Correlation of pattern of visual field loss by perimetry and anterior chamber angle parameters by anterior segment optical coherence tomography in primary angle-closure glaucoma

Purpose: To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods: This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 ?m (AOD 500) and 750 ?m (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results: The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman’s rank correlation coefficient (r = -0.3329). Conclusion: The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG

Association between the red blood cell distribution width with primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the changes of the red blood cell volume distribution width(RDW)level and the correlation between them in patients with primary angle-closure glaucoma(PACG).<p>METHODS: Retrospective case-control study was conducted. A total of 306 PACG patients in Eye & ENT Hospital of Fudan University from February 2019 to October 2020 were selected as the case group and 126 healthy patients who received physical examination at the hospital during the same period were selected as the control group. The PACG patients were divided into three subgroups according to the mean defect of visual field(MD): mild(MD≤6dB), moderate(6<MD≤12dB), and severe(MD>12dB). The detailed eye and physical examinations information of the two groups were collected from the medical data platform of Eye & ENT Hospital of Fudan University. The blood sample parameters were detected by automated hematology and biochemistry analyzers. Independent sample <i>t</i>-test, Chi-square test, one-way ANOVA test, Pearson correlation analyses and multiple linear regression analyses were performed in this research. <p>RESULTS: There was no significant difference between the PACG group and the control group in age, gender, body mass index and blood pressure(<i>P></i>0.05). Based on the laboratory results, the mean RDW level was significantly higher(<i>t</i>=2.132, <i>P</i>=0.034)in the PACG group(12.64%±0.96%)than that in the control group(12.45%±0.49%). Moreover, the mean RDW level and the mean hemoglobin(HG)level was significantly lower(<i>P</i><0.05)in the mild PACG subgroup than that in the moderate and severe PACG subgroups. The Pearson correlation analyses showed a positive correlation between the MD and the RDW level(<i>r</i>=0.141, <i>P</i>=0.013), a significantly positive correlation between the IOP and the RDW level(<i>r</i>=0.148, <i>P</i>=0.002), and a negative correlation between the MS and the RDW level(<i>r</i>=-0.154, <i>P</i>=0.007)in patients with PACG. After adjusting for the confounding factors, multiple linear regression analyses showed a positive association between between the MD and the RDW level in patients with PACG(<i>β</i>=1.405, <i>P</i>=0.018, 95%<i> CI</i>=0.240-2.570). <p>CONCLUSION: The RDW level of PACG patients is higer than normal. The RDW level may help to predict the PACG patients' conditions for better treatments.

Development of an LCD-Based Visual Field System

BACKGROUND: The present study investigated the diagnostic effectiveness of an LCD-based visual field testing system (LVF) in comparison with the standard automated perimetry Humphrey Field Analyzer II-750i (HFA). METHODS: A randomized controlled crossover study was conducted with 202 normal and 128 glaucomatous eyes using both LVF and HFA. The visual field testing systems were compared in terms of mean deviation (MD), pattern standard deviation (PSD), and area under the receiver operating characteristics curve (AUC) of MD and PSD differentiating the normal and glaucomatous eyes. RESULTS: Significant correlations were found between MD measurements from LVF and those from HFA for normal eyes (r = 0.342) and glaucomatous eyes (r = 0.796); slightly higher significant correlations were identified between PSD measurements from LVF and those from HFA for normal eyes (r = 0.363) and glaucomatous eyes (r = 0.828). Furthermore, high AUCs of MD were found as 0.786 for LVF and 0.868 for HFA and AUCs of PSD as 0.913 for LVF and 0.932 for HFA. CONCLUSION: The comparison results of the present study support the competence of LVF compared with HFA in visual field testing for early detection of glaucoma.

Short wavelength automated perimetry can detect visual field changes in diabetic patients without retinopathy.

Purpose: The purpose of the following study is to compare short wave automated perimetry (SWAP) versus standard automated perimetry (SAP) for early detection of diabetic retinopathy (DR). Materials and Methods: A total of 40 diabetic patients, divided into group I without DR (20 patients = 40 eyes) and group II with mild non‑proliferative DR (20 patients = 40 eyes) were included. They were tested with central 24‑2 threshold test with both shortwave and SAP to compare sensitivity values and local visual field indices in both of them. A total of 20 healthy age and gender matched subjects were assessed as a control group. Results: Control group showed no differences between SWAP and SAP regarding mean deviation (MD), corrected pattern standard deviation (CPSD) or short fluctuations (SF). In group I, MD showed significant more deflection in SWAP (−4.44 ± 2.02 dB) compared to SAP (−0.96 ± 1.81 dB) (P = 0.000002). However, CPSD and SF were not different between SWAP and SAP. In group II, MD and SF showed significantly different values in SWAP (−5.75 ± 3.11 dB and 2.0 ± 0.95) compared to SAP (−3.91 ± 2.87 dB and 2.86 ± 1.23) (P = 0.01 and 0.006 respectively). There are no differences regarding CPSD between SWAP and SAP. The SWAP technique was significantly more sensitive than SAP in patients without retinopathy (p), but no difference exists between the two techniques in patients with non‑proliferative DR. Conclusion: The SWAP technique has a higher yield and efficacy to pick up abnormal findings in diabetic patients without overt retinopathy rather than patients with clinical retinopathy.

