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Thomsen AK, Gøttsche LF, Hinnerskov JMV, Falk MK, Sørensen TL. Microperimetry and Structural Risk Factors on OCT in Intermediate Age-Related Macular Degeneration. Ophthalmol Retina 2024:S2468-6530(24)00088-5. [PMID: 38442827 DOI: 10.1016/j.oret.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To determine the relationship between structural biomarkers on OCT that increase the risk of disease progression and microperimetric retinal sensitivity in patients with intermediate age-related macular degeneration (iAMD). DESIGN Prospective cross-sectional, observational study. PARTICIPANTS Forty-five eyes of 23 patients with iAMD. METHODS Patients underwent OCT and microperimetry. OCT scans were evaluated for the risk factors intraretinal hyperreflective foci (HRF), hyporeflectivity within drusenoid lesions (HRDL), subretinal drusenoid deposits, double-layer sign (DLS), and drusen volume. Microperimetric retinal sensitivity was analyzed with a 33-point grid covering the macula. With a novel method of determining what part of the retina corresponded to each microperimetry point, a Voronoi diagram was constructed, dividing the macula in cells consisting of the region nearer to each point than any other. The Voronoi diagram was superimposed on the OCT, making it possible to determine the point-to-point location of the OCT risk factors. Univariable and multivariable linear mixed-effect models were used for analysis. MAIN OUTCOME MEASURES Association between microperimetric retinal sensitivity and OCT risk factors at individual measuring points. RESULTS One thousand four hundred seventy-nine points of retinal sensitivity and corresponding structural area on OCT were included in this study. Retinal sensitivity was significantly decreased with presence of the OCT risk factors HRF, HRDL, DLS, and drusen volume (all P < 0.001) when analyzed with the univariable linear mixed-effect model. The multivariable model showed a significant decrease of retinal sensitivity with presence of HRF (P < 0.001), DLS (P = 0.025), and greater drusen volume (P < 0.001). CONCLUSIONS Presence of HRF, DLS, and greater drusen volume, all of which increase the risk of disease progression, is significantly and independently associated with decreased microperimetric retinal sensitivity in patients with iAMD. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alexander Kai Thomsen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Liselotte Fribo Gøttsche
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Jenni Martinez Villarruel Hinnerskov
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Krüger Falk
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Torben Lykke Sørensen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Liu H, Liao F, Blanco R, de la Villa P. Multifocal Visual Evoked Potentials (mfVEP) for the Detection of Visual Field Defects in Glaucoma: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10184165. [PMID: 34575285 PMCID: PMC8465367 DOI: 10.3390/jcm10184165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Some discrepancies have been observed in the diagnostic efficacy of multifocal visual evoked potential (mfVEP) when evaluating visual field defects in glaucoma patients. Therefore, we evaluated the diagnostic precision of the mfVEP in glaucoma to find its best diagnostic indicator. A systematic review and meta-analysis of quantitative studies published up to 1 April 2021 was performed. The methodological quality of the included articles was assessed. Publication bias analysis and heterogeneity tests were performed. The sensitivity, specificity and diagnostic odds ratio were calculated. The area under the curve (AUC) was calculated using the summary of receiver operating characteristics curve. Six studies with a total of 241 patients were included according to the inclusion and exclusion criteria. The AUC was 0.98. There was no evidence of publication bias or threshold effect. The pooled sensitivity and pooled specificity of the mfVEP amplitude for detection of visual field defects in all studies was 0.93 and 0.89, respectively. The positive and negative likelihood ratios of mfVEP amplitude were 6.56 and 0.08, respectively. The amplitude of mfVEP showed a good diagnostic precision in the prediction of visual field defects. Interocular mfVEP amplitude analysis can be a good diagnostic indicator for visual field study.
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Affiliation(s)
- Haitao Liu
- Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, 28005 Madrid, Spain; (H.L.); (F.L.)
| | - Fei Liao
- Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, 28005 Madrid, Spain; (H.L.); (F.L.)
| | - Román Blanco
- Department of Surgery, School of Medicine, University of Alcalá, 28005 Madrid, Spain;
- Visual Neurophysiology Group-IRYCIS, 28034 Madrid, Spain
| | - Pedro de la Villa
- Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, 28005 Madrid, Spain; (H.L.); (F.L.)
