Importance of Pattern Standard Deviation of Humphrey 10-2 Visual Field to Evaluate Central Visual Function in Patients with Early-Stage Glaucoma.

To explore various parameters that can evaluate the central visual impairment in patients with early-stage glaucoma, we included patients into a study with central visual impairments with an MD value greater than -6.0 dB on the 24-2 VF test. A possible association between structural parameters acquired by OCT and functional parameters of VF and PERG was determined. A total of 70 eyes of patients with suspected glaucoma or NTG underwent VF, OCT, and PERG examinations. The patients were classified into two groups according to the MD of the 24-2 VF test. We used Pearson correlation analysis to evaluate the relationships between GCIPL thickness/RNFL thickness and visual functional parameters, such as PERG and perimetry. Linear regression analyses were conducted to evaluate the significant factors affecting the PSD of VF 10-2. In the low MD group, the P50 amplitude presented significant correlations (r = 0.346, p = 0.048) with GCIPL thickness. In the correlation analysis of the high MD group, it was found that only the PSD of 10-2 uniquely presented borderline significant correlations with GCIPL thickness (r = -0.327, p = 0.055), and no other functional parameter showed significant correlation. Univariate and multivariate analyses revealed that GCIPL thickness was significantly associated with a PSD of 10-2 VF (p < 0.001 and 0.013, respectively). Among various parameters, the P50 amplitude and 10-2 PSD demonstrated statistically borderline significant structure-function relationships with GCIPL thickness in early-stage glaucoma.

The Comparison of Foveal Sensitivity Between Diabetic and Non-diabetic Patients by Using Standard Automated Perimetry 10-2 Protocol: A Cross-Sectional Study.

Purpose The purpose of the study is to assess whether standard automated perimetry (SAP) was capable of detecting early neuroretinal changes by comparing foveal sensitivity in diabetic and non-diabetic subjects. Settings and design This is an observational and cross-sectional study that compared foveal sensitivity between a case group of 47 subjects with no or mild-to-moderate diabetic retinopathy (DR) without maculopathy and a control group of 43 healthy subjects. Materials and Methods After a thorough ocular examination, all patients were put through tests using a Humphrey visual field analyzer with the Swedish interactive threshold algorithm (SITA) standard system (10-2 software). The primary indicator of success was the age-adjusted foveal awareness-esteem difference. Mean deviation (MD) and pattern standard deviation (PSD) readings were the supplementary performance indicators. Results The mean age of the case and control group was 50.76 ± 13.20 years and 49.90 ± 12.20 years, respectively. The probability of cataract development was higher in the case group (p < 0.0001). In the control group, 95.3% had best-corrected visual acuity (BCVA) in the category of good visual acuity (VA) (p < 0.0001). The mean foveal sensitivity in the case group was 28.57 ± 7.54 and 32.16 ± 7.09 for the control group, and the difference was statistically significant (p < 0.023). The mean of MD in the case group was -6.05 ± 7.93, whereas in the control group, it was -3.28 ± 1.70, which was found significant (p = 0.027). There was no difference in PSD between the study groups. Conclusions Foveal sensitivity decreased in diabetics, even without maculopathy, so SAP helps identify a patient at risk of future vision loss.

Comparative Analysis of 10-2 Test on Advanced Vision Analyzer and Humphrey Perimeter in Glaucoma.

