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ItemIncreased Depth, Reduced Extent, and Sharpened Edges of Visual Field Defects Measured by Compass Fundus Perimeter Compared to Humphrey Field AnalyzerLiu, P ; Nguyen, BN ; Turpin, A ; McKendrick, AM (ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2021-10-01)PURPOSE: The purpose of this study was to compare visual field results of the COMPASS fundus perimeter (CMP) and the Humphrey Field Analyzer (HFA) in the same eyes; to compare structure-function concordance between circumpapillary retinal nerve fiber layer (Cp-RNFL) profiles and the two perimetry results; and to evaluate whether differences between the two results reflect postulated advantages of real-time eye movement compensation during perimetry. METHODS: We retrospectively analyzed 24-2 visual field data measured with CMP and HFA together with Cp-RNFL optical coherence tomography (OCT) scan data from 95 eyes of 65 people with glaucoma. We defined visual field locations with total deviation (TD) less than -5 dB as defective. The CMP and HFA fields were compared on measures of: spatial extent (number of defective locations); depth (TD values); and sharpness of scotomata edges (maximum TD difference between defective locations and their neighbors). Structure-function concordance between Cp-RNFL profile and respective visual field was also compared. RESULTS: Compared to the HFA, scotomata measured by CMP were of reduced spatial extent (mean difference = -3.14 locations, p < 0.001), greater depth (median TD of CMP = -17 dB versus HFA = -13 dB, p = 0.029) and steeper edges (median of maximum TD difference of CMP = 10.6 dB versus HFA = 6 dB, p < 0.001). Structure-function concordance between Cp-RNFL profile and either visual field were comparable despite the reduced scotoma spatial extent measured by CMP. CONCLUSIONS: Glaucomatous visual fields measured by CMP displayed characteristics consistent with expected effects of using real-time eye movement compensation technology compared to the widely used HFA. TRANSLATIONAL RELEVANCE: Glaucomatous visual field defects measured by the CMP are more localized, deeper, and steeper than those of the HFA.
ItemIncreasing the Spatial Resolution of Visual Field Tests Without Increasing Test Duration: An Evaluation of ARRESTMuthusamy, V ; Turpin, A ; Walland, MJ ; Nguyen, BN ; McKendrick, AM (Association for Research in Vision and Ophthalmology, 2020-12)Purpose: The Australian Reduced Range Extended Spatial Test (ARREST) approach was designed to improve visual field spatial resolution while maintaining a similar test duration to clinically used testing algorithms. ARREST does not completely threshold visual field locations with sensitivity < 17 dB, and uses the presentations saved to test new locations in areas of steep gradient within the visual field. Previous assessments of ARREST's performance have used computer simulation. In this study, we cross-sectionally assessed the performance of ARREST in people with visual field loss. Methods: We tested 23 people with glaucoma (mean age: 71 ± 8 years) with established visual field loss. Three visual field procedures were performed using the Open Perimetry Interface: cZEST and ARREST on the Octopus 900 perimeter (Haag-Streit AG, Switzerland), and a reference standard (best available estimate [BAE]) on the Compass perimeter (CenterVue SpA, Italy). ARREST was compared against the cZEST and the BAE. Results: On average, ARREST added seven new locations (range = 0-15) to a visual field test. There was no significant difference in the number of stimulus presentations between procedures (mean = 259 ± 25 [ARREST] vs. 261 ± 25 [cZEST], P = 0.78). In classifying threshold values < 17 dB, ARREST performed similarly when compared against BAE. Conclusions: This study provides empirical evidence to support conclusions from previous computer simulations that ARREST can be used to increase spatial sampling in regions of interest without increasing test time. Translational Relevance: ARREST is a new approach that augments current visual field testing procedures to provide better spatial description of visual field defects without increasing test duration.
ItemOrientation of the Temporal Nerve Fiber Raphe in Healthy and in Glaucomatous EyesBedggood, P ; Nguyen, B ; Lakkis, G ; Turpin, A ; McKendrick, AM (ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2017-08-01)PURPOSE: To determine the normal variation in orientation of the temporal nerve fiber raphe, and the accuracy with which it may be predicted or approximated in lieu of direct measurement. METHODS: We previously described an algorithm for automatic measurement of raphe orientation from optical coherence tomography, using the intensity of vertically oriented macular cubes. Here this method was applied in 49 healthy participants (age 19-81 years) and 51 participants with primary open angle glaucoma (age 51-80 years). RESULTS: Mean fovea-disc-raphe angle was 173.5° ± 3.2° (range = 166°-182°) and 174.2° ± 3.4° (range = 166°-184°) in healthy and glaucoma patients, respectively. Differences between groups were not significant. Fovea-disc-raphe angle was not correlated with age or axial length (P > 0.4), showed some symmetry between eyes in glaucoma (R2 = 0.31, P < 0.001), and little symmetry in the healthy group (P = 0.06). Fovea-disc angle was correlated with fovea-raphe angle (R2 = 0.27, P = 0.0001), but was not a good predictor for raphe orientation (average error = 6.8°). The horizontal axis was a better predictor (average error = 3.2°; maximum error = 9.6°), but still gave approximately twice the error previously reported for direct measurement from macular cubes. CONCLUSIONS: There is substantial natural variation in temporal nerve fiber raphe orientation, which cannot be predicted from age, axial length, relative geometry of the disc and fovea, or the contralateral eye. For applications to which the orientation of the raphe is considered important, it should be measured directly.