- Visual Neurophysiology Group-IRYCIS, 28034 Madrid, Spain
- Correspondence:
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Muthusamy V, Turpin A, Walland MJ, Nguyen BN, McKendrick AM. Increasing the Spatial Resolution of Visual Field Tests Without Increasing Test Duration: An Evaluation of ARREST. Transl Vis Sci Technol 2020; 9:24. [PMID: 33364079 PMCID: PMC7745600 DOI: 10.1167/tvst.9.13.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose The Australian Reduced Range Extended Spatial Test (ARREST) approach was designed to improve visual field spatial resolution while maintaining a similar test duration to clinically used testing algorithms. ARREST does not completely threshold visual field locations with sensitivity < 17 dB, and uses the presentations saved to test new locations in areas of steep gradient within the visual field. Previous assessments of ARREST's performance have used computer simulation. In this study, we cross-sectionally assessed the performance of ARREST in people with visual field loss. Methods We tested 23 people with glaucoma (mean age: 71 ± 8 years) with established visual field loss. Three visual field procedures were performed using the Open Perimetry Interface: cZEST and ARREST on the Octopus 900 perimeter (Haag-Streit AG, Switzerland), and a reference standard (best available estimate [BAE]) on the Compass perimeter (CenterVue SpA, Italy). ARREST was compared against the cZEST and the BAE. Results On average, ARREST added seven new locations (range = 0–15) to a visual field test. There was no significant difference in the number of stimulus presentations between procedures (mean = 259 ± 25 [ARREST] vs. 261 ± 25 [cZEST], P = 0.78). In classifying threshold values < 17 dB, ARREST performed similarly when compared against BAE. Conclusions This study provides empirical evidence to support conclusions from previous computer simulations that ARREST can be used to increase spatial sampling in regions of interest without increasing test time. Translational Relevance ARREST is a new approach that augments current visual field testing procedures to provide better spatial description of visual field defects without increasing test duration.
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Affiliation(s)
- Vasanth Muthusamy
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Turpin
- School of Computing and Information Systems, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark J Walland
- Department of Medical Education (St. Vincent's Hospital Clinical School), The University of Melbourne, Parkville, Victoria, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Stoll C, Palluel-Germain R, Gueriot FX, Chiquet C, Pascalis O, Aptel F. Visual field plasticity in hearing users of sign language. Vision Res 2018; 153:105-110. [PMID: 30165056 DOI: 10.1016/j.visres.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/03/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
Studies have observed that deaf signers have a larger Visual Field (VF) than hearing non-signers with a particular large extension in the lower part of the VF. This increment could stem from early deafness or from the extensive use of sign language, since the lower VF is critical to perceive and understand linguistics gestures in sign language communication. The aim of the present study was to explore the potential impact of sign language experience without deafness on the VF sensitivity within its lower part. Using standard Humphrey Visual Field Analyzer, we compared luminance sensitivity in the fovea and between 3 and 27 degrees of visual eccentricity for the upper and lower VF, between hearing users of French Sign Language and age-matched hearing non-signers. The sensitivity in the fovea and in the upper VF were similar in both groups. Hearing signers had, however, higher luminance sensitivity than non-signers in the lower VF but only between 3 and 15°, the visual location for sign language perception. Sign language experience, no associated with deafness, may then be a modulating factor of VF sensitivity but restricted to the very specific location where signs are perceived.
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Affiliation(s)
- Chloé Stoll
- Univ. Grenoble-Alpes, LPNC, F-38040, Grenoble-CNRS, LPNC UMR 5105, F-38040 Grenoble, France; Laboratory for Investigative Neurophysiology, University Hospital Center and University of Lausanne, 1011 Lausanne, Switzerland; Department of Ophthalmology, Jules Gonin Eye Hospital, University of Lausanne, 1004 Lausanne, Switzerland.
| | | | | | - Christophe Chiquet
- Department of Ophthalmology, Centre Hospitalo-Universitaire de Grenoble, BP217, France
| | - Olivier Pascalis
- Univ. Grenoble-Alpes, LPNC, F-38040, Grenoble-CNRS, LPNC UMR 5105, F-38040 Grenoble, France
| | - Florent Aptel
- Department of Ophthalmology, Centre Hospitalo-Universitaire de Grenoble, BP217, France
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Dong ZM, Wollstein G, Schuman JS. Clinical Utility of Optical Coherence Tomography in Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT556-67. [PMID: 27537415 PMCID: PMC4991023 DOI: 10.1167/iovs.16-19933] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Optical coherence tomography (OCT) has established itself as the dominant imaging modality in the management of glaucoma and retinal diseases, providing high-resolution visualization of ocular microstructures and objective quantification of tissue thickness and change. This article reviews the history of OCT imaging with a specific focus on glaucoma. We examine the clinical utility of OCT with respect to diagnosis and progression monitoring, with additional emphasis on advances in OCT technology that continue to facilitate glaucoma research and inform clinical management strategies.
