Meridian photopic and mesopic color perimetry in normal, young and presbyopic subjects

The authors report their results of static color perimetry performed with the Harms perimeter. Photopic testing was performed among 10 young normal subjects and then with 10 presbyopes with otherwise unremarkable ocular examinations. Mesopic testing was done with 9 young subjects. Three thresholds of perception were stated: achromatic, minimally colored, and chromatic. Using photopic testing, red perception was far more sensitive in central vision, and the inverse was found in peripheral vision. Tritanomaly exists in the fovea, and at 15 degrees nasal to the fovea, the 3 color curves cross. In presbyopia, age is responsible for decreased sensation of red and green compared to white, and, all color perception disappears beyond the blind spot. The decrease in sensitivity for blue is even more significant realising a foveal tritanopia. At a lower luminance level, mesopic testing revealed an achromatic threshold for green and blue with central lowering of sensitivity. Deductions are made concerning the anatomo-physiologic mechanisms involved.     

Video color perimetry: impairment in glaucoma suspects

Purpose: To detect mild visual field impairment in asymptomatic glaucoma suspect patients. Methods: Color perception within the visual field was tested with customized color video perimetry. The key features of the system were stimuli color desaturation, low-level luminance and equiluminant gray background. Twenty patients with asymptomatic glaucoma were tested and compared with a group of age-matched control subjects. Results: Automated perimetry test findings differed significantly in the two groups, particularly for short-wavelength sensitivity (blue). The severity of color impairment correlated directly with intraocular pressure. Conclusion: Desaturated low-luminance video perimetry will reliably detect and quantify asymptomatic visual field defects. A previous work on multiple sclerosis has detected a mild long-wavelength (red) impairment in asymptomatic patients after an episode of optic neuritis, even in clinically unaffected fellow eyes. Our findings in glaucoma suspect patients indicate that a mild blue impairment could be the initial sign of this disease.     

早期原发性青光眼的蓝黄视野及黄斑阈值视野检测

目的 探讨蓝黄视野及黄斑阈值视野检测在早期原发性青光眼诊断中的应用价值。 方法 采用Humphrey II 750型自动视野计，对正常人60例60只眼、早期原发性青光眼患者63 例63只眼进行标准视野（white-on-white perimetry, W/W）、蓝黄视野（blue-on-yellow perimetry, B/Y）及黄斑阈值视野（macular threshold perimetry, MTP）检查,计算比较3 种检测方法在早期原发性青光眼诊断中的敏感度及特异度，并采用B/Y及MTP并联及串联实验进行分析。 结果 比较正常组与早期原发性青光眼组W/W、B/Y、MTP的平均光敏感度，差异均有显著性的意义［t=-3.01, P=0.0054 (W/W)；t=-2.95, P=0.0063 (B/Y)；t=-2.59,P=0.0150 (MTP)］。在早期原发性青光眼诊断中，MTP的敏感度最高（83%），B/Y次之（65%），W/W最低（48%）。将B/Y与MTP联合运用时，并联试验可使敏感度提高到94%；串联试验可使特异度提高到87%。 结论 在早期原发性青光眼诊断中，B/Y、MTP及两者的联合应用均可提高诊断的敏感度与特异度，有一定的应用价值。 （中华眼底病杂志，2003，19：102-105）     

蓝/黄视野计与标准白色视野计检测早期青光眼的敏感性比较

目的　探讨蓝 /黄视野计 (blue on yellowperimetry ,B/Y)又称短波视野计 (short wavelengthperimetry)及自动标准白色视野计 (white on whiteperimetry ,W/W)检测早期青光眼的敏感性。方法　采用自行改装的德国Twinfield视野计 ,对 36例 (46只眼 )早期原发性开角型青光眼患者及 38例对照组正常人 (46只眼 )进行B/Y及W/W检测 ,两组的年龄及性别相匹配。视野检查采用 2 4 2程序 ,将中心 2 5°内全视网膜光敏感度均值及各象限光敏感度均值 (dB值 )进行组间比较和分析。结果　两种视野计检测正常人 ,B/Y较W/W检测全视网膜光敏感度均值低 ,差异有显著意义 (t=3 57,P <0 0 0 1 ) ,但两者仅相差 1 63dB ;两种视野计检测的各对应象限间视网膜光敏感度均值比较 ,差异均有显著意义 (t=3 45 ,P <0 0 0 1 ) ,W/W检测的各象限视网膜光敏感度均值 >与之相对应象限的B/Y检测结果。两种视野计检测早期青光眼 ,全视网膜光敏感度均值差为 2 87dB ,差异有显著意义 (t=4 57,P <0 0 0 1 ) ;各对应象限间视网膜光敏感度均值差 >2 5dB ,差异有显著意义 (t=3 42 ,P <0 0 0 1 ) ;光敏感度均值依次为鼻下 >颞下 >鼻上 >颞上 ;以B/Y检测出的视野缺损面积大且深。按视岛 (islandofvision)矫正的偏差图 (correcteddeviation)     