Purpose: To evaluate diagnostic precision and prove equivalence of 2 devices, Advanced vision analyzer (AVA, Elisar Vision Technology) and Humphrey field analyzer (HFA, Zeiss) for the detection of glaucoma on 10-2 program. Design: Prospective, cross-sectional, observational study. Participants: Threshold estimates of 1 eye each of 66 patients with glaucoma, 36 control participants, and 10 glaucoma suspects were analyzed on 10-2 test with AVA and HFA. Methods: Mean sensitivity (MS) values of 68 points and central 16 test points were calculated and compared. Intraclass correlation (ICC), Bland-Altman (BA) plots, linear regression of MS, mean deviation (MD), and pattern standard deviation (PSD) were computed to assess the 10-2 threshold estimate of the devices. Receiver operating characteristic curves were generated for MS and MD values, and the area under the curve (AUC) was compared with assessing diagnostic precision. Main Outcome Measures: Mean sensitivity values of 68 points and central 16 points, AUC for MS and MD values, ICC values, BA plots, and linear-regression analysis. Results: Bland-Altman plot showed significant correlation for MS, MD, and PSD values for both devices. For MS, the overall ICC value was 0.96 (P < 0.001) with a mean bias of 0.0 dB and limits of agreement range of 7.59. The difference in MS values between both devices was -0.4760 ± 1.95 (P > 0.05). The AUC for MS values for AVA was 0.89 and for HFA was 0.92 (P = 0.188); whereas it was similar at 0.88 for MD values (P = 0.799). Advanced vision analyzer and HFA identically discriminated between healthy and patients with glaucoma (P < 0.001), although HFA denoted marginally greater ability (P > 0.05). Conclusions: Statistical results denote adequate equivalence between AVA and HFA because threshold estimates of AVA strongly correlate with HFA for 10-2 program. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Augmenting Kalman Filter Machine Learning Models with Data from OCT to Predict Future Visual Field Loss: An Analysis Using Data from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovation in Glaucoma Study.

Purpose: To assess whether the predictive accuracy of machine learning algorithms using Kalman filtering for forecasting future values of global indices on perimetry can be enhanced by adding global retinal nerve fiber layer (RNFL) data and whether model performance is influenced by the racial composition of the training and testing sets. Design: Retrospective, longitudinal cohort study. Participants: Patients with open-angle glaucoma (OAG) or glaucoma suspects enrolled in the African Descent and Glaucoma Evaluation Study or Diagnostic Innovation in Glaucoma Study. Methods: We developed a Kalman filter (KF) with tonometry and perimetry data (KF-TP) and another KF with tonometry, perimetry, and global RNFL data (KF-TPO), comparing these models with one another and with 2 linear regression (LR) models for predicting mean deviation (MD) and pattern standard deviation values 36 months into the future for patients with OAG and glaucoma suspects. We also compared KF model performance when trained on individuals of European and African descent and tested on patients of the same versus the other race. Main Outcome Measures: Predictive accuracy (percentage of MD values forecasted within the 95% repeatability interval) differences among the models. Results: Among 362 eligible patients, the mean ± standard deviation age at baseline was 71.3 ± 10.4 years; 196 patients (54.1%) were women; 202 patients (55.8%) were of European descent, and 139 (38.4%) were of African descent. Among patients with OAG (n = 296), the predictive accuracy for 36 months in the future was higher for the KF models (73.5% for KF-TP, 71.2% for KF-TPO) than for the LR models (57.5%, 58.0%). Predictive accuracy did not differ significantly between KF-TP and KF-TPO (P = 0.20). If the races of the training and testing set patients were aligned (versus nonaligned), the mean absolute prediction error of future MD improved 0.39 dB for KF-TP and 0.48 dB for KF-TPO. Conclusions: Adding global RNFL data to existing KFs minimally improved their predictive accuracy. Although KFs attained better predictive accuracy when the races of the training and testing sets were aligned, these improvements were modest. These findings will help to guide implementation of KFs in clinical practice.

Changes in Visual Field Indices after Pterygium Surgery.

OBJECTIVES: This study was a prospective evaluation of changes in the results of visual field tests taken before and after pterygium excision. METHODS: This was a prospective, single-center study. Seventy-five eyes of 75 patients who had undergone pterygium excision with autograft implantation were enrolled. All of the patients had stage III pterygium according to the Johnston classification. The mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) global index changes after pterygium excision were compared to evaluate the effect of pterygium on visual field analysis. RESULTS: The mean preoperative MD value was -3.04±2.63 dB (range: -14.84-0.62 dB) and the mean postoperative MD value was -1.83±2.09 dB (range: -13.82-1.74 dB) (p<0.001). The mean preoperative PSD value was 2.59±1.92 dB (range: 1.16-12.76 dB) and the mean postoperative PSD value was 2.41±1.62 dB (1.15-13.29 dB) (p>0.05). The mean preoperative VFI value was 96.01±4.46% (range: 68-100%) and the mean postoperative VFI value was 96.28±4.18% (range: 70-100%) (p>0.05). CONCLUSION: After pterygium excision, the MD improved significantly. However, the PSD and VFI did not change significantly. The significant change in MD value was related to the reduction in corneal light scattering, contrast sensitivity, aberrations, and blockage on the optic axis.

