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Improving Visual Field Examination of the Macula Using Structural Information
摘要： Purpose: To investigate a novel approach for structure-function modeling in glaucoma to improve visual field testing in the macula. Methods: We acquired data from the macular region in 20 healthy eyes and 31 with central glaucomatous damage. Optical coherence tomography (OCT) scans were used to estimate the local macular ganglion cell density. Perimetry was performed with a fundus-tracking device using a 10-2 grid. OCT scans were matched to the retinal image from the fundus perimeter to accurately map the tested locations onto the structural damage. Binary responses from the subjects to all presented stimuli were used to calculate the structure-function model used to generate prior distributions for a ZEST (Zippy Estimation by Sequential Testing) Bayesian strategy. We used simulations based on structural and functional data acquired from an independent dataset of 20 glaucoma patients to compare the performance of this new strategy, structural macular ZEST (MacS-ZEST), with a standard ZEST. Results: Compared to the standard ZEST, MacS-ZEST reduced the number of presentations by 13% in reliable simulated subjects and 14% with higher rates (≥20%) of false positive or false negative errors. Reduction in mean absolute error was not present for reliable subjects but was gradually more important with unreliable responses (≥10% at 30% error rate). Conclusions: Binary responses can be modeled to incorporate detailed structural information from macular OCT into visual field testing, improving overall speed and accuracy in poor responders. Translational Relevance: Structural information can improve speed and reliability for macular testing in glaucoma practice.
关键词： glaucoma,ganglion cells,optical coherence tomography,perimetry,visual field
更新于2025-09-23 15:23:52
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Home-based visual field test for glaucoma screening comparison with Humphrey perimeter
摘要： Purpose: To present a home-based visual field examination method using a PC monitor or virtual reality glasses and evaluate the reliability of the method by comparing the results with those of the Humphrey perimeter, in order to assess the possibility of glaucoma screening through the Internet. Materials and methods: Software implementing a supra-threshold algorithm for the central 24° (52 points) of visual field at three threshold levels: 1) -4 db, 2) -8 db, and 3) -12 db, from the age-expected sensitivity was used for the purpose of testing. The software uses the web camera as a “virtual photometer” in order to detect room luminosity and allows self-testing using a computer monitor or virtual reality glasses using an Android smartphone with a 6-inch display. The software includes an expert system to analyze the visual field image and validate the reliability of the results. It also allows the physician to combine the results from two or more tests into a single test in order to achieve higher statistical accuracy of the final result. A total of ten patients, 20 eyes tested×52 points per eye=1,040 visual field test points, were compared point to point to those obtained using the Humphrey perimeter for the same patients, as they appeared randomly and consecutively at the glaucoma department within hours. Results: Good receiver operating characteristic/area under the curve coefficient was found, ranging from 0.762 to 0.837 (P,0.001). Sensitivity ranged from 0.637 to 0.942, and specificity ranged from 0.735 to 0.497. Conclusion: The home-based visual field test exhibits a reasonable receiver operating characteristic curve when compared to the Humphrey perimeter, without the need of specialized equipment. The test may be useful for glaucoma screening.
关键词： glaucoma,virtual reality,android smart-phone,online visual field,computer monitor,internet,teleophthalmology,telemedicine,screening
更新于2025-09-23 15:22:29
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[IEEE 2018 3rd International Conference on Pattern Analysis and Intelligent Systems (PAIS) - Tebessa, Algeria (2018.10.24-2018.10.25)] 2018 3rd International Conference on Pattern Analysis and Intelligent Systems (PAIS) - A system for the automatic detection of glaucoma using retinal images
摘要： Glaucoma is an optic neuropathy and it principal cause of blindness in the world. In this paper, a system able to treat and analyze the Visual Field (VF) images and Optical Coherence Tomography of the Ganglion Cell Layer (OCT-GCL) images is proposed, in order to help early detection of glaucoma in its early stages. The proposed approach is based on calculating the percentage of healthy, sick and dead regions of VF and OCT-GCL images. In order to carry out this calculation, we combined the thresholding methods with morphological operators and median filter to extract all regions. These algorithms developed were tested on a set of images of a local database composed of 58 OCT-GCL images and 21 VF images. The results obtained are satisfactory and confirmed by experts in ophthalmology.