视野检查在青光眼早期诊断中的应用

视野检查作为视功能检测的一种方法，在青光眼的诊断、指导治疗、追踪随访中占有重要地位。近些年来一些具有较高敏感性和特异性的新型视野检测方法如蓝黄视野和黄斑阈值视野等为早期诊断及密切观测青光眼的发展提供了重要信息，提高了青光眼早期诊断水平。对近年几种新型视野检测在早期青光眼诊断中的应用近况作一介绍。     

黄斑阈值检测在早期青光眼诊断中的应用

目的　通过对早期青光眼组和正常对照组进行标准视野 ( white- on- white perim etry,W/ W )、黄斑阈值检测( macular threshold perim etry,MTP) ,探讨黄斑阈值检测在青光眼早期诊断中的应用价值。方法　采用 Hum phrey II-75 0型自动视野计 ,对正常组 6 0例 6 0眼 ,早期原发性青光眼组 6 3例 6 3眼进行 W/ W与 MTP,并对 2种视野检查结果进行比较分析。结果　 ( 1)正常人 W/ W平均光敏感度 ( m eansensibility,MS)为 ( 2 8.2 2± 1.38) d B;MTP的 MS为 ( 31.84± 1.91) d B,二者 MS差别具有统计学意义 ( P<0 .0 1)。正常人 W/ W及 MTP上下方无缺损点。 W/ W与年龄无明显相关性 ( P=0 .12 ) ;MTP与年龄呈负相关性 ( P=0 .0 44 ) ;( 2 )早期青光眼组的 W/ W的 MS为 ( 2 6 .43± 2 .81) d B;MTP的MS为 ( 30 .44± 2 .10 ) d B。 2种方法 MS之间差别有显著性( P<0 .0 1)。 W/ W及 MTP缺损点数上方多于下方 ,之间的差别无显著性 ( P>0 .0 5 )。早期青光眼组中 W/ W及 MTP的 MS均与年龄相关 ( P<0 .0 1) ;( 3)正常组与早期青光眼组的 W/ W与 MTP的 MS差别具有统计学意义 ( P <0 .0 5 )。结论　 MTP与 W/ W正常人及早期青光眼均有较好相符性 ;MTP在早期青光眼即引起其光敏感度下降 ,是早期青光眼诊断敏感性较     

Discriminating ability of Humphrey matrix perimetry in early glaucoma patients

PURPOSE: To determine the discriminating ability of some parameters provided by Humphrey Matrix perimetry for early glaucoma detection. METHODS: A prospective cross-sectional study was performed. Sixty-five primary open-angle glaucoma patients with early-stage visual field defects on standard automated perimetry (mean deviation = -1.98 +/- 1.93 dB) and 56 healthy subjects were included. All subjects performed the Humphrey Matrix perimetry with a threshold 30-2 strategy. The receiver operating characteristic (ROC) curve was constructed for each parameter and calculated the area under the ROC curve (AUC) to seek the best discriminating parameter for early glaucoma detection. RESULTS: The AUCs of Humphrey Matrix perimetry with the mean deviation, pattern standard deviation, Glaucoma Hemifield Test, number of points that have a p < 5% in pattern deviation plot (PDP) and number of points that have a p < 1% in PDP were 0.795, 0.808, 0.689, 0.985 and 0.946, respectively. CONCLUSION: Humphrey Matrix perimetry allowed accurate discrimination between normal and early glaucomatous eyes. The number of points that had a p < 5% in PDP was the best discriminating parameter for early glaucoma detection using Humphrey Matrix perimetry.     

