A Method to Measure Visual Field Sensitivity at the Edges of Glaucomatous Scotomata

METHODS. Subjects comprised 22 glaucomatous patients. Gradients of sensitivity were calculated for ''squares'' of test points in a patient's 24-2/30-2 VF results, so that the edges of scotomata could be identified where gradients were steep. Next, 10 new VF points were placed in these locations for each patient. Each patient's VF was then measured using this novel test grid (52 standard 24-2 test points and 10 additional points examined concurrently) on two separate occasions. The absolute difference between the measured sensitivity at each new additional test point and the average of the sensitivities of its surrounding four test points was calculated (D ave ). The intra-and intervisit reproducibility of the additional test points' thresholds was calculated. Finally, fluctuation of overall VF damage was estimated using the intraclass correlation coefficient (ICC) and the coefficient of variation (CV). RESULTS. The average of the sensitivities (D ave ) increased as the gradient of the plane steepened, whereas the reproducibility of the additional test points' thresholds remained stable. ICC was significantly higher and CV was significantly lower for the novel test grid compared with the standard 24-2 test pattern. CONCLUSIONS. It may be advantageous to increase the density of VF test points where there are large local differences in VF sensitivity. These additional measurements may result in more reproducible and well-defined estimates of scotomata

Establishment of an experimental ferret ocular hypertension model for the analysis of central visual pathway damage

Glaucoma optic neuropathy (GON) is a condition where pathogenic intraocular pressure (IOP) results in axonal damage following retinal ganglion cell (RGC) death, and further results in secondary damage of the lateral geniculate nucleus (LGN). Therapeutic targets for glaucoma thus focus on both the LGN and RGC. However, the temporal and spatial patterns of degeneration and the mechanism of LGN damage have not been fully elucidated. Suitable and convenient ocular hypertension (OH) animal models with binocular vision comparable to that of monkeys are strongly needed. The ferret is relatively small mammal with binocular vision like humans - here we report on its suitability for investigating LGN. We developed a new method to elevate IOP by injection of cultured conjunctival cells into the anterior chamber to obstruct aqueous outflow. Histologically, cultured conjunctival cells successfully proliferated to occlude the angle, and IOP was elevated for 13 weeks after injection. Macroscopically, the size of the eye gradually expanded. Subsequent enlargement of optic nerve head cupping and atrophic damage of LGN projected from the OH eye were clearly observed by anterograde staining with cholera toxin B. We believe the ferret may be a promising OH model to investigate secondary degeneration of central nervous system including LGN

Applying ''Lasso'' Regression to Predict Future Visual Field Progression in Glaucoma Patients

Citation: Fujino Y, Murata H, Mayama C, Asaoka R. Applying ''Lasso'' regression to predict future visual field progression in glaucoma patients

Detection of Progression of Glaucomatous Visual Field Damage Using the Point-Wise Method with the Binomial Test

<div><p>Purpose</p><p>To compare the performance of newly proposed point-wise linear regression (PLR) with the binomial test (binomial PLR) against mean deviation (MD) trend analysis and permutation analyses of PLR (PoPLR), in detecting global visual field (VF) progression in glaucoma.</p> <p>Methods</p><p>15 VFs (Humphrey Field Analyzer, SITA standard, 24-2) were collected from 96 eyes of 59 open angle glaucoma patients (6.0 ± 1.5 [mean ± standard deviation] years). Using the total deviation of each point on the 2^nd to 16^th VFs (VF2-16), linear regression analysis was carried out. The numbers of VF test points with a significant trend at various probability levels (p<0.025, 0.05, 0.075 and 0.1) were investigated with the binomial test (one-side). A VF series was defined as “significant” if the median p-value from the binomial test was <0.025. Similarly, the progression analysis was carried out using only second to sixth VFs (VF2-6). The performance of each method was evaluated using the ‘consistency measures’; proportion both significant (PBS): both VF series (VF2-6 and VF2-16) were “significant”, proportion both were not significant (PBNS): both were “not significant”, proportion inconsistently significant (PIS): VF2-16 was “not significant” but VF2-6 was “significant”. A similar analysis was carried out using VF2-7 and VF2-15 series, and the performance was compared with MD trend analysis and PoPLR.</p> <p>Results</p><p>The PBS of the binomial PLR method (0.14 to 0.86) was significantly higher than MD trend analysis (0.04 to 0.89) and PoPLR (0.09 to 0.93). The PIS of the proposed method (0.0 to 0.17) was significantly lower than the MD approach (0.0 to 0.67) and PoPLR (0.07 to 0.33). The PBNS of the three approaches were not significantly different.</p> <p>Conclusions</p><p>The binomial BLR method gives more consistent results than MD trend analysis and PoPLR, hence it will be helpful as a tool to ‘flag’ possible VF deterioration.</p> </div

Transient but significant visual field defects after robot-assisted laparoscopic radical prostatectomy in deep tRendelenburg position.

