Characteristics of frequency-of-seeing curves for a motion stimulus in glaucoma eyes, glaucoma suspect eyes, and normal eyes

Development and validation of a new glaucoma screening test using temporally modulated flicker

PURPOSE

Describing the psychometric characteristics and diagnostic accuracy of the Accelerator 4-Alternative Forced-Choice Flicker Test prototype (A4FTp) for detecting chronic open angle glaucoma (COAG).

METHODS

A4FTp measures temporally-modulated flicker thresholds in regions of the visual field with high susceptibility to glaucomatous loss. We initially evaluated its psychometric properties on 20 normals (aged 33.8 ± 8.5 years) who were tested multiple times over a period of 3 months. All subjects underwent four repetitions for shorter (T8) and longer (T12) staircase termination criteria, to determine the most suitable threshold criterion. Four randomly selected subjects underwent a total of 10 repetitions to study test-retest repeatability and learning effects. To determine its diagnostic accuracy, one eye of 40 participants with COAG and 38 normal controls were tested with the A4FTp in comparison with the Frequency Doubling Technology (FDT; C20-5 programme) and iVue Spectral Domain Optical Coherence Tomography (SD-OCT). Tests were conducted in a random order with results masked to the clinician conducting the reference ophthalmic examination. The accuracy of each test was determined by analysis of the area under the receiver operator characteristic curve (AUROC).

RESULTS

A4FTp flicker thresholds were stable, with standard deviations of only 0.52 decilog (dL) for T8, increasing to 1.32 dL for T12, and no significant flicker sensitivity threshold improvement over the 10 repeat runs. T8 was superior to T12 on several other measures, so it was used for the remaining comparisons. In terms of diagnostic accuracy, the mean AUROC for the three tests were A4FTp [T8 criterion; 0.82, 95% confidence interval (0.73-0.92)]; SD-OCT [any RNFL parameter p < 1% level; 0.90 (0.83-0.97)]; and FDT [one or more locations missed at p < 5% level; 0.91 (0.82-0.96)]. There was no statistical difference in AUROC between A4FTp and SD-OCT (p = 0.18) or FDT (p = 0.12). The A4FTp test duration averaged just over 2 min per eye, taking approximately one-third of the time for completion of the HFA SITA 24-2 algorithm (conducted as part of the reference examination) and twice the time for the suprathreshold FDT.

CONCLUSION

Test accuracy for the A4FTp was comparable to those of the FDT and SD-OCT for the detection of COAG. Time taken to complete the A4FTp was relatively short and initial results are promising. With further refinement, the A4FTp could have a future role in glaucoma detection.

Sequentially optimized reconstruction strategy: A meta-strategy for perimetry testing

Perimetry testing is an automated method to measure visual function and is heavily used for diagnosing ophthalmic and neurological conditions. Its working principle is to sequentially query a subject about perceived light using different brightness levels at different visual field locations. At a given location, this query-patient-feedback process is expected to converge at a perceived sensitivity, such that a shown stimulus intensity is observed and reported 50% of the time. Given this inherently time-intensive and noisy process, fast testing strategies are necessary in order to measure existing regions more effectively and reliably. In this work, we present a novel meta-strategy which relies on the correlative nature of visual field locations in order to strongly reduce the necessary number of locations that need to be examined. To do this, we sequentially determine locations that most effectively reduce visual field estimation errors in an initial training phase. We then exploit these locations at examination time and show that our approach can easily be combined with existing perceived sensitivity estimation schemes to speed up the examinations. Compared to state-of-the-art strategies, our approach shows marked performance gains with a better accuracy-speed trade-off regime for both mixed and sub-populations.

Defining the nature of motion perception deficits in glaucoma using simple and complex motion stimuli

PURPOSE

The purpose of this study is to determine the nature of motion perception deficits in primary open-angle glaucoma by measuring the sensitivity of simple (luminance-defined) and complex (texture-defined) motion, the latter requiring supplementary neural processing to be resolved. These findings will help address the possible extent of the cortical damage in glaucoma that has been recently demonstrated by anatomic and physiological studies. They also serve the purpose of establishing which motion paradigms would be most appropriate for assessing glaucoma-related functional loss.

METHODS

Direction-identification thresholds for first-order and second-order motion were measured for 26 patients with primary open-angle glaucoma (for both phakic and pseudophakic) and 18 nonglaucomatous observers.

RESULTS

The glaucomatous observers showed significantly increased motion thresholds for both first- and second-order motion conditions when compared with nonglaucomatous observers. However, the relative increase in threshold for first-order motion did not differ significantly from that of second-order motion.

CONCLUSIONS

These findings imply that there is no measurable higher-level cortical function damage caused by the glaucomatous process because no greater loss in second-order motion was observed. Based on the results, we suggest that motion paradigms used to assess functional loss in primary open-angle glaucoma should consist of simple, first-order type stimuli to minimize potential confounds such as those introduced by both the normal and pathologic aging process on complex motion processing (i.e., perimetry using complex motion stimuli).