Advanced Vision Analyzer-Virtual Reality Perimeter: Device Validation, Functional Correlation and Comparison with Humphrey Field Analyzer.

Purpose: To evaluate the Advanced Vision Analyzer (AVA; Elisar Vision Technology) and to compare pointwise threshold sensitivity and functional correlation of Elisar Standard Algorithm (ESA) with the Swedish Interactive Threshold Algorithm (SITA) of the Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Inc). Design: Prospective, cross-sectional, observational case series. Participants: One hundred sixty eyes (85 control participants, 75 glaucoma patients) for functional assessment, 15 eyes for test-retest variability (TRV), 107 eyes for blind spot trial (45 normal eyes, 62 glaucoma eyes) were recruited consecutively. A separate group of participants was chosen for each assessment. Methods: All participants underwent ESA and SITA Standard 24-2 testing, and 1 eye of each participant was selected randomly. Intraclass correlation coefficient (ICC), Bland-Altman, linear regression, mean bias (MB), and proportional bias analyses were quantified and assessed. Threshold measurements, TRV, and blind spot location accuracy were compared with those of the HFA. Main Outcome Measures: Pointwise threshold sensitivity, sectoral mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), TRV, blind spot location, average test time were computed, and data were correlated. Results: The mean time required to perform a field test with the AVA was 7.08 ± 1.55 minutes and with HFA was 6.26 ± 0.54 minutes (P = 0.228). The MS difference between AVA and HFA was -2.2 ± 2.3 dB in healthy participants (P < 0.001) and -2.6 ± 3.5 dB in participants with glaucoma (P < 0.001). The correlation coefficients for pointwise threshold values were moderately to strongly correlated for both the devices (r = 0.68-0.89). For MS, the overall ICC value was 0.893 (P < 0.001) with MB of 2.48 dB and a limits of agreement (LOA) of 10.90 (range, 7.93 to -2.97). For TRV, response variability decreased with an increase in sensitivity and increased with eccentricity. Blind spot location was accurate, and global indices of testing methods correlated well. Conclusions: The AVA effectively captures threshold values for each point in the visual field. Adequate functional correlation suggests substantial equivalence between the AVA (ESA) and HFA (SITA Standard), implying that AVA may allow accurate assessment of visual field.

Paraoxonase 1 (PON1) promoter (-107T/C) and coding region (192Q/R and 55L/M) genetic variations in pseudoexfoliation syndrome and pseudoexfoliative glaucoma risk.

PURPOSE: Pseudoexfoliation syndrome (PEX) is characterized by the accumulation of microscopic extracellular material in the anterior chamber of the eye and can lead to the development of pseudoexfoliative glaucoma (PEG) in some patients. The pathogenesis of PEX is not fully understood, and there are no objective biomarkers for its early diagnosis. Recent research has indicated that oxidative stress and inflammation might play a role in the pathophysiology of the production of pseudoexfoliation material. Therefore, in the present study, we aimed to analyze the possible association between three genetic variants of paraoxonase 1 (PON1), a well-recognized antioxidant and anti-inflammatory enzyme, and PEX/PEG. METHODS: The study population consisted of patients with PEX (n = 150), patients with PEG (n = 150), and control subjects (n = 150). PON1 -107T/C, 192Q/R, and 55L/M genotypes were determined using PCR followed by restriction fragment length polymorphism analysis. The correlation between these genetic alterations and clinical visual characteristics was also investigated. RESULTS: The minor allele frequencies and genotype distributions of PON1 did not differ significantly between the PEG, PEX, and control groups. Moreover, PON1 genotypes did not significantly influence visual clinical parameters in stratification analysis. On the other hand, in correlation analysis, pattern standard deviation was significantly correlated with the -107T/C genotypes in PEX group. In addition, intraocular pressure was correlated with the 55L/M genotypes and mean deviation was correlated with the -107T/C genotypes in the control group. Furthermore, intraocular pressure was significantly inversely correlated with sex (r =  - 0.116, P = 0.011) in the overall study group. Logistic regression analysis showed that having a PON1 -107TC or CC genotype is significantly associated with PEX (OR = 1.909, P = 0.020). CONCLUSIONS: This study, for the first time, analyzed the relationship between PON1 genetic variants, clinical visual parameters, and PEX/PEG. The results indicated a possible role for the PON1 promoter variant in PEX.

