Comparison of isolated-check visual evoked potential and standard automated perimetry in early glaucoma and high-risk ocular hypertension

AIM：To compare the diagnostic performance of isolatedcheck visual evoked potential（ic VEP） and standard automated perimetry（SAP）,for evaluating the application values of ic VEP in the detection of early glaucoma.METHODS：Totally 144 subjects（288 eyes） were enrolled in this study.ic VEP testing was performed with the Neucodia visual electrophysiological diagnostic system.A 15% positive-contrast（bright） condition pattern was used in this device to differentiate between glaucoma patients and healthy control subjects.Signal-to-noise ratios（SNR） were derived based on a multivariate statistic.The eyes were judged as abnormal if the test yielded an SNR≤1.SAP testing was performed with the Humphrey Field Analyzer II.The visual fields were deemed as abnormality if the glaucoma hemifield test results outside normal limits;or the pattern standard deviation with P〈0.05;or the cluster of three or more non-edge points on the pattern deviation plot in a single hemifield with P〈0.05,one of which must have a P〈0.01.Disc photographs were graded as either glaucomatous optic neuropathy or normal by two experts who were masked to all other patient information.Moorfields regression analysis（MRA） used as a separate diagnostic classification was performed by Heidelberg retina tomograph（HRT）.RESULTS：When the disc photograph grader was used as diagnostic standard,the sensitivity for SAP and ic VEP was 32.3% and 38.5% respectively and specificity was 82.3% and 77.8% respectively.When the MRA Classifier was used as the diagnostic standard,the sensitivity for SAP and ic VEP was 48.6% and 51.4% respectively and specificity was 84.1% and 78.0% respectively.When the combined structural assessment was used as the diagnostic standard,the sensitivity for SAP and ic VEP was 59.2%and 53.1% respectively and specificity was 84.2% and 84.6% respectivlely.There was no statistical significance between the sensitivity or specificity of SAP and ic VEP,regardless of which diagnostic standard was based on.CONCLUSION：The diagnostic performance of ic VEP is not better than that of SAP in the detection of early glaucoma.

Relationship between short-wavelength automatic perimetry and Heidelberg retina tomograph parameters in eyes with ocular hypertension

AIMTo compare and correlate optic nerve head parameters obtained by Heidelberg retina tomograph (HRT) with short-wavelength automatic perimetry (SWAP) indices in eyes with ocular hypertension (OHT).METHODSOne hundred and forty-six patients with OHT included in the present study. All subjects had reliable SWAP and HRT measurements performed within a 2wk period. The eyes were classified as normal/abnormal according to visual field criteria and Moorfields regression analysis (MRA). Correlations between visual field indices and HRT parameters were analyzed using Pearson correlation coefficient (r).RESULTSTwenty-nine eyes (19.9%) had SWAP defects. Twenty-nine eyes (19.9%) were classified as abnormal according to global MRA. Six eyes (4.1%) had abnormal global MRA and SWAP defects. The k statistic is 0.116 (P=0.12) indicating a very poor agreement between the methods. No statistical significant correlation between HRT and SWAP parameters was detected.CONCLUSIONSWAP defects may coexist with abnormalities of optic disc detected by HRT in eyes with OHT. In most eyes, however, the two methods detect different glaucoma properties.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

AIM：To evaluate the refractive correction for standard automated perimetry（SAP）in eyes with refractive multifocal contact lenses（CL）in healthy young participants.METHODS：Twenty-nine eyes of 29 participants were included.Accommodation was paralyzed in all participants with 1%cyclopentolate hydrochloride.SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions：monofocal CL corrected for near distance（baseline）;multifocal CL corrected for distance（m CL-D）;and m CL-D corrected for near vision using a spectacle lens（m CL-N）.Primary outcome measures were the foveal threshold,mean deviation（MD）,and pattern standard deviation（PSD）.RESULTS：The foveal threshold of m CL-N with both the24-2 and 10-2 protocols significantly decreased by 2.2-2.5 d B（P〈0.001）,while that of m CL-D with the 24-2 protocol significantly decreased by 1.5 d B（P=0.0427）,as compared with that of baseline.Although there was no significant difference between the MD of baseline and m CL-D with the24-2 and 10-2 protocols,the MD of m CL-N was significantly decreased by 1.0-1.3 d B（P〈0.001）as compared with that of both baseline and m CL-D,with both 24-2 and 10-2 protocols.There was no significant difference in the PSD among the three refractive conditions with both the 24-2 and 10-2 protocols.CONCLUSION：Despite the induced mydriasis and the optical design of the multifocal lens used in this study,our results indicated that,when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs,distance correction without additional near correction is to be recommended.