Comparison of Mean Deviation Between Integrated Binocular Visual Field and Monocular Visual Field

PURPOSE: To compare the mean deviation (MD) between monocular and integrated binocular visual field (BVF). METHODS: Thirty-six patients with glaucoma in at least 1 eye were recruited for the present study. Seventy-two threshold sensitivities of the BVF were obtained without additional visual field test by the Best Location and Binocular Summation methods using the 2 monocular visual fields of central 30degrees. The MD of the BVF was obtained by comparison to the value distribution in the age-matched population with normal BVF. After defining the better eye with the better MD value from the 2 eyes, comparison of the MDs between individual eyes and the integrated BVF were assessed. In addition, the MDs between the integrated BVF and actual BVF were compared in 11 patients. RESULTS: In patients with a mean age of 58.7 years, the MD of the better eye was -2.3 dB, and the worse eye was -4.9 dB (p 0.1). CONCLUSIONS: The integrated BVF more improved than the better eye. When providing guidance to glaucoma patients regarding therapeutic decisions considering the MD of IVF may be important.

Clinical Validation of Visual Field Index in Glaucoma Patients with Central Visual Field Defects

PURPOSE: To evaluate the glaucoma discrimination ability of visual field index (VFI), a new perimetric index of Humphrey field analyzer II, in glaucoma patients with central and peripheral visual field defects (VFD). METHODS: Humphrey visual field test and OCT were performed in 204 glaucomatous eyes and 70 healthy eyes. The associations of VFI with mean deviation (MD), pattern standard deviation (PSD), and average retinal nerve fiber layer thickness (RNFLT) were analyzed using Pearson's correlation. The diagnostic abilities of the parameters were analyzed using the areas under the receiver operating characteristic curves (AUROC). The AUROC were compared between MD-matched patients with central VFD (at least one point with p 0.05). The AUROC value of VFI was greater than those of the MD and average RNFLT but was not different from that of PSD (p = 0.332) in the central VFD group. However, there were no significant differences between AUROC value of VFI and those of other parameters in the peripheral VFD group (all, p > 0.05). CONCLUSIONS: The results from the present study suggest that VFI may be more useful than MD in diagnosing glaucoma, especially in patients with central VFD.

Postoperative Visual Field Outcomes in Patients Showing Visual Field Defects due to Pituitary Adenoma

PURPOSE: To evaluate visual field (VF) changes in patients with pituitary adenoma after surgical treatment. METHODS: The present study retrospectively evaluated 96 eyes of 48 patients with pituitary adenoma who received surgical tumor removal between July 2001 and February 2010. Preoperative and postoperative clinical data including age, tumor volume, logMAR BCVA, surgical technique (transsphenoidal surgery and transcranial surgery), static perimetry scores (mean deviation [MD], pattern standard deviation [PSD], and visual field defect [VFD] scores) were reviewed. RESULTS: The MD (15.79%, p = 0.001) and PSD (3.98%, p = 0.003) improved postoperatively (mean postoperative follow-up period 1.85 months). Transsphenoidal surgery for tumor removal showed significant MD (26.99%, p = 0.000) and PSD (12.92%, p = 0.003) improvements. A multivariate regression analysis of the transsphenoidal surgery patient group revealed that the preoperative MD was related to the postoperative MD (Pearson = 0.762, p = 0.000), but negatively correlated to the amount of postoperative improvement in MD score (Pearson = -0.231, p = 0.046). Transcranial surgery did not significantly improve the MD (p = 0.419), PSD (p = 0.562), VFD score (p = 0.135), or logMAR BCVA (p = 0.708). CONCLUSIONS: Visual filed defects in patients with pituitary adenoma improved after neurosurgical treatment. Better postoperative visual field outcomes were achieved in patients who had smaller preoperative visual field defects. Transsphenoidal surgery significantly improved the visual field defects and visual acuity in patients with non-functioning pituitary adenoma, compared to the transcranial surgery patients.

