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Perimetry Update 2000/2001

edited by: M. Wall & R.P. Millam

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Publication details: Book. 2001. xii and 426 pages. Publication date: 2001-08-30. 145 figures and 54 tables. Hardbound. 16x24 cm (6.3x9.4 in).

ISBN: 978-90-6299-187-7 (ISBN 10: 90-6299-187-4; Kugler Publications)
This publication is part of the International Perimetric Society series




By: Stephen Drance
Vancouver, BC, Canada

Thank you for inviting me to Halifax. It is lovely to be here again; in fact, at my stage in life, it is nice to be anywhere! The choice of the topic 'Is there a future for perimetry?' came from the IPS Board and not from me. I presume I was asked to do this assignment because, apart from speculation, the only guide to the future is through the past. Unfortunately, history is often ignored, and one of my teachers used to say that experience is the ability of the human to make the same mistakes over and over again!

The notion of the visual field has been discussed since the days of Ptolemy in the second century A.D., and probably since the days of Euclid in the third century B.C. Clinically, hemianoptic field defects were recognized by Hippocrates, but the more modern times started with plotting of the blind spot by Mariotte in 1666, while the first exact measurements were carried out by Thomas Young some 200 years ago. It was the work of Von Graefe in 1856 that clinically introduced diagnostic perimetry, followed by Förster's development of the perimeter, Bjerrum's return to campimetry, and Traquair's introduction of quantitative perimetry. These were all milestones in the development of the art of the visual field examination as we know it today. I always omit to mention Hans Goldmann in describing the evolutionary advances, but his perimeter, the concept of examining the entire visual field, and the advance in the quantitative relationships of target size and its brightness, were also fundamental.

We should remind ourselves that the visual field examination was used, not so long ago, by neurologists and neurosurgeons to help localize intracranial pathology; to identify, localize, and follow pituitary disease, often at an early stage; to elucidate the many perimetric consequences of strokes; and to recognize and follow optic nerve
isease, particularly optic and retrobulbar neuritis. But, above all, perimetry has been used to identify the damage of glaucoma and, of course, to follow its progression. It was in this disease that the development of static perimetry found its greatest application, since the finding of small scotomas in parts of the hill of visions that have a shallow slope was not easy, except on a huge tangent screen, which was impractical for most settings. As a result of static testing, computerized methods of examination were introduced which have made it more possible for most patients, in the developed world, to receive quality visual field examinations. However, we should not forget that, with skilled technicians, kinetic perimetry produced excellent results, and to this day, possibly 20% of patients, particularly those with great field loss, do better as a result of good interaction with a technician performing kinetic perimetry.

The IPS was born some time after Sloan initiated the notion of static perimetry and at the time when manual static perimetry was introduced into clinical practice by Harms and Aulhorn after they had built, with the Oculus Company, the first clinically usable static perimeter.

Let us look for a moment at what has happened in our lifetime to the examination of the visual field. As we went from examination of central and paracentral scotomas to concentrating on the periphery of the visual field, our notions, particularly in glau-coma, as to what constituted the earliest signs of damage in the disease fluctuated. So did our continuing discussion as to whether perimetry or optic nerve head observation was the best way to recognize the disease early. As ophthalmoscopy, stereoscopy with magnification and photography, improved, ever more subtle disc abnormalities could be detected, and this allowed earlier recognition of disease. Similarly, the introduction of static perimetry, flicker perimetry, SWAP, FDP, and the examination of other psychophysical phenomena and other refinements has also provoked the question of what constitutes the most subtle and, hopefully, earliest signs of damage.

However, the great advances in imaging of the central nervous system have also greatly influenced the place of perimetry as a diagnostic tool. The bitemporal defects of pituitary tumors, which were an essential part of the neurological evaluation, have given way to the accurate hormonal measurements that, with or without the CT scan, make the search for bitemporal defects quite superfluous. MRI allows the accurate location of intracranial tumors, and even very small strokes. Again, this has greatly decreased the perimetric requirements in those areas of medicine. Most perimetry, at this time, is related to the recognition and progression of glaucoma and some of the other optic nerve diseases. Therefore, we have witnessed a decline in diagnostic or localizing perimetry in neurology and neurosurgery.

