Yes / Combining information from optical coherence tomography (OCT) imaging and visual field testing is useful in the clinical assessment and monitoring of patients with glaucoma. Measurements of retinal nerve fibre layer thickness or neuroretinal rim width taken around the optic nerve head may be related to the visual field using a structure–function map. In this review, the structure–function mapping methods in clinical use are discussed. Typical clinical maps provide a population average, ‘one size fits all’ representation, but in recent years methods for customising structure–function maps to individual eyes have been developed and these are reviewed here. In the macula, visual field stimuli stimulate photoreceptors for which associated retinal ganglion cells are peripherally displaced. Recently developed methods that relate OCT measurements to visual field test locations in the macula are therefore also reviewed. The use of structure–function maps to relate OCT measurements to localised visual field sensitivity in new applications is also explored. These new applications include the selection of visual field test locations and stimulus intensities based on OCT data, and the formal post‐test combination of results across modalities. Such applications promise to exploit the structure–function relationship in glaucoma to improve disease diagnosis and monitoring of progression. Limitations in the validation and use of current structure–function mapping techniques are discussed. / >Heidelberg Engineering >Australian Research Council. Grant Number: LP130100055 >College of Optometrists. Grant Number: College of Optometrists Research Fellowship

Yes / The purpose of this study was to isolate and quantify the effects of observer response criterion on perimetric sensitivity, response variability, and maximum response probability. Twelve people with glaucoma were tested at three locations in the visual field (age = 47-77 years, mean deviation = -0.61 to -14.54 dB, test location Humphrey field analyzer [HFA] sensitivities = 1 to 30 dB). Frequency of seeing (FoS) curves were measured using a method of constant stimuli with two response paradigms: a "yes-no" paradigm similar to static automated perimetry and a criterion-free two interval forced choice (2IFC) paradigm. Comparison measures of sensitivity, maximum response probability, and response variability were derived from the fitted FoS curves. Sensitivity differences between the tasks varied widely (range = -11.3 dB to 21.6 dB) and did not correlate with visual field sensitivity nor whether the visual field location was in an area of steep sensitivity gradient within the visual field. Due to the wide variation in differences between the methods, there was no significant difference in mean sensitivity between the 2IFC task relative to the yes-no task, but a trend for higher sensitivity (mean = 1.9 dB, SD = 6.0 dB, P = 0.11). Response variability and maximum response probability did not differ between the tasks (P > 0.99 and 0.95, respectively). Perimetric sensitivity estimates are demonstrably altered by observer response criterion but the effect varies widely and unpredictably, even within a single test. Response bias should be considered a factor in perimetric test variability and when comparing sensitivities to nonperimetric data. The effect of response criterion on perimetric response variability varies widely and unpredictably, even within a single test. / Supported by ARC LP130100055; ARC LP150100815 (AT and AMM), College of Optometrists Research Fellowship (JD).

Yes / Measuring the spatial extent of defects may be advantageous in advanced glaucoma where conventional perimetric sensitivity measurements are unreliable. We test whether suprathreshold tests on a higher density grid can more efficiently map advanced visual field loss. Data from 97 patients with mean deviation / Supported by a College of Optometrists Research Fellowship (to JD).

