Age-dependent changes in visual sensitivity induced by moving fixation points in adduction and abduction using imo perimetry

Abstract

Visual field (VF) testing has usually been performed with the central gaze as a fixed point. Recent publications indicated optic nerve head deformations induced by optic nerve traction force can promote the progression of optic neuropathies, including glaucoma. We generated a new static test protocol that adds 6° adduction and abduction to gaze position (fixation points) movement. The aim of this study was to investigate both whether quantifying VF sensitivities at lateral horizontal gaze positions is feasible and whether horizontal gaze positions change sensitivities differently in subjects of different ages. Healthy adult eyes from 29 younger (≤ 45 years) and 28 elderly (> 45 years) eyes were examined in this cross-sectional study. After VF testing with central gaze as a fixation point using 24 plus (1) imo static perimetry, subjects underwent VF testing with 6° adduction and 6° abduction as fixation points. The average mean sensitivities with central gaze, adduction, and abduction were 29.9 ± 1.0, 29.9 ± 1.3, and 30.0 ± 1.2 decibels (dB) in younger subjects and 27.7 ± 1.2, 27.5 ± 1.7, and 28.1 ± 1.3 dB in elderly subjects, respectively. Visual sensitivity in young healthy subjects was similar among the three fixation points, whereas visual sensitivity in elderly healthy subjects was significantly better with abduction as a fixation point than with central gaze and adduction (both p < 0.05). We expect this test protocol to contribute to our understanding of visual function during horizontal eye gaze movement in various eye diseases.

A Novel Visual Field Screening Program for Glaucoma With a Head-Mounted Perimeter

“…Glaucoma diagnoses were performed as previously described,7,15,19 and the presence of glaucomatous optic neuropathy and VFDs consistent with optic changes was evaluated. Glaucomatous optic neuropathy was diagnosed when (1) the vertical cup-to-disc ratio of the optic nerve head was ≥0.7, (2) the rim-to-disc ratio at the superior portion (11–1 o’clock positions) or inferior portion (5–7 o’clock positions) was ≤0.1, (3) the difference in the vertical cup-to-disc ratio between eyes was ≥0.2, or (4) an retinal nerve fiber layer defect was found 15,20. Visual field sensitivity was measured using the 30-2 or 24-2 Swedish Interactive Thresholding Algorithm standard program (SITA-standard) with the Humphrey Visual Field Analyzer (HFA; Carl Zeiss Meditec Dublin, CA).…”

“…Glaucomatous optic neuropathy was diagnosed when (1) the vertical cup-to-disc ratio of the optic nerve head was ≥ 0.7, (2) the rim-to-disc ratio at the superior portion (11-1 o'clock positions) or inferior portion (5-7 o'clock positions) was ≤ 0.1, (3) the difference in the vertical cup-to-disc ratio between eyes was ≥ 0.2, or (4) an retinal nerve fiber layer defect was found. 15,20 Visual field sensitivity was measured using the 30-2 or 24-2 Swedish Interactive Thresholding Algorithm standard program (SITA-standard) with the Humphrey Visual Field Analyzer (HFA; Carl Zeiss Meditec Dublin, CA). On the basis of the Anderson-Patella criteria, a glaucomatous VFD was diagnosed when (1) the glaucoma hemifield test results were outside normal limits; (2) pattern deviation probability plots in the upper or lower hemifield showed a cluster of three or more non-edge contiguous points with a sensitivity of <5%, of which at least one point had a probability of <1%; or (3) a pattern standard deviation outside the 95% normal confidence limits was noted.…”

“…For developing the new VFSP, we chose 28 test points based on the existing 24 test points, and one program consisting of 36 inspection points as previously reported. 20 We excluded 6 outermost part points and 2 points above or below the Mariotte blind spot on the original temporal side point, and then decreased the number of test points from 36 to 28 (Fig. 1).…”