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Affiliation(s)
- Zachary M Dong
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States
| | - Gadi Wollstein
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States 2Departmen
| | - Joel S Schuman
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States 2Departmen
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Dong ZM, Wollstein G, Wang B, Schuman JS. Adaptive optics optical coherence tomography in glaucoma. Prog Retin Eye Res 2017; 57:76-88. [PMID: 27916682 PMCID: PMC5350038 DOI: 10.1016/j.preteyeres.2016.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 02/07/2023]
Abstract
Since the introduction of commercial optical coherence tomography (OCT) systems, the ophthalmic imaging modality has rapidly expanded and it has since changed the paradigm of visualization of the retina and revolutionized the management and diagnosis of neuro-retinal diseases, including glaucoma. OCT remains a dynamic and evolving imaging modality, growing from time-domain OCT to the improved spectral-domain OCT, adapting novel image analysis and processing methods, and onto the newer swept-source OCT and the implementation of adaptive optics (AO) into OCT. The incorporation of AO into ophthalmic imaging modalities has enhanced OCT by improving image resolution and quality, particularly in the posterior segment of the eye. Although OCT previously captured in-vivo cross-sectional images with unparalleled high resolution in the axial direction, monochromatic aberrations of the eye limit transverse or lateral resolution to about 15-20 μm and reduce overall image quality. In pairing AO technology with OCT, it is now possible to obtain diffraction-limited resolution images of the optic nerve head and retina in three-dimensions, increasing resolution down to a theoretical 3 μm3. It is now possible to visualize discrete structures within the posterior eye, such as photoreceptors, retinal nerve fiber layer bundles, the lamina cribrosa, and other structures relevant to glaucoma. Despite its limitations and barriers to widespread commercialization, the expanding role of AO in OCT is propelling this technology into clinical trials and onto becoming an invaluable modality in the clinician's arsenal.
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Affiliation(s)
- Zachary M Dong
- University of Pittsburgh Medical Center (UPMC) Eye Center, Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, PA, United States.
| | - Gadi Wollstein
- New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, NY, United States.
| | - Bo Wang
- University of Pittsburgh Medical Center (UPMC) Eye Center, Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, PA, United States.
| | - Joel S Schuman
- New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, NY, United States; Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.
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Miranda MA, Henson DB, Fenerty C, Biswas S, Aslam T. Development of a Pediatric Visual Field Test. Transl Vis Sci Technol 2016; 5:13. [PMID: 27980876 PMCID: PMC5156444 DOI: 10.1167/tvst.5.6.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/01/2016] [Indexed: 12/02/2022] Open
Abstract
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 ± 15 data points were collected on 1 eye of each patient. Mean background luminance and stimulus contrast were 9.9 ± 0.3 cd/m2 and 27.9 ± 0.1 dB, respectively. Sensitivity values obtained were similar to an adult population but variability was considerably higher – 8.3 ± 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.
