Comparison of imo and Humphrey field analyzer perimeters in glaucomatous eyes

Evaluation of visual function within the central 10 degrees using IMOvifa™ 24plus (1-2)

PURPOSE

The IMOvifa™ perimeter with a 24plus (1-2) testing mode has additional measurement points within the central 10 degrees, which may help evaluate the visual field within this area. Here, we comparatively evaluated the IMOvifa™ 24plus (1-2) and HFA 10-2 for the first time.

METHODS

We included 30 patients (48 eyes) who underwent HFA 24-2 Swedish Interactive Threshold Algorithm Standard and IMOvifa™ 24plus (1-2) Ambient Interactive Zippy Estimated tests on the same day and HFA 10-2 within six months. We used Spearman's rank correlation coefficient to analyze the mean deviation (MD) and pattern standard deviation (PSD) between HFA 10-2 and IMOvifa™. The central 10-degree visual field was divided into four sectors, and concordance of visual field defects between IMOvifa™ 24plus (1-2) and HFA 10-2 was evaluated using kappa analysis. Additionally, all sectors showing a sensitivity of 0 dB on the HFA 24-2 were assessed for the presence and agreement of residual visual field in HFA 10-2 and IMOvifa™ 24plus (1-2).

RESULTS

The MD (0.843/0.804) and PSD (0.852/0.763) of IMOvifa™ 24plus (1-2) and HFA 24-2 correlated strongly with those of HFA 10-2. Regarding the ability to detect visual field defects within the central 10 degrees, agreement with HFA 10-2 was κ = 0.715 (0.611,0.819) and 0.754 (0.654,0.854) for IMOvifa™ 24plus (1-2) and HFA 24-2, respectively. In the evaluation of residual visual field, IMOvifa™ 24plus (1-2) detected residual visual function in 100% of cases where HFA 10-2 indicated residual function.

CONCLUSION

The IMOvifa™ 24plus (1-2) may have a higher ability to detect defects in certain areas of the visual field, compared with HFA 24-2, and may also detect residual visual function. However, the IMOvifa™ 24plus (1-2) is difficult to substitute for the 10-2 test, as the 10-2 test is necessary for evaluating visual field defects within the central 10 degrees.

Comparison of a Novel Head-mounted Perimeter vs. the Humphrey Field Analyzer

PURPOSE

Perimetry is a critical tool for the diagnosis and monitoring of glaucomatous visual field defects. The Humphrey Field Analyzer (HFA) is a large, relatively expensive device that does not normally allow for examination outside of the clinic, and it can be ergonomically difficult to tolerate for some patients. The present study compared the novel Smart System Virtual Reality (SSVR) perimetric headset test to that of the HFA in a group of patients with glaucoma.

DESIGN

Prospective comparative study.

SUBJECTS

Seventy-two eyes from 36 patients with glaucoma recruited at the University of Iowa Hospitals and Clinics.

METHODS

Patients completed both HFA and SSVR visual field tests on the same day, with the order of tests randomized. After completing both visual field tests, subjects completed a survey regarding their subjective experience using each perimeter. Visual fields were analyzed using a linear mixed model to assess differences between devices accounting for intereye correlation and Bland-Altman analysis.

MAIN OUTCOME MEASURES

Primary outcome measures included mean deviation (MD), pattern standard deviation (PSD), and test duration.

RESULTS

No statistically significant difference in MD was observed between the SSVR (-7.17 ± 6.36 dB) and HFA (-6.88 ± 6.78 dB; P = 0.859). Statistically significant differences in PSD were observed between the SSVR (4.26 ± 2.37 dB) and HFA (6.38 ± 4.51 dB; P < 0.001) and test duration (323.44 ± 72.27 seconds and 372.20 ± 61.44 seconds, respectively; P < 0.001). Subjectively, the SSVR was the preferred perimeter by 88.5% of patients.

CONCLUSIONS

The SSVR headset is a novel visual field testing device that produces similar results to the HFA with a shorter testing duration. The SSVR was the preferred perimeter by the majority of patients. Future study is required to determine if the SSVR can identify visual field progression.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of structure-function correlation among IMO visual function analyser and Humphrey field analyser

PURPOSE

To compare the structure-function correlations between optical coherence tomography (OCT) thickness parameters and the corresponding sectorial mean sensitivity (MS) values obtained with IMO visual function analyser (IMOvifa) and Humphrey field analyser (HFA) perimeters.

DESIGN

Prospective cross-sectional study.

METHODS

Glaucoma suspect, glaucoma and ocular hypertension patients underwent IMOvifa 24-2 Ambient Interactive Zippy Estimated Sequential Testing, HFA 24-2 Swedish Interactive Threshold Algorithm-Standard and OCT tests within 12 weeks. Based on the Garway-Heath map, the sensitivity points were divided in corresponding OCT peripapillary retinal nerve fibre layer (pRNFL) sectors, and also the central 10° points in corresponding ganglion cell-inner plexiform layer thickness over the macula. The structure-function correlations were analysed by Spearman's rank coefficient and compared by Steiger's test.

