A new static visual field test algorithm: the Ambient Interactive ZEST (AIZE).

Visual field (VF) test is one of the most vital tests in the diagnosis of glaucoma and to monitor the disease worsening. In the past couple of decades, the standard automated perimetry (SAP) test takes a major role in VF test for glaucoma patients. The SAP has been demanded to finish a test in short time without sacrificing accuracy. In this study, we developed and evaluated the performance of a new perimetric algorithm (ambient interactive zippy estimation by sequential testing (ZEST): AIZE) by computer simulation. AIZE is a modification of the ZEST procedure that utilizes the spatial information (weighted likelihood: WL) of neighboring test locations, which varies from the distance to the tested location, to estimate a visual threshold. Ten glaucomatous and 10 normal empirical visual field (VF) test results were simulated with five error conditions [(3% false positives (FP), 3% false negatives (FN)), (9% FP, 9% FN), (15% FP, 15% FN), (3% FP, 15% FN), (15% FP, 3% FN)]. The total number of test presentations and the root mean square error (RMSE) of the estimated visual sensitivities were compared among AIZE, the non-weighted test (WL = 0) and the fixed-weighted test (WL = 0.33). In both glaucomatous (G) and normal (N) VFs, the fixed-weighted test had the lowest number of test presentations (median G 256, N 139), followed by the AIZE (G 285, N 174) and the non-weighted test (G 303, N 195). The RMSE of the fixed-weighted test was lower (median 1.7 dB) than that of the AIZE (1.9 dB) and the non-weighted test (1.9 dB) for normal VFs, whereas the AIZE had a lower RMSE (3.2 dB) than the fixed-weighted test (4.5 dB) and the non-weighted test (4.0 dB) for glaucomatous VFs. Simulation results showed that AIZE had fewer test presentations than the non-weighted test strategy without affecting the accuracy for glaucomatous VFs. The AIZE is a useful time saving test algorithm in clinical settings.

Measurement of Fixational Eye Movements With the Head-Mounted Perimeter Imo.

Purpose: Although visual field testing is conducted with the subject gazing at a fixation target, constant minute eye movements, called fixational eye movements, do occur during fixation. We examined dynamic changes in fixational eye movements associated with stimulus presentation during visual field testing. Methods: We used the head-mounted perimeter imo, which is capable of measurement under binocular conditions, with the frame rate of its fixation monitoring camera improved to 300 Hz, to assess fixational eye movements in 18 healthy individuals. We measured changes in fixational eye movements during testing under monocular and binocular conditions and analyzed these changes based on the bivariate contour ellipse area (BCEA). We also assessed the changes in the horizontal and vertical microsaccade rates separately. Results: Both the BCEA and horizontal microsaccade rates were higher at 400 to 600 msec after stimulus presentation than during stimulus presentation (P < 0.01). Additionally, the BCEA and vertical microsaccade rates were significantly lower in the binocular condition than in the monocular condition (P < 0.01 and P < 0.05, respectively). We did not observe a significant correlation between the test locations and microsaccade direction during visual field testing. Conclusions: Fixational eye movements, especially vertical microsaccade rates, were lower in the binocular condition than in the monocular condition. Visual field testing under binocular conditions is a useful method for suppressing fixational eye movements and stabilizing the fixation during testing and may improve the reliability of the test results. Translational Relevance: Visual field testing under binocular conditions can make the fixation more stable during the testing compared with monocular conditions.

Utility of CLOCK CHART binocular edition for self-checking the binocular visual field in patients with glaucoma.

BACKGROUND/AIMS: Car accidents caused by drivers unaware of their visual field (VF) defects under binocular vision have become an issue. We developed a simple self-check chart (CLOCK CHART binocular edition (CCBE)) to help patients with glaucoma recognise their abnormalities in the binocular VF and evaluated its usefulness. METHODS: The chart has four targets displayed at 10°, 15°, 20° and 25° eccentricities. The examinee gradually rotates the chart 360° clockwise. At every 30°, the examinee confirms the fixation and indicates if all four targets can be seen. This study enrolled 88 eyes of 44 patients with glaucoma (mean age, 64.4±13.1 years) and 64 eyes of 32 visually normal individuals (mean age, 32.0±8.4 years). Except the CCBE test, static VF testing using the Humphrey field analyser (HFA) Swedish Interactive Threshold Algorithm-Standard 30-2 and binocular Esterman programmes was also performed for the subjects with glaucoma. RESULTS: VF abnormality was defined as two or more contiguous points with a sensitivity of <10 dB within the central 30°. The CCBE test had sensitivities of 85% and 82% with respect to the HFA and Esterman results, respectively. We also used the British VF standards for Group 1 (car/motorcycle) drivers, and a sensitivity of 88% was obtained for the CCBE. The chart had a specificity of 100% for the visually normal subjects. CONCLUSION: The CCBE test enables drivers with glaucoma to notice their VF abnormalities under binocular condition. The application of this simple self-check method appears promising for occasions such as driver licensing.

