A Review of Learning Effect in Perimetry

2020 ◽  
pp. 23-30
Author(s):  
Aristeidis Chandrinos ◽  
Dorotheos-Dimitrios Tzamouranis
Keyword(s):  
Visual Field ◽  
Visual Impairment ◽  
Learning Effect ◽  
Vision Loss ◽  
Signal To Noise Ratio ◽  
Test Procedure ◽  
Field Tests ◽  
Visual Field Loss ◽  
Visual Field Defects ◽  
Specific Patient

Glaucoma is the second most common cause of visual impairment in the UK, with visual impairment registrations have increased by 22% since 2010. Glaucoma refers to a group of optic neuropathies leading to visual impairment and blindness. If glaucoma remains untreated, it may produce optic nerve damage, leading to vision loss. Consequently, visual field tests can be extremely valuable for glaucoma. At the same time, visual field assessment should be performed at baseline and periodically in the glaucoma follow-up or monitor the effectiveness of adopted therapeutic schemes. Any visual field test can be masked by one or more artefacts, which can either lead to the incorrect result of visual field loss or to the possible deterioration of existing loss. One of the most important factors is the perimetric learning effect that is present in almost all types of perimetry. To minimize the learning effect, we either have to conduct a practice test procedure, as a demonstration for the patient without collecting data, or to calculate and establish a learning index of the specific patient. By the establishment of such an index, assist the clinician in detecting possible masked or overestimated visual field defects or progression of glaucoma damage. Conclusion: Potentially, the intense data collection at a large number of locations throughout the field in a larger cohort of subjects (visually healthy and glaucomatous) would be required for a better index establishment. The incorporation of fatigue also may be required to form a robust index enough to simulate procedures of glaucoma prognosis. The low signal to noise ratio associated with perimetric testing suggests that improvements will always be difficult to make.

scholarly journals Acute Zonal Occult Outer Retinopathy: Vision Loss in an Active Duty Soldier

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Courtney M. Crawford ◽  
Bruce A. Rivers ◽  
Mark Nelson
Keyword(s):  
Visual Field ◽  
Visual Field Defect ◽  
Vision Loss ◽  
Fundus Autofluorescence ◽  
Final Diagnosis ◽  
Active Duty ◽  
Visual Field Defects ◽  
Fundus Photographs ◽  
Optical Coherence Tomograph ◽  
Field Defect

Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient.Methods. In this paper we studied fundus photographs, optical coherence tomograph, Humphrey visual field 30-2, fundus autofluorescence images, fluorescein angiograms, and electroretinography.Results. Exam findings on presentation: a 34-year-old American Indian female presented with bilateral photopsias, early RPE irregularity, and an early temporal visual field defect. Progression RPE damage and visual field defect along with ERG findings support final diagnosis of AZOOR.Conclusion. AZOOR may initially be identified as a broader category of disease called the “AZOOR complex of disorders”. Specific visual field defects, ERG results, and clinical exam findings will help distinguish AZOOR from other similar disorders.

scholarly journals What do patients with glaucoma see: a novel iPad app to improve glaucoma patient awareness of visual field loss

2020 ◽  
pp. bjophthalmol-2020-317034
Author(s):  
Meghal Gagrani ◽  
Jideofor Ndulue ◽  
David Anderson ◽  
Sachin Kedar ◽  
Vikas Gulati ◽  
...  
Keyword(s):  
Visual Field ◽  
Vision Loss ◽  
Peripheral Vision ◽  
Glaucoma Patient ◽  
Visual Field Loss ◽  
Sensitivity Threshold ◽  
Roc Curve Analysis ◽  
The Mean ◽  
Ipad App ◽  
Field Defects