Investigating the effects of glaucomatous damage on the multifocal visual evoked potential parameters.

PURPOSE: To investigate the effects of glaucomatous damage on the mfVEP parameters of patients suffering from primary open-angle glaucoma (POAG). METHODS: Fifteen healthy subjects and 15 patients with unilateral POAG participated in this study. In addition, routine ophthalmological examinations including visual acuity, anterior segment examination, posterior segment examination, intraocular pressure, mfVEP with electrophysiological system, RETI-port/Scan 21, and visual field test with automated Humphrey ZEISS HFA II 750i Perimeter were also performed. RESULTS: The results show that there was a strong correlation between the ∆MDs and the number of abnormal points with the ∆amplitudes more than 256 nV, in patients (n = 15, r = 0.802, p < 0.05), but no correlations were found between the mean sensitivity differences (ΔPSDs) and mfVEP parameters. CONCLUSIONS: Comparing the monocular mfVEP responses from both eyes is an appropriate method to detect unilateral damage. Achievement of more development and making the mfVEP test more functional can be a solution for early diagnosis in most of the eye diseases.

Quantitative assessment of secondary white matter injury in the visual pathway by pituitary adenomas: a multimodal study at 7-Tesla MRI.

OBJECTIVE: The objective of this study was to investigate microstructural damage caused by pituitary macroadenomas by performing probabilistic tractography of the optic tracts and radiations using 7-T diffusion-weighted MRI (DWI). These imaging findings were correlated with neuro-ophthalmological results to assess the utility of ultra-high-field MRI for objective evaluation of damage to the anterior and posterior visual pathways. METHODS: Probabilistic tractography employing 7-T DWI was used to reconstruct the optic tracts and radiations in 18 patients with adenomas and in 16 healthy volunteers. Optic chiasm compression was found in 66.7% of the patients and visual defects in 61.1%. Diffusion indices were calculated along the projections and correlated with tumor volumes and results from neuro-ophthalmological examinations. Primary visual cortical thicknesses were also assessed. RESULTS: Fractional anisotropy was reduced by 21.9% in the optic tracts (p < 0.001) and 17.7% in the optic radiations (p < 0.001) in patients with adenomas. Patients showed an 8.5% increase in mean diffusivity of optic radiations compared with healthy controls (p < 0.001). Primary visual cortical thickness was reduced in adenoma patients. Diffusion indices of the visual pathway showed significant correlations with neuro-ophthalmological examination findings. CONCLUSIONS: Imaging-based quantification of secondary neuronal damage from adenomas strongly correlated with neuro-ophthalmological findings. Diffusion characteristics enabled by ultra-high-field DWI may allow preoperative characterization of visual pathway damage in patients with chiasmatic compression and may inform prognosis for vision recoverability.

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.

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.

Surgical Treatment of Dysthyroid Optic Neuropathy: Long-Term Visual Outcomes with Comparison of 2-Wall versus 3-Wall Orbital Decompression.

