The learning and fatigue effect in automated perimetry

A visual field test was performed on 100 volunteers to study learning or fatigue effects during one session. The test was carried out with the help of the Octopus program J1, which measures the threshold 12 times at 3 test locations. In the majority of cases the sensitivity was quite stable during the session. We noted no difference between trained and untrained subjects or between normal and pathological eyes. However, patients with refractive errors, especially myopes, revealed a larger learning effect than did emmetropes. Offprint requests to: J. Flammer     

The effect of attention on conventional automated perimetry and luminance size threshold perimetry

PURPOSE: To investigate the effects of divided attention on conventional automated perimetry (CAP) and luminance size threshold perimetry (LSTP). METHODS: Ten healthy subjects, ages 27 to 65, with two perimetry types (CAP and LSTP) were tested in random order. At a later session, these tests were given with a mental workload to simulate the effect of anxiety or distraction on subjects performing visual field testing, also in random order. The mental workload, the Paced Auditory Serial Addition Test (PASAT), was first administered to each subject, and the score was recorded. During the visual field testing, the PASAT was again administered continuously. Each subject was instructed to attend primarily to the PASAT while taking each visual field test. RESULTS: CAP was affected by the addition of the PASAT, with a worsening of sensitivity from an average of 30.0 +/- 0.67 to 24.2 +/- 7.4 dB with a range of -0.04 to -23.2 dB (P = 0.04). LSTP showed a generalized reduction in threshold 1.71 +/- 0.22 to 2.35 +/- 0.72 dB with a range of 0.12 to -2.17 dB (P = 0.25). The percentage of correct responses on the PASAT was not significantly different between CAP (76.9%) and LSTP (74.8%). False-positive and -negative catch trial responses were increased during CAP with PASAT testing (P = 0.009). A substantial increase of fixation losses occurred during CAP with PASAT (3.7-16.2, P = 0.002). LSTP with PASAT showed increases in localization error (P < 0.001) and reaction time (P = 0.004). CONCLUSIONS: Divided attention significantly affects performance on conventional automated perimetry with its fixed size stimuli and when the stimuli are scaled (LSTP). The deficits may simulate nerve-fiber-bundle-like defects.     

视野检查法

视野计已成为一种被广泛应用的主要视功能检查手段，它具有独特的临床应用价值。随着视觉理论、现代检测技术及信息技术的进步，它将不断发展和完善。近年来学者们对其进行了大量的研究；本文就此作一综述。     

视野检查法

视野计已成为一种被广泛应用的主要视功能检查手段,它具有独特的临床应用价值。随着视觉理论、现代检测技术及信息技术的进步,它将不断发展和完善。近年来学者们对其进行了大量的研究;本文就此作一综述。     

The effect of cataract on Accumap multifocal objective perimetry

PURPOSE: To determine the effect of visually significant cataract on Accumap multifocal objective perimetry. DESIGN: Interventional case series. METHODS: Fifteen eyes of 15 adult patients who underwent standard outpatient phacoemulsification cataract surgery with posterior chamber intraocular lens insertion with subsequent improvement of best-corrected visual acuity underwent Accumap testing before and after cataract extraction. Patients had no other ophthalmic disease or other conditions that may have affected visual evoked potentials. Results were analyzed statistically. RESULTS: Visually significant cataract was associated with a statistically significant reduction of mean Accumap amplitudes within the central 107 degrees (zone 1, P =.002; zone 2, P =.003; zone 3, P =.001) but did not affect the outer two zones (zone 4, P =.074; zone 5, P =.931). CONCLUSIONS: Accumap visual fields may be affected by visually significant cataract. Multifocal objective perimetry defects in the central 10 degrees should be interpreted with caution in patients with cataract.     