PurposeGlaucoma patients with peripheral vision loss have in the past subjectively described their field loss as ‘blurred’ or ‘no vision compromise’. We developed an iPad app for patients to self-characterise perception within areas of glaucomatous visual field loss.MethodsTwelve glaucoma patients with visual acuity ≥20/40 in each eye, stable and reliable Humphrey Visual Field (HVF) over 2 years were enrolled. An iPad app (held at 33 cm) allowed subjects to modify ‘blur’ or ‘dimness’ to match their perception of a 2×2 m wall-mounted poster at 1 m distance. Subjects fixated at the centre of the poster (spanning 45° of field from centre). The output was degree of blur/dim: normal, mild and severe noted on the iPad image at the 54 retinal loci tested by the HVF 24-2 and was compared to threshold sensitivity values at these loci. Monocular (Right eye (OD), left eye (OS)) HVF responses were used to calculate an integrated binocular (OU) visual field index (VFI). All three data sets were analysed separately.Results36 HVF and iPad responses from 12 subjects (mean age 71±8.2y) were analysed. The mean VFI was 77% OD, 76% OS, 83% OU. The most common iPad response reported was normal followed by blur. No subject reported dim response. The mean HVF sensitivity threshold was significantly associated with the iPad response at the corresponding retinal loci (For OD, OS and OU, respectively (dB): normal: 23, 25, 27; mild blur: 18, 16, 22; severe blur: 9, 9, 11). On receiver operative characteristic (ROC) curve analysis, the HVF retinal sensitivity cut-off at which subjects reported blur was 23.4 OD, 23 OS and 23.3 OU (dB).ConclusionsGlaucoma subjects self-pictorialised their field defects as blur; never dim or black. Our innovation allows translation of HVF data to quantitatively characterise visual perception in patients with glaucomatous field defects.

scholarly journals Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

2020 ◽  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Cerebral Artery ◽  
Vision Loss ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Past History ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

scholarly journals A Case Report on Treating Post-stroke Visual Impairment with Gami-banhabakchulchunma-tang and Acupuncture

2021 ◽  
Vol 42 (5) ◽  
pp. 1045-1053
Author(s):  
Jeong-hui Kim ◽  
Hae-yoong Kim ◽  
Seo-young Won ◽  
Ju-young Ryu ◽  
Eun-sun Jung ◽  
...  
Keyword(s):  
Visual Field ◽  
Herbal Medicine ◽  
Visual Impairment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Visual Field Defects ◽  
Blurred Vision ◽  
Post Stroke ◽  
Numerical Rating ◽  
Field Defects

Objectives: This study investigated the effectiveness of acupuncture and herbal medicine (Gami-banhabakchulchunma-tang) for post-stroke visual impairment.Methods: A 79-year-old male with headache, dizziness, visual field defects, and blurred vision caused by a posterior cerebral infarction was treated with acupuncture and Gami-banhabakchulchunma-tang for three months. We used the Numerical Rating Scale (NRS) for each symptom and measured the patient’s eye-movement range.Results: Following treatment, the NRS score for headache decreased from 5 to 0, and for dizziness and blurred vision, it decreased from 5 to 1. The NRS score for visual field defects decreased from 5 to 2. The range of the patient’s left and right eye movements both improved, and no adverse side effects were observed during the admission period.Conclusions: Korean medical treatment with acupuncture and herbal medicine (Gami-banhabakchulchunma-tang) could effectively treat post-stoke visual impairment.

Charles Bonnet syndrome as first manifestation of occipital infarction

2022 ◽  
pp. 112067212110697
Author(s):  
Marta Isabel Martínez-Sánchez ◽  
Gema Bolívar
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Field Tests ◽  
Visual Field Loss ◽  
Visual Hallucinations ◽  
Correct Treatment ◽  
Cerebral Magnetic Resonance Imaging ◽  
Full Field ◽  
Charles Bonnet Syndrome ◽  
The Right

Purpose To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. Observations We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Conclusions and Importance Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects

2019 ◽  
Vol 103 (11) ◽  
pp. 1600-1604 ◽  
Author(s):  
Sean T Garrity ◽  
Joo Yeon Jung ◽  
Olivia Zambrowski ◽  
Francesco Pichi ◽  
Daniel Su ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Field ◽  
Vision Loss ◽  
Tertiary Care ◽  
Fundus Photography ◽  
Visual Field Defects ◽  
Optical Coherence ◽  
Humphrey Visual Field ◽  
Hydroxychloroquine Retinopathy ◽  
Field Defects

Background/AimsHydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.MethodsData from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.ResultsSeventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.ConclusionPatients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.

Neuro-ophthalmological assessment of vision before and after radiation therapy alone for pituitary macroadenomas

1990 ◽  
Vol 72 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Stephen C. Rush ◽  
Mark J. Kupersmith ◽  
Irving Lerch ◽  
Paul Cooper ◽  
Joseph Ransohoff ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Radiation Therapy ◽  
Visual Field ◽  
Visual Impairment ◽  
Optic Atrophy ◽  
Radiation Treatment ◽  
Visual Field Defects ◽  
Content Type ◽  
Pituitary Macroadenomas