In the glaucomas, it is not only conceivable but also very likely that the mapping of gene abnormalities, not only for elevated intraocular pressure but also for many of the other risk factors and their interactions with intraocular pressure and each other, will be greatly improved. Many risk factors have still not even been established at this time. Their recognition and genetic characterization may also have serious implications for diagnostic perimetry, depending on practicality, costs, and the identification of all those risk factors. When we add to this the non-invasive ability to receive signals from sick ganglion cells in vivo, which is probably closer than we all think, the need for our perimetric searches for early abnormality may indeed become redundant or less important. The advances in imaging of the optic nerve and retina, which are still fairly primitive compared to what will evolve in the future, may again change some of the requirements for perimetric services.

It is in the follow-up of glaucoma that perimetry is most likely to retain a more secure footing. In the later stages of the disease, it is our only reliable guide to the course of the disease. We still have a long way to go before being able to define a robust, yet sensitive way of dealing with the recognition of what constitutes clinical change. We will undoubtedly reduce the variance of our examination by more objective perimetry, which is already creating interest. We have the additional challenge of understanding what the significance of such changes in the visual field means for the individual's future quality of vision and life and, therefore, how best to treat the disease. It is in this area and in the functional assessment of the visual capability of our patients that some form of perimetry will always have a place. It might, however, be imaged very differently from the way it is currently done. However, we have to be aware that, even in this area, the recognition of sick ganglion cells in vivo might become more sensitive in detecting the adequacy of therapy, but that is further along the pathway into the future. My prediction is that we will see great changes in perimetric requirements and, of course, methodology. We would be wise to adapt, as opposed to resist, such change.

As I have been collecting my thoughts in order to reflect on the future of perimetry,
I was reminded of how closely connected I have been with perimetry over the last 40 years, how the changes taking place are clearly so much more rapid all the time, and how privileged I feel to have been able to work in this field, to make so many friends, and to influence so many of them, for better or for worse. I also realize that all my musing can only be of a personal nature and that major changes, as yet unforeseen, may - and almost certainly will - make these thoughts grotesquely naive. For this, I wish to apologize in advance. Nevertheless, I want to thank you for making me think again. Thank you for honoring me and forcing me to acknowledge that I may have been fortunate to live in perimetry's possibly fleeting Golden Era, and, finally, for reminding me and all of us that, for everything, there is a season. Above all, I value the many friendships Betty and I were able to forge as a result of this unusual society called IPS, whose very existence has often been seriously questioned and whose continuing success may, in fact, come from our social interactions every two years, in addition to the science on which it was based.
Table of Contents

Table of Contents


IPS lecture

Is there a future for perimetry?
S. Drance

Objective measures

Does the multifocal electroretinogram provide a topographic, objective measure of ganglion cell function in glaucoma?
B. Fortune, C.A. Johnson and G.A. Cioffi

Comparison of threshold and multifocal-visual evoked potential perimetry in recovered optic neuritis
R. Kardon, S. Givre, M. Wall and D. Hood

Retinal thickness measurements in chronic glaucoma and ocular hypertension
P. Brusini, C. Tosoni and F. Miani

Image processing of scanning laser tomography images to determine retinal thickness
N. Hutchings, J.G. Flanagan, C. Hudson, X. He and T.J. Holmes

The relationship between retinal nerve fiber layer thickness and static visual fields in glaucoma
R. Asaoka, M. Osako, K. Tachibana, T. Okano and M. Usui

Perimetry methods and applications

The effectiveness of detecting early glaucomatous field defects using the size I stimulus
K. Yamada, M. Osako, S. Osako, T. Okan and M. Usui

The intrinsic noise of contrast sensitivity perimetry
R.S. Harwerth and E.L. Smith, III

Influence of refractive correction on the peripheral visual field in static perimetry. Preliminary results
G. Koller, A. Haas, M. Zulauf, F. Koerner and D. Mojon

Modeling the hill of vision
R. Schwabe, R. Vonthein, N. Ata, J. Paetzold, T.J. Dietrich and U. Schiefer

