Multifocal pupillographic visual field testing in glaucoma

Maddess, Ted; Bedford, Suzanne; Goh, Xin-Lin; James, Andrew

doi:10.1111/j.1442-9071.2009.02107.x

Cited by 46 publications

(76 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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“…This device utilizes dichoptic presentation of temporally and spatially sparse multifocal stimuli at 60 frames/s. 1 (Fig. 1).…”

Section: Multifocal Pupillographic Objective Perimetrymentioning

confidence: 99%

“…1). 1 Subjects fixated a small cross in the center of the viewing field whilst mfPOP stimuli were presented, as concurrent uncorrelated sequences of pulses to each of the test regions, the mean rate being one presentation/4 seconds/ test region. The mean number of stimuli active at any given point in a test was 0.60 (60.68 SD) for 4-minute protocols and 0.60 (60.73 SD) for 8-minute protocols.…”

Section: Multifocal Pupillographic Objective Perimetrymentioning

confidence: 99%

“…2013;54:467-475) DOI:10.1167/iovs.12-10829 W e have recently developed multifocal pupillographic objective perimetry (mfPOP), with which retinotopic loss or dysfunction of the visual system can be mapped through differences in the magnitude or time-course of dynamic pupil responses. [1][2][3][4][5] As well as clinical applications, the ability to measure pupillary sensitivity at many locations in the visual field provides a unique opportunity to explore the processing of visual stimuli that influence pupil responses. Midbrain projecting melanopsin retinal ganglion cells (mRGCs) form the afferent arm of the subcortical pupillary pathway, 6 the vast majority of other classes of RGCs being involved in conveying retinal responses to the thalamus for transmission to the visual cortex and the subsequent processing of a conscious visual percept.…”

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The Pupillary Response to Color and Luminance Variant Multifocal Stimuli

Carle

James²,

Maddess³

2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We are developing multifocal pupillographic objective perimetry (mfPOP) to assess localized changes in function within visual pathways. In this study, we investigate novel mfPOP stimuli designed to target neural components from either or both the sub-cortical pupillary luminance response and the cortically driven color response.METHODS. Pupillary responses of 12 subjects were recorded to eight mfPOP stimulus variants (protocols). Forty-eight visual field test-regions (24/eye) were stimulated concurrently with uncorrelated sequences of either high or low luminancecontrast, luminance-plus color-contrast, or equiluminant colorexchange stimuli. Stimulus pulses were of 50 ms duration and were presented at mean intervals of 4 seconds/region. Test durations were 4 or 8 minutes; therefore, estimated responses were derived from 60 or 120 stimulus presentations to each test region.RESULTS. Pupillary response amplitudes were more influenced by luminance-contrast than the color-contrast of stimuli; response delays, however, were more closely linked to the proportion of color-versus luminance-contrast in each protocol. Significant differences (P < 0.05) in amplitudes but not delays were present between all three high luminancecontrast protocols and a low luminance-contrast luminance protocol, regardless of color content. The reverse pattern was observed between the equiluminant color exchange protocol and this same low luminance-contrast luminance protocol. Only the low luminance-contrast plus color exchange protocol differed significantly from the low luminance-contrast luminance protocol in both measures.CONCLUSIONS. Two protocols, utilizing low and high luminancecontrast plus color exchange, were identified as likely to incorporate both cortical and subcortical response components, and were deemed potential candidates for further investigation in clinical studies. (Invest Ophthalmol Vis Sci.

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“…Die simultane Stimulation beider Augen mit nur 24 Stimuli innerhalb des 30°-Gesichtsfelds lieferte nach dem Vergleich von Pupillenkontraktionsamplituden bei Glaukompatienten und gesunden Probanden einen AUC-Wert von 0,84, womit sich die diagnostische Genauigkeit derjenigen der automatischen Perimetrie annä-hert. Wichtig war auch, dass die Untersuchung nur 4 min dauerte [19]. Eine weitere Studie mit mehreren und kleineren …”

Section: Introductionunclassified

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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Multifocal pupillographic visual field testing in glaucoma

Abstract: The method produced diagnostic accuracy approaching that of automated perimetry, but unlike perimetry provides standard errors for every point in each field as well as information on response delay and efferent defects. Only one pupil needs to function to measure both visual fields.

Cited by 46 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

The Pupillary Response to Color and Luminance Variant Multifocal Stimuli

Aktueller Stand der pupillenbasierten Diagnostik der glaukomatösen Optikusneuropathie

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