Comparison of Contrast Sensitivity, Visual Acuity, and Humphrey Visual Field Testing in Patients with Glaucoma

• Glaucoma results in progressive visual field deterioration, and detecting changes or recording stability in the visual field is important in the management of glaucoma. • Visual field testing is a highly subjective and operator-dependent test. • In patients with glaucoma, the visual field is tested in monocular fashion. •The boundaries of the visual field (in a well-lit environment with an easily visible target) are grossly 60 degrees superiorly, 75 degrees inferiorly, 100 degrees temporally, and 60 degrees nasally. • Basic concept in determination of visual field is “threshold” •Definition of “threshold”: weakest test stimulus that is just visible in a particular location (stimulus intensity at which the patient responds 50% of the time) •Types of visual field testing strategies •Confrontation •Spot testing •Kinetic spot testing •Static spot testing •An initial screening tool to look for large and dense visual field defects that may be present in very advanced glaucoma •Both hands should be used in the testing processed. The patient should occlude the untested eye with the palm of the hand. •If the visual acuity will allow the finger counting technique, all four quadrants may be tested at 3 to 4 feet from the patient at an approximate 45-degree angle holding up either one or two fingers, or a whole hand. • If the visual acuity is HM or LP, then test for light perception in the respective 4 quadrants. • It is important that the patient be able to tell you where the light is located in the field of vision, not simply the presence of light. • Factors that affect the visibility of the spot • Size Intensity • Background illumination Others: color, movement, duration of presentation, attentiveness of the patient, and refractive state of the eye • Kinetic • Usually Goldmann perimetry (though some of the automated machines such as the Octopus will perform kinetic perimetry) • The perimetrist may adjust the location, size, and intensity of the stimulus throughout the test. •Useful in the following cases: Those who need coaching and an altered pace of testing (e.g., elderly, wheelchair-bound, or limited concentration)

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Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study)

BMC Ophthalmology ◽

10.1186/s12886-019-1225-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

M. A. Nuijts ◽

M. H. Degeling ◽

I. Stegeman ◽

A. Y. N. Schouten-van Meeteren ◽

S. M. Imhof

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Brain Tumor ◽

Visual Field ◽

Visual Impairment ◽

Visual Function ◽

Field Testing ◽

Optical Coherence ◽

Visual Field Testing

Abstract Background Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. Methods/design The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. Discussion The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. Trial registration The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.

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