Visual field changes in glaucoma patients after blepharoptosis surgery

Purpose To examine changes in parameters of the visual field test before and after blepharoptosis surgery in patients with glaucoma. Methods Twenty-three eyes of 14 glaucoma patients who underwent blepharoptosis surgery at Toyama University Hospital between July 2015 and September 2020 were included in this study. Pre- and post-operative values for the mean deviation (MD), pattern standard deviation (PSD) and total deviation (TD) of the upper or lower hemi-visual field in the Humphrey visual field test, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and margin reflex distance (MRD)-1 were compared. Results MRD-1 showed a significant improvement after blepharoptosis surgery (preoperative MRD-1: 1.0 ± 0.82 mm, postoperative MRD-1: 3.26 ± 0.66 mm, p < 0.001). There were no significant differences in BCVA, IOP, MD and PSD values before and after surgery. On the other hand, there was a significant improvement in the superior TD (preoperative: −11.29 ± 6.57 dB, postoperative: −9.88 ± 7.31 dB, p = 0.044) although no significant difference was detected in the inferior TD postoperatively. The preoperative parameters of 2 groups (improvement and non-improvement groups of postoperative superior TD) were compared. Preoperative MD and superior TD were significantly lower in the improvement group (p = 0.03, p = 0.004, respectively), although there was no significant difference in preoperative PSD and inferior TD between the two groups. Conclusion In glaucoma patients, blepharoptosis may interfere with accurate visual field assessment, especially of superior TD.

Path to Diagnosis and Clinical Characteristics of Advanced Glaucoma at Initial Diagnosis: a Tertiary Single Center Experience

Purpose: As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma.Methods: We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic.Results: We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively.Conclusions: We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.

Periphery kinetic perimetry: clinically feasible to complement central static perimetry

Background Existing evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals. The following study compared the central visual field defects with the peripheral visual field defects in patients with suspect glaucoma and primary open-angle glaucoma (POAG) and investigated whether using the central visual field test alone could result in loss of clinically valuable information. Methods In this prospective observational study, 167 eyes from 89 patients with suspect glaucoma or POAG were first examined with static automated perimetry (SAP), followed by a peripheral visual field test on Octopus 900 perimeter (Haag-Streit, Koeniz, Switzerland). The peripheral visual field test was performed by “Auto Kinetic Perimetry” program, in which Goldmann III4e stimuli randomly moved along 16 vectors at a constant angular velocity of 5 deg/s. Results Glaucomatous peripheral visual field defects were seen in 18% of the eyes with a normal central visual field. In addition, 86% of glaucoma patients with moderate-to-severe central visual field defects had corresponding peripheral visual field defects in the form of localized or diffuse depression of the isopters. Furthermore, a moderate correlation was found between the central and peripheral visual fields. The median test duration was 71 s for the peripheral test and 803 s for the central test (p < 0.001). Conclusions Our study demonstrated the diversity of glaucomatous visual field defects, as well as the possibility of losing the clinically valuable information due to focusing on the central visual field test alone. The peripheral kinetic perimetry is clinically feasible to complement the central static perimetry for a comprehensive assessment of visual function in glaucoma patients.

Visual Field Test With Gaze Check Tasks: Application in a Homonymous Hemianopic Patient Unaware of the Visual Defects

Gaze control is required for applying visual stimuli to a particular area of the visual field. We developed a visual field test with gaze check tasks to investigate hemianopia. In this test, participants must report the presence or absence of visual stimuli when a small object at the fixation point vibrates. Trials in the absence of visual stimuli were used as gaze check tasks, since the vibration could be observed only when the gaze was directed at the fixation point. We evaluated the efficacy of our test in four control participants and one patient with homonymous hemianopia who was unaware of the defects in the left visual field. This patient presented hemianopia in the test with gaze check tasks, but not when the gaze check tasks were omitted. The patient showed spontaneous gaze movements from the fixation point to the upper left direction, as well as scanning of the left visual field during the test without gaze check tasks. Thus, we concluded that the visual defects in this patient were compensated in daily life by spontaneous eye movements coordinated with visual information processing. The present results show the usefulness of the visual field test with gaze check tasks.

Impact of binocular visual field loss on driving performance in glaucoma patients

AIM: To evaluate the driving performance in young and middle-aged Chinese glaucoma patients with mild to severe visual field loss compared to those without glaucoma by using a driving simulation test. METHODS: Twenty-nine participants were included in this study: nine patients with glaucoma but pass the binocular Esterman visual field test, ten patients with glaucoma and fail the binocular Esterman visual field test, and ten age-matched healthy controls. A driving simulation test was designed as a frequency-based analysis of a lane-keeping task. The total performance error, the control-response amplitude and delay were calculated. RESULTS: Esterman visual field test fail group showed the longest delay of control-response among three groups (P=0.02). And the delay in lane-keeping task was significantly associated with inferior field of better-eye (r=0.51, P=0.004) and integrated visual field (r=0.55, P=0.002). CONCLUSION: Young and middle-aged glaucoma patients with binocular visual field loss suffered from a longer delay of response in driving simulation test, while inferior visual field having more impact than superior visual field.