The Volume of Tumor Mass and Visual Field Defect in Patients with Pituitary Macroadenoma

PURPOSE: We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. METHODS: We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. RESULTS: Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). CONCLUSIONS: In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.

Clinical Validation of Visual Field Index

PURPOSE: To determine the associations of visual field index (VFI) with advanced glaucoma intervention study (AGIS) score, mean deviation (MD), pattern standard deviation (PSD), and average retinal nerve fiber layer (RNFL) thickness as measured by optical coherence tomography (OCT) and to evaluate the diagnostic abilities of these parameters. METHODS: One hundred fifteen glaucomatous eyes and 78 healthy eyes were enrolled in this cross-sectional study. Each participant had a Humphrey visual field analyzer test and OCT done. The diagnostic abilities of these parameters were analyzed using the receiver operating characteristic (ROC) curve, and we sought to determine the association of these parameters with VFI by Pearson correlation analysis. RESULTS: The associations between analyzed parameters and VFI were statistically significant (all, p<0.001). The area under the ROC curve (AUROC) value of VFI was greater than that of the MD and AGIS score (all, p<0.001) but was not different from the PSD and RNFL average thickness measured by OCT (p=0.756, p=0.638). CONCLUSIONS: The VFI showed significant associations with AGIS score, MD, PSD, and average RNFL thickness as measured by OCT and revealed similar diagnostic abilities as these parameters.

Effect of optical media changes on white-on-white Humphry field analyser perimetry and frequency doubling technology perimetry / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To simulate the effect of changes of pupil size and optical media with diffusing filters on visual acuity, and to compare these effects on Humphrey field analyser(HFA) and frequency doubling technology (FDT) perimetry. METHODS: The left eyes of 15 normal subjects aged 23-39 years underwent: 1) Snellen visual acuity and Pelli-Robson(P-R) chart testing; 2) white-on-white automatic perimetry of HFA model 630 using the 30-2 programme and size III stimulus; 3) FDT perimetry using N-30 programme. For each procedure, no filter, 1, 2, 3, 4 and 5 diffusing filters were mounted in random order in front of the eye to be tested.RESULTS: For Snellen visual acuity, 1 filter had no effect on all but 2 subjects who lost 1 line; 2 filters had little effect on all subjects and had no effect on 2 subjects (9 subjects lost 1 line and 4 lost 2 lines); 3 filters had the same effect on all subjects who lost 3 lines; 4 filters caused 5 subjects to lose 4 lines, 5 subjects to lose 5 lines, 3 subjects to lose 6 lines and 2 subjects to lose 7 lines; 5 filters caused 9 lines loss in all the subjects. For P-R chart , 3 filters usage caused 13 subjects to see none of the groups of letters and while 2 subjects could see only 1 group of letters. Both mean deviation(MD) of HFA and FDT were reduced with increased numbers of filters. For HFA, 5 filters caused nearly absolute scotomas, while for FDT, 3 filters caused the same result. The pattern standard deviation(PSD) for both HFA and FDT was uniformly consistent; the short-term fluctuation(SF) and corrected pattern standard deviation(CPSD) were all uniformly consistent.CONCLUSION: These findings showed that luminance reduction and light scattering caused by diffusing filters have marked effect on white-on-white and frequency doubling perimetry; the visual field loss of HFA and FDT was relatively diffuse, which could be effectively reduced through the use of pattern deviation analysis in separating visual field loss caused by glaucoma from that caused by cataract; the effect of media opacities on FDT was greater than it on HFA.

Probability of global indices in low tension glaucoma

To know the pattern of visual field (VF) defect of low tension glaucoma (LTG), its diffuse and localized VF defects were compared using the significance values (p-value) of mean deviation (MD) and corrected pattern standard deviation (CPSD), which are calculated with STATPAC in Humphrey Visual Field Analyser. Sixteen eyes of LTG were enrolled and 34 eyes of primary open angle glaucoma (POAG) were used as controls. The degree of VF defects in LTG and POAG was relatively mild with the p-value of MD equal to or greater than 1%. Neither mean MD nor mean CPSD of LTG was significantly different from each of POAG (p > 0.8 and p > 0.2, respectively). Comparing the p-values of MD and CPSD, many patients showed more significant p-value of MD in LTG and POAG (62.5% and 61.8%, respectively). However, relatively more severe defect of CPSD tended to occur more frequently in LTG than in POAG (25% and 5.9%, respectively, chi-square = 4.964, p < 0.09). The relation between p-values of MD and CPSD was not significantly influenced by the intraocular pressure, MD or vertical cup to disc ratio in either LTG or POAG.