关键词： Optical coherence tomography of ganglion cell layer,Segmentation,Visual field,Glaucoma,Characterization
更新于2025-09-23 15:22:29
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Development of a Visual Field Simulation Model of Longitudinal Point-Wise Sensitivity Changes From a Clinical Glaucoma Cohort
摘要： Purpose: To develop a new visual field simulation model that can recreate real-world longitudinal results at a point-wise level from a clinical glaucoma cohort. Methods: A cohort of 367 glaucoma eyes from 265 participants seen over 10.1 ± 2.5 years were included to obtain estimates of "true" longitudinal visual field point-wise sensitivity and estimates of measurement variability. These two components were then combined to reconstruct visual field results in a manner that accounted for correlated measurement error. To determine how accurately the simulated results reflected the clinical cohort, longitudinal variability estimates of mean deviation (MD) were determined by calculating the SD of the residuals from linear regression models fitted to the MD values over time for each eye in the simulated and clinical cohorts. The new model was compared to a previous model that does not account for spatially correlated errors. Results: The SD of all the residuals for the clinical and simulated cohorts was 1.1 dB (95% confidence interval [CI]: 1.1–1.2 dB) and 1.1 dB (95% CI: 1.1–1.1 dB), respectively, whereas it was 0.4 dB (95% CI: 0.4–0.4 dB) using the previous simulation model that did not account for correlated errors. Conclusions: A new simulation model accounting for correlated measurement errors between visual field locations performed better than a previous model in estimating visual field variability in glaucoma. Translational Relevance: This model can provide a powerful framework to better understand use of visual field testing in clinical practice and trials and to evaluate new methods for detecting progression.
关键词： visual field,glaucoma,simulations,longitudinal
更新于2025-09-23 15:22:29
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Cross-Sectional and Longitudinal Assessment of Retinal Sensitivity in Patients With Childhood-Onset Stargardt Disease
摘要： Purpose: We assess cross-sectional and longitudinal microperimetry and full-field static perimetry-derived retinal sensitivity with conventional and volumetric indices of retinal function in childhood-onset Stargardt disease (STGD1). Methods: Subjects with molecularly confirmed childhood-onset STGD1 underwent full-field static perimetry and/or microperimetry using custom designed grids. Mean sensitivity (MS) and total volume (VTOT) were computed for each microperimetry test. MS, VTOT, and central field volume (V30) were computed for each full-field static perimetry test. Subjects under 18 years old at baseline were classified as children and subjects 18 years or older as adults. Results: A total of 43 children (mean age at baseline, 13.0 years; range, 8–17) and 13 adults (mean age at baseline, 23.1 years; range, 18–32) were included in the analysis. For full-field static perimetry and microperimetry for both subgroups, intraclass correlation coefficient results for MS and volumetric indices were good to excellent, indicating strong test–retest reliability. Interocular symmetry in terms of baseline measurements and the annual rate of progression was observed. A greater rate of progression was observed in childhood. Conclusions: To our knowledge, this is the first prospective study of retinal sensitivity in a large cohort of molecularly confirmed subjects with childhood-onset STGD1 demonstrating that children with STGD1 can reliably undertake detailed functional testing. Moreover, using custom designed grids and subsequent topographic analysis, volumetric indices of retinal function provide a reliable measure of retinal sensitivity.
关键词： endpoints,Stargardt disease,retina,clinical trials,ABCA4,perimetry,visual field,STGD1,Retinal sensitivity
更新于2025-09-23 15:22:29
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Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial
摘要： To compare visual field outcomes of ocular hypertensive and glaucoma patients treated with Medicine-1st against those treated with selective laser trabeculoplasty (SLT, Laser-1st). Secondary analysis of patients from Laser in Glaucoma and Ocular Hypertension (LiGHT), a multicentre randomised controlled trial. 344 patients (588 eyes) treated with Medicine-1st, 344 patients (590 eyes) treated with Laser-1st. Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration: 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (< -1 dB/y) or moderate (< -0.5 dB/y) progression were compared using log-binomial regression. Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD). A greater proportion of eyes underwent moderate or fast TD progression in the Medicine-1st group compared with the Laser-1st group (26.2% vs. 16.9%; Risk Ratio, RR = 1.55 [1.23, 1.93], P < 0.001). A similar pattern was observed for pointwise rates (Medicine-1st 26.1% vs. Laser-1st 19.0%, RR = 1.37 [1.33, 1.42], P < 0.001). A greater proportion of pointwise PD rates were categorised as moderate or fast in the Medicine-1st group (Medicine-1st 11.5% vs. Laser-1st 8.3%, RR = 1.39 [1.32, 1.46], P < 0.001). There was no statistical difference in the proportion of eyes that underwent moderate or fast PD progression (Medicine-1st 9.9% vs. Laser-1st 7.1%, RR = 1.39 [0.95, 2.03], P = 0.0928). A slightly larger proportion of ocular hypertensive and glaucoma patients treated with Medicine-1st underwent rapid VF progression compared with those treated with Laser-1st.