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Affiliation(s)
- Marco A Miranda
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Faculty of Brain Sciences, Visual Neurosciences, Institute of Ophthalmology, University College London, London, United Kingdom ; NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - David B Henson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom
| | - Cecilia Fenerty
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom
| | - Susmito Biswas
- Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom
| | - Tariq Aslam
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom ; Heriot-Watt University, Edinburgh, United Kingdom
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Michelessi M, Lucenteforte E, Oddone F, Brazzelli M, Parravano M, Franchi S, Ng SM, Virgili G. Optic nerve head and fibre layer imaging for diagnosing glaucoma. Cochrane Database Syst Rev 2015; 2015:CD008803. [PMID: 26618332 PMCID: PMC4732281 DOI: 10.1002/14651858.cd008803.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The diagnosis of glaucoma is traditionally based on the finding of optic nerve head (ONH) damage assessed subjectively by ophthalmoscopy or photography or by corresponding damage to the visual field assessed by automated perimetry, or both. Diagnostic assessments are usually required when ophthalmologists or primary eye care professionals find elevated intraocular pressure (IOP) or a suspect appearance of the ONH. Imaging tests such as confocal scanning laser ophthalmoscopy (HRT), optical coherence tomography (OCT) and scanning laser polarimetry (SLP, as used by the GDx instrument), provide an objective measure of the structural changes of retinal nerve fibre layer (RNFL) thickness and ONH parameters occurring in glaucoma. OBJECTIVES To determine the diagnostic accuracy of HRT, OCT and GDx for diagnosing manifest glaucoma by detecting ONH and RNFL damage. SEARCH METHODS We searched several databases for this review. The most recent searches were on 19 February 2015. SELECTION CRITERIA We included prospective and retrospective cohort studies and case-control studies that evaluated the accuracy of OCT, HRT or the GDx for diagnosing glaucoma. We excluded population-based screening studies, since we planned to consider studies on self-referred people or participants in whom a risk factor for glaucoma had already been identified in primary care, such as elevated IOP or a family history of glaucoma. We only considered recent commercial versions of the tests: spectral domain OCT, HRT III and GDx VCC or ECC. DATA COLLECTION AND ANALYSIS We adopted standard Cochrane methods. We fitted a hierarchical summary ROC (HSROC) model using the METADAS macro in SAS software. After studies were selected, we decided to use 2 x 2 data at 0.95 specificity or closer in meta-analyses, since this was the most commonly-reported level. MAIN RESULTS We included 106 studies in this review, which analysed 16,260 eyes (8353 cases, 7907 controls) in total. Forty studies (5574 participants) assessed GDx, 18 studies (3550 participants) HRT, and 63 (9390 participants) OCT, with 12 of these studies comparing two or three tests. Regarding study quality, a case-control design in 103 studies raised concerns as it can overestimate accuracy and reduce the applicability of the results to daily practice. Twenty-four studies were sponsored by the manufacturer, and in 15 the potential conflict of interest was unclear.Comparisons made within each test were more reliable than those between tests, as they were mostly based on direct comparisons within each study.The Nerve Fibre Indicator yielded the highest accuracy (estimate, 95% confidence interval (CI)) among GDx parameters (sensitivity: 0.67, 0.55 to 0.77; specificity: 0.94, 0.92 to 0.95). For HRT measures, the Vertical Cup/Disc (C/D) ratio (sensitivity: 0.72, 0.60 to 0.68; specificity: 0.94, 0.92 to 0.95) was no different from other parameters. With OCT, the accuracy of average RNFL retinal thickness was similar to the inferior sector (0.72, 0.65 to 0.77; specificity: 0.93, 0.92 to 0.95) and, in different studies, to the vertical C/D ratio.Comparing the parameters with the highest diagnostic odds ratio (DOR) for each device in a single HSROC model, the performance of GDx, HRT and OCT was remarkably similar. At a sensitivity of 0.70 and a high specificity close to 0.95 as in most of these studies, in 1000 people referred by primary eye care, of whom 200 have manifest glaucoma, such as in those who have already undergone some functional or anatomic testing by optometrists, the best measures of GDx, HRT and OCT would miss about 60 cases out of the 200 patients with glaucoma, and would incorrectly refer 50 out of 800 patients without glaucoma. If prevalence were 5%, e.g. such as in people referred only because of family history of glaucoma, the corresponding figures would be 15 patients missed out of 50 with manifest glaucoma, avoiding referral of about 890 out of 950 non-glaucomatous people.Heterogeneity investigations found that sensitivity estimate was higher for studies with more severe glaucoma, expressed as worse average mean deviation (MD): 0.79 (0.74 to 0.83) for MD < -6 db versus 0.64 (0.60 to 0.69) for MD ≥ -6 db, at a similar summary specificity (0.93, 95% CI 0.92 to 0.94 and, respectively, 0.94; 95% CI 0.93 to 0.95; P < 0.0001 for the difference in relative DOR). AUTHORS' CONCLUSIONS The accuracy of imaging tests for detecting manifest glaucoma was variable across studies, but overall similar for different devices. Accuracy may have been overestimated due to the case-control design, which is a serious limitation of the current evidence base.We recommend that further diagnostic accuracy studies are carried out on patients selected consecutively at a defined step of the clinical pathway, providing a description of risk factors leading to referral and bearing in mind the consequences of false positives and false negatives in the setting in which the diagnostic question is made. Future research should report accuracy for each threshold of these continuous measures, or publish raw data.