Blue-on-yellow perimetry and corneal thickness in patients with ocular hypertension

AIM: To evaluate the frequency of blue-on-yellow perimetry (B/YP) deficits in ocular hypertension (OHT) patients and to correlate these findings with central corneal thickness (CCT), and to investigate the influence of age, refraction and gender on the B/YP results in OHT patients. METHODS: The B/YP and CCT were checked respectively in 72 OHT patients with normal white-on-white perimetry (W/WP) and normal optic nerve head. The B/YP was tested by Octopus 101 automated perimetry using G2 strategy, while the CCT was checked with DGH-550 ultrasound pachymeter. All patients were chosen randomly one eye for statistical analysis, a binary regression model was used to determine the independent contribution of variables included in the model, and the differences of the intraocular pressure (TOP), CCT, age, refraction and gender between the normal B/YP group and abnormal B/YP group were compared. RESULTS: Forty-nine out of 72 patients with OHT showed normal B/YP results, whereas 23 of 72 patients (31.9%) demonstrated abnormal B/YP results. CCT showed a correlation with the B/YP results (B=-0.038, SE=0.019, P=0.044), whereas none of the TOP, age, refraction and gender was found to be correlated with the B/YP results. The mean CCT in OHT patients with abnormal B/YP group was lower than that with normal B/YP group (t=2.066, P=0.043). There was a significant positive correlation between TOP and CCT (R(2)=0.513, P=0.000). CONCLUSION: The mean CCT in OHT patients with abnormal B/YP results was lower than that with normal B/YP results. There was a significant positive correlation between TOP and CCT in OHT patients. The age, refraction and gender didn't influence the B/YP results in OHT patients.

Combined Hamartoma of the Optic Disc and Retinal Pigment Epithelium—3 Years of the Follow-Up with Semi-Automated Kinetic Perimetry

Aim: To present a case of hamartoma of the optic disc and Retinal Pigment Epithelium (RPE) and follow up of the visual function over three-years period. Methods: A seventeen-year-old boy has observed reduced visual acuity in his left eye. The visual acuity was 0.2 and there was RAPD in the left eye. Fundoscopy revealed an elevation of the optic disc obscuring disc vessels with epiretinal gliosis. Fluorescein angiography demonstrated hyperfluorescent saccular dilatations with leakage in the late phase. Ocular Coherence Tomography (OCT) showed hyperreflective elevation of the optic disc and epiretinal membrane. There was a juxtapapillary scotoma in Semi-automated Kinetic Perimetry (SKP). There was no systemic diseases. Results of blood tests, CT and MRI of CNV were normal. Results: After 3 years period of the follow-up the visual acuity was 0.1 and there was a progression of the visual field defect to the altitudinal scotoma in the upper hemisphere. Fluorescein anhiography and OCT revealed the same. Conclusion: Hamartoma of RPE and optic disc is a rare condition consisting of glial, vascular and RPE cells. It should be differentiated from optic disc oedema and vascular tumors of the retina. Assessment of the visual function is very important in the longitudinal follow-up.

The analysis of macular perimetry with octopus 900 in acute central serous chorioretinopathy

Background:To find the changes of macular perimetry(MP) and the correlations between MP and best correct visual acuity(BCVA) in different phases of the acute central serous chorioretinopathy(CSC).Methods:Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively.MP at 2°,4°and BCVA in the active and resolved phase were collected and analyzed.The differences of these parameters in CSC eyes and fellow eyes were analyzed.Spearman correlation was used for analysis of correlation between MP and BCVA.Results:From 29 eyes with CSC analysed 27 eyes(93.10%) recovered to the previous VA.Compared with the active phase,MP at 2°,4° and BCVA were significantly improved in the resolved phase(P=0.000,0.000,0.000,respectively).MP at 2°,4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase(P=0.000,0.000,0.000,respectively).In the resolved phase there was no significant difference between the CSC eyes and fellow eyes(P=0.339,0.141,0.161,respectively).BCVA was shown to significantly correlate with MP at 2° in the active phase(ρ=-0.630,P<0.001).Conclusions:The acute CSC often had a good prognosis both in BCVA and MP.MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC.

Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition

Objective:To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing.Methods:In this retrospective pre-post study,an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020.Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses.As part of routine practice,glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition;taped examinations were excluded from analysis.Clinical and demographic characteristics,mean deviation,and pattern standard deviation were evaluated within a two year period before and after eyelid surgery.Results:The final analysis included 60 eyes of 38 patients.Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses.Among patients with ptosis,the margin reflex distance-1 was not associated with change in mean deviation after surgery(Pearson R^(2)=0.0061;P=0.700).Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery.Conclusions:Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields.Unreliable visual fields could be a sign of eyelid interference in this population.

Structure-function relationship comparison between retinal nerve fibre layer and Bruch's membrane opening-minimum rim width in glaucoma

AIM：To evaluate and compare structural optical coherence tomography（OCT）-based parameters,such as Bruch’s membrane opening-minimum rim width（BMO-MRW）,and retinal nerve fiber layer（RNFL）thickness in glaucoma patients with visual field（VF）defects,and to correlate both to mean deviation（MD）values of obtained standard achromatic perimetry（SAP）examinations.METHODS：Patients with glaucoma and glaucomatous VF defects were enrolled in this prospective study and compared to age-matched healthy individuals.All study participants underwent a full ophthalmic examination and VF testing with SAP.Peripapillary RNFL thickness and BMO-MRW were acquired with SD-OCT.Correlation analyses between obtained global functional and global as well as sectorial structural parameters were calculated.RESULTS：A consecutive series of 30 glaucomatous right eyes of 30 patients were included and compared to 36healthy right eyes of 36 individuals in the control group.Global MD of values correlated significantly with global RNFL（Pearson corr.coeff：0.632,P=0.001）and global BMO-MRW（Pearson corr.coeff：0.746,P〈0.001）values in the glaucoma group.Global MD and sectorial RNFL or BMO-MRW values correlated less significantly.In the control group,MD values did not correlate with RNFL or BMO-MRW measurements.A subgroup analysis of myopic patients（〉4 diopters）within the glaucoma group（n=6）revealed a tendency for higher correlations between MD and BMO-MRW than MD and RNFL measurements.CONCLUSION：In a clinical setting,RNFL thickness and BMO-MRW correlate similarly with global VF sensitivity in glaucoma patients with BMO-MRW showing higher correlations in myopic glaucoma patients.

Analysis of optic disc damage by optical coherence tomography in terms of therapy in non-arteritic anterior ischemic optic neuropathy

This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic anterior ischemic optic neuropathy（NAION） and time delay before therapy.Total 24 patients received the same treatment within or after 2wk（early and late groups）.There were significantly lower level of destruction of nerve fibers（P=0.0014） and significantly better visual field sensitivity（P=0.039） in early group.The results indicate that therapy should be started within 2wk.The degree of ischemic damage due to NAION correlates well with retinal nerve fiber layer thickness and the ischemia-induced decrease in visual field sensitivity.

Validation and reproducibility of the Heidelberg Edge Perimeter in the detection of glaucomatous visual field defects

AIM: To validate the ability of the Heidelberg Edge Perimeter(HEP) in detecting glaucomatous visual field(VF) defects compared to the Octopus Visual Field(OVF) Analyzer and to determine the test-retest repeatability of both modalities.METHODS: This prospective, cross-sectional study was conducted at Wills Eye Hospital, Philadelphia, PA. Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry(SAP) Ⅲ 30-2 Adaptive Staircase Thresholding Algorithm(ASTA) FAST protocol and OVF G-TOP white-on-white strategy. Testing order was randomized. Pearson's correlation coefficient was calculated for both mean deviation(MD) and pattern standard deviation/square root of loss of variance(PSD/s LV). Receiver operating characteristic(ROC) curves were used to determine the diagnostic abilities of both modalities. Glaucoma subjects returned for repeat testing and intraclass correlation coefficients(ICCs) were calculated to assess test-retest repeatability. RESULTS: Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled. HEP and OVF were significantly correlated for both MD(r=-0.84; P<0.01) and PSD/s LV(r=0.79; P<0.01). Areas under the ROC curves(AUCs) were also comparable between HEP and OVF for both MD(0.74 and 0.79, respectively; P=0.26) and PSD/sL V(0.74 and 0.82; P=0.08). ICC was high for both HEP (0.96 for MD, 0.95 for PSD/s LV) and OVF(0.82 and 0.88, respectively). Mean test duration(min) was significantly shorter for OVF(2.63) compared to HEP(5.15; P<0.01). CONCLUSION: HEP and OVF show strong correlation for both MD and PSD/s LV, and have similar validity for detecting glaucoma. The test-retest repeatability is high for both HEP and OVF, however the average testing duration of HEP is significantly longer than that of OVF.