Orientador: Vital Paulino Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T07:32:57Z (GMT). No. of bitstreams: 1 Bernardi_Luciana_M.pdf: 10999549 bytes, checksum: d383c5723aeda31781676f1567189a65 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi determinar os valores médios da freqüência crítica de fusão (FCF), a flutuação a curto prazo e a variabilidade inter e intra-individual, analisar a influência da idade e sexo e investigar a ocorrência de efeito aprendizado em indivíduos normais submetidos à perimetria ¿flicker¿. A investigação foi dividida em dois estudos. No estudo 1, 95 indivíduos normais foram submetidos à perimetria ¿flicker¿ com o perímetro Octopus 301 (programa G1, estratégia dinâmica) em um olho. Determinaram-se os seguintes valores da FCF: média global, média dos pontos centrais, média dos pontos periféricos, média foveal e média dos quadrantes. Os valores médios foram comparados entre ambos os sexos e a influência da idade foi avaliada utilizando análise de regressão linear. No estudo 2, 20 indivíduos normais foram submetidos à perimetria ¿flicker¿ cinco vezes. Os três primeiros exames foram realizados em dias diferentes, separados por intervalos que variaram de um a 30 dias, enquanto os três últimos exames foram realizados no mesmo dia com intervalos de pelo menos 15 minutos. Os valores obtidos nos três primeiros exames foram utilizados para investigar o efeito aprendizado. A flutuação a curto prazo foi definida como a média das diferenças obtidas entre o valor da FCF mais alto e o mais baixo para cada ponto testado considerando-se os três últimos exames. Também determinou-se a variabilidade média dos valores de FCF inter e intra-individual. No estudo 1, os valores médios de FCF global, foveal, central e periférica foram, respectivamente, 38,2±4,3Hz, 36,4±3,5Hz, 38,7±3,7Hz e 37,9±5,0Hz. O valor médio de FCF periférica foi significativamente menor do que o valor médio de FCF central (p=0,007). A análise de regressão linear demonstrou que os valores médios FCF global, foveal, central, periférico e por quadrante diminuíram significativamente com a idade, porém com baixo coeficiente de determinação (R2 variando entre 0,074 e 0,163). Não houve diferença estatisticamente significante nos valores médios de FCF entre os indivíduos do sexo masculino e feminino (p>0,05) com exceção da área central e do quadrante nasal inferior, onde os valores foram significativamente menores no sexo feminino (p=0,029 e p=0,008 respectivamente). No estudo 2, a comparação entre os três primeiros exames não mostrou diferença estatisticamente significante em relação à duração do teste, porcentagem de respostas falso-positivas e falso-negativas (p>0,05). Os valores médios de FCF global (p=0,010), central (p=0,13) e periférico (p=0,033) foram significativamente menores no 1º exame em relação ao 2º exame . A média global da flutuação a curto prazo foi 5,06±1,13Hz, a li variabilidade média inter-individual foi 11,2±2,3% e a variabilidade média intra-individual foi 6,4±1,5%. Este estudo sugere que os valores da FCF diminuem com a idade e não são influenciados significativamente pelo sexo. Também sugere que a perimetria ¿flicker¿ está associada a efeito aprendizado e que flutuação a curto prazo e variabilidade inter e intra-individual moderadas são esperadas em indivíduos normais submetidos a este teste / Abstract: The aim of this study was to determine the mean critical fusion frequency (CFF), the short term fluctuation and inter and intraindividual variability, to analyze the influence of age and gender, and to investigate the occurrence of a learning effect in healthy subjects undergoing flicker perimetry. The investigation was divided in two study. In study 1, 95 normal subjects underwent flicker perimetry (Octopus 301, G1 program, dynamic strategy) in one eye. Mean global, central, peripheral, and foveal CFF values were determined, as well as mean CFFs per quadrant. Mean CFF values were compared between the two genders, and the influence of age was evaluated using linear regression analysis. In study 2, 20 normal subjects underwent flicker perimetry 5 times. The first 3 sessions were separated by an interval of 1 to 30 days, whereas the last 3 sessions were performed within the same day, with 15-minute intervals. The analysis of the first 3 sessions was used to investigate the presence of a learning effect. The mean of the differences between the highest and the lowest CFF value for each tested point during the last 3 tests were used to calculate the short term fluctuation (SF). Mean interindividual and intraindividual variabilities were determined. In study 1, mean global, foveal, central, and peripheral CFFs were 38.2±4.3Hz, 36.4±3.5Hz, 38.7±3.7Hz, and 37.9±5.0Hz, respectively. The mean peripheral CFF was