Models for the description of angioscotomas

Using high-density perimetry to explore new approaches for characterizing visual field defects

High-density threshold perimetry has found that conventional static threshold perimetry misses defects due to undersampling. However, high-density testing can be both slow and limited by normal fixational eye movements. We explored alternatives by studying displays of high-density perimetry results for angioscotomas in healthy eyes-areas of reduced sensitivity in the shadows of blood vessels. The right eyes of four healthy adults were tested with a Digital Light Ophthalmoscope that gathered retinal images while presenting visual stimuli. The images were used to infer stimulus location on each trial. Contrast thresholds for a Goldmann size III stimulus were measured at 247 locations of a 13°×19° rectangular grid, with separation 0.5°, extending from 11° to 17° horizontally and -3° to +6° vertically, covering a portion of the optic nerve head and several major blood vessels. Maps of perimetric sensitivity identified diffuse regions of reduced sensitivity near the blood vessels, but these showed moderate structure-function agreement that was only modestly improved when effects of eye position were accounted for. An innovative method termed slice display was used to locate regions of reduced sensitivity. Slice display demonstrated that many fewer trials could yield similar structure-function agreement. These results are an indication that test duration might be reduced dramatically by focusing on location of defects rather than maps of sensitivity. Such alternatives to conventional threshold perimetry have the potential to map the shape of defects without the extensive time demands of high-density threshold perimetry. Simulations illustrate how such an algorithm could operate.

The representation of retinal blood vessels in primate striate cortex

The blood vessels that nourish the inner retina cast shadows on photoreceptors, creating "angioscotomas" in the visual field. We have found the representations of angioscotomas in striate cortex of the squirrel monkey. They were detected in 9 of 12 normal adult animals by staining flatmounts for cytochrome oxidase activity after enucleation of one eye. They appeared as thin profiles in layer 4C radiating from the blind spot representation. Angioscotomas can be regarded as a local form of amblyopia. After birth, when light strikes the retina, photoreceptors beneath blood vessels are denied normal visual stimulation. This deprivation induces remodeling of geniculocortical afferents in a distribution that corresponds to the retinal vascular tree. Angioscotoma representations were most obvious in monkeys with fine ocular dominance columns and were invisible in monkeys with large, well segregated columns. In monkeys without columns, their width corresponded faithfully to the inducing retinal shadow, making it possible to calculate the minimum shadow required to produce a cortical representation. The "amblyogenic threshold" was calculated as the fraction of the pupil area eclipsed to trigger remodeling of geniculocortical afferents. It was found to be constant over retinal eccentricity, vessel size, and shadow size. Ambliogenic shadows only three to four cones wide were sufficient to generate a cortical representation, testifying to the remarkable precision of the cortical map. The representations of retinal blood vessels separated by only 0.65 degrees were resolvable in the cortex, yielding an upper limit on cortical resolution of 340 microm in layer 4C.

Evaluation of glaucomatous visual field loss with locally condensed grids using fundus-oriented perimetry (FOP)

PURPOSE

We compared detection rates of glaucomatous visual field defects (VFDs) between a conventional rectangular stimulus grid and locally condensed test point arrangements in morphologically suspicious regions.

METHODS

Humphrey Field Analyzer model 630 (HFA I, program 30-2 with a rectangular 6 degrees x 6 degrees grid) was used as the conventional perimetric method. Individual local test-point condensation was realized by fundus-oriented perimetry (FOP) on the Tuebingen Computer Campimeter (TCC).

RESULTS

Of a total of 66 glaucoma patients, or suspected sufferers, 23 showed normal findings and 27 showed pathological findings with both methods. In 15 cases we found normal visual fields in HFA 30-2, whereas FOP revealed early glaucomatous functional damage. Only one case showed pathological HFA results, while FOP was normal. Detection rates of VFDs significantly differed between the two methods (p < 0.001; sign test).

CONCLUSIONS

FOP, using individually condensed test grids, significantly increases detection rates of glaucomatous VFDs in morphologically suspicuous areas compared with a conventional HFA 30-2 technique using equidistant rectangular (6 degrees x 6 degrees) test point arrangements.