Objective perimetry in glaucoma

PURPOSE: Objective perimetry in glaucoma is described using the multifocal pattern visually evoked potential (VEP). A multichannel recording technique was used to improve signal detection in healthy volunteers and assess its ability to detect glaucoma and early changes in patients with suspected glaucoma. DESIGN: Prospective, case-control study. PARTICIPANTS: Thirty healthy volunteers, 30 patients with suspected glaucoma, and 30 patients with glaucomatous visual field defects were tested. METHOD: The VEP was recorded using cortically scaled, multifocal, pseudorandomly alternated pattern stimuli with the VERIS system (Electro-Diagnostic Imaging, Inc., San Francisco, CA). An array of four bipolar occipital electrodes provided four differently oriented channels for simultaneous recording. Signals were compared for different locations within the field up to 26 degrees of eccentricity. Healthy volunteers, patients with suspected glaucoma, and glaucoma patients with established visual field defects were tested, and results were compared with Humphrey visual fields (Humphrey Systems, Dublin, CA) performed on the same day. For reproducibility, five healthy volunteers were each tested on four separate days. The patients with suspected glaucoma and the established glaucoma patients were analyzed for intereye asymmetry of signals, and these data were compared with the asymmetry values of the healthy volunteers. RESULTS: Multiple recording channels significantly enhanced the recording of signals from parts of the visual field not reliably sampled with a single channel technique in all healthy volunteers, particularly along the horizontal meridian (P: < 0.001). Signal amplitude did not decline with age in healthy volunteers. Recordings showed good reproducibility within individuals. In all 30 glaucoma patients, the Humphrey visual field defects were well demonstrated by the VEP, and topographic location was strongly correlated (r(s) = 0.79). Despite large interindividual variations in amplitude, scotomas were well demonstrated when compared with normal values. In the patients with suspected glaucoma, smaller changes in signal amplitude could be identified in parts of the field still normal on perimetry using intereye asymmetry analysis. CONCLUSIONS: The multifocal, multichannel VEP can objectively detect glaucomatous visual field defects. The nasal step region can be more reliably tested using multiple channels. Asymmetry analysis has the potential to detect early defects. This technique represents a significant step toward the clinical application of objective perimetry in glaucoma.     

Pattern-reversal electroretinograms and high-pass resolution perimetry in suspected or early glaucoma

Twenty-one patients, age 28 to 78 years, with elevated intraocular pressure (IOP) in one or both eyes, were examined with pattern-reversal electroretinograms (PERG), high-pass resolution perimetry (HRP), and conventional computer-assisted perimetry (CAP). Among the 42 eyes, 33 were hypertensive (IOP greater than or equal to 22 mmHg) and nine were normotensive (IOP less than or equal to 20 mmHg). The optic disc was judged abnormal in 14 of the hypertensive and one of the normotensive eyes. Fourteen abnormal PERGs and 19 abnormal HRPs were observed in the 33 hypertensive eyes. Conventional CAP gave abnormal results in three of the hypertensive eyes. Seven of the nine normotensive eyes were normal in all examinations. HRP was abnormal in one of the normotensive eyes and conventional CAP was abnormal in another. Thus, PERG and HRP showed a high incidence of optic nerve dysfunction in suspected or early glaucoma. These new methods should be clinically useful for diagnosis and management of conditions with increased IOP.     

蓝色视野检测早期青光眼的临床研究

目的 探讨蓝色(蓝/白)视野检测早期青光眼的敏感性.方法 采用美国HumphreyⅡ-740型全自动视野计,对32例(32只眼)早期青光眼患者(其中早期原发性开角型青光眼患者16例(16只眼),早期原发性慢性闭角型青光眼患者16例(16只眼)及38例(38只眼)正常对照组进行蓝色(蓝/白)及白色(白/白)视野检测,两组的年龄及性别相匹配.视野检查采用全阈值C-30-2程序,将中心30°内全视网膜光敏感度均值及各象限光敏感度均值(dB值)进行组间比较和分析.结果 两种视野检测方法检测正常人,蓝色视野比白色视野全视网膜光敏感度均值低,差异有显著意义(t=43.46,P<0.001);白色视野检测各点的视网膜光敏感度均值>蓝色视野检测的各对应点,差异有非常显著意义(t=74.642,P<0.001).两种视野检测方法检测早期青光眼,白色视野检测全视网膜光敏感度均值(23.71±4.05)dB;蓝色视野检测全视网膜光敏感度均值(14.16±4.55)dB,较白色视野检测值低,差异有显著意义(t=15.81,P<0.001).两种检测结果有明显相关性(r=0.678,P<0.001).32只眼中,蓝色视野检测异常者29只眼,阳性率84%(27/32);白色视野检测异常者25只眼,阳性率63%(20/32);两种视野计检测的阳性率比较,差异有显著意义(x2=3.864,P=0.049).结论 蓝色与白色视野检测结果有良好的符合性.检测早期青光眼性视野改变,蓝色较白色敏感,表现为早期青光眼的检出率高.