Distribution and Progression of Visual Field Defects With Binocular Vision in Glaucoma.

PURPOSE: To evaluate the distribution and progression of glaucomatous visual field (VF) defects with binocular vision. PATIENTS AND METHODS: Subjects were 167 patients (average age, 67±10.7 y) with glaucoma who received the Humphrey 24-2 VF test (SITA-Standard) for the 2 eyes. Using the Best Location Algorithm, patient's binocular integrated VF (IVF) was calculated from their Humphrey 24-2 results. Of 167, 77 subjects (average age, 68±11.0 y) also underwent monocular/binocular Humphrey Esterman tests. Patient's stage of glaucomatous VF loss was classified by the Esterman Disability Score for each test, and the distribution and progression of the defects with binocular vision was evaluated for each stage. The frequencies of the defects in the upper and lower halves of the VF were also investigated. RESULTS: With the IVF, the glaucomatous VF defects were most frequently found around the Mariotte blind spots and the Bjerrum areas and extended to the periphery. With the binocular Humphrey Esterman VF, the defects were most frequently found around the bitemporal and Bjerrum areas. The IVF results showed 31%, 49%, and 20% of the patients with the earliest glaucoma having defects in the upper, lower, and both halves of the VF, respectively. CONCLUSIONS: Glaucomatous VF defects with binocular vision were frequently found at the Mariotte blind spots in the central VF and around the bitemporal areas in the periphery. They appeared to have distributions and progression different from those of the defects with monocular vision previously reported.

The interpretation of results of 10-2 visual fields should consider individual variability in the position of the optic disc and temporal raphe.

AIMS: To clarify the anatomical relation between the optic disc and temporal raphe and to examine how these are related to test points in the 10-2 visual field test pattern. SUBJECTS AND METHODS: For 22 eyes of volunteers with normal vision (+0.75 D spherical equivalent 7.88 D), a volume scan was used to obtain en-face images from a plane fitted to the inner limiting membrane using optical coherence tomography (OCT). The clearest en-face retinal nerve fibre (RNF) image was chosen for each subject and superimposed on fundus photographs using blood vessels for alignment. Individual landmarks (disc, fovea and visual field blind spot) were then used to superimpose the Humphrey Field Analyzer 10-2 visual field on the OCT image to compare with the RNF image. RESULTS: The average disc-fovea-raphe angle was 169.4°±3.2°. Both the disc and temporal raphe were located above the horizontal midline (ie, were inferior in visual field space). For the 10-2 test pattern superimposed on the OCT image, in 54.5% of eyes, the temporal inferior test points adjacent to the horizontal midline mapped to the anatomical inferior hemifield. In 22.7% of eyes, nasal inferior test points adjacent to the horizontal midline mapped to the anatomical inferior hemifield. This mapping is opposite to typically assumed. CONCLUSION: The position of the disc and raphe affects the mapping between structure and function with respect to superior and inferior hemifields. Individual differences in the position of the temporal raphe should be considered when mapping between structure and function for the 10-2 test pattern.

Exploring Test-Retest Variability Using High-Resolution Perimetry.

