A history of perimetry and visual field testing.

Perimetry and visual field testing have been used as clinical ophthalmic diagnostic tools for many years, and this manuscript will provide a brief historical overview of these procedures and the individuals who developed them. Today, we have many different forms of perimetry that are designed to evaluate different locations within the visual pathways and various mechanisms and subsets of mechanisms within the visual system. However, the most widely used method of performing perimetry and visual field testing has not substantially changed for more than 150 years, consisting of detecting a small target superimposed on a uniform background at different locations within the field of view. Although the basic test procedure has remained similar throughout the ages, there have been many advances in test administration, standardization, statistical evaluation, clinical analysis, interpretation, and prediction of outcome based on visual field findings.

Franz Fankhauser: the father of the automated perimeter.

Franz Fankhauser is known as the father of automated perimetry and of the q-switched Nd:YAG laser knife. His 15-year journey to computerize perimetry started in 1958 with unsuccessful attempts to automate kinetic perimetry. The switch to using static perimetry resulted in a breakthrough in 1973, and in 1975 the OCTOPUS perimeter came on the market. At the same time Fankhauser was working on the use of light sources for the treatment of ocular tissues. During his career, Fankhauser worked in very close collaboration with mathematicians, physicists, engineers. One of the most astonishing characteristics of Fankhauser was his ability to find and to motivate young scientists to work as a cohesive group for his projects.

The visual fields: an interdisciplinary history II. neurosurgeons and quantitative perimetry.

When operations for brain tumours became possible, exact charting of visual field defects assumed great importance in diagnosis and in monitoring post-operative progress. This process, known as quantitative perimetry, was energetically practised and taught by Harvey Cushing and by many of his pupils. The advent of non-invasive methods of imaging the brain and the rise of neuro-ophthalmology as an independent discipline were associated with a decline in neurosurgical commitment to quantitative perimetry, but it remains an important branch of the clinical neurosciences.

[The history of neuro-ophthalmology in Edinburgh. Part I]. / Historia neurookulistyki w Edynburgu. Czesci I.

The Edinburgh Medical School occupies a unique position in the history of medicine. It gave the three famous clinicians and scientists who significantly developed the fundamentals of neuro-ophthalmology: Sir Charles Bell, Douglas Argyll Robertson and Harry Moss Traquair. Sir Charles Bell (1774-1842) was a Scottish anatomist, physiologist, neurologist and surgeon who enjoyed a distinguished career in London and Edinburgh during the first half of the nineteenth century. He was a prolific medical writer, a brilliant researcher and a skilled artist. Argyll Robertson (AR) (1837-1909) was the first surgeon in Scotland to practise entirely in the field of ophthalmology. In 1869 Robertson published the records of cases, which showed that disease of the spinal cord is sometimes associated with loss of the light reflex of the pupil but retention of its movement in accommodation. Harry Moss Traquair (1875-1954) was one of the founders of neuro-ophthalmology, being concentrated on bitemporal hemianopia, the course of the geniculo-calcarine visual pathway, pituitary tumours, optic nerve diseases (including acute retrobulbar neuritis), tobacco amblyopia and traumatic lesions of the optic tract. In his many publications, his most outstanding contribution to medical knowledge was the work which culminated in the publication, in 1927, of "An Introduction to Clinical Perimetry".

Carl Friedrich Richard Foerster (1825-1902) - the inventor of perimeter and photometer.

Carl Friedrich Richard Foerster (1825-1902) was a German who was born in the Polish city Leszno. He studied medicine at the Medical Faculty of Breslau (now Wroclaw, Poland) University, and later in Heidelberg and Berlin. From 1855, he worked in Breslau, where he established in 1857 the first ophthalmology clinic. Later, he became a professor in ophthalmology, the first director of the Department of Ophthalmology at the University of Breslau, and even the rector of this University. Forster did many pioneering works on visual fields, invented a photometer and the first perimeter, known for many years as the Foerster perimeter. Moreover, he studied night blindness, visual field changes due to different pathologies, and many eye diseases, including glaucoma, cataract, retinal and choroidal diseases.

[Problems and their solutions in today's perimetry]. / Problèmes et solutions de la périmétrie d'aujourd'hui.