significantly lower than the mean central CFF (p=0.007). Linear regression analysis demonstrated that mean global, foveal, central, and CFF per quadrant significantly decreased with age, however with a low correlation coefficient (R2 ranging between 0.074 and 0.163). There were no statistically significant differences in mean CFF values between males and females (p> 0.05), with the exception of the central area and the inferonasal quadrant, where the values were significantly lower in females (p=0.029 and p=0.008, respectively). In study 2, there were no statistically significant differences among the first three sessions regarding test duration, rates of false positive and false negative responses (p>0.05). The mean global (p=0.010), central (p=0.013), and peripheral (p=0.033) CFFs were significantly lower in first session compared to the second session. The mean global SF was 5.06+1.13Hz, the mean interindividual variability was 11.2±2.8%, and the mean intraindividual variability was 6.4+1.5%. This study suggests that CFFs decrease with age, and that CFFs are not significantly influenced by gender. It also suggests that flicker perimetry is associated with a learning effect, and that moderately high short term fluctuation and inter and intraindividual variability were expected in normal subjects undergoing such test / Mestrado / Oftalmologia / Mestre em Ciências Médicas

No / Purpose To document the magnitude of any learning effect for short-wavelength automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard automated perimetry (SAP). Participants Thirty-five patients (22 with OHT and 13 with OAG) who had previously undergone at least 3 threshold SAP visual field examinations with the Humphrey Field Analyzer (HFA; Carl Zeiss Meditech Inc., Dublin, CA), and 9 patients with OHT who had not previously undertaken any form of perimetry. Methods Each patient attended for SWAP on 5 occasions, each separated by 1 week. At each visit, both eyes were examined using Program 24-2 of the HFA; the right eye was always examined before the left eye. Main Outcome Measures (1) Change over the 5 examinations, in each eye, of the visual field indices Mean Deviation (MD), Short-term Fluctuation (SF), Pattern Standard Deviation (PSD), and Corrected Pattern Standard Deviation. (2) Change in each eye between Visits 1 and 5 in proportionate Mean Sensitivity (pMS) for the central annulus of stimulus locations compared with that for the peripheral annulus thereby determining the influence of stimulus eccentricity on any alteration in sensitivity. (3) Change between Visits 1 and 5 in the number and magnitude of the Pattern Deviation (PD) probability levels associated with any alteration in sensitivity. Results The MD, SF, and PSD each improved over the 5 examinations (each at P<0.001). The improvement in pMS between Visits 1 and 5 was greater for the peripheral annulus than for the central annulus by approximately twofold for the patients with OAG. Considerable variation was present between patients, within and between groups, in the number of locations exhibiting an improving sensitivity between Visits 1 and 5 by 1 or more PD probability levels. Conclusions Care should be taken to ensure that, during the initial examinations, apparent field loss with SWAP in patients exhibiting a normal field by SAP is not the result of inexperience in SWAP. Apparently deeper or wider field loss in the initial examinations with SWAP compared with that exhibited by SAP in OAG also may arise from inexperience in SWAP.

Glaucoma is the second leading cause of blindness affecting over 60 million people worldwide. The objectives of this study were to expand the existing methods of trend analysis in visual field time series data testing to aid in the early and accurate detection of glaucoma progression. Visual field data including 54 locations for each of 140 eyes (one per participant among 96 cases and 44 controls) were evaluated using the Humphrey Field Analyzer II program 24-2 Swedish interactive thresholding algorithm (SITA) standard test strategy and Goldmann size III stimuli. One eye was randomly selected for the study and data were collected between 2003 and 2009. Two visual field examinations were conducted at baseline and at eight additional time points of visual field exams taken every six months for four years. Demographic, clinical, structural and other health data in the VIP study were collected from the electronic medical record and health questionnaires. A variety of pointwise linear regression (PLR) criteria have been proposed for determining glaucomatous visual field progression. However, alternative PLR criteria have only been assessed on a limited basis. The first aim of this glaucoma progression detection study thoroughly examined