关键词： Medicine-1st,Laser-1st,Glaucoma,Visual field,Ocular hypertension,Selective laser trabeculoplasty
更新于2025-09-23 15:21:01
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Enhanced Structure-Function Relationship in Glaucoma With an Anatomically and Geometrically Accurate Neuroretinal Rim Measurement
摘要： PURPOSE. To evaluate the structure–function relationship between disc margin–based rim area (DM-RA) obtained with confocal scanning laser tomography (CSLT), Bruch’s membrane opening–based horizontal rim width (BMO-HRW), minimum rim width (BMO-MRW), peripapillary retinal nerve fiber layer thickness (RNFLT) obtained with spectral-domain optical coherence tomography (SD-OCT), and visual field sensitivity. METHODS. We examined 151 glaucoma patients with CSLT, SD-OCT, and standard automated perimetry on the same day. Optic nerve head (ONH) and RNFL with SD-OCT were acquired relative to a fixed coordinate system (acquired image frame [AIF]) and to the eye-specific fovea-BMO center (FoBMO) axis. Visual field locations were mapped to ONH and RNFL sectors with fixed Garway-Heath (VFGH) and patient-specific (VFPS) maps customized for various biometric parameters. RESULTS. Globally and sectorally, the structure–function relationships between DM-RA and VFGH, BMO-HRWAIF and VFGH, and BMO-HRWFoBMO and VFPS were equally weak. The R2 for the relationship between DM-RA and VFGH ranged from 0.1% (inferonasal) to 11% (superotemporal) whereas that between BMO-HRWAIF and VFGH ranged from 0.1% (nasal) to 10% (superotemporal). Relatively stronger global and sectoral structure–function relationships with BMO-MRWAIF and with BMO-MRWFoBMO were obtained. The R2 between BMO-MRWAIF and VFGH ranged from 5% (nasal) to 30% (superotemporal), whereas that between BMO-MRWFoBMO and VFPS ranged from 5% (nasal) to 25% (inferotemporal). The structure–function relationship with RNFLT was not significantly different from that with BMO-MRW, regardless of image acquisition method. CONCLUSIONS. The structure–function relationship was enhanced with BMO-MRW compared with the other neuroretinal rim measurements, due mainly to its geometrically accurate properties.
关键词： glaucoma,structure–function relationship,visual field,optic nerve head,automated perimetry
更新于2025-09-23 15:21:01
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Development of a Pediatric Visual Field Test
摘要： Purpose: We describe a pediatric visual field (VF) test based on a computer game where software and hardware combine to provide an enjoyable test experience. Methods: The test software consists of a platform-based computer game presented to the central VF. A storyline was created around the game as was a structure surrounding the computer monitor to enhance patients’ experience. The patient is asked to help the central character collect magic coins (stimuli). To collect these coins a series of obstacles need to be overcome. The test was presented on a Sony PVM-2541A monitor calibrated from a central midpoint with a Minolta CS-100 photometer placed at 50 cm. Measurements were performed at 15 locations on the screen and the contrast calculated. Retinal sensitivity was determined by modulating stimulus in size. To test the feasibility of the novel approach 20 patients (4–16 years old) with no history of VF defects were recruited. Results: For the 14 subjects completing the study, 31 6 15 data points were collected on 1 eye of each patient. Mean background luminance and stimulus contrast were 9.9 6 0.3 cd/m2 and 27.9 6 0.1 dB, respectively. Sensitivity values obtained were similar to an adult population but variability was considerably higher – 8.3 6 9.0 dB. Conclusions: Preliminary data show the feasibility of a game-based VF test for pediatric use. Although the test was well accepted by the target population, test variability remained very high. Translational Relevance: Traditional VF tests are not well tolerated by children. This study describes a child-friendly approach to test visual fields in the targeted population.