Visual function alterations in essential tremor: A case report

Our purpose is to report alterations in contrast sensitivity function(CSF)and in the magno,parvo and koniocellular visual pathways by means of a multichannel perimeter in case of an essential tremor(ET).A complete evaluation of the visual function was performed in a 69-year old patient,including the analysis of the chromatic discrimination by the Fansworth–Munsell 100 hue test,the measurement of the CSF by the CSV-1000E test,and the detection of potential alteration patterns in the magno,parvo and koniocellular visual pathways by means of a multichannel perimeter.Visual acuity and intraocular pressure(IOP)were within the ranges of normality in both eyes.No abnormalities were detected in the fundoscopic examination and in the optical coherence tomography(OCT)exam.The results of the color vision examination were also within the ranges of normality.A signi¯cant decrease in the achromatic CSFs for right eye(RE)and left eye(LE)was detected for all spatial frequencies.The statistical global values provided by the multichannel perimeter confirms that there were significant absolute sensitivity losses compared to the normal pattern in RE.In the LE,only a statistically significant decrease in sensitivity was detected for the blue-yellow(BY)channel.The pattern standard deviation(PSD)values obtained in our patient indicated that there were significant localized losses compared to the normality pattern in the achromatic channel of the RE and in the red-green(RG)channel of the LE.Some color vision alterations may be present in ET that cannot be detected with conventional color vision tests,such as the FM 100 Hue.

Flicker defined form and RareBit measurements lack in specificity of visual pathways

AIM:To evaluate the different visual pathways represented by the Heidelberg Engineering Perimeter flicker defined form and RareBit(magnocellular and parvocellular respectively)in different age-groups and according to the fatigue.METHODS:Totally 64 eyes of 32 healthy subjects were included in the prospective study.Each participant underwent screening—ophthalmic examination including best-corrected visual acuity,anterior and posterior segment assessment,and visual field examination with Heidelberg Edge Perimetry(HEP)-standard automated perimeter(SAP)24-2.They were observed for 2 y previously to the enrollment.This helped to define that the enrolled patients did not bear the glaucoma-developing potential.During the screening and after two years the HEP had been conducted in the standard protocol 24-2 and RareBit perimetry(RBP)in accordance with the manufacturer’s description.Participants were randomly assigned to the groups:flicker defined form(FDF)-first or RBP-first.This defined from which additional visual field test the participant started.Participants were additionally subdivided to younger and older study groups.The effect of subject variables was explored with Mann-Whitney U-test.Testing for the presence of correlations between parameters was performed using the Spearman Rank Order Correlations and confirmed by the parametric tests.For the influence of additional factors,the Kruskal-Wallis test was performed.RESULTS:The positive correlation between meandeviation(MD)and mean hit rate(MHR)and pattern standard deviation(PSD)and standard deviation of MHR(±MHR)were found in younger study group(P=0.005,r=0.481 and P=0.0074,r=0.465),whereas in the older subgroup no correlation was observed.Additionally,the randomization protocol helped in defining the role of fatigue on the HEP-FDF results.Participant for whom the HEPFDF was performed after RareBit had significantly worse results than those for whom the HEP-FDF was first.In the younger group,the MHR and±MHR depend from age in that group(P<0.05,r=0.43 and r=-0.57 respectively)while no age-dependent differences were found in HEPrelated parameters.On the contrary in the older group the MD and PSD varies with age(P<0.05,r=0.47 and r=-0.44 respectively)while the RBP parameters remained unchanged.The questionnaire showed that participants preferred RareBit over HEP-FDF in terms of a duration time,comfort,understanding of the test procedures,and ocular pain(P<0.05).CONCLUSION:The influence of patient’s fatigue should be considered during HEP-FDF examination.An overlap hypothesis should be reevaluated after determining of other factors that affect HEP-FDF and RareBit results.