PLR cut-point criteria to maximize the sensitivity and specificity of this standard tool in visual field analysis. The pointwise linear regression A2 (PLRA2) method was used to analyze the data, and Ocular Hypertension Treatment Study (OHTS) data were used to validate the decision rule. Results showed that visual field trend analysis using PLR can be refined by adjusting the standard slope-based and significance level-based criteria. By considering more restrictive declines in visual field data (e.g., < -1.2dB/y, which is approximately 12 times the normal rate of age-related decay) and relaxing the significance level criterion of the PLR slope to p < 0.04 a high specificity can be maintained, while increasing the hit rate, i.e., the proportion of glaucoma cases in which progression was detected by PLR. This work serves to improve a familiar and commonly used method of time series visual field trend analysis that can be implemented quickly to improve early detection of glaucoma progression. The second aim of this project was to investigate the performance of the nonlinear exponential and tobit regression models relative to the normal regression model in the analysis of visual field decay. The goodness-of-fit, as measured by Akaike Information Criteria (AIC), and rates of progression obtained by fitting three alternative regression models to longitudinal visual field data were compared at the location level. The results showed that visual field trend analysis using the tobit regression model results in a better model fit to visual field data, increased precision in the estimation of the rate of progression, and provides a specific advantage in modeling data from cases with advanced glaucoma. The third, and final, aim of this glaucoma progression research project sought to determine if demographic, clinical and health factors, including intraocular pressure, retinal nerve fiber layer thickness, hypertension and diabetes, differ in participants whose visual field data are best fit overall by one statistical model compared to another. This was the first study to examine person-level factors that may affect the fit of proposed analysis models for visual field data, and to utilize bivariable and multivariable methods to understand patient-level predictors of visual field model fit. In the majority of eyes, the tobit model provided either a significantly better fit or there was no difference among models. Significant differences in patient characteristics included baseline MD and previous ocular surgery. This indicates that the tobit model may fit visual field time series data at least as well as the normal and nonlinear exponential models in all cases and controls; and in some advanced cases, it may provide a significantly improved fit. This research overcame critical barriers in visual field trend analysis by increasing the sensitivity of PLR methods and further developing methods using alternative distributions to determine significant loss of function within each visual field test location. Furthermore, results of this study will contribute to the ongoing improvement of visual field trend analysis and the early detection and treatment of glaucoma progression.

Bakalauro darbas skirtas žmogaus akipločio analizei ir jo tyrimui. Darbą sudaro trys skyriai. Pirmame skyriuje analizuojami pagrindiniai akiplotį nulemiantys veiksniai bei akipločio defektai. Antrame skyriuje – aptarti dažniausiai naudojami akipločio tyrimo metodai. Praktinėje dalyje analizuojami eksperimento metu gauti akipločio duomenys. Tyrimo metu pastebėta, kad skirtingų spalvų chromatinės akipločio ribos skiriasi. Eksperimento metu paaiškėjo, kad akiplotis siaurėja tokia seka: baltos, mėlynos, raudonos ir žalios spalvos. Akipločio ribos spalvotiems stimulams skiriasi priklausomai nuo to, ar stimulas stumiamas iš centro į išorę, ar atvirkščiai (pirmuoju atveju akiplotis didesnis. / The subject of the Bachelor’s work is to analyze and investigate the visual field. The work consists of three sections. The first section gives the analysis of the main determinants and defects of the visual field. In the second section, commonly used methods of the visual field investigation are studied. In the practical part of the work, the data of the visual field investigation are analyzed. It was noticed that chromatic visual thresholds of different colours differ. The experiment showed that the field of vision narrows in the following sequence: white, blue, red and green colors. Visual thresholds for color stimuli vary depending on whether the stimulus is moved from the center to outside or vice versa (the visual field is bigger in the first case.

Thesis (Ph. D.)--University of California, San Diego, 1999. / Vita. Includes bibliographical references (leaves 139-141).