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Affiliation(s)
- Manuele Michelessi
- Ophthalmology, Fondazione G.B. Bietti per lo studio e la ricerca in Oftalmolologia-IRCCS, Via Livenza n 3, Rome, Italy, 00198
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Abstract
PURPOSE To study the performance of the Matrix perimeter compared with the Humphrey Field Analyzer II (HFA) with the Swedish Interactive Thresholding Algorithm over the range of contrast sensitivities each machine could estimate. METHODS Fifty stable glaucoma subjects at various stages of disease and three normal subjects had visual fields testing done on five different days within 8 weeks with both perimeters. Intraclass correlation coefficient of mean deviation, pattern standard deviation, and the SD of repeat measurements were evaluated. The repeatability of the sensitivity estimates at individual locations and global indices was quantified, as well as their dependence on disease severity. The relationship between sensitivity determinations with the two instruments was explored (principal curve analysis). RESULTS Mean deviation on the HFA ranged from -31 to +2.5 dB. The mean deviation and pattern standard deviation had intraclass correlation coefficients above 0.90 for both instruments. Over most of the useful range (above 20 dB on the HFA), a difference of 1 dB for the Matrix corresponded to a difference of 2 dB for the HFA. The SD of repeat measurements increased with disease severity with HFA, but not with Matrix, except that values of 12 or 34 dB were highly variable on repeat. Variability was reduced for both HFA and Matrix when duplicate sensitivity values were used. A single Matrix test provided only 15 possible sensitivity values, unevenly spaced, but the average of duplicate measurements provided more numerous sensitivity values. A learning effect was detected for Matrix. CONCLUSIONS The decibel values reported by the two machines are not equivalent. Variability of sensitivity determinations is affected more by the sensitivity level with HFA than with Matrix. Duplicate measurements for baseline and follow-up evaluation could be important, especially for Matrix. Further information on learning effects is needed, as is commercially available progression software for Matrix.
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Musch DC, Gillespie BW, Palmberg PF, Spaeth G, Niziol LM, Lichter PR. Visual field improvement in the collaborative initial glaucoma treatment study. Am J Ophthalmol 2014; 158:96-104.e2. [PMID: 24727262 DOI: 10.1016/j.ajo.2014.04.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate critically visual field (VF) improvement in participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN Prospective, comparative case series from a randomized clinical trial comparing trabeculectomy and topical medications in treating open-angle glaucoma (OAG). METHODS A total of 607 subjects with newly diagnosed OAG were identified for study. Baseline and follow-up VF tests were obtained and mean deviation (MD) change from baseline over follow-up was analyzed. Clinically substantial change (loss or improvement) was defined as change from baseline of ≥ 3 decibels in MD. Baseline factors were inspected to determine their association with VF improvement in repeated measures regression models. RESULTS The percentage of participants showing substantial VF improvement over time was similar to that showing VF loss through 5 years after initial treatment, after which VF loss became more frequent. Measures of better intraocular pressure (IOP) control during treatment were significantly predictive of VF improvement, including a lower mean IOP, a lower minimum IOP, and lower sustained levels of IOP over follow-up. Other predictive factors included female sex (odds ratio [OR] = 1.73), visits 1 year prior to cataract extraction (OR = 0.11), and an interaction between treatment and baseline MD wherein surgically treated subjects with worse baseline VF loss were more likely to show VF improvement. CONCLUSIONS In the CIGTS, substantial VF loss and improvement were comparable through 5 years of follow-up, after which VF loss became more frequent. Predictive factors for VF improvement included several indicators of better IOP control, which supports the postulate that VF improvement was real.
