Comparison of Humphrey MATRIX and Swedish interactive threshold algorithm standard strategy in detecting early glaucomatous visual field loss

Virtual Reality Hemifield Measurements for Corrective Surgery Eligibility in Ptosis Patients: A Pilot Clinical Trial

Purpose

We developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis.

Methods

In a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients' Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities.

Results

VR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = -0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P < 0.05; MCHT P < 0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P < 0.01), speed (P < 0.001), and overall experience (P < 0.01).

Conclusions

This pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment.

Translational Relevance

In this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.

Responses of primate retinal ganglion cells to perimetric stimuli

PURPOSE

Perimetry is used clinically to assess glaucomatous ganglion cell loss. It has been proposed that frequency-doubling stimuli are better than the conventional size III perimetric stimulus in preferentially stimulating magnocellular (M) versus parvocellular (P) ganglion cells. However, little is known about how primate ganglion cells respond to perimetric stimuli. The authors recorded contrast responses of M and P ganglion cells to size III and frequency-doubling stimuli and compared contrast gain of M and P cells to these stimuli to assess the ability of these stimuli to preferentially stimulate M versus P cells.

METHODS

Data were recorded from 69 macaque retinal ganglion cells, by an in vivo preparation, at eccentricities of 5° to 15°. The size III stimulus was a circular luminance increment 26 min arc in diameter, 200 ms in duration. The frequency-doubling stimulus was a sinusoidal grating (0.5 cyc/deg) temporally modulated in counterphase at 13 Hz. A Michaelis-Menten function was fit to each cell's contrast responses to assess contrast gain.

RESULTS

For both size III and frequency-doubling stimuli, ganglion cell responses increased linearly at low contrasts, and then the increase slowed at high contrasts (saturation). The mean (± SE) difference in estimated log contrast gain between M and P cells for the size III stimulus was significantly higher than that for the frequency-doubling stimulus (1.24 ± 0.09 vs. 0.89 ± 0.13; P < 0.01).

CONCLUSIONS

The size III stimulus was superior to the frequency-doubling stimulus in preferentially stimulating M cells versus P cells.