Student's visual field map
L. Frisén

New ideas

Is detection and resolution acuity of the short-wavelength-sensitive system sampling-limited in foveal and peripheral vision?
S. Demirel, R.S. Anderson and M. Zlatkova

An experimental automatic perimeter that displays the fundus images on a monitor
T. Sawada, T. Murata, Y. Nishida and K. Kani

Optimum number of stimulus oscillations for motion displacement detection in glaucoma
G.M. Verdon-Roe, M.C. Westcott, A.C. Viswanathan, F.W. Fitzke and R.A. Hitchings

Optimum stimulus duration for motion displacement detection in glaucoma
M.C. Westcott, G.M. Verdon-Roe, A.C. Viswanathan, F.W. Fitzke and R.A. Hitchings

Combined spatial resolution and contrast perimetry in normal subjects
M. González-Hernández, A. Pareja Ríos, M. Rodríguez and M. González de la Rosa

The effect of object blur on luminance-pedestal flicker thresholds
A.J. Anderson and A.J. Vingrys

Adaptation phenomenon in pupil perimetry
O. Bergamin, K. Lemola and M. Zulauf

Evaluation of advanced visual field loss with computer-assisted kinetic perimetry
U. Schiefer, J. Schiller, T.J. Dietrich, D. Besch, J. Paetzold and R. Vonthein

New thresholding strategies

Development of a maximum likelihood procedure for short-wavelength automated perimetry
A. Turpin, C.A. Johnson and P.G.D. Spry

TOP flicker fluctuation in ocular hypertension
J. Rodríguez, L. Cordovés, A. Abreu and M. González de la Rosa

Second generation of the tendency oriented perimetry algorithm: TOP plus
M. González de la Rosa, F. Mesa, V. Arteaga and M. González-Hernández

Performance evaluation of Octopus standard and TOP strategies
N. Hutchings, S.K. Archibald, J.A. Killoran, P.B. Waind and J.G. Flanagan

Tendency oriented perimetry in children
J. Morales and S.M. Brown

CLIP: an improved strategy in automated static perimetry
B.K. Wabbels, R.O.W. Burk and G. Kolling

Impact of fatigue on full-threshold and SITA algorithms
E.J. Casson and W.A. Sanford

Comparing perimetric technique

Frequency doubling technology C20.5 versus Humphrey 24.2 in ocular hypertension and open-angle glaucoma
F. May, J.-P. Renard and J.-F. Maurin

Clinical agreement between the frequency doubling technique and the Octopus perimeter
M. Iester, C. Schnyder and A. Mermoud

Comparison of achromatic automated perimetry, short-wavelength automated perimetry and frequency doubling technology perimetry in the diagnosis of early glaucoma
G. Milano, G.C.M. Rossi, A. Djeugoue and A. Clemente

Comparison of blue/yellow and frequency doubling technology perimetry in glaucoma patients, glaucoma suspects, and normals
C.T. Langerhorst, L.L. Carenini, D. Bakker and T.J.T.P. van den Berg

High-pass resolution perimetry and frequency doubling technology in glaucoma patients and ocular hypertensive subjects
M. Altieri, M. Iester, C.E. Traverso, P. Capris, P. Vittone and M. Zingirian

High-pass resolution perimetry versus light sensitivity perimetry in ocular hypertensives. A prospective study of test sensitivity
C.M. Birt and F. Malam

Frequency doubling perimetry fails to detect some patients with hemianopias
M. Wall and K. Woodward

The influence of cataracts on perimetric threshold values in light-sense perimetry and flicker perimetry
C. Matsumoto, S. Okuyama, S. Takada, E. Arimura, S. Hashimoto and Y. Shimomura

Effect of lens opacity on white-on-white perimetry, frequency doubling perimetry, and motion detection perimetry
L. Membrey and F.W. Fitzke

Identifying the best parameters for glaucomatous abnormality in various types of perimetry
P.A. Sample, J.M. Williams, C.F. Bosworth, J.P. Pascual, C. Vasile and R.N. Weinreb