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Affiliation(s)
- David C Musch
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paul F Palmberg
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | | | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Paul R Lichter
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan
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Yu TY, Jacobs RJ, Anstice NS, Paudel N, Harding JE, Thompson B. Global motion perception in 2-year-old children: a method for psychophysical assessment and relationships with clinical measures of visual function. Invest Ophthalmol Vis Sci 2013; 54:8408-19. [PMID: 24282224 DOI: 10.1167/iovs.13-13051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We developed and validated a technique for measuring global motion perception in 2-year-old children, and assessed the relationship between global motion perception and other measures of visual function. METHODS Random dot kinematogram (RDK) stimuli were used to measure motion coherence thresholds in 366 children at risk of neurodevelopmental problems at 24 ± 1 months of age. RDKs of variable coherence were presented and eye movements were analyzed offline to grade the direction of the optokinetic reflex (OKR) for each trial. Motion coherence thresholds were calculated by fitting psychometric functions to the resulting datasets. Test-retest reliability was assessed in 15 children, and motion coherence thresholds were measured in a group of 10 adults using OKR and behavioral responses. Standard age-appropriate optometric tests also were performed. RESULTS Motion coherence thresholds were measured successfully in 336 (91.8%) children using the OKR technique, but only 31 (8.5%) using behavioral responses. The mean threshold was 41.7 ± 13.5% for 2-year-old children and 3.3 ± 1.2% for adults. Within-assessor reliability and test-retest reliability were high in children. Children's motion coherence thresholds were significantly correlated with stereoacuity (LANG I & II test, ρ = 0.29, P < 0.001; Frisby, ρ = 0.17, P = 0.022), but not with binocular visual acuity (ρ = 0.11, P = 0.07). In adults OKR and behavioral motion coherence thresholds were highly correlated (intraclass correlation = 0.81, P = 0.001). CONCLUSIONS Global motion perception can be measured in 2-year-old children using the OKR. This technique is reliable and data from adults suggest that motion coherence thresholds based on the OKR are related to motion perception. Global motion perception was related to stereoacuity in children.
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Affiliation(s)
- Tzu-Ying Yu
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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Haleem MS, Han L, van Hemert J, Li B. Automatic extraction of retinal features from colour retinal images for glaucoma diagnosis: A review. Comput Med Imaging Graph 2013; 37:581-96. [DOI: 10.1016/j.compmedimag.2013.09.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 09/11/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
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Moschos MM, Georgopoulos G, Chatziralli IP, Koutsandrea C. Multifocal VEP and OCT findings in patients with primary open angle glaucoma: a cross-sectional study. BMC Ophthalmol 2012; 12:34. [PMID: 22856337 PMCID: PMC3549724 DOI: 10.1186/1471-2415-12-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 07/23/2012] [Indexed: 11/05/2022] Open
Abstract
Bakground To evaluate objectively the anatomical and functional changes of optic nerve in eyes with primary open angle glaucoma (POAG) by the joint use of optical coherence tomography (OCT) and multifocal visual evoked potentials (mfVEP). Methods 29 eyes with open angle glaucoma and visual field defects, as well as 20 eyes of 10 age-matched control normal subjects were tested. All participants underwent a complete ophthalmological examination. Moreover, Humphrey visual field test, OCT examination and recording of mfVEP were performed. Amplitude and implicit time of mfVEP, as well as RNFL thickness were measured. Differences in density components of mfVEP and in RNFL thickness among POAG eyes and control eyes were examined using Student’s t-test. Results In glaucomatous eyes the mean Retinal Response Density (RRD) was lower than normal in ring 1, 2 and 3 of mfVEP (p < 0.0001). Specifically the mean amplitude of mfVEP in POAG eyes was estimated at 34.2 ± 17.6 nV/deg2, 6.9 ± 4.8 nV/deg2 and 2.6 ± 1.6 nV/deg2 in rings 1, 2 and 3 respectively. In contrast the mean implicit time was similar to control eyes. In addition, the mean RNFL thickness in POAG eyes was estimated at 76.8 ± 26.6 μm in the superior area, 52.1 ± 16.3 μm in the temporal area, 75.9 ± 32.5 μm in the inferior area and 58.6 ± 19.4 μm in the nasal area. There was a statistically significant difference in RNFL thickness in all peripapillary areas (p < 0.0001) between POAG eyes and controls, with superior and inferior area to present the highest decrease. Conclusions Our study shows that, although Standard Automatic Perimetry is the gold standard to evaluate glaucomatous neuropathy, the joint use of mfVEP and OCT could be useful in better monitoring glaucoma progression.
