中心视野检查联合周边视野检查在青光眼诊断中的价值

目的探讨中心视野检查联合周边视野检查是否能减少青光眼诊断的漏诊率。方法病例组（青光眼患者）84例（165只眼）与对照组（按性别、年龄、文化程度与病例组相配比的正常人群）110例（220只眼）分别使用Octopus101自动电脑视野计进行中心视野检查和周边视野检查,将中心视野检查及中心与周边视野检查的联合结果请三位医生在盲法的情况下独立进行分析评价,最后将评价结果进行统计学的分析,计算出漏诊率。结果病例组中中心视野检查结果异常的有129只眼,而中心视野检查联合周边视野检查结果异常的有153只眼;对照组中中心视野检查结果异常的有17只眼,而中心视野检查联合周边视野检查结果异常的有36只眼。将其中的中心视野检查结果与联合视野检查结果相比较,使用SPSS11.5统计软件进行分析可知：中心视野检查联合周边视野检查漏诊率为7.3%,单独的中心视野检查的漏诊率为21.8%,P=0.000〈0.05,具有统计学意义。结论使用Oc-topus101自动电脑视野计中心视野检查联合周边视野检查能减少青光眼诊断的漏诊率。     

倍频视野检查在青光眼视野缺损的应用

目的研究倍频视野检查在青光眼视野检查中的效果.方法应用倍频视野仪及Humphrey视野仪对64眼正常眼及120眼青光眼患者进行视野检查.结果倍频视野检查在青光眼视野检查中的特异性为55/64(85.9%),敏感性为104/120(86.7%).倍频视野检查在184眼正常眼及青光眼的视野检查中与Humphrey视野检查结果有密切相关(MD的相关系数为0.948,p＜0.001,PSD相关系数为0.712,p＜0.001).结论倍频视野检查是青光眼视野检查的一个有效手段.     

视野检查法的研究进展

计算机自动视野计检查是主要的视功能检测手段，自动视野计的发展已使这一检查手段日臻完善。但是，近几年的研究表明光阈值的改变并不能真正代表视功能的损害程度，自动视野检查仍然无法发现最早期的视野缺损。高通分辨视野、模型分辨视野和自动瞳孔视野是近年国外新发展起来的定量视野检查法。初步应用的报道显示这些视野检查法在检测视功能损害上比自动视野计具有更高的敏感性和特异性，而且还具有阈值变异小、检查时间短、容易为     

新型视野检查方法的进展

视野是眼科临床主要的视功能检测手段。常规计算机视野如今已普遍应用,但仍然无法发现最早期的视野缺损。为此,短波长视野、运动觉视野、倍频视野、高通分辨和模型辨别视野、自动瞳孔视野、闪烁视野、微视野、客观视野等多种新型视野检查方法被开发。本文对这些新型视野检查的进展进行介绍。     

计算机视野计技术及其在青光眼诊断上的应用

计算机自动视野计的出现是近十年来视野领域中一个最重要的进步。它的主要优点是检查过程自动化,排除了视野检查过程中技术人员的主观诱导作用,使检查条件标准化。本文结合目前国际上应用较广泛的Octopus自动视野计,详细介绍了计算机视野计测量视网膜敏感度的基本原理、程序分类、结果的可靠性参数和波动,以及一些有关结果分析的常用视野指数的统计方法和临床意义。最后对计算机视野计在青光眼视野检查中的诊断价值、视野异常的判断、和视野分析方法及发展趋势进行了详细介绍。     

视野检查法的研究进展

计算机自动视野计检查是主要的视功能检测手段，自动视野计的发展已使这一检查手段日臻完善。但是，近几年的研究表明光阈值的改变并不能真正代表视功能的损害程度，自动视野检查仍然无法发现最早期的视野缺损。高通分辨视野、模型分辨视野和自动瞳孔视野是近年国外新发展起来的定量视野检查法。初步应用的报道显示这些视野检查法在检测视功能损害上比自动视野计具有更高的敏感性和特异性，而且还具有阈值变异小、检查时间短、容易为被检查者接受等优点。但其应用价值尚需更多的研究。     

17 564例视野检查结果的临床统计分析

视野检查对很多疾病的诊断及病情的观察有极其重要的作用,应用视野检查对某些眼科、神经科及内科疾病的诊断和病情的观察是不可缺少的手段之一。我科神经视野组从1979年1月～1989年12月对17564例患者进行了视野检查,平均每年检查1500例,从这些视野检查资料中我们进行了临床统计分析,报告如下。     

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)     

青光眼患者的中心视野

青光眼患者的中心视野镇江医学院附属医院眼科郑振世，黄燕，王彦视野检查是诊断青光眼、对视功能损害程度的评估及随访疗效观察等方面常用的、精确可靠的检查方法之一。近年来广泛应用的自动视野计是一种标准的定量的检查方法，比传统的手工操作视野检查更为精确，且可提...     