✓ Between 1972 and 1988, 25 patients were treated by radiation therapy (RT) alone for pituitary macroadenomas causing visual impairment. Twenty-three patients were evaluated by a neuro-ophthalmologist before treatment and at the time of follow-up review. Radiation treatment consisted of 4000 to 5000 cGy over 4 to 5 weeks. The median follow-up period was 36 months (range 2 to 192 months). Eighteen patients (78%) experienced visual field improvement. Deterioration occurred in four patients due to tumor recurrence, tumor hemorrhage, possible optic nerve necrosis, and optic chiasm herniation. Visual field improvement occurred predominantly in patients whose pretreatment visual field defects were less than a dense hemianopsia, who did not have diffuse optic atrophy, and who were younger than the median age of 69 years (p < 0.001). Visual acuity improvement occurred in patients without diffuse optic atrophy, with only mild impairment of the visual acuity, and with only mild visual field loss prior to RT (p < 0.002). It is concluded that there is a subset of patients with pituitary macroadenomas and visual impairment for whom primary RT is a treatment option.

Progression of visual field loss in open angle glaucoma in the Melbourne Visual Impairment Project

2006 ◽  
Vol 34 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Mimiwati Zahari ◽  
Bickol N Mukesh ◽  
Julian L Rait ◽  
Hugh R Taylor ◽  
Catherine A McCarty
Keyword(s):  
Visual Field ◽  
Visual Impairment ◽  
Open Angle Glaucoma ◽  
Visual Field Loss ◽  
Open Angle

scholarly journals Minocycline-Associated Pseudotumor Cerebri with Severe Papilledema

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Simon R. Bababeygy ◽  
Michael X. Repka ◽  
Prem S. Subramanian
Keyword(s):  
Visual Field ◽  
Surgical Management ◽  
Vision Loss ◽  
Case Series ◽  
Visual Field Loss ◽  
Pseudotumor Cerebri ◽  
Drug Discontinuation ◽  
Unusual Complication ◽  
Limited Condition ◽  
Nonobese Patients

Background. Pseudotumor cerebri is an acknowledged but unusual complication of oral minocycline use. Vision loss and papilledema have been described as mild and transient, and some authors suggest that treatment is not needed.Methods. Case series of 2 patients with severe papilledema and visual field loss.Results. Severe pseudotumor cerebri developed in 2 nonobese patients taking minocycline. Their disease required further treatment even upon drug discontinuation because of visual field loss and papilledema.Conclusions. Minocycline-associated pseudotumor cerebri is not always a self-limited condition and may require aggressive medical or surgical management.

scholarly journals Linking Multi-Modal MRI to Clinical Measures of Visual Field Loss After Stroke

2022 ◽  
Vol 15 ◽  
Author(s):  
Anthony Beh ◽  
Paul V. McGraw ◽  
Ben S. Webb ◽  
Denis Schluppeck
Keyword(s):  
White Matter ◽  
Visual Field ◽  
Brain Imaging ◽  
Vision Loss ◽  
Receptive Fields ◽  
Visual Field Loss ◽  
Visual Pathway ◽  
Sensitivity Threshold ◽  
Treatment Pathways ◽  
Cortical Areas

Loss of vision across large parts of the visual field is a common and devastating complication of cerebral strokes. In the clinic, this loss is quantified by measuring the sensitivity threshold across the field of vision using static perimetry. These methods rely on the ability of the patient to report the presence of lights in particular locations. While perimetry provides important information about the intactness of the visual field, the approach has some shortcomings. For example, it cannot distinguish where in the visual pathway the key processing deficit is located. In contrast, brain imaging can provide important information about anatomy, connectivity, and function of the visual pathway following stroke. In particular, functional magnetic resonance imaging (fMRI) and analysis of population receptive fields (pRF) can reveal mismatches between clinical perimetry and maps of cortical areas that still respond to visual stimuli after stroke. Here, we demonstrate how information from different brain imaging modalities—visual field maps derived from fMRI, lesion definitions from anatomical scans, and white matter tracts from diffusion weighted MRI data—provides a more complete picture of vision loss. For any given location in the visual field, the combination of anatomical and functional information can help identify whether vision loss is due to absence of gray matter tissue or likely due to white matter disconnection from other cortical areas. We present a combined imaging acquisition and visual stimulus protocol, together with a description of the analysis methodology, and apply it to datasets from four stroke survivors with homonymous field loss (two with hemianopia, two with quadrantanopia). For researchers trying to understand recovery of vision after stroke and clinicians seeking to stratify patients into different treatment pathways, this approach combines multiple, convergent sources of data to characterize the extent of the stroke damage. We show that such an approach gives a more comprehensive measure of residual visual capacity—in two particular respects: which locations in the visual field should be targeted and what kind of visual attributes are most suited for rehabilitation.

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