Prognostic Value of Retinal Nerve Fiber Layer and Ganglion Cell Complex after Optic Chiasmal Decompression

This paper is an attempt to ascertain the role of the optical coherence tomography by measuring the retinal nerve fiber layer thickness and ganglion cell complex area to predict postoperative visual outcome after chiasmal decompression. 16 eyes scheduled for chiasmal decompression surgery were assessed before and 3 months after surgery with standard automated perimetry and OCT (optical coherence tomography). Preoperative RNFL (retinal nerve fibre layer) thickness and GCC (ganglion cell complex) area were compared with 20 normal control eyes. 13 cases were operated by microscopic assisted endoscopic endonasal transsphenoidal approach;the remaining 3 cases were operated transcranially. Spearman’s correlation analysis was used to evaluate the relationship between preoperative RNFL thickness, GCC area, postoperative mean deviation and temporal visual field sensitivity (1/Lambert). Preoperative measurements of RNFL thickness and all GCC area were significantly reduced in the patients compared with normal control. 3 months postoperative evaluation showed improvement of the visual field, but reduction in global and sectorial RNFL thickness except for nasal sector. Moreover, absolute postoperative (not pre-post change) visual field parameters were significantly correlated to preoperative RNFL (P = 0.00399 for mean deviation, P = 0.0023 for temporal sensitivity), GCC thickness (P = 0.00736 for mean deviation, P = 0.0469 for temporal sensitivity), with FLV (focal loss value) (P = 0.0012 for mean deviation, P = 0.0021 for temporal sensitivity) showed a higher correlation. Reduced RNFL thickness mainly, and GCC area minimally, were associated with the worst visual field outcome. FLV is a new prognostic value.

Central visual function and inner retinal structure in primary open-angle glaucoma

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma(POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential(ic VEP) testing, 24-2 standard automated perimetry(SAP), and Cirrus optical coherence tomography(OCT) examinations. Signal-to-noise ratio(SNR) measures obtained from ic VEP responses to isolated checks presented at four depths of modulation(DOMs;8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity(mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness(GCL+IPLT) and peripapillary retinal nerve fiber layer thickness(pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls(P<0.001). A significant positive association was found between SNR at 14% DOM and GCL+IPLT at the inferior sector in early glaucoma(r=0.465, P=0.004). In moderate to advanced glaucoma, significant correlations were found between SNR at 32% DOM and mean GCL+IPLT(r=0.364, P=0.023), superior GCL+IPLT(r=0.358, P=0.025), and mean p RNFLT(r=0.396, P=0.025). In addition, in moderate to advanced glaucoma, there were significant correlations between mMS and all relevant measures of retinal thickness(r=0.330–0.663, P< 0.010). In early glaucoma, significant correlations were found between mean mMS and minimum GCL+IPLT(r=0.373, P=0.023), and between inferior mMS and superior GCL+IPLT(r=0.470, P=0.003). Linear models provided a good explanation for the relationship between SNR and inner retinal thickness(IRT), whereas nonlinear models better explained the relationship between mMS and IRT. In early glaucoma, both SNR and mMS were related moderately and significantly to IRT, whereas in moderate to advanced glaucoma, mMS was more strongly correlated with IRT than SNR.

Meta-analysis of the diagnostic efficiency of frequency-doubling technology for primary glaucoma

The overall diagnostic capabilities and utility of frequency-doubling technology(FDT)in patients with primary glaucoma,which was diagnosed by standard automated perimetry(SAP)and/or optic disc appearance as the gold standard,were assessed.A comprehensive electric retrieval in MEDLINE,EMBASE,Cochrane Library,BIOSIS,Previews,HMIC,IPA,OVID,CNKI,CBMdisc,VIP information,CMCC,CCPD,SSreader,21dmedia and manual retrieval in related textbooks,journals,congress articles and their references at home and abroad were performed to identify relevant articles in English or Chinese.The corresponding references were retrieved by means of electric retrieval and manual retrieval from different databases or materials.Criteria for inclusion or exclusion were established according to validity criteria for diagnostic studies published by the Cochrane Methods Group on Screening and Diagnostic Tests.The quality of the included articles was then assessed and characteristics were extracted.Statistical analysis was performed with Meta Test version 0.6 software to test the heterogeneity of the included articles.The appropriate effects model was selected to calculate pooled weighted sensitivity and specificity.Summary receiver operating characteristic(SROC)curve was drawn and the area under the curve(AUC)was calculated.Finally,sensitivity analysis was performed.Twenty-one studies out of 206 retrieved articles were included,with a total of 3172 patients.The reported sensitivity of FDT ranged from 0.51 to 1.00,and specificity from 0.58 to 1.00.The pooled weighted sensitivity and specificity of FDT with 95% confidence intervals(95% CI)after correction for standard error were 0.86(0.80–0.90)and 0.87(0.81–0.91),respectively.The AUC of SROC was 93.01%.Sensitivity analysis demonstrated no disproportionate influences of individual studies.The included articles are of good quality and FDT can be a highly efficient diagnostic test for primary glaucoma based on Meta-analysis.