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Ernest PJG, Schouten JSAG, Beckers HJM, Hendrikse F, Prins MH, Webers CAB. The evidence base to select a method for assessing glaucomatous visual field progression. Acta Ophthalmol 2012; 90:101-8. [PMID: 21812943 DOI: 10.1111/j.1755-3768.2011.02206.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A large number of methods have been developed for assessing glaucomatous visual field progression, but their properties have not yet been systematically evaluated. In this systematic literature review, we summarize the evidence base for selecting a method by providing answers to ten relevant questions on the variety, validity and reproducibility of methods. In total, we found 301 different methods in 412 articles. The majority of studies (54%) used the Humphrey Field Analyzer. No data have been published about the reproducibility of methods. Although there is no gold standard to assess glaucomatous visual field progression, we found evidence on validity for 48 different methods. Some methods were less capable of distinguishing between progressive and nonprogressive patients. Choosing among twelve methods is supported by some evidence of their validity. These methods still differ in sensitivity, specificity and predictive values of test results within studies comparing several methods. In conclusion, the current evidence base is not perfect. A selection should be made from a limited number of methods, according to the clinical purpose of progression assessment. Methods that quantify the rate of visual field progression seem to be the most appropriate for guiding subsequent medical actions in individual patients. Future studies should investigate whether using one method to monitor patients is superior to another method in preventing loss of quality of life.
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Affiliation(s)
- Paul J G Ernest
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
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The distribution of visual field defects per quadrant in standard automated perimetry as compared to frequency doubling technology perimetry. Int Ophthalmol 2010; 30:683-9. [PMID: 20924646 DOI: 10.1007/s10792-010-9400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 09/10/2010] [Indexed: 10/19/2022]
Abstract
To test the ability of frequency doubling technology (FDT) perimetry to reveal defects in the same field quadrants as detected by standard automated perimetry (SAP). Ninety-two eyes with open-angle glaucoma and documented visual field defects by threshold SAP (Octopus Dynamic strategy) also underwent threshold FDT testing after successfully passing the FDT screening test. All eyes revealed varying stages of SAP defects while only 80 revealed FDT damage: 31:21 eyes in the early field loss stage, 36:35 in the moderate field loss stage, and 25:24 in the severe field loss stage in SAP versus FDT, respectively. SAP was able to detect abnormalities in 74 and 79% of the superotemporal, and inferotemporal quadrants, respectively, while the corresponding FDT figures were 70 and 69% for the same quadrants (P < 0.05 each). With regards to the nasal hemifield, SAP detected defects in 73 and 81% of the superonasal and inferonasal quadrants, respectively, compared to 69 and 66% for FDT (P < 0.001 each). The test duration per individual eye was significantly shorter with FDT than with SAP (P < 0.05). As well as the already established lower sensitivity of FDT compared to SAP, this study also demonstrated the significantly poorer ability of FDT in detecting the same field quadrant defects, especially in the early stages of glaucomatous damage.
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Grinter EJ, Maybery MT, Badcock DR. Vision in developmental disorders: is there a dorsal stream deficit? Brain Res Bull 2010; 82:147-60. [PMID: 20211706 DOI: 10.1016/j.brainresbull.2010.02.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 01/09/2010] [Accepted: 02/28/2010] [Indexed: 12/12/2022]
Abstract
The main aim of this review is to evaluate the proposal that several developmental disorders affecting vision share an impairment of the dorsal visual stream. First, the current definitions and common measurement approaches used to assess differences in both local and global functioning within the visual system are considered. Next, studies assessing local and global processing in the dorsal and ventral visual pathways are reviewed for five developmental conditions for which early to mid level visual abilities have been assessed: developmental dyslexia, autism spectrum disorders, developmental dyspraxia, Williams syndrome and Fragile X syndrome. The reviewed evidence is broadly consistent with the idea that the dorsal visual stream is affected in developmental disorders. However, the potential for a unique profile of visual abilities that distinguish some of the conditions is posited, given that for some of these disorders ventral stream deficits have also been found. We conclude with ideas regarding future directions for the study of visual perception in children with developmental disorders using psychophysical measures.
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Affiliation(s)
- Emma J Grinter
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6008, Australia.
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A method to detect progression of glaucoma using the multifocal visual evoked potential technique. Doc Ophthalmol 2008; 118:139-50. [PMID: 18830654 DOI: 10.1007/s10633-008-9149-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 09/11/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe a method for monitoring progression of glaucoma using the multifocal visual evoked potential (mfVEP) technique. METHODS Eighty-seven patients diagnosed with open-angle glaucoma were divided into two groups. Group I, comprised 43 patients who had a repeat mfVEP test within 50 days (mean 0.9 +/- 0.5 months), and group II, 44 patients who had a repeat test after at least 6 months (mean 20.7 +/- 9.7 months). Monocular mfVEPs were obtained using a 60-sector pattern reversal dartboard display. Monocular and interocular analyses were performed. Data from the two visits were compared. The total number of abnormal test points with P < 5% within the visual field (total scores) and number of abnormal test points within a cluster (cluster size) were calculated. Data for group I provided a measure of test-retest variability independent of disease progression. Data for group II provided a possible measure of progression. RESULTS The difference in the total scores for group II between visit 1 and visit 2 for the interocular and monocular comparison was significant (P < 0.05) as was the difference in cluster size for the interocular comparison (P < 0.05). Group I did not show a significant change in either total score or cluster size. CONCLUSION The change in the total score and cluster size over time provides a possible method for assessing progression of glaucoma with the mfVEP technique.
