between computer simulation and patient testing, which may allow more rapid development of new perimetric approaches.
关键词： psychophysics,GOANNA,algorithms,visual fields,perimetry
更新于2025-09-04 15:30:14
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Exploring Test–Retest Variability Using High-Resolution Perimetry
摘要： Purpose: Test–retest variability (TRV) of visual field (VF) data seriously degrades our capacity to recognize true VF progression. We conducted repeated high-resolution perimetry with a test interval of 0.58 to investigate the sources of TRV. In particular, we examined whether the spatial variance of the observed sensitivity changes or if their absolute magnitude was of more importance. Methods: Sixteen eyes of 16 glaucoma patients were each tested three times at 61 VF locations along the superior-temporal 458 meridian using a modified protocol of the Octopus 900 perimeter. TRV was quantified as the standard deviation of the repeats at each point (retest-SD). We also computed the mean sensitivity at each point (retest-MS) and the running spatial-SD along the tested meridian. Multiple regression models investigated whether any of those variables (and also age, sex, and VF eccentricity) were significant independent determinants of TRV. Results: The main independent determinants of TRV were the retest-MS at (cid:2)0.04 dB TRV/dB loss (P , 0.0001, t-statistic 5.05), and the retest-SD at 0.47 dB spatial variance/dB loss (P , 0.0001, t-statistic 12.5). Conclusions: The larger effect for the spatial-SD suggested that it was perhaps a stronger determinant of TRV than scotoma depth per se. This might support the hypothesis that rapidly varying interactions between small perimetric stimuli, sensitivity across the field, and normal fixational jitter are strong determinants of TRV. Translational Relevance: Our study indicates that methods that might reduce the effects of jagged sensitivity changes, such as increasing stimulus size or better gaze tracking, could reduce TRV.
关键词： glaucoma,high-resolution perimetry,test–retest variability
更新于2025-09-04 15:30:14
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Multifocal Pupillography Identifies Changes in Visual Sensitivity According to Severity of Diabetic Retinopathy in Type 2 Diabetes
摘要： PURPOSE. Retinal light sensitivity loss has been shown to occur prior to other signs of retinopathy and may predict the sight-threatening sequelae. A rapid, objective perimetric test could augment diabetes care. We investigated the clinical use of multifocal pupillographic objective perimetry (mfPOP) to identify patients with and without diabetic retinopathy. METHODS. Retinopathy severity was determined using the Early Treatment of Diabetic Retinopathy Study (ETDRS) standard for fundus photography. Pupillary responses were measured from both eyes of 25 adults with none to moderate diabetic retinopathy and 24 age-matched controls, using three mfPOP stimulus variants. Multifocal pupillographic objective perimetry stimulus variants tested 44 regions per eye arranged in a ?ve-ring dartboard layout presented within either the central 308 or 608 of ?xation. Receiver operator characteristic (ROC) curves were produced from contraction amplitudes and time to peak responses. RESULTS. Regression analysis revealed that mean amplitude deviations were larger with severity of early retinopathy. On average, the longest delays were measured in patients with no retinopathy. The brightest wide-?eld stimuli produced the highest area under the ROC curve for differentiating eyes with no retinopathy from nonproliferative diabetic retinopathy (NPDR) and from healthy eyes (100 6 0.0%, mean 6 SE). The asymmetry in local delay deviations between eyes tended to produce higher sensitivity and speci?city than amplitude deviations. CONCLUSIONS. Asymmetry in local response delays measured by mfPOP may provide useful information regarding the severity of diabetic retinopathy and may have clinical use as a rapid, noninvasive method for identifying functional loss even in the absence of NPDR.
关键词： type 2 diabetes,pupils,objective perimetry,diabetic retinopathy,multifocal
更新于2025-09-04 15:30:14