RESULTS

57 eyes of 57 patients (mean age 59.2 years, 61.4% female) with reliable field and adequate OCT strength were included in this analysis. IMOvifa had significantly shorter testing time (3.7 vs 5.3 mins), lower mean deviation (difference -0.6 dB) and greater visual field index (difference +1.0%) compared with HFA (p<0.001 for all). There was moderate to strong correlation between IMOvifa and HFA MS sectors (p<0.001 for all). IMOvifa had significant correlations in the inferior (I, r=0.46), superior (S, r=0.45), temporal (T, r=0.28) pRNFL sectors and in the I (r=0.63) and S (r=0.53) mGCPIPL hemispheres (p≤0.03 for all). There was no significant difference in the strength of the correlation of IMOvifa versus HFA results with OCT parameters (p≥0.06).

CONCLUSIONS

The IMOvifa test took less time and resulted in slightly less severe defects than HFA. MS in all sectors was moderately to strongly correlated. Function-structure correlations were similar when using either perimeter.

Validation of a Novel Suprathreshold Strategy for Screening Visual Function

Background/Objectives: Glaucoma, a leading cause of blindness worldwide, is often associated with high intraocular pressure (IOP), which eventually leads to loss of retinal ganglion cells and the retinal nerve fiber layer. Visual field (VF) testing is a principal method of diagnosing and monitoring this disease. Suprathreshold VF test programs are quicker than threshold strategies and are often used as a screening tool. This study evaluates the TEMPO/IMOvifa (Topcon Healthcare/CREWT Medical Systems, Tokyo, Japan), a bilateral standard automated perimeter with a suprathreshold screening program by assessing the sensitivity in a glaucoma cohort and the specificity in a healthy cohort. Methods: All subjects were tested at a single site and underwent a comprehensive ocular examination to categorize them into either a healthy or glaucoma group. As part of the testing procedure, two TEMPO suprathreshold VFs were conducted in sequence and accompanied by a threshold VF test. Results: A total of 193 eyes (randomized study eye) (193 subjects) were evaluated in the final analysis (101 healthy and 92 glaucoma), and average suprathreshold test time (SD) per eye was 39.4 (±4.86) seconds. Specificity was at 91% in the healthy group and sensitivity was at 49% in the glaucoma group. Sensitivity was at 100% when applied to glaucoma cases with an MD of less than -3 dB. Conclusions: The TEMPO screening program demonstrated strong specificity in detecting true healthy cases. It also demonstrated a strong sensitivity when screening mild to moderate glaucoma. Early glaucoma and glaucoma suspects would benefit from complementary modalities such as optical coherence tomography and threshold perimetry to effectively diagnose. Utilizing this screening program in optometric and ophthalmic settings could yield benefits for both the practitioner and the patient.

Comparison of IMO vifa24plus(1-2) and Humphrey Field Analyzer 24-2

Purpose

This study aimed to compare the results of the IMO vifa 24plus(1-2) and HFA 24-2 visual field tests.

Patients and Methods

We included 52 patients (104 eyes) with glaucoma who visited Chukyo Eye Clinic between June 2023 and March 2024. On the same day, the HFA 24-2 test using the Swedish Interactive Threshold Algorithm Standard and the IMO vifa 24plus(1-2) test using the Ambient Interactive Zippy Estimated strategy were performed. A Wilcoxon signed-rank test was used to compare fixation, false positives, false negatives, and total test time for both eyes between the HFA and IMO vifa tests. Only eyes with reliable test results were selected, and the visual field index (VFI), mean deviation (MD), and pattern standard deviation (PSD) were examined using Spearman's rank correlation coefficient and the Wilcoxon signed-rank test.

Results

The test times for the HFA 24-2 and IMO vifa 24plus(1-2) were 716.83±118.80 and 628.75±142.70 s, respectively, with the IMO vifa being significantly shorter (P<0.001). For fixation, the results were 15.85±16.57% and 11.09±15.20%, with significantly better fixation in the IMO vifa (P<0.0001). False positives and negatives were 4.52±5.19 / 4.14±6.85% and 4.97±7.99 / 5.47±7.86%, respectively, with no significant differences, though the IMO vifa showed a slightly higher trend (P=0.980, 0.056). In eyes with reliable results, the HFA 24-2 and IMO vifa 24plus(1-2) outcomes were as follows: MD (-6.45±7.23, -6.85±7.35, P=0.724), PSD (7.13±4.75, 7.49±4.87, P=0.061), VFI (80.86±21.61, 80.86±21.74, P=0.644). The Spearman rank correlation coefficients between the HFA 24-2 and IMO vifa 24plus(1-2) were MD: 0.938, PSD: 0.949, VFI: 0.932 (all P<0.001).

Conclusion

The IMO vifa demonstrates a very high correlation with HFA and allows for a shorter examination time. Fixation errors are significantly improved compared to HFA, while there is no significant difference in false positives or false negatives.

