Este trabalho descreve o desenvolvimento de um instrumento automático para medida de campo visual do olho humano, baseado na ocorrência de potenciais visuais evocados O principal objetivo do estudo foi demonstrar que os potenciais visuais evocados (P100) observados na região occipital podem ser correlacionados à visão de flashes de fontes luminosas pontuais distribuídas sobre uma calota com a forma de um elipsóide deformado. Aplicou-se ao domo hemisférico uma distribuição de fontes luminosas pontuais que descrevem a forma do campo visual humano (limitado a 60º acima, 70º abaixo do eixo central, limitado a 60º no lado nasal e 105º no lado temporal de cada olho). A ausência de potenciais visuais evocados por flashes luminosos é utilizada como indicador de perda da sensitividade da retina. Detalhes do desenvolvimento deste instrumento e os resultados preliminares são apresentados. / An instrument for automatic in vivo evaluation of the human visual field boundaries based on the evoked visual potentials was developed. The main objective of this study is to demonstrate that evoked potentials (P100) over the occipital area can be correlated to the vision of punctual light flashes from a deformed ellipsoid-shaped calotte. A punctual light sources distribution that follows the human visual field (boundaries lying 60º upward, 70º downward from the central axis, limited to 60º in the nasal side and 105º on the temple side of each eye) was applied to the hemispherical dome. The absences of light flashes evoked potentials are used as an indicator of lack the sensivity of the retina. The details of the development of this instrument and preliminary results for in vivo eyes are presented.

yes / We have read with interest the recent article by Sponsel et al.1 There is much evidence that glaucomatous damage occurs at the optic nerve head,2 and therefore we were surprised by the authors' conjecture that there may be a central mechanism that preserves the binocular visual field in advanced glaucoma.

yes / Purpose: We evaluated variability and conviction in tracing paths of retinal nerve fiber bundles (RNFBs) in retinal images, and compared traced paths to a computational model that produces anatomically-customized structure–function maps. Methods: Ten retinal images were overlaid with 24-2 visual field locations. Eight clinicians and 6 naïve observers traced RNFBs from each location to the optic nerve head (ONH), recording their best estimate and certain range of insertion. Three clinicians and 2 naïve observers traced RNFBs in 3 images, 3 times, 7 to 19 days apart. The model predicted 10° ONH sectors relating to each location. Variability and repeatability in best estimates, certain range width, and differences between best estimates and model-predictions were evaluated. Results: Median between-observer variability in best estimates was 27° (interquartile range [IQR] 20°–38°) for clinicians and 33° (IQR 22°–50°) for naïve observers. Median certain range width was 30° (IQR 14°–45°) for clinicians and 75° (IQR 45°–180°) for naïve observers. Median repeatability was 10° (IQR 5°–20°) for clinicians and 15° (IQR 10°–29°) for naïve observers. All measures were worse further from the ONH. Systematic differences between model predictions and best estimates were negligible; median absolute differences were 17° (IQR 9°–30°) for clinicians and 20° (IQR 10°–36°) for naïve observers. Larger departures from the model coincided with greater variability in tracing. Conclusions: Concordance between the model and RNFB tracing was good, and greatest where tracing variability was lowest. When RNFB tracing is used for structure–function mapping, variability should be considered.

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.

No / To explore the performance of patient-specific prior information, for example, from structural imaging, in improving perimetric procedures. Computer simulation was used to determine the error distribution and presentation count for Structure–Zippy Estimation by Sequential Testing (ZEST), a Bayesian procedure with prior distribution centered on a threshold prediction from structure. Structure-ZEST (SZEST) was trialled for single locations with combinations of true and predicted thresholds between 1 to 35 dB, and compared with a standard procedure with variability similar to Swedish Interactive Thresholding Algorithm (SITA) (Full-Threshold, FT). Clinical tests of glaucomatous visual fields (n = 163, median mean deviation −1.8 dB, 90% range +2.1 to −22.6 dB) were also compared between techniques. For single locations, SZEST typically outperformed FT when structural predictions were within ± 9 dB of true sensitivity, depending on response errors. In damaged locations, mean absolute error was 0.5 to 1.8 dB lower, SD of threshold estimates was 1.2 to 1.5 dB lower, and 2 to 4 (29%–41%) fewer presentations were made for SZEST. Gains were smaller across whole visual fields (SZEST, mean absolute error: 0.5 to 1.2 dB lower, threshold estimate SD: 0.3 to 0.8 dB lower, 1 [17%] fewer presentation). The 90% retest limits of SZEST were median 1 to 3 dB narrower and more consistent (interquartile range 2–8 dB narrower) across the dynamic range than those for FT. Seeding Bayesian perimetric procedures with structural measurements can reduce test variability of perimetry in glaucoma, despite imprecise structural predictions of threshold. Structural data can reduce the variability of current perimetric techniques. A strong structure–function relationship is not necessary, however, structure must predict function within ±9 dB for gains to be realized.