APS—6000B全自动视野计的临床应用

视野检查是眼科临床诊断的重要检测项目，在视力受损之前，视野检查可有效地检测出由于青光眼、视网膜病变、神经系统病变等眼疾所致的网膜视敏度缺损。视野检查也由最简单的对比法到以后的动态视野计，再发展到现在的自动静态视野检查。我院自2001年6月引进一台由重庆康华科技公司生产的APS-6000B全自动视野计，至2004年10月共检测病人254例，现报告如下。     

Contrast sensitivity testing: a more complete assessment of vision

Contrast sensitivity testing is a powerful tool for determining the capability of the visual system to process spatial and temporal information about the everyday objects we see. The current gold standard in the assessment of vision, visual acuity, provides only a limited amount of information, obtained under artificial conditions. Contrast sensitivity testing measures a range of visual performance under real-life conditions. It measures the least amount of contrast needed to detect a visual stimulus and gives us a more complete quantitization of patients' visual capabilities. Many instances in which losses in contrast sensitivity were detected when visual acuity (one point on the contrast sensitivity function) was normal have been reported. These include amblyopia, neuro-ophthalmology, retina, anterior segment disease, and glaucoma. Therefore, contrast sensitivity testing enables the clinician to diagnose selective deficits in visual processing at an earlier stage than is possible with conventional testing methods.     

Use of a portable head mounted perimetry system to assess bedside visual fields

AIM: This study was designed to test the ability of a portable computer driven, head mounted visual field testing system to perform automated perimetry on patients at their bedside and to compare these results with the "gold standard" for bedside examinations, confrontation visual fields. METHODS: The Kasha visual field system is a portable automated perimeter which utilises a virtual reality headset. 37 neurosurgery patients were examined at their bedside with a central 24 degree suprathreshold testing strategy after confrontation visual field testing. The patterns of visual field defects were categorised and compared with the results of confrontation testing. RESULTS: A total of 42 field examinations were completed on 37 patients, and the average testing time for both eyes was 4.8 minutes with the perimetry system. Each of the 11 fields (100%) classified with defects on confrontation testing was similarly categorised on head mounted perimetry. 26 out of 31 (84%) visual fields were normal on both confrontation and perimetry testing, while five out of the 31 fields (16%) which were full on confrontation had visual field defects identified by head mounted perimetry. CONCLUSION: The head mounted, automated perimetry system proved easily portable and convenient for examining neurosurgical patients at their bedside in the perioperative period. The device demonstrated equal sensitivity to confrontation visual field testing methods in detecting field defects and offers the advantage of standardised, quantifiable testing with graphic results for follow up examinations.     

Legal aspects of visual field assessment

Visual field testing can fail to satisfy the standard of care if the optometrist does not test the patient's visual field when it is necessary, and if, even when testing is performed, it is of insufficient sensitivity. In general, the duty to test the visual field arises when examining symptomatic patients and when a suspicious finding is encountered, but "routine" eye health assessments should include a screening visual field test. In some cases the doctrine of informed consent will require the optometrist to inform the patient that testing of the visual field at threshold should be performed. Documentation of both test results and patient communications should be retained in the record.     

Contrast sensitivity versus static visual field testing during experimental elevation of intraocular pressure

Contrast sensitivity testing has been recommended as a more sensitive indicator of early visual loss than visual field testing. Using gravity inversion to induce an intraocular pressure rise, we performed contrast sensitivity testing on each eye of 10 normal subjects in the upright and inverted positions. Contrast sensitivity results were not altered in the head-down position, even though in 5 of the 10 subjects (7 of 20 eyes), visual field alterations on static perimetry were elicited during inversion. In both of these evaluations, the subject's results in the upright position served as the control, freeing us from reliance upon age-matched populations. We conclude that precise measurement of static thresholds with automated perimetry is more sensitive than routine contrast sensitivity testing in detecting visual dysfunction related to transient acute elevations of intraocular pressure.     

The utility of clinical electrophysiology in a case of nonorganic vision loss

BACKGROUND: Nonorganic vision loss (NOVL) usually refers to reports of acuity reduction, field constrictions, or both without any associated organic pathology. Regardless of the underlying cause, the primary concern of the eye care practitioner is to demonstrate visual potential better than suggested by the patient's subjective reports. CASE REPORT: This article presents a case report of a 43-year-old woman with NOVL. The report shows the utility of visual electrodiagnostics in providing an objective assessment of the functional integrity of retinal and afferent visual pathway integrity and highlights how careful case history, subjective testing, observation of visual behavior, and objective testing can be used to establish a diagnosis of NOVL. CONCLUSIONS: The clever use of subjective testing and the careful selection and interpretation of objective tests such as visual electrodiagnostics can be exceptionally useful in making a diagnosis of NOVL.     