Learning effect of Humphrey Matrix perimetry

BACKGROUND: Humphrey Matrix perimetry is a recent development in automated perimetry that uses frequency-doubling technology (FDT). We evaluated the learning effect of Humphrey Matrix perimetry with a full-threshold 30-2 strategy. METHODS: Twenty-four patients with primary open-angle glaucoma and early visual field defects as assessed by standard automated perimetry and 24 healthy control subjects participated. All subjects had no prior experience with FDT visual field tests. Humphrey Matrix perimetry using a full-threshold 30-2 strategy was performed 3 times within 1 month. Various visual field indices were compared across multiple tests. RESULTS: Mean deviation (MD) showed a larger defect at the first test than at the second and third tests (p < 0.001), and the mean total improvement of the MD was 2.80 decibels (dB) in the glaucoma group and 1.71 dB in the control group. Pattern standard deviations (PSDs) were decreased as the tests were repeated, but test duration, fixation losses, and false-positive or false-negative rate were not changed significantly. Additionally, the Glaucoma Hemifield Test (GHT) showed unstable results. INTERPRETATION: In patients naive to the FDT test, Humphrey Matrix perimetry showed a large learning effect on MD and PSD among the various visual field indices. The GHT results of Humphrey Matrix perimetry showed a large instability.     

Optical coherence tomography and fundus-related perimetry in spontaneous closure of a traumatic macular hole

We describe the spontaneous closure of a traumatic macular hole as evaluated with optical coherence tomography (OCT) and fundus-related perimetry. A 36-year-old man was examined by fundus biomicroscopy, ultrasonography, fundus-related perimetry, and OCT a few hours after injury to his left eye and during the following 18 months. At first examination, OCT showed a full-thickness macular hole, while fundus-related perimetry showed reduction of mean macular sensitivity, with an eccentric and unstable fixation. After 1 month, OCT scans showed complete closure of the macular hole, while fundus-related perimetry revealed a new eccentric but stable fixation (new preferred-retinal-locus). OCT and fundus-related perimetry seem to be useful tools to evaluate traumatic macular holes during follow-up.     

Influence of learning effect on blue-on-yellow perimetry

PURPOSE. Some studies have found that a significant blue-on-yellow perimetry (B/YP) learning effect exists in patients with ocular hypertension (OHT) or open-angle glaucoma who were experienced in standard automated perimetry. However, very little is known about the B/YP learning effect in normal subjects and patients without previous white-on-white perimetry (W/WP) experience. Meanwhile, it is unclear whether the B/YP learning effect is influenced by age and refraction. METHODS. Twenty healthy subjects, 26 OHT and 14 primary open angle glaucoma (POAG) patients, underwent three full-threshold B/YP tests at intervals of 7 to 21 days. Of the 60 subjects, 38 had no previous W/WP experiences, 22 had previous W/WP experiences for at least two times. The parameters investigated to detect a learning effect were the perimetric indices and the test duration (TD). RESULTS. Learning effects were demonstrated for mean deviation (MD), pattern standard deviation (PSD), short-term fluctuation (SF), and TD. Significant differences were found between the MD, PSD, SF, and TD of the first test and those of the second and third tests (p<0.05). However, no difference was found between those parameters of the second and third tests. No statistically significant differences were noted in terms of MD1st-2nd, MD1st-3rd, PSD1st-2nd, PSD1st-3rd, TD1st-2nd, and TD1st-3rd between the group with W/WP experience and the group without previous W/WP experience (p>0.05). No statistically significant differences were noted in terms of those parameters among the normal subjects and the patients with OHT or POAG (p>0.05). No significant difference was found in the B/YP learning effect among various age groups (p>0.05) and among various refraction groups (p>0.05). CONCLUSIONS. A significant learning effect was observed between the first and the second or third tests and the perimetric indices appeared improved at full-threshold B/YP. The previous W/WP experience and the subject age and refraction did not influence the B/YP learning effect. This above all should be taken into account when considering the clinical use of this test to avoid erroneous diagnostic conclusions.     

