Ординатура / Офтальмология / Английские материалы / Visual Fields Examination and Interpretation_Walsh_2011

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B

Figure 4-19. (Continued)

4-6-1-4 Ring Perimetry. High-pass resolution perimetry uses circular targets of varying sizes that consist of a white center with a dark annular margin presented on a white background to selectively stimulate parvocellular ganglion cells (Figure 4-22). The test is rapid, has been well received by patients, and is comparable in sensitivity to conventional perimetry for glaucoma diagnosis. Longitudinal data regarding disease progression are presently lacking.49–51

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B

Figure 4-20. (Continued)

color monitors if background conditions and luminance can be standardized; the test would be useful for large-scale population screening. Longitudinal data are currently lacking.57

4-6-2 Altered Strategies. Several areas of research currently under way retain the conventional white-on-white stimulus but attempt to increase the efficiency of stimulus presentation. One technique uses posterior probability estimation with a

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A

Figure 4-21. Humphrey Matrix 24-2 (A) demonstrates confluent central and paracentral field loss. Follow-up testing with SITA Standard white-on-white perimetry (B) provides greater detail of the visual field defects.

priori knowledge about normal and abnormal fields to determine the appropriate next stimulus intensity.58 An additional advantage of this technique is the ability to determine false-positive and false-negative answers from the actual threshold process.59

4-6-3 Interpretive Aids. A final active area of research uses conventional stimuli and presentation strategies but expands the statistical manipulation of the raw data. Examples include using neural networks that have been trained to recognize visual field abnormality or progression.60,61 Another recent advance suggests comparing mean deviation slope over time with the general height index (currently not an available index) over time to differentiate progressive cataract formation from

172 Visual Fields

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B

Figure 4-21. (Continued)

progressive glaucoma.62 Pointwise regression analysis of serial fields has been described by Fitzke and colleagues (Program Progressor)63,64 and Weber and Krieglstein (Graphical Analysis of Topographical Trends).65 These techniques identify both location and statistical significance as well as rate of change. Spatial filtering technique and cluster analysis also attempt to minimize the influence of LTF and improve the sensitivity for detecting scotomas or their progression.66

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Figure 4-22. High pass resolution perimetry uses progressively smaller circular targets to rapidly and reliably identify field defects.

REFERENCES

1.Anderson DR. Collaborative normal tension glaucoma study. Curr Opin Ophthalmol. 2003;14:86–90.

2.Varma R, et al, Los Angeles Latino Eye Study Group. Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111:1439–1448.

3.Hart WM Jr, Becker B. The onset and evolution of glaucomatous visual field defects. Ophthalmology. 1982;89:268–279.

4.Heijl A, Lundqvist L. The frequency distribution of earliest glaucomatous visual field defects documented by automatic perimetry. Acta Ophthalmol. 1984;62:658–664.

5.Phelps CD, Hayreh SS, Montague PR. Visual fields in low-tension glaucoma, primary open angle glaucoma, and anterior ischemic optic neuropathy. In: Greve EL, Heijl A, eds. Fifth International Visual Field Symposium. Dordrecht: Dr WJ Junk; 1983: 113–124.

6.Koseki N, Araie M, Suzuki Y, et al. Visual field damage proximal to fixation in normaland high-tension glaucoma eyes. Jpn J Ophthalmol. 1995;39:274–283.

7.Araie M. Pattern of visual field defects in normal-tension and high-tension glaucoma.

Curr Opin Ophthalmol. 1995;6:36–45.

8.Drance SM, Douglas GR, Airaksinen PJ, et al. Diffuse visual field loss in chronic openangle and low-tension glaucoma. Am J Ophthalmol. 1987;104:577–580.

9.Heijl A. Lack of diffuse loss of differential light sensitivity in early glaucoma. Acta Ophthalmol. 1989;67:353–360.

10.Langerhorst CT, van den Berg TJ, Greve EL. Is there general reduction of sensitivity in glaucoma? Int Ophthalmol, 1989;13:31–35.