Orientadores: Vital Paulino Costa, Jose Paulo Cabral de Vasconcellos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T20:41:36Z (GMT). No. of bitstreams: 1 PierreFilho_PaulodeTarsoPonte_D.pdf: 3436232 bytes, checksum: b12cfb5d9f75e955568b115e88f61e29 (MD5) Previous issue date: 2008 / Resumo: O objetivo deste estudo foi avaliar a sensibilidade e a especificidade da perimetria de freqüência dupla (FDT), Tendency-Oriented Perimetry (TOP), SITA Standard (SS) e SITA Fast (SF) para o diagnóstico de glaucoma em indivíduos submetidos ao exame de perimetria computadorizada pela primeira vez. Sessenta e quatro pacientes glaucomatosos e 53 indivíduos normais, que nunca haviam realizado exame de campo visual, foram submetidos à perimetria computadorizada com as estratégias screening C-20-5 (FDT), G1 (TOP), SS e SF (programa 24-2), no mesmo dia, com intervalo de 15 a 30 minutos. A ordem dos exames foi aleatória para cada indivíduo, avaliando-se somente um olho por paciente. O diagnóstico de glaucoma baseou-se na presença de lesão típica de disco óptico e pressão intra-ocular (PIO) = 21mmHg. Para definir campo visual anormal, utilizaram-se três critérios para SS e SF e dois critérios para TOP e FDT, todos já descritos na literatura. Perimetrias SITA (SS e SF) foram considerados anormais quando: 1) O GHT (glaucoma hemifield test) era borderline ou fora dos limites da normalidade (outside normal limits); 2) O gráfico de probabilidade do pattern deviation apresentava três pontos adjacentes, não periféricos, de baixa sensibilidade com probabilidade menor de 5% de não ser percebido por população normal da mesma idade (p<5%) com um dos pontos com p<1%; 3) O PSD (¿pattern standard deviation¿) apresentava valor encontrado em menos de 5% (p<5%) da população normal de mesma idade. TOP foi considerado anormal quando: 1) O MDe (mean defect) > 2dB e/ou LV (loss variance) >6dB; 2) Havia sete pontos, sendo três deles adjacentes, com redução de sensibilidade = 5dB no gráfico de comparações corrigidas (corrected comparisons). FDT foi considerada anormal quando: 1) Havia uma área alterada (p<5%, p<2% ou p<1%); ou 2) Havia duas ou mais áreas alteradas, independente da profundidade do defeito. Realizaram-se análises comparativas da sensibilidade e especificidade de cada critério para o diagnóstico de glaucoma, incluindo: 1) Todos os exames independentemente da ordem de realização; 2) Somente os primeiros exames. Compararam-se também o tempo requerido para cada teste e a porcentagem de exames não confiáveis. O FDT foi o teste que requereu menor tempo para ser realizado, seguido por TOP, SF e SS (p<0,0001). Pacientes glaucomatosos apresentaram maior tempo de teste (p<0,05), mas não houve diferença estatisticamente significante em relação a porcentagem de exames não confiáveis quando comparados com indivíduos normais (p>0,05). As sensibilidades variaram de 87,5 a 89,1% para SS, 92,2 a 93,8% para SF, 87,5 a 89,1% para TOP e 82,8 a 85,9% para FDT (p=0,34). As especificidades variaram de 73,6 a 83% para FDT, 56,6 a 62,3% para TOP, 60,4 a 69,8% para SF e 66 a 71,7% para SS. A especificidade obtida com o critério 2 do FDT (baseado na presença de duas ou mais áreas anormais independente da severidade) foi significativamente mais alta que as medidas com outras estratégias (p<0,01). Quando somente os primeiros exames foram comparados, as sensibilidades foram de 78,6% para FDT, 94,1% para TOP, 89,5% para SS e variou de 92,7 a 100% para SF (p=0,63). As especificidades foram 76,9% para FDT, e variaram de 53,9 a 61,5% para TOP, de 57,1 a 71,4% para SF e 76,9 a 84,6% para SS (p=0,65). Concluiu-se que, quando testamos indivíduos sem experiência perimétrica, moderadas sensibilidades e especificidades são esperadas, qualquer que seja a estratégia escolhida / Abstract:The aim of this study was to evaluate the sensitivity and specificity of the screening mode of Frequency-Doubling Technology (FDT), Tendency-Oriented Perimetry (TOP), SITA Standard (SS) and SITA Fast (SF) for the diagnosis of glaucoma in perimetrically inexperienced individuals. One eye of 64 glaucoma patients and 53 normal subjects who had never undergone automated perimetry were tested with programs C-20-5 (FDT), G1 (TOP), and 24-2 (SS and SF), during a single visit on the same day. The order of tests was randomly assigned for each subject, with an interval of