The usefulness of frequency doubling technology perimetry in glaucoma screening in health-check program

PURPOSE: Visual field testing has not been used as a screening procedure because it requires too much testing time and manpower. We evaluated the usefulness of Frequency Doubling Technology(FDT) visual field testing as a screening procedure for glaucoma in a health-check screening program. METHODS: A total of 800 eyes of 400 persons were examined for visual acuity, noncontact tonometry, slit-lamp biomicroscopy, funduscopy, and FDT testing of visual fields (N-30-5). The initial screening result was considered positive for glaucoma if any abnormality of FDT perimetry was detected, the intraocular pressure exceeded 21 mmHg, or funduscopy showed glaucomatous disc cupping or retinal nerve fiber layer defect. The re-examination comprised several ophthalmic examinations such as automatic perimetry 9 Humphrey field analyzer). RESULTS: Glaucoma was suspected in 118 eyes; 16 eyes were thus diagnosed after re-examination. FDT detected visual field abnormalities in 15 eyes. There were 40 eyes that were not diagnosed although FDT detected visual field abnormalities. CONCLUSIONS: FDT detected visual field abnormalities in glaucoma patients with high sensitivity and specificity. FDT is a useful screening test for glaucoma.     

Computerized method of visual acuity testing: adaptation of the amblyopia treatment study visual acuity testing protocol

PURPOSE: To report a computerized method for determining visual acuity in children using the Amblyopia Treatment Study visual acuity testing protocol. METHODS: A computerized visual acuity tester was developed that uses a programmed handheld device that uses the Palm operating system (Palm, Inc, Santa Clara, California). The handheld device communicates with a personal computer running a Linux operating system and 17-inch monitor. At a test distance of 3 m, single letters can be displayed from 20/800 to 20/12. A C program on the handheld device runs the Amblyopia Treatment Study visual acuity testing protocol. Using this method, visual acuity was tested in both the right and left eyes, and then the testing was repeated in 156 children age 3 to 7 years at four clinical sites. RESULTS: Test-retest reliability was high (r =.92 and 0.95 for and right and left eyes, respectively), with 88% of right eye retests and 94% of left eye retests within 0.1 logarithm of minimal angle of resolution (logMAR) units of the initial test. The 95% confidence interval for an acuity score was calculated to be the score +/- 0.13 logMAR units. For a change between two acuity scores, the 95% confidence interval was the difference +/- 0.19 logMAR units. CONCLUSIONS: We have developed a computerized method for measurement of visual acuity. Automation of the Amblyopia Treatment Study visual acuity testing protocol is an effective method of testing visual acuity in children 3 to 7 years of age.     

Critical analysis of visual function evaluating techniques in newborn babies

The most widely-used techniques for testing visual function in babies are reviewed. Advantages and limitations of optokinetic nystagmus testing, visual evoked responses and preferential looking techniques are considered. The theoretical basis and the clinical applicability of those techniques are outlined. Other simple methods are considered as well, which allow practicing ophthalmologists to assess the presence or absence of vision in babies. The importance of early diagnosis for prevention and treatment of visual deficits in babies is stressed.     

Glaucoma: the value of a diurnal curve and Goldmann visual field

A 35-year-old man was treated with maximum medical therapy for open-angle glaucoma. A diurnal curve revealed that the pressure was not controlled as might have been thought by a single reading. Reference is also made to the value of Goldmann visual field testing, since in this patient visual field defects were discovered with normal, healthy-appearing optic discs. A careful regimen including precise visual field testing and the plotting of the diurnal curve is most important in evaluating ocular hypertension and glaucoma.     

Influence of amblyopia on high-pass resolution perimetry.

Seventeen subjects with amblyopia due to strabismus and anisometropia were examined using high-pass resolution perimetry. In addition to the standard technique, testing the 5-30 degrees visual field, an optional program testing the central 4 degrees visual field was used. Threshold elevation was confined to the central 4 degrees visual field and strongly correlated with visual acuity, expressed as minimum angle of resolution. Standard high-pass resolution perimetry did not reveal any significant abnormalities in the amblyopic subjects. In conclusion, the technique is useful for the diagnosis of ocular or neurologic disorders also in subjects with a high degree of amblyopia.