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Malik R, Swanson WH, Garway-Heath DF. Development and evaluation of a linear staircase strategy for the measurement of perimetric sensitivity. Vision Res 2006; 46:2956-67. [PMID: 16764899 PMCID: PMC2430742 DOI: 10.1016/j.visres.2006.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 02/20/2006] [Accepted: 03/02/2006] [Indexed: 11/24/2022]
Abstract
Perimetric sensitivity of patients with glaucoma has traditionally been measured in logarithmic (dB) units, but linear sensitivity correlates better with conventional structural measures of glaucomatous damage. Monte Carlo simulations of perimetric algorithms were used to assess potential effects of logarithmic steps on bias and variability when perimetric sensitivity was represented in linear units, and to assess the potential benefits of algorithms using linear steps. Simulations predicted that linear staircases could reduce the sensitivity-dependence of bias, variability and efficiency. These predictions were supported by a perimetric study of 21 patients with glaucoma and 20 age-similar controls who made repeat visits over several weeks.
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Affiliation(s)
- Rizwan Malik
- Glaucoma Research Unit, Moorfields Eye Hospital, London, EC1V 2PD, UK.
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Fortune B, Demirel S, Zhang X, Hood DC, Johnson CA. Repeatability of Normal Multifocal VEP: Implications for Detecting Progression. J Glaucoma 2006; 15:131-41. [PMID: 16633227 DOI: 10.1097/00061198-200604000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the repeatability of the multifocal visual evoked potential (mfVEP) and to compare it with the repeatability of standard automated perimetry (SAP) in the same group of 50 normal controls retested after 1 year. Our second aim was to assess the repeatability of false alarm rates determined previously for the mfVEP using various cluster criteria. METHODS Fifty individuals with normal vision participated in this study (33 females and 17 males). The age range was 26.7 to 77.9 years and the group average age (+/- SD) was 51.4 (+/- 12.1) years. Pattern-reversal mfVEPs were obtained using a dartboard stimulus pattern in VERIS and two 8-minute runs per eye were averaged. The average number of days between the first and second mfVEP tests was 378 (+/- 58). SAP visual fields were obtained within 17.4 (+/- 20.3) days of the mfVEP using the SITA-standard threshold algorithm. Repeatability of mfVEPs and SAP total deviation values were evaluated by calculating point-wise limits of agreement (LOA). Specificity (1-false alarm rate) was evaluated for a range of cluster criteria, whereby the number and probability level of the points defining a cluster were varied. RESULTS Point-wise LOA for the mfVEP signal-to-noise ratio (SNR) ranged from 2.0 to 4.3 dB, with an average of 2.9 dB across all 60 locations. For SAP, LOA ranged from 2.4 to 8.9 dB, with an average of 4.0 dB (excluding the points immediately above and below the blind spot). Clusters of abnormal points were not likely to repeat on either mfVEP or SAP. When an mfVEP abnormality was defined as the repeat presence (confirmation) of a 3-point (P < 0.05) cluster anywhere within a single hemifield, only 1 (of 200) monocular hemifield was deemed abnormal. Although the LOA of the mfVEP were similar throughout the field, the limited dynamic range of SNR at superior field locations will limit the ability to follow progression in "depth" at those locations. CONCLUSIONS Repeatability of the mfVEP was slightly better than SAP visual fields in this group of controls with a 1-year retest interval. This suggests that progression in early stages should be more easily detectable by mfVEP. However, in certain field locations (eg, superior periphery), the relatively more narrow dynamic range of the SNR of the mfVEP may limit detection of progression to just 1 event. Confirmation of a 3-point cluster abnormality is highly suggestive of a true defect on the mfVEP.
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Affiliation(s)
- Brad Fortune
- Discoveries in Sight, Devers Eye Institute, Legacy Health System, Portland, OR 97232, USA.
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