High-Resolution Multifocal Pupillographic Objective Perimetry in Glaucoma

Carle, Corinne F.; James, Andrew; Kolic, Maria; Loh, Yik-Wen; Maddess, Ted

doi:10.1167/iovs.10-5737

Cited by 36 publications

(58 citation statements)

References 39 publications

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“…However, a more advanced device that would readily allow for such testing is in development, and extensive testing on prototypes has been published. 48,49 Once available, such testing methods may help better define actual functional visual disability and more accurately reflect the functional efficacy of current ocular and future CNS-oriented therapeutic approaches, even in patients with relatively mild disease.…”

Section: Discussionmentioning

confidence: 99%

Refined Frequency Doubling Perimetry Analysis Reaffirms Central Nervous System Control of Chronic Glaucomatous Neurodegeneration

Reilly

Villarreal

Maddess

et al. 2015

Trans. Vis. Sci. Tech.

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Citation: Reilly MA, Villarreal A, Maddess T, Sponsel WE. Refined frequency doubling perimetry analysis reaffirms central nervous system control of chronic glaucomatous neurodegeneration. Trans Vis Sci Tech. 2015;4(3):7, doi:10.1167/tvst.4. 3.7 Purpose: Refined analysis of frequency doubling perimetric data was performed to assess binocular visual field conservation in patients with comparable degrees of bilateral glaucomatous damage, to determine whether unilateral visual field loss is random, anatomically symmetric, or non-random in relation to the fellow eye.Methods: Case control study of 41 consecutive patients with bilaterally mild to severe glaucoma; each right eye visual field locus was paired with randomly-selected coisopteric left eye loci, performing 690,000 (10,000 complete sets of 69 loci) such iterations per subject. The potential role of anatomic symmetry in bilateral visual field conservation was also assessed by pairing mirror-image loci of the right-and left-eye fields. The mean values of the random co-isopteric and the symmetric mirror pairings were compared with natural point-for-point pairings of the two eyes by paired t-test.Results: Mean unilateral Matrix threshold across the entire 30-degree visual field were 17.0 dB left and 18.4 dB right (average 17.7). The better of the naturally paired concomitant loci yielded binocular equivalent mean bilateral Matrix threshold of 20.9 dB, 1.6 dB higher than the population mean of the 690,000 coisopteric pairings (t ¼ À10.4; P , 10 À12 ). Thus, a remarkable natural tendency for conservation of the binocular Matrix visual field was confirmed, far stronger than explicable by random chance. Symmetric pairings of precise mirror-image loci also produced values higher than random co-isopteric pairings (D 1.1 dB; t ¼ À4.0; P ¼ 0.0004).Conclusions: Refined data analysis of paired Matrix visual fields confirms the existence of a natural optimization of binocular visual function in severe bilateral glaucoma via interlocking fields that could only be created by CNS involvement. The disparity of paired Matrix threshold values at mirror-image loci was also highly nonrandom and quantitatively inverse from the expected if anatomic symmetry factors were merely passively contributing systematically to the compensatory binocular Matrix effect.Translational Relevance: The paired eyes and brain are reaffirmed to function as a unified system in the progressive age-related neurodegenerative condition chronic open angle glaucoma, maximizing the binocular visual field. Given the extensive homology of this disorder with other age-related neurodegenerations, it is reasonable to assume that the brain will similarly resist simultaneous bilateral loss of paired functional zones in both hemispheres in diseases like Alzheimer's and Parkinson's disease. Glaucomatous eyes at all stages of the disease appear to provide a highly accessible paired-organ study model for developing therapeutics to optimize conservation of function in neurodegenerative disorders.

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Section: Discussionmentioning

confidence: 99%

Refined Frequency Doubling Perimetry Analysis Reaffirms Central Nervous System Control of Chronic Glaucomatous Neurodegeneration

Reilly

Villarreal

Maddess

et al. 2015

Trans. Vis. Sci. Tech.

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“…Individual stimuli were presented for 33 ms. For these transient stimuli, the response amplitudes are related to the stimulus luminance and the mean interval between presentations. 15,16,[21][22][23] The mean intervals between presentation of stimuli at one location were 0.25, 1 and 4 s ( Table 3) making four different stimulus protocols. The protocol names reflect the differing features of the number of regions/field and the mean presentation interval per region in seconds.…”

Section: Stimulimentioning

confidence: 99%

“…This group has been investigating mfPOP methods combining concurrent independent assessment of both visual fields and sparse stimulation, 13 providing recording times of 2 to 3 min/eye. Those methods have been demonstrated to have diagnostic value in glaucoma, [14][15][16] early-stage diabetic retinopathy, 17 and age-related macular degeneration. [18][19][20] Aside from the 60 degree-wide stimuli used in most of those studies, mfPOP stimuli for the central retina have also been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

“…14,16 More recently a 40-region/field mfPOP variant provided improved diagnostic performance in glaucoma. 15 Like SAP stimuli, the 40-region stimuli had large gaps between them, which can contribute to TRV, 8 and at the very least not test considerable parts of the visual field. The current study compared variants of our original 24-region stimuli with stimuli that have 44 test regions/field that cover the visual field well.…”

Section: Introductionmentioning

confidence: 99%

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High‐ versus low‐density multifocal pupillographic objective perimetry in glaucoma

Maddess

Essex

Kolic

et al. 2013

Clinical Exper Ophthalmology

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“…Der Test ist kurz, wenig belastend und nur gering von einer Fehlrefraktion oder einer Linsentrübung abhängig[3]. Die bisherigen Ergebnisse ermutigen zur Weiterentwicklung dieser Methode (u. a. Normwertdefinition, Feinabstimmung von Stimuluseigenschaften).…”

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Aktueller Stand der pupillenbasierten Diagnostik der glaukomatösen Optikusneuropathie

Skorkovská¹,

Schiefer

Wilhelm

et al. 2012

Ophthalmologe

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There are considerable differences between pupillary reactions to light in glaucoma patients and healthy subjects which can be identified by various techniques. These methods are based on the early asymmetry of the afferent conduction in the visual pathway, on the examination of the visual field by focal light stimuli or on visual stimuli in analogy with multifocal electrophysiological tests. Latest findings in pupillary research also suggest a possible use of the intrinsically photosensitive (melanopsin expressing) retinal ganglion cells in glaucoma diagnostics. The current results of pupillary experiments in glaucoma patients are encouraging for further research in this field because suitable objective screening methods for glaucoma are continually being sought.

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High-Resolution Multifocal Pupillographic Objective Perimetry in Glaucoma

Cited by 36 publications

References 39 publications

Refined Frequency Doubling Perimetry Analysis Reaffirms Central Nervous System Control of Chronic Glaucomatous Neurodegeneration

Refined Frequency Doubling Perimetry Analysis Reaffirms Central Nervous System Control of Chronic Glaucomatous Neurodegeneration

High‐ versus low‐density multifocal pupillographic objective perimetry in glaucoma

Aktueller Stand der pupillenbasierten Diagnostik der glaukomatösen Optikusneuropathie

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