Frequency doubling technology perimetry as a screening tool in the general ophthalmic elderly population
M. Fingeret, E. Smith, L. Reminick and C.A. Johnson

A portable visual field screener using a back-projection method with a laser pointer in the diagnosis of glaucomatous field loss
E. Mutlukan and G.L. Spaeth

Pointwise pass/fail criteria in suprathreshold perimetry
P.H. Artes, D.B. Henson and S.J. Chaudry

The design of a simple, low cost perimetry instrument for visual field screening in developing regions of the world
U.M. Anicho and D. Yager

Clinical glaucoma

The influence of myopic refraction and intraocular pressure on the visual field in normal-tension glaucoma
Y. Yamazaki and T. Oshida

Diffuse loss of contrast sensitivity in early glaucoma
E.A. Ansari, J.E. Morgan and R.J. Snowden

Comparison of the effectiveness of frequency doubling technology perimetry in detecting abnormalities in primary open-angle glaucoma and normal-tension glaucoma
M. Osako, N. Horikoshi, Y. Tamura, T. Okano and M. Usui

The effect of Ginkgo biloba extract on visual field damage in normal-tension glaucoma
L. Quaranta, S. Bettelli, F. Morescalchi and E. Gandolfo

Comparison of optic disc parameters between normal tension glaucoma and visual-field-matched high tension glaucoma
M. Iester


Monitoring ' healthy' areas of the visual field in glaucoma patients with deep perimetric defects
G. Corallo

The rate of progression of visual field defects in normal tension glaucoma
H. Suzumura and K. Harasawa

Staging of the glaucomatous disease using frequency doubling technology. A prospective study
E. Gramer and D. Spata

Evaluation of methods for determining glaucomatous visual field progression
M. Sehi, N. Hutchings, Y.M. Buys and J.G. Flanagan

Sensitivity differences between real-patient and computer-simulated visual fields
E. Vesti, P.G.D. Spry, B.C. Chauhan and C.A. Johnson

Progressive shrinkage of the visual field during automated perimetry following traumatic brain injury. Patients' experience during the testing procedure
C.T. Langerhorst and A.B. Safran

Agreement of Humphrey glaucoma change probability and pointwise linear regression analysis on glaucomatous visual field progression
Y. Kono, S.-Y. Liou, A. Iwase, T. Yamamoto and Y. Kitazawa

Discriminatory power of pointwise linear regression for the detection of glaucomatous visual field defect progression
P.G.D. Spry, C.A. Johnson, A.B. Bates and B.C. Chauhan


Receptor alignments and visual fields in high and low myopia
J.M. Enoch, S.S. Choi, M. Kono, V. Lakshminarayanan and M. Luisa Calvo

Central retinal sensitivity assessment after laser grid photocoagulation extended to near the foveal area
F. Morescalchi, E. Gandolfo, L. Quaranta, F. Danieli, S. Formenti, A. Franzoni and F. Gandolfo

Evaluation of retinal sensitivity in subretinal hemorrhages using an automated fundus perimeter
T. Murata, Y. Nishida, K. Yoshida, T. Sawada and K. Kani

Quantification of metamorphopsia in patients with epiretinal membranes
C. Matsumoto, E. Arimura, S. Hashimoto, S. Takada, S. Okuyama and Y. Shimomura

Receiver operating characteristic curve analysis of conventional automated perimetry and short-wavelength automated perimetry for patients with clinically significant diabetic macular edema
C. Hudson, B.M. McCreesh, G. Silvestri and J.G. Flanagan

Evaluation of retinal sensitivity in retinal vascular disease using automated fundus perimetry
K. Yoshida, Y. Nishida, T. Murata, T. Sawada and K. Kani

Relationship between vigabatrin medication and visual field loss measured with a surface method
W.M. Verduin, P. Hardus, T.T.J.M. Berendschot and J.S. Stilma

Perimetric follow-up of young patients receiving chronic vigabatrin
E. Gandolfo, F. Morescalchi, A. Franzoni, S. Formenti, S. Sancassani, F. Gandolfo and L. Quaranta

Index of authors

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