approximately 15-30 minutes. The gold standard for the diagnosis of glaucoma was based on the presence of a typical glaucomatous optic disc appearance, and intraocular pressure (IOP) = 21mmHg. To define an abnormal visual field, we applied three criteria for SS and SF and two criteria for TOP and FDT, all of them previously described in the literature. SS and SF results were considered abnormal if: 1) the glaucoma hemifield test (GHT) was borderline or outside normal limits; 2) if the pattern deviation probability map showed a cluster of three or more nonedge points deviating at p<5%, one of which deviating at p<1%; or 3) if pattern standard deviation (PSD) was increased to values deviating at p<5%. The TOP test was considered abnormal: 1) if the mean defect (MDe) > 2dB and/or the loss variance (LV) > 6dB, and/or 2) if there were at least seven points (three of them contiguous) with a reduction in sensitivity of 5dB or more in the corrected comparisons graphic. FDT test results were considered abnormal if 1) there was the presence of at least one abnormal location (p<5%, p<2% or p<1%); and 2) there were two or more abnormal locations regardless of the severity of abnormal points. Comparative analyses of the sensitivities and specificities of each criterion were carried out, including 1) All the exams regardless of the order of application; 2) Only the first exams. Comparative analyses of times for test completion and percentage of unreliable tests were also performed. FDT showed the shortest mean test duration, followed by TOP, SF and SS (p<0.0001). Glaucomatous patients had longer test times (p<0.05), but not statistically significant more unreliable visual fields than normal subjects for all tests (p>0.05). Sensitivities ranged from 87.5 - 89.1% for SS, 92.2 - 93.8% for SF, 87.5 - 89.1% for TOP and 82.8 - 85.9% for FDT (p=0.34). Specificities ranged from 73.6 - 83% for FDT, 56.6 - 62.3% for TOP, 60.4 - 69.8% for SF and 66 - 71.7% for SS. The specificity obtained with criterion 2 for FDT (based on the presence of two or more abnormal locations regardless of the severity of abnormal points) was higher than those measured with the other strategies (p<0.01). When only the first exams were compared, sensitivities were 78.6% for FDT, 94.1% for TOP, 89.5% for SS, and varied between 92.7 and 100% for SF (p=0.63). Specificities were 76.9% for FDT, and in the range of 53.9 - 61.5% for TOP, 57.1 - 71.4% for SF and 76.9 - 84.6% for SS (p=0.65). In conclusion, when testing individuals with no perimetric experience, moderate sensitivities and specificities should be expected, regardless of the strategy chosen / Doutorado / Oftalmologia / Doutor em Ciências Médicas

yes / Purpose: We have developed customized maps that relate visual field and optic nerve head (ONH) regions according to individual anatomy. In this study, we aimed to determine feasible map resolution for research use, and to make a principled recommendation of sector size for clinical applications. Methods: Measurement variability in fovea–ONH distance and angle was estimated from 10 repeat OCT scans of 10 healthy people. Errors in estimating axial length from refractive error were determined from published data. Structure–function maps were generated, and customized to varied clinically-plausible anatomical parameters. For each parameter set (n = 210), 200 maps were generated by sampling from measurement/estimation error distributions. Mapped 1° sectors at each visual field location from each parameter set were normalized to difference from their mean. Variation (90% ranges) in normalized mapped sectors represents the precision of individualized maps. Results: Standard deviations of repeated measures of fovea–ONH distance and angle were 61 μm and 0.97° (coefficients of variation 1.3% and 12.0%, respectively). Neither measure varied systematically with mean (Spearmans's ρ = 0.26, P = 0.47 for distance, ρ = −0.31, P = 0.39 for angle). Variation (90% ranges) in normalized mapped sectors varied across the visual field and ranged from 3° to 18° when axial length was measured accurately, and from 6° to 32° when axial length was estimated from refractive error. Conclusions: The 90% ranges represent the minimum feasible ONH sector size at each visual field location. For clinical use an easily interpretable scheme of 30° sectors is suggested.