Yes / Although gaze during adaptive gait involving obstacle crossing is typically directed two or more steps ahead, visual information of the swinging lower-limb and its relative position in the environment (termed visual exproprioception) is available in the lower visual field (lvf). This study determined exactly when lvf exproprioceptive information is utilised to control/update lead-limb swing trajectory during obstacle negotiation. 12 young participants negotiated an obstacle wearing smart-glass goggles which unpredictably occluded the lvf for certain periods during obstacle approach and crossing. Trials were also completed with lvf occluded for the entirety of the trial. When lvf was occluded throughout, footplacement distance and toe-clearance became significantly increased; which is consistent with previous work that likewise used continuous lvf occlusion. Both variables were similarly affected by lvf occlusion from instant of penultimate-step contact, but both were unaffected when lvf was occluded from instant of final-step contact. These findings suggest that lvf (exproprioceptive) input is typically used in an online manner to control/update final foot-placement, and that without such control, uncertainty regarding foot placement causes toe-clearance to be increased. Also that lvf input is not normally exploited in an online manner to update toe-clearance during crossing: which is contrary to what previous research has suggested.

No / We often complete step downs in the absence of visual feedback of the lower-limbs, and/or of the area on the ground where we intend to land (e.g. when descending a step whilst carrying a laundry basket). Therefore, the present study examined whether information from lower visual field (lvf) provides any advantage to the control of step descent. Ten healthy subjects (age 24.4 ± 9.4 years) completed repeated step downs over three-step heights with visual information available from either full or upper visual fields (lvf occluded), and for specific intervals relative to step initiation. Visuomotor control of step descent was assessed by determining pre-landing kinematic measures and landing mechanic variables for the initial landing period. Findings indicate that whilst there were only limited effects on pre-landing kinematic measures under lvf occlusion, individual’s ability to plan/control landing mechanics was significantly different in such conditions compared to when they had access to full field vision. These changes were consistent with participants being uncertain regarding precise floor height when access to lvf was restricted, and consequently led them to adapt their landing behaviour but without fundamentally altering their stepping strategy. Compared to when vision was available throughout, the occlusion of vision (full or upper visual field) from toe-off or mid-swing onwards caused very few differences in landing behaviour. This suggests that the contribution of information from lvf to the control of landing behaviour occurs predominantly prior to or during movement initiation and that ‘online’ vision is used only in the latter portion of the descent phase to subtly ‘fine tune’ landings.

Yes / Purpose.: Crowding describes the increased difficulty in identifying a target object when it is surrounded by nearby objects (flankers). A recent study investigated the effect of age on visual crowding and found equivocal results: Although crowded visual acuity was worse in older participants, crowding expressed as a ratio did not change with age. However, the spatial extent of crowding is a better index of crowding effects and remains unknown. In the present study, we used established psychophysical methods to characterize the effect of age on visual crowding (magnitude and extent) in a letter recognition task. Methods.: Letter recognition thresholds were determined for three different flanker separations in 54 adults (aged 18–76 years) with normal vision. Additionally, the spatial extent of crowding was established by measuring spacing thresholds: the flanker-to-target separation required to produce a given reduction in performance. Uncrowded visual acuity, crowded visual acuity, and spacing thresholds were expressed as a function of age, avoiding arbitrary categorization of young and old participants. Results.: Our results showed that uncrowded and crowded visual acuities do not change significantly as a function of age. Furthermore, spacing thresholds did not change with age and approximated Bouma's law (half eccentricity). Conclusions.: These data show that crowding in adults is unaffected by senescence and provide additional evidence for distinct neural mechanisms mediating surround suppression and visual crowding, since the former shows a significant age effect. Finally, our data suggest that the well-documented age-related decline in peripheral reading ability is not due to age-related changes in visual crowding. / Supported by an Age UK Scholarship (AJB); a National Institute of Health Research (NIHR) Postdoctoral Fellowship (ATA); and a Wellcome Trust Career Development Fellowship (BSW).

Background: To define age-related changes in the visual field by comparing "standard" central and unique peripheral visual field measurements in healthy volunteers. Methods: In a single center, retrospective, Cross-sectional, observational study, 20 volunteers with no retinal diseases or risk factors, ranging in age between 30 and 94 years (four age groups: 30’s, 50’s, 70’s, 90’s) were measured in one eye (preferentially the right one) using a Humphrey visual field 24–2 and 60–4. Results: While the central visual field remained relatively well preserved during aging showing only a mild reduction in sensitivity, a profound loss of the peripheral visual field was observed beginning in the fifth decade of life and decreasing continuously up to the 90ies. Conclusions: The peripheral visual field declined substantially from the 4th decade onward while the central visual field remained quite stable.

The majority of previous research investigating the role of vision in controlling adaptive gait has predominantly focused on over-ground walking or obstacle negotiation. Thus there is a paucity of literature investigating visuomotor control of step descent. This thesis addressed the importance of the lower visual field (lvf) in regulating step descent landing control, and determined when visual feedback is typically used in regulating landing control prior to/during step descent. When step descents were completed from a stationary starting position, with the lvf occluded or degraded, participants adapted their stepping strategy in a manner consistent with being uncertain regarding the precise location of the foot/lower leg relative to the floor. However, these changes in landing control under conditions of lvf occlusion were made without fundamentally altering stepping strategy. This suggests that participants were able to plan the general stepping strategy when only upper visual field cues were available. When lvf was occluded from either 2 or 1 step(s) prior to descending a step during on-going gait, stepping strategy was only affected when the lvf was occluded in the penultimate step. Findings suggest that lvf cues are acquired in the penultimate step/few seconds prior to descent and provide exproprioceptive information of the foot/lower leg relative to the floor which ensures landing is regulated with increased certainty. Findings also highlight the subtle role of online vision used in the latter portion of step descent to 'fine tune' landing control.