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Structure–Function Relationship in Glaucoma Using Ganglion Cell–Inner Plexiform Layer Thickness Measurements
摘要： PURPOSE. To evaluate the structure–function relationship between ganglion cell–inner plexiform layer (GCIPL) thickness at the macula and 10-2 standard automated perimetry (SAP) in glaucoma and to evaluate the relationship using a recently proposed linear model. METHODS. In a cross-sectional analysis, structure–function relationship was determined in 50 glaucomatous eyes (40 patients, mean deviation: (cid:2)15.4 6 7.5 dB) and 21 control eyes (13 subjects, mean deviation: (cid:2)3.4 6 3.0 dB), which had undergone 10-2 SAP and GCIPL imaging on the same day. Functional loss was derived from total deviation numerical values on 10-2 SAP and calculated on both a linear (reciprocal of Lambert) and a decibel scale after accounting for the retinal ganglion cell displacement at the macula. Strength of relationship was reported as coef?cient of determination (R2) of the linear regression models ?tted to the data separately for different sectors. The relationship was also evaluated using a linear model. RESULTS. The R2 for the associations between GCIPL thickness sectors and the corresponding sector SAP total deviation values ranged from 0.19 (for superonasal GCIPL sector) to 0.60 (for average GCIPL thickness) when functional loss was calculated on the decibel scale and 0.16 (for superonasal sector) to 0.54 (for inferior sector) on the linear scale. All associations were statistically signi?cant (P < 0.05). The linear model ?tted the data reasonably well. CONCLUSIONS. Signi?cant structure–function associations were found between GCIPL thickness measurements at the macula and the functional loss measured on 10-2 SAP in glaucoma. Best ?t was found for the inferior and average GCIPL sector thickness. The linear model was useful to study the structure–function relationship.
关键词： visual ?eld,ganglion cell–inner plexiform layer,glaucoma,structure–function relationship
更新于2025-09-11 14:15:04
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Blue Multifocal Pupillographic Objective Perimetry in Glaucoma
摘要： This study investigated multifocal pupillographic objective perimetry (mfPOP) stimuli that target the intrinsic photosensitivity of melanopsin retinal ganglion cells. The diagnostic potential for glaucoma is compared between stimuli biased toward either cone input to these cells or their melanopsin response. Nineteen glaucoma patients and 24 normal subjects were tested using mfPOP stimulus protocols with either 33-ms yellow or 750-ms blue stimuli. Subjects’ color discrimination was assessed using the Farnsworth 100-hue test. Pupillary responses were measured, and mixed-effects regression was used to quantify results. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. The mean reduction in moderate to severe glaucoma pupil responses using blue mfPOP stimuli was larger but more variable than that of the shorter yellow stimuli (blue: (cid:2)1.32 dB [t(40) ? (cid:2)2.29; P ? 0.027]; yellow: (cid:2)0.93 dB [t(40) ? (cid:2)3.13; P ? 0.003]). Color discrimination decreased signi?cantly with age and glaucoma, with type III blue-yellow anomalies dominating. ROC analysis revealed similar diagnostic accuracies (AUC for eyes classi?ed as moderate to severe; blue: 81.7%, yellow: 83.7). Slightly higher sensitivity and speci?city were obtained using blue stimuli in mild disease (AUCs blue: 71.1, cf. yellow: 67.7), although this difference was not signi?cant. In moderate to severe glaucoma, diagnostic accuracy of yellow and blue was similar, but blue stimuli showed limited ability to resolve scotomas. Blue mfPOP stimuli, however, may have advantages over yellow in detecting early glaucoma.
关键词： pupil,melanopsin,visual ?eld,glaucoma
更新于2025-09-04 15:30:14
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The Usefulness of Gaze Tracking as an Index of Visual Field Reliability in Glaucoma Patients
摘要： PURPOSE. We evaluated the usefulness of gaze tracking (GT) results as an index of visual ?eld reliability in glaucoma. METHODS. The study population consisted of 631 eyes of 400 patients with open angle glaucoma in an institutional practice, with 10 visual ?elds (VFs). For the observational procedure, visual ?xation was assessed using the gaze ?xation chart at the bottom of the VF (Humphrey Field Analyzer, 30-2 SITA standard) printout. Average frequency of eye movement between 18 and 28 (move1–2), 38 and 58 (move3–5), and greater than or equal to 68 (move?6) were calculated. In addition, average tracking failure frequency (TFF) and average blinking frequency (BF) were calculated. The relationship between mean deviation (MD), ?xation losses (FLs), false-positives (FPs), false-negatives (FNs), move1–2, move3–5, move?6, TFF, BF, and pattern standard deviation (PSD) were evaluated using linear modeling. Main outcome measures included parameters related to over- or underestimation of MD values. RESULTS. Patients’ mean MD progression rate was (cid:2)0.23 dB/y. The best model to predict MD values included FL rate, FP rate, move3–5, move?6, TFF, BF, and PSD as dependent variables with coef?cients of 0.90, 9.2, (cid:2)0.57, (cid:2)0.52, (cid:2)2.2, (cid:2)1.1, and (cid:2)0.56, respectively (P < 0.001). CONCLUSIONS. High FL and FP rates tend to raise MD values. By contrast, high values of move3–5, move?6, TFF, BF, and PSD tend to lower MD values. Thus, GT parameters can be used as new indices of VF reliability through the prediction of over- or underestimation of VF results.