PURPOSE: To compare the long-term visual outcomes after 2-wall (medial-lateral) versus 3-wall (medial-lateral-inferior) orbital decompression combined with fat removal in patients with dysthyroid optic neuropathy (DON). METHODS: Records of 68 eyes of 42 patients were retrospectively reviewed. Two-and 3-wall decompression was performed in 41 and 27 eyes, respectively. Transcaruncular approach was used for medial wall decompression. Lateral canthotomy combined with upper eyelid crease incision was used for lateral wall removal, and combined with transconjunctival lower eyelid incision if floor decompression performed. Outcome measures were visual acuity (VA), color vision, Hertel measures, visual field mean deviation (MD) and pattern standard deviation (PSD) Result: The mean follow-up time was 39.3 months (range, 12-72 months). All indicators of visual function significantly improved after 2-and 3-wall decompression. The improvement in VA and color vision was similar between groups. (logMAR VA: 2-wall: 0.52 ± 0.68 versus 3-wall: 0.71 ± 0.86, p = 0.335); (color vision on Ishihara plates: 2-wall: 10.1 ± 8.1 versus 3-wall: 11.6 ± 7.8, p = 0.447). The improvement in MD and PSD were higher after 3-wall decompression (MD: 2-wall: 10.0 ± 5.5 versus 3-wall: 14.3 ± 7.5 dB, p = 0.020); (PSD: 2-wall: 3.5 ± 1.9 versus 3-wall: 4.8 ± 3.0 dB, p = 0.045). Proptosis reduction was higher after 3-wall decompression (2-wall: 5.1 ± 1.3 versus 3-wall: 7.2 ± 1.9 mm, p = 0.0001). New onset diplopia was seen 20% and 28.5% of cases in 2-and 3-wall decompression, respectively. No adnexal/orbital complications were seen in 2-wall group, however orbital hematoma (1 case) and persisting eyelid edema (1 case) were encountered in 3-wall group. CONCLUSION: Both 2-and 3-wall orbital decompressions are safe and effective for management of visual dysfunction in DON. Although 3-wall decompression provide better improvement in the parameters of visual field analysis and Hertel measures, new onset diplopia, adnexal/orbital complications are more common with this technique.

Changes in visual field and retinal nerve fiber layer thickness after Ex - press glaucoma shunt implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe and analyze the change of visual field and retinal nerve fiber layer thickness of primary open-angle glaucoma ( POAG ) after the Ex-press glaucoma shunt implantation. ●METHODS:A total of 14 patients (24 eyes) with POAG were underwent Ex-press glaucoma shunt implantation. Visual acuity, intraocular pressure ( lOP ) , mean defect ( MD) , pattern standard deviation ( PSD ) , retinal nerve fiber layer thickness ( RNFLT ) , and corneal endothelial cell number were collected preoperatively. Visual acuity and lOP were collected in 1wk, 1 and 3mo postoperatively respectively. Also, MD, PSD, RNFLT, and corneal endothelial cell number were collected preoperatively and 3mo postoperatively respectively. Complication, the additional treatment, success rate were analyzed. ●RESULTS:There was no significant difference (P>0. 05) in visual acuity preoperative and postoperative 1wk, 1, 3mo. Visual acuity did not significantly reduce after operation. Compared with preoperative, there was significant decreased (P 0. 05 ) after postoperative 3mo. Corneal endothelial cell number decrease had significant difference (Z=-2. 585, P=0. 01) between preoperative and postoperative 3mo. Success rate: complete success: 79. 2% ( 19 eyes ); partial success:8. 3% (2 eyes);failure:12. 5% (3 eyes). ●CONCLUSION: Ex-press glaucoma shunt implantation could efficiently decrease the lOP in POAG patients. Although it results in reduction of RNFLT in short time. The visual acuity and visual field keep stable after operation. lt is a safe and effective device for treating primary open-angle glaucoma.

Correlation of pattern reversal visual evoked potential parameters with the pattern standard deviation in primary open angle glaucoma.

AIM: To evaluate whether glaucomatous visual field defect particularly the pattern standard deviation (PSD) of Humphrey visual field could be associated with visual evoked potential (VEP) parameters of patients having primary open angle glaucoma (POAG). METHODS: Visual field by Humphrey perimetry and simultaneous recordings of pattern reversal visual evoked potential (PRVEP) were assessed in 100 patients with POAG. The stimulus configuration for VEP recordings consisted of the transient pattern reversal method in which a black and white checker board pattern was generated (full field) and displayed on VEP monitor (colour 14″) by an electronic pattern regenerator inbuilt in an evoked potential recorder (RMS EMG EP MARK II). RESULTS: The results of our study indicate that there is a highly significant (P<0.001) negative correlation of P100 amplitude and a statistically significant (P<0.05) positive correlation of N70 latency, P100 latency and N155 latency with the PSD of Humphrey visual field in the subjects of POAG in various age groups as evaluated by Student's t-test. CONCLUSION: Prolongation of VEP latencies were mirrored by a corresponding increase of PSD values. Conversely, as PSD increases the magnitude of VEP excursions were found to be diminished.

