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      The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

      , MPH BOptom BSc FAAO 1 , 2 , , PhD BSc 2 , , MOptom PGCertOcTher FAAO 1 , 2 , , MBBS MBiomedE FRANZCO 1 , 3 , , MBBS MBiomedE FRANZCO 1 , 3 , , PhD MScOptom FAAO 1 , 2 ,
      Clinical & Experimental Optometry
      Wiley Publishing Asia Pty Ltd
      Bloch's law, glaucoma, optical coherence tomography, perimetry, psychophysics, Ricco's law, spatial summation, structure‐function, temporal summation, tilted disc syndrome

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          White‐on‐white standard automated perimetry ( SAP) is widely used in clinical and research settings for assessment of contrast sensitivity using incremental light stimuli across the visual field. It is one of the main functional measures of the effect of disease upon the visual system. SAP has evolved over the last 40 years to become an indispensable tool for comprehensive assessment of visual function. In modern clinical practice, a range of objective measurements of ocular structure, such as optical coherence tomography, have also become invaluable additions to the arsenal of the ophthalmic examination. Although structure‐function correlation is a highly desirable determinant of an unambiguous clinical picture for a patient, in practice, clinicians are often faced with discordance of structural and functional results, which presents them with a challenge. The construction principles behind the development of SAP are used to discuss the interpretation of visual fields, as well as the problem of structure‐function discordance. Through illustrative clinical examples, we provide useful insights to assist clinicians in combining a range of clinical results obtained from SAP and from advanced imaging techniques into a coherent picture that can help direct clinical management.

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          Most cited references166

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          Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma.

          Vascular factors may have important roles in the pathophysiology of glaucoma. A practical method for the clinical evaluation of ocular perfusion is needed to improve glaucoma management.
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            Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial.

            Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure, but to our knowledge no placebo-controlled trials have assessed visual function preservation, and the observation periods of previous (unmasked) trials have typically been at least 5 years. We assessed vision preservation in patients given latanoprost compared with those given placebo.
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              Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons.

              To compare the number of retinal ganglion cells (RGCs) topographically mapped with specific visual field threshold test data in the same eyes among glaucoma patients. Seventeen eyes of 13 persons with well-documented glaucoma histories and Humphrey threshold visual field tests (San Leandro, CA) were obtained from eye banks. RGC number was estimated by histologic counts of retinal sections and by counts of remaining axons in the optic nerves. The locations of the retinal samples corresponded to specific test points in the visual field. The data for glaucoma patients were compared with 17 eyes of 17 persons who were group matched for age, had no ocular history, and had normal eyes by histologic examination. The mean RGC loss for the entire retina averaged 10.2%, indicating that many eyes had early glaucoma damage. RGC body loss averaged 35.7% in eyes with corrected pattern SD probability less than 0.5%. When upper to lower retina RGC counts were compared with their corresponding visual field data within each eye, a 5-dB loss in sensitivity was associated with 25% RGC loss. For individual points that were abnormal at a probability less than 0.5%, the mean RGC loss was 29%. In control eyes, the loss of RGCs with age was estimated as 7205 cells per year in persons between 55 and 95 years of age. In optic nerves from glaucoma subjects, smaller axons were significantly more likely to be present than larger axons (R2 = 0.78, P<0.001). At least 25% to 35% RGC loss is associated with statistical abnormalities in automated visual field testing. In addition, these data corroborate previous findings that RGCs with larger diameter axons preferentially die in glaucoma.

                Author and article information

                Clin Exp Optom
                Clin Exp Optom
                Clinical & Experimental Optometry
                Wiley Publishing Asia Pty Ltd (Melbourne )
                22 June 2017
                July 2017
                : 100
                : 4 ( doiID: 10.1111/cxo.2017.100.issue-4 )
                : 313-332
                [ 1 ] Centre for Eye Health The University of New South Wales Kensington New South Wales Australia
                [ 2 ] School of Optometry and Vision Science The University of New South Wales Kensington New South Wales Australia
                [ 3 ] Department of Ophthalmology Prince of Wales Hospital Randwick New South Wales Australia
                Author notes
                © 2017 The Authors. Clinical and Experimental Optometry published by John Wiley & Sons Australia, Ltd on behalf of Optometry Australia.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                : 05 October 2016
                : 31 January 2017
                : 02 February 2017
                Page count
                Figures: 13, Tables: 1, Pages: 20, Words: 13923
                Funded by: PhD scholarship provided by Guide Dogs NSW/ACT and an Australian Postgraduate Award PhD scholarship
                Funded by: National Health and Medical Research Council of Australia
                Award ID: #1033224
                Custom metadata
                July 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.4 mode:remove_FC converted:21.07.2017

                bloch's law,glaucoma,optical coherence tomography,perimetry,psychophysics,ricco's law,spatial summation,structure‐function,temporal summation,tilted disc syndrome


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