Robot-assisted laparoscopic radical prostatectomy (RALP) is a minimally invasive surgical procedure for prostate cancer. During RALP, the patient must be in a steep Trendelenburg (head-down) position, which leads to a significant increase in intraocular pressure (IOP). The association of RALP with visual field sensitivity, however, has not been prospectively studied. The purpose of this study was to evaluate prospectively the visual field, retinal nerve fiber layer (RNFL) thickness, and optic disc morphology in 50 normal eyes of 25 male patients that underwent RALP.The subjects were 25 males among 33 consecutive patients who underwent uneventful RALP under general anesthesia in our hospital. Visual field tests using the Humphrey visual field analyzer 30-2 SITA-standard program were performed before, 7 days after, and 1-3 months after RALP. IOP was measured before, during, and after RALP; and ophthalmologic examinations, including slit-lamp, fundus examination, and optical coherence tomography (OCT), were scheduled before and 7 days after surgery.IOP was significantly increased during RALP up to 29.4 mmHg (P<0.01). Postoperative local visual field defects were detected in 7 eyes of 7 subjects dominantly in the lower hemifield without abnormal findings in the optic nerve head or retina, and the visual field recovered to normal within 3 months after surgery. General factors associated with RALP, IOP, RNFL thickness, or optic disc parameters did not differ significantly between eyes with and without postoperative visual field defects, and parameters of OCT measurements were not altered after surgery.Transient but significant unilateral visual field defects were found in 28% of the subjects examined. The probable cause are the increased IOP and altered perfusion during surgery and ophthalmologic examinations are therefore suggested before and after RALP

Identifying areas of the visual field important for quality of life in patients with glaucoma.

The purpose of this study was to create a vision-related quality of life (VRQoL) prediction system to identify visual field (VF) test points associated with decreased VRQoL in patients with glaucoma.VRQoL score was surveyed in 164 patients with glaucoma using the 'Sumi questionnaire'. A binocular VF was created from monocular VFs by using the integrated VF (IVF) method. VRQoL score was predicted using the 'Random Forest' method, based on visual acuity (VA) of better and worse eyes (better-eye and worse-eye VA) and total deviation (TD) values from the IVF. For comparison, VRQoL scores were regressed (linear regression) against: (i) mean of TD (IVF MD); (ii) better-eye VA; (iii) worse-eye VA; and (iv) IVF MD and better- and worse-eye VAs. The rank of importance of IVF test points was identified using the Random Forest method.The root mean of squared prediction error associated with the Random Forest method (0.30 to 1.97) was significantly smaller than those with linear regression models (0.34 to 3.38, p<0.05, ten-fold cross validation test). Worse-eye VA was the most important variable in all VRQoL tasks. In general, important VF test points were concentrated along the horizontal meridian. Particular areas of the IVF were important for different tasks: peripheral superior and inferior areas in the left hemifield for the 'letters and sentences' task, peripheral, mid-peripheral and para-central inferior regions for the 'walking' task, the peripheral superior region for the 'going out' task, and a broad scattered area across the IVF for the 'dining' task.The VRQoL prediction model with the Random Forest method enables clinicians to better understand patients' VRQoL based on standard clinical measurements of VA and VF

Iridotrabecular Contact Observed Using Anterior Segment Three-Dimensional OCT in Eyes With a Shallow Peripheral Anterior Chamber

Citation: Mishima K, Tomidokoro A, Suramethakul P, et al. Iridotrabecular contact observed using anterior segment three-dimensional OCT in eyes with a shallow peripheral anterior chamber. Invest Ophthalmol Vis Sci

PBNS of detecting progression by MD slope method and point-wise method with the binomial test.

<p>PBNS: proportion of VF series where both were not significant, MD: mean deviation.</p