Study of long term structural and functional changes in medically controlled glaucoma.

AIM: Prospectively analyze the long term structural and functional changes in patients of primary open angle glaucoma (POAG) receiving medical therapy (beta blockers and non beta blockers). In this study an attempt has been made to evaluate whether medical reduction of IOP prevents or delays the progression of glaucomatous visual field loss and/or optic nerve damage in patients with open angle glaucoma. METHODS: Study conducted over a period of 27 months, at a tertiary eye care hospital including both eyes of 40 patients with POAG. Group 1 (20 patients, 40 eyes) received beta-blockers, and Group 2 (20 patients, 40 eyes) received non-beta-blockers. Each patient underwent intraocular pressure measurement, best corrected visual acuity, slit-lamp, fundus examination, gonioscopy, central corneal thickness, visual field assessment by Humphrey automated perimetry and retinal nerve fibre layer thickness by Stratus optical coherence tomography at baseline and at two subsequent visits. The average time interval between each visit was 10-11 months. The statistical analysis was done using one-way analysis of variance (ANOVA). Post-hoc test, using tukey' method were adopted. Probablity (P) value of 0.05 or less was considered to be statistically significant. RESULTS: A total of 80 eyes of 40 patients of POAG were enrolled, 24 males, 16 females, age group 50-80 years. In both beta and non beta blocker group, reduction (improvement) in mean IOP from initial levels to the levels achieved at the 2nd and 3rd visits was statistically significant. One way ANOVA (df=2), fisher f value=11.64, P=0.000, one way ANOVA (df=3), fisher f value=35.61, P=0.000. Both mean deviation (MD) and pattern standard deviation (PSD) in both beta and non beta blockers at different visits were not statistically significant. Retinal nerve fibre layer thickness (RNFL) -only mean inferior retinal nerve fibre layer, the difference between the mean value in beta and non beta blocker groupwere statistically significant. [unpaired t test value (df=78) =2.27, P=0.03]. Side effects with beta blocker were conjunctival hyperemia (10%), burning (5%), and conjunctival hyperemia (5%) in non beta blockers. CONCLUSION: Non-beta-blockers are as effective as beta-blockers in bringing about a significant lowering of intraocular pressure to the normal range, and in preventing progressive damage to the visual fields and retinal nerve fibre layer. The absence of systemic side effects and superior IOP lowering efficacy has made non beta-blockers attractive for first line therapy for the treatment of glaucoma worldwide.

The Heidelberg retina tomograph ancillary study to the European glaucoma prevention study: study design and baseline factors.

PURPOSE: To describe the study design and baseline factors of the Heidelberg Retina Tomograph ancillary study within the EGPS. Furthermore, to examine the relationship between HRT optic disc topographic measurements and baseline demographic and ocular factors. METHODS: Four hundred and eighty-nine ocular hypertensive participants were included. Each participant completed HRT imaging at least annually. The associations between HRT measurements and IOP, central corneal thickness (CCT), baseline photographic estimates of vertical CDR ratio (CDR), asymmetry between the two eyes in CDR ratio and baseline visual field indices were assessed using regression analysis. RESULTS: Associations between HRT measurements and vertical CDR by photographs were found for almost all stereometric optic disc parameters in both univariate and multivariate analysis. The strongest association was found between vertical CDR measurements and disc, cup and rim area; cup and rim volume, CDR area, linear CDR, mean and maximum cup depth and cup shape measure (all p < 0.0001). In multivariate analysis, pattern standard deviation (PSD) and HRT disc area had significant associations with several HRT optic disc measurements. Furthermore, CCT was significantly associated with reference height and the glaucoma probability score (GPS, outside normal limits). CONCLUSIONS: The EGPS is the first multicentre, placebo-controlled randomized clinical trial to use HRT for monitoring optic disc changes in participants with ocular hypertension. We found strong associations between stereophotographic vertical CDR estimates, HRT disc area, PSD and several HRT parameters. We found, furthermore, that the parameters reference height and GPS were significantly related to central corneal thickness.

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.

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 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.