Progress in the development of perimetry has been slow but certain since the first description of the perimeter by Goldmann in 1946. The creation of static perimetry, and of threshold detection with the multiple stimuli analyser of Friedmann, have been important stages in its development. Automatic perimetry (A.P.) is now available, our choice of apparatus being the Peritest, this instrument combining all the possibilities of A.P. with multiple or single manual perimetry in a very flexible manner. The apparatus allows 153 positions to be examined in the central 25 degrees and 55 in the periphery. The examination is conducted at a suprathreshold level (+ 0,6 log. U) after determination of the patient's eye threshold. Results are grouped in classes on a special chart to facilitate assessment. It is now possible, with the same instrument, to perform a detection A.P. (very useful in suspected glaucoma), a confirmative and limited manual study and, if necessary, a consecutive refined analysis.

Psychophysical factors that have been applied to clinical perimetry.

Perimetry is the most common clinical diagnostic test procedure for evaluating the status of peripheral visual function in the management of ocular and neurologic diseases. This procedure has an extended history, and its design, implementation and interpretation is dependent on many principles that have been developed through visual psychophysical studies of target size, target duration, background adaptation level, chromatic characteristics and other stimulus properties (see Greve, 1973; Johnson, 1994, chap. 17, 1996, 2008, 2010, chap. 23; Johnson & Keltner, 1998, chap. 7; Johnson & Sample, 2002, chap. 22; Johnson & Wall, 2011, chap. 35; Wall & Johnson, 2005, chap. 2 for reviews). This paper will provide a general overview of the history of perimetry, selection of stimulus parameters, development of test strategies, clinical testing conditions, new procedures and approaches to perimetry, experimental design, analysis and interpretation methods, hypothesis testing, prediction and forecasting procedures, and other related topics. It is somewhat paradoxical that although there have been major advances in all of these areas that have significantly enhanced the utility and value of this clinical diagnostic test, the fundamental methodology has remained mostly unchanged for thousands of years. It is hoped that this overview will be of assistance to investigators and clinicians who wish to use or modify this diagnostic procedure for their ongoing career activities.

Harry Moss Traquair (1875-1954), Scottish ophthalmologist and perimetrist.

Harry Moss Traquair (1875-1954) was an Edinburgh Ophthalmologist, who was especially involved in the studies of perimetry and neuro-ophthalmology. In his monumental work, An Introduction to Clinical Perimetry, which for years was the standard textbook of perimetry, he included the description of the visual field as "an island of vision or hill of vision surrounded by a sea of blindness". His name continues to be recalled in the use of the term "Traquair Junctional Scotoma". In this history of Ophthalmology research, Traquair's life and work, including his major achievements, are discussed.

[40 years' of the Goldmann perimeter]. / Vierzig Jahre Goldmann-Perimeter.

For 40 years ophthalmologists all over the world have been using the Goldmann perimeter to examine visual fields by various methods. This paper describes and summarizes the constant improvements to the instrument, the development of accessories and attachments, and examination techniques that have been introduced over the years. The Goldmann perimeter has become the accepted standard against which new perimeters are measured.

[Perimetry yesterday and today]. / Perimetrie gestern und heute.

The historical development of perimetry, from the first technical devices for testing the visual field (arc perimeter) through the manual hemispherical perimeters (Tübingen and Goldmann perimeters) to the latest developments in automated, computer-controlled perimeters, is described with reference to the basic measuring methods and strategies on the one hand and technical realization on the other. The future development of perimetry will be characterized by a refinement of measured value statistics and the testing of perimetric procedures that test more complex physiological functions than sensitivity to differences (e.g., analysis of temporal transmission characteristics in flicker perimetry.

[Development of perimetry since antiquity]. / Die Entwicklung der Perimetrie seit der Antike.

Even in greeque medicine the visual field has been described and recognized. Besides the visual acuity, references are given on early observations of the visual field and its defects. Ptolemaeus (87-165 n. Chr.) first mentioned a method to test the visual field and also gave some physical definitions. Further developments are described in detail. From this oldest method it was a long way to develop techniques for measurement and quantification which could be used in clinical practice. There was an amazing high number of different inventions and parallel developments of methods testing the visual field in the last century.