关键词： glaucoma,visual ?eld,gaze tracking
更新于2025-09-04 15:30:14
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Standard Automated Perimetry: Determining Spatial Summation and Its Effect on Contrast Sensitivity Across the Visual Field
摘要： PURPOSE. To establish Ricco’s critical area (Ac) using the 30-2 Humphrey visual ?eld analyzer (HVFA) and thereby identify Goldmann test sizes that are within or outside complete spatial summation at all visual ?eld testing locations. We also determined the suitability of using age normative data for different test sizes. Finally, by modifying current output measures (dB values), we provide a new method that allows comparison of contrast sensitivity when testing with different Goldmann test sizes within complete spatial summation. METHODS. We used the HVFA in full threshold mode and measured thresholds for all ?ve Goldmann test sizes in 12 observers. Normative data of Heijl et al. were used for age transformation and comparison. RESULTS. All the data converted to a 50-year-old equivalent lie within 1 SD of expected variance for all test locations of the 30-2 paradigm. We established Ac values at all locations of the 30-2 paradigm and showed a systematic increase in Ac as a function of increased visual ?eld eccentricity, consistent with previous studies. Age does not appear to affect Ac or the slope of partial summation for a wide range of visual ?eld eccentricities tested using the HVFA. By equating spatial summation, we propose a new metric, dB*, that returns a uniform sensitivity value for different test sizes that are operating within complete spatial summation (i.e., follow Ricco’s law). CONCLUSIONS. We established that converting to age-equivalent thresholds and application of dB* principle advantageously allows comparison of data sets across age and test size at different locations of the visual ?eld. By identifying the Ac across the visual ?eld, it is now possible to systematically determine threshold changes across the 30-2 locations in ocular disease and further characterize the importance of testing within complete spatial summation in standard automated perimetry.
关键词： retinal eccentricity,contrast sensitivity,Ac,Ricco’s Law,Humphrey visual ?eld analyzer
更新于2025-09-04 15:30:14
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Imaging Glaucomatous Damage Across the Temporal Raphe
摘要： PURPOSE. To image and analyze anatomical differences at the temporal raphe between normal and glaucomatous eyes using adaptive optics scanning laser ophthalmoscopy (AOSLO) and optical coherence tomography (OCT), and to relate these differences to visual ?eld measurements. METHODS. Nine glaucomatous eyes of 9 patients (age 54–78 years, mean deviation of visual ?eld [MD] (cid:2)5.03 to (cid:2)0.20 dB) and 10 normal eyes of 10 controls (age 54–81, MD (cid:2)1.13 to t1.39 dB) were enrolled. All the participants were imaged in a region that was centered approximately 98 temporal to the fovea. The size of imaging region was at least 108 vertically by 48 horizontally. The raphe gap, de?ned as the distance between the superior and inferior retinal nerve ?ber layer (RNFL) bundles, was measured. A bundle index was computed to quantify the relative re?ectivity and density of the nerve ?ber bundles. We also measured thickness of the ganglion cell complex (GCC) and RNFL. RESULTS. The raphe gap was larger in glaucomatous eyes than control eyes. Speci?cally, eight glaucomatous eyes with local averaged ?eld loss no worse than (cid:2)3.5 dB had larger raphe gaps than all control eyes. The bundle index, GCC thickness, and RNFL thickness were on average reduced in glaucomatous eyes, with the ?rst two showing statistically signi?cant differences between the two groups. CONCLUSIONS. Structural changes in the temporal raphe were observed and quanti?ed even when local functional loss was mild. These techniques open the possibility of using the raphe as a site for glaucoma research and clinical assessment.
关键词： visual ?eld,OCT,raphe,glaucoma,adaptive optics
更新于2025-09-04 15:30:14