A case of functional visual loss diagnosed through bilateral randomized visual field testing with a trick method

Purpose

To report a case of functional visual loss (FVL) diagnosed through bilateral randomized visual field testing using Imo vifa with a trick method.

Observations

A 27-year-old man complained of visual field abnormality in his left eye after falling from a height of 4 m. The left eye had a best-corrected visual acuity (BCVA) of 20/16 and a critical flicker frequency (CFF) of 44.5 Hz at the first visit. Commotio retinae was observed in the inferior retina of the left eye, and the pupillary light reflex was normal. Computed tomography and magnetic resonance imaging of the head revealed no abnormalities. However, the Goldmann perimeter (GP) showed constriction of visual field in the left eye. Since traumatic optic neuropathy was suspected initially; therefore, two courses of methylprednisolone pulse therapy were administered. However, the BCVA and CFF gradually worsened to 20/200 and 14 Hz, respectively. Nevertheless, his pupillary light reflex was still normal, and GP showed a spiral visual field. Thus, we suspected that this was a case of FVL and performed bilateral randomized visual field testing using Imo vifa in three steps as a trick method. In the first step, we performed the normal method for bilateral randomized visual field testing. In the second and third steps, we explained to the patient that only the right or left eye would be examined on purpose; bilateral randomized visual field testing was then performed. The results of examinations revealed left homonymous hemianopsias and normal and concentric contraction of the visual field in both eyes. These results could not be explained by organic disease, and the patient was diagnosed with FVL.

Conclusions and Importance

Bilateral randomized visual field testing using Imo vifa with a trick method was useful for diagnosing FVL.

Identification of appropriate tools to gauge brain functions in a clinical setup of a developing country: A pilot study

Objective

To identify the most appropriate tools to measure functions of the brain that can be utilized in the clinical setups of developing countries.

Methods

This qualitative research with a three-step approach was carried out from January 2022 to May 2022 at the Institute of Basic Medical Sciences, Khyber Medical University, Pakistan. Firstly, literature was searched to identify main brain faculties, then interviews were conducted with regional field experts to identify appropriate scales for the selected functions. Lastly a rubric was filled using interview transcripts and literature.

Results

The identified functions were vision, hearing, cognition, motor and emotions. Based on the rubric the best tests were visual fields (17/24), pure tone audiometry (16/24), Mini-Mental State Exam (20/24), Trait Emotional Intelligence Questionnaire (18/24), Romberg's test (19/24) and Manual Muscle Testing (18/24).

Conclusion

The clinicians in developing countries can utilize the visual fields, pure tone audiometry, Mini-Mental State Exam, Trait Emotional Intelligence Questionnaire, Romberg's test and Manual Muscle Testing for most efficient, feasible, accurate and cost-effective measurement of brain functions.

Perimetric Comparison Between the IMOvifa and Humphrey Field Analyzer

PRCIS

IMO visual function analyzer (IMOvifa), a binocular perimeter, has similar output to the Humphrey Field Analyzer (HFA), but reduced the measurement time.

PURPOSE

The purpose of this study is to evaluate the performance of IMOvifa, a perimeter that performs binocular visual field (VF) testing, and to compare its results with standard automated perimetry.

METHODS

All patients underwent HFA 24-2 SITA-Fast and IMOvifa 24-2 AIZE-Rapid on the same day. Mean deviation (MD), pattern SD (PSD), foveal threshold, and visual field index (VFI) were compared between the 2 perimeters using Wilcoxon signed-rank tests, Pearson correlation, and Bland-Altman plot. Measurement time for performing VF for both eyes was also collected for each device.

RESULTS

In this cross-sectional study, 138 eyes (including 25 healthy, 48 glaucoma suspects, and 65 primary open angle glaucoma) of 69 patients were evaluated. Measurement time was significantly faster for IMOvifa compared with HFA (256 vs. 419 s, P <0.001). No significant differences were seen in MD and VFI between HFA and IMOvifa (both P >0.05). Significant differences were seen in mean PSD 3.2 (2.7, 3.6) dB for HFA versus 4.1 (3.5, 4.6) for IMOvifa ( P <0.001), and foveal threshold 33.9 (33.1, 34.6) dB for HFA versus 30.6 (29.3, 31.9) dB for IMOvifa ( P <0.001). Pearson r was strong for MD ( r =0.90, P <0.001), PSD ( r =0.78, P <0.001), and VFI ( r =0.94, P <0.001). The mean difference (95% limits of agreement) was -0.1 (-3.8, 3.5) dB for MD, -0.4 (-3.4, 2.5) dB for PSD, and 0.1 (-8.9, 9.1) dB for VFI, respectively.

CONCLUSIONS

IMOvifa reduced measurement time by 39%. MD, PSD, and VFI values for IMOvifa showed good agreement with HFA SITA-Fast strategy. This perimeter reduced fatigue for both patient and examiner. Additional studies are needed to determine whether it will be useful for routine VF testing.