趋势导向视野检查法与常规阈值视野检查法的对比研究

目的 评价趋势导向视野检查法(tendency-oriented perimetry, TOP)在青光眼视功能检测中的应用价值。 方法 利用Octopus 101全自动视野计分别对20名正常人的20只正常眼、32例原发性开角型青光眼(primary open angle glaucoma, POAG)患者的32只患眼和14例可疑POAG患者的14只眼分别进行常规阈值视野检查(Normal/Normal程序)和TOP视野检查(TOP/Normal程序)。所有受检眼在2周内再次分别进行常规阈值视野检查和TOP视野检查。将两种视野检查的结果、视野检查指数、点对点阈值变异及视野缺损点数进行比较和分析。 结果 TOP视野检查正常人的阴性检出率为90%，POAG的阳性检出率为75%，其中检测中晚期POAG的阳性检出率达100％。2种视野检查的视野指数呈明显正相关，平均敏感度(mean sensitivity, MS)的相关系数为0.9335，平均缺损(mean defect, MD)的相关系数为0.9189，偏离缺失(loss variance, LV)的相关系数为0.9621。点对点阈值变异和视野缺损点数TOP视野检查结果略高于常规阈值视野检查结果，但二者间差异均无显著性的意义(P＝0.2019，P＝0.4448)。 结论 TOP视野检查指数与常规阈值视野检查指数呈明显正相关，其检测中晚期POAG的敏感性及可重复性高。 (中华眼底病杂志, 2002, 18: 169-272)     

The effect of Goldmann applanation tonometry on automated static threshold perimetry

Automated static threshold perimetry was performed in both eyes of 10 normal and 12 ocular hypertensive subjects treated with a topical beta-blocker, before and after Goldmann applanation tonometry of their right eyes. Both objective statistical comparison and subjective evaluation of the resultant visual fields showed no detrimental effect on visual field test results after applanation tonometry.     

The effect of myelination on perimetry and retinal nerve fibre analysis

Background: Myelinatecl retinal nerve fibres around the optic nerve head can lead to an enlargement of blind spot with kinetic perimetry. Presumably extensive myelination will also decrease the visual sensitivity with static perimetry. This study reports the effect of myelination on static perimetry in several patients. Scanning laser polarimetry can measure the retinal nerve fibre layer thickness around the optic nerve head in vivo. This technique was applied at the myelination to investigate its effect on retinal nerve fibre layer thickness determination. Methods: Four eyes of three subjects with myelination around the optic nerve head were tested with Bjerrum screen at one metre to measure the blind spot size. They were followed by Humphrey Visual Field Analyser with a custom pattern to quantify the threshold level at the blind spot region. A GDx Nerve Fiber Analyser was used to measure the retinal nerve fibre layer thickness around the optic nerve head. Results: All the patients demonstrated an enlargement of the blind spot, with different extents, corresponding to the area of myelination. Threshold testing revealed a depression in the myelinated regions. The results for retinal nerve fibre layer were not conclusive with two eyes demonstrating thickening and two eyes showing no effect from myelination. Conclusions: A static field test with a modern visual field analyser may help to quantify the effect of myelination on visual sensitivity. More studies on the effect of myelination on retinal nerve fibre layer thickness measurement are suggested with more subjects involved.     

The effect of stimulus size on the measured threshold values in automated perimetry

Patients with severely depressed visual fields as determined by automated static perimetry are often tested with larger test stimuli in order to obtain meaningful data. "Normal" threshold values are known and included in some perimeters' data analysis programs for stimulus III, but not for larger stimuli. Using a user-defined program on the Octopus 201 perimeter to determine mean retinal sensitivity, a study was conducted in 17 normal subjects to determine the effect of stimulus size on measured threshold. With stimulus III, the mean retinal sensitivity within the central 30 degrees was 28.4 +/- 2.3 dB; it was 31.9 +/- 2.3 dB for stimulus IV, and measured 36.00 +/- 2.5 dB with stimulus V. The differences between the values are statistically significant (P less than 0.001). It is not known whether these differences can be generalized from normals to patients with glaucoma or other diseases.     

The influence of the learning effect on automated perimetry in patients with suspected glaucoma

The influence of the learning effect on the outcome of automated perimetry was studied as a function of eccentricity. The same comprised 20 patients with suspected glaucoma who were all naive to automated perimetry. Visual field examination of the right eye followed by that of the left eye was undertaken on each of three successive days and after a further interval of 12 days using a customized full-field program of the Humphrey Field Analyser 630 (stimulus size III). The program comprised 60 points out to an eccentricity of 60 degrees with an interstimulus grid of 12 degrees. Global, central, peripheral, superior and inferior mean sensitivity each significantly increased (P less than or equal to 0.01) from the first to the second right eye examinations and from the third to the fourth left eye examinations (P less than or equal to 0.01). The global short-term fluctuation, central mean defect and number of stimulus presentations decreased from the first to the second right eye examination (P 0.01). The order of examination between eyes and the interval between examination sessions influences the response recorded by automated perimetry.