关键词： glaucoma,visual field,children’s vision,perimetry,psychophysics
更新于2025-09-23 15:21:01
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Segmentation of the Optic Nerve Head Based on Deep Learning to Determine its Hemoglobin Content in Normal and Glaucomatous Subjects
摘要： Objective: To determine the limits of the optic nerve head (ONH) in color fundus images using Deep learning (DL) for the estimation of its hemoglobin topographic distribution. Also, to evaluate the usefulness of that distribution in glaucoma diagnosis singly or in association with perimetry. Methods: A DL method was trained using 40000 fundus images and applied to 89 normal eyes and 77 confirmed or suspect glaucomas. DL and manual segmentation were compared. The eyes were also examined once with TOP perimetry (Octopus 300) and Spectralis-OCT and twice with Cirrus-OCT and Laguna ONhE, a program which estimates hemoglobin from color photographs, using improved criteria from previous studies. Results: The Sorensen-Dice similarity index between manual and automatic segmentations was 0.993. Intra-class correlation coefficients were similar when comparing the results of the Laguna ONhE indices using the manual and automatic segmentations (confidence intervals: 0.933-0.978). For specificity close to 95%, the GDF index, a factor that measures the distribution of hemoglobin at the nerve, obtained sensitivities between 70.1 and 74.0% (manual vs. automatic segmentations). The retinal nerve fiber layer thickness (RNFLT) of both OCTs provided sensitivities between 67.1 and 68.8% and the BMO-RMW of Spectralis-OCT 69.7%. Associating several normalized indices, e.g. a new visual field harmony index (Threshold Coefficient of Variation, TCV) and GDF, provided 85.7% sensitivity for 97.8% specificity. GDF correlation with Spectralis-OCT BMO-RMW index was similar to that obtained between this index and the RNFLT of the same instrument. For 95% specificity, the diagnostic concordance (kappa value) between both Spectralis-OCT indices was 0.694 and between its BMO-RMW and Laguna ONhE GDF 0.804-0.828. Conclusion: A fully automatic delimitation of the optic nerve head allows the correct, reproducible and efficient use of the Laguna ONhE method, and its effectiveness is greatly increased if associated with a perimetric harmony index.
关键词： Glaucoma,Visual field,Hemoglobin,Perfusion,Morphology,Perimetry,Optic nerve head
更新于2025-09-19 17:15:36
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Spectral Domain Optical Coherence Tomography Assessment of Macular and Optic Nerve Alterations in Patients with Glaucoma and Correlation with Visual Field Index
摘要： Introduction. To evaluate the sectorial thickness of single retinal layers and optic nerve using spectral domain optic coherence tomography (SD-OCT) and highlight the parameters with the best diagnostic accuracy in distinguishing between normal and glaucoma subjects at di?erent stages of the disease. Material and Methods. For this cross-sectional study, 25 glaucomatous (49 eyes) and 18 age-matched healthy subjects (35 eyes) underwent a complete ophthalmologic examination including visual ?eld testing. Sectorial thickness values of each retinal layer and of the optic nerve were measured using SD-OCT Glaucoma Module Premium Edition (GMPE) software. Each parameter was compared between the groups, and the layers and sectors with the best area under the receiver operating characteristic curve (AUC) were identi?ed. Correlation of visual ?eld index with the most relevant structural parameters was also evaluated. Results and Discussion. All subjects were grouped according to stage as follows: Controls (CTRL); Early Stage Group (EG) (Stage 1 + Stage 2); Advanced Stage Group (AG) (Stage 3 + Stage 4 + Stage 5). mGCL TI, mGCL TO, mIPL TO, mean mGCL, cpRNFLt NS, and cpRNFLt TI showed the best results in terms of AUC according classi?cation proposed by Swets (0.9 < AUC < 1.0). These parameters also showed signi?cantly di?erent values among group when CTRL vs EG, CTRL vs AG, and EG vs AG were compared. SD-OCT examination showed signi?cant sectorial thickness di?erences in most of the macular layers when glaucomatous patients at di?erent stages of the disease were compared each other and to the controls.
关键词： glaucoma,spectral domain optical coherence tomography,macular thickness,optic nerve,visual field index
更新于2025-09-11 14:15:04