Frequency of seeing characteristics of the short wavelength sensitive visual pathway in clinically normal subjects and diabetic patients with focal sensitivity loss

AIMS

To define the frequency of seeing (FOS) characteristics of the short wavelength (SW) sensitive visual pathway in clinically normal subjects and in diabetic patients with focal SW sensitivity loss.

METHODS

For clinically normal subjects, FOS was assessed at two retinal locations (4.24 degrees and 9.90 degrees eccentricity) for both white on white (WW) and SW stimulus parameters. Inter-examination variability was quantified for the clinically normal subjects only. For patients with diabetes, FOS was assessed inside an area of focal SW sensitivity loss, and at the same eccentricity in the quadrant diametrically opposite, using SW stimulus parameters only.

RESULTS

For clinically normal subjects, the group mean SW FOS slope was significantly flatter (p<0.0001) than that of WW at both locations. The coefficient of repeatability for SW FOS slope was+/-41.55 dB(-1) (relative to a group mean sensitivity of 23.98 dB(-1)) and+/-19.98 dB(-1) (group mean sensitivity 16.15 dB(-1)) for 4.24 degrees and 9.90 degrees , respectively. For the patients with diabetes, the group mean SW FOS slope was significantly flatter (p=0.020), and group mean SW threshold significantly higher (p=0.007) in the area of focal SW sensitivity loss than in that of the non-focal sensitivity loss.

CONCLUSIONS

The results of this study suggest that the clinical utility of SW automated perimetry will be limited by a greater magnitude of measurement variability, as indicated by a flatter FOS slope, compared to conventional automated perimetry.

Visual magnocellular and structure from motion perceptual deficits in a neurodevelopmental model of dorsal stream function

Williams syndrome (WS) is a neurodevelopmental disorder of genetic origin that has been used as a model to understand visual cognition. We have investigated early deficits in the afferent magnocellular pathway and their relation to abnormal visual dorsal processing in WS. A spatiotemporal contrast sensitivity task that is known to selectively activate that pathway was used in six WS subjects. Additionally, we have compared visual performance in 2D and 3D motion integration tasks. A novel 3D motion coherence task (using spheres with unpredictable axis of rotation) was used in order to investigate possible impairment of occipitoparietal areas that are known to be involved in 3D structure from motion (SFM) perception. We have found a significant involvement of low-level magnocellular maps in WS as assessed by the contrast sensitivity task. On the contrary, no significant differences were observed between WS and the control groups in the 2D motion integration tasks. However, all WS subjects were significantly impaired in the 3D SFM task. Our findings suggest that magnocellular damage may occur in addition to dorsal stream deficits in these patients. They are also consistent with recently described genetic and neuroanatomic abnormalities in retinotopic visual areas. Finally, selective SFM coherence deficits support the proposal that there is a specific pathway in the dorsal stream that is involved in motion processing of 3D surfaces, which seems to be impaired in this disorder.

Comparison of three tests using the frequency doubling illusion to diagnose glaucoma

PURPOSE

The introduction of the FDT perimeter prompted the comparison of three tests employing frequency doubling (FD) stimuli. These measures compared different visual field locations and contrast ranges. Frequency of seeing curves were examined for the method most similar to FDT.

METHODS

For 146 eyes the following were obtained: (i) contrast matches to two suprathreshold FD stimuli (normal subjects, ocular hypertensve suspects, primary open angle glaucoma subjects); (ii) two alternative forced choice (2AFC) thresholds for horizontally versus vertically orientated FD gratings: and (iii) contrast thresholds determined by method of adjustment (MOA) for five different stimulus types.

RESULTS

A model based on the worst of the MOA hemifield thresholds performed best. The suprathreshold contrast matching tests performed worst. Frequency of seeing curves were fitted for the 146 eyes of the 2AFC tests. Although the MOA thresholds were higher than the 2AFC thresholds (for normals mean +/- SE, 8.47 +/- 0.43 dL, P < 0.0000), the best diagnostic concordance was at lower limens (75% or 80% correct) of the fitted frequency of seeing curves.

CONCLUSIONS

There was good diagnostic concordance between the MOA and 2AFC methods although the thresholds were 1.8-fold different on a log-scale. This suggests that the same neural mechanism mediates both thresholds for rapidly flickering, spatially coarse, patterns.

Psychophysical examination of paracentral defects in glaucoma

More than 50% of ganglion cells may be damaged before visual field loss is measurable by conventional methods in primary open angle glaucoma. There is general agreement on the need to improve early diagnosis of visual field loss in primary open angle glaucoma. In this article, new techniques that enlist measurement of paracentral regions are discussed, and the ability of each method to detect visual field loss prior to perimetric loss is described.