PURPOSE: Test-retest variability (TRV) of visual field (VF) data seriously degrades our capacity to recognize true VF progression. We conducted repeated high-resolution perimetry with a test interval of 0.5° to investigate the sources of TRV. In particular, we examined whether the spatial variance of the observed sensitivity changes or if their absolute magnitude was of more importance. METHODS: Sixteen eyes of 16 glaucoma patients were each tested three times at 61 VF locations along the superior-temporal 45° meridian using a modified protocol of the Octopus 900 perimeter. TRV was quantified as the standard deviation of the repeats at each point (retest-SD). We also computed the mean sensitivity at each point (retest-MS) and the running spatial-SD along the tested meridian. Multiple regression models investigated whether any of those variables (and also age, sex, and VF eccentricity) were significant independent determinants of TRV. RESULTS: The main independent determinants of TRV were the retest-MS at -0.04 dB TRV/dB loss (P < 0.0001, t-statistic 5.05), and the retest-SD at 0.47 dB spatial variance/dB loss (P < 0.0001, t-statistic 12.5). CONCLUSIONS: The larger effect for the spatial-SD suggested that it was perhaps a stronger determinant of TRV than scotoma depth per se. This might support the hypothesis that interactions between small perimetric stimuli, rapidly varying sensitivity across the field, and normal fixational jitter are strong determinants of TRV. TRANSLATIONAL RELEVANCE: Our study indicates that methods that might reduce the effects of jagged sensitivity changes, such as increasing stimulus size or better gaze tracking, could reduce TRV.

Test Conditions in Macular Visual Field Testing in Glaucoma.

PURPOSE: The purpose of this study is to evaluate the suitable visual field (VF) test conditions (target size, test type, and eccentricity) for the macular region, we investigated the correlations between the ganglion cell layer (GCL) thickness and 6 VF test results. METHODS: We tested 32 eyes of patients (61.1±9.2 y) with preperimetric (6), early-stage (16), and moderate-stage (10) glaucoma. The VF tests included 3 SAP (the 10-2 HFA using SITA with target size III [HFA SITA (III)], full threshold with size III [HFA FULL (III)] and size I [HFA FULL (I)]) and 3 visual function-specific perimetry tests (the 10-2 SWAP, 10-2 flicker, and 10-2 Humphrey Matrix). The GCL and inner plexiform layer (GCL+IPL) thickness was measured by Spectral Domain Optical Coherence Tomography (SD-OCT) with a macular 7×7 mm cube scan (3D OCT-2000, Topcon). The coefficient of determination (r) for the correlation between visual sensitivity and the GCL+IPL thickness was calculated for each test at eccentricities 0 to 5 degrees, 5 to 7 degrees, and 7 to 10 degrees using linear and quadratic regressions. RESULTS: All 6 tests showed the strongest correlation with the GCL+IPL thickness at 5 to 7 degrees. The respective r (linear) and R (quadratic) for HFA SITA (III), HFA FULL (III), HFA FULL (I), SWAP, Flicker, and Matrix were (0.40, 0.50), (0.43, 0.53), (0.44, 0.46), (0.51, 0.51), (0.33, 0.34), and (0.52, 0.52). CONCLUSIONS: As compared with the frequently-used SAP with a size III, SAP with size I and the function-specific perimetry tests (especially the Matrix) could be more suitable for testing the macular region.

Effects of head tilt on visual field testing with a head-mounted perimeter imo.

PURPOSE: A newly developed head-mounted perimeter termed "imo" enables visual field (VF) testing without a fixed head position. Because the positional relationship between the subject's head and the imo is fixed, the effects of head position changes on the test results are small compared with those obtained using a stationary perimeter. However, only ocular counter-roll (OCR) induced by head tilt might affect VF testing. To quantitatively reveal the effects of head tilt and OCR on the VF test results, we investigated the associations among the head-tilt angle, OCR amplitude and VF testing results. SUBJECTS AND METHODS: For 20 healthy subjects, we binocularly recorded static OCR (s-OCR) while tilting the subject's head at an arbitrary angle ranging from 0° to 60° rightward or leftward in 10° increments. By monitoring iris patterns, we evaluated the s-OCR amplitude. We also performed blind spot detection while tilting the subject's head by an arbitrary angle ranging from 0° to 50° rightward or leftward in 10° increments to calculate the angle by which the blind spot rotates because of head tilt. RESULTS: The association between s-OCR amplitude and head-tilt angle showed a sinusoidal relationship. In blind spot detection, the blind spot rotated to the opposite direction of the head tilt, and the association between the rotation angle of the blind spot and the head-tilt angle also showed a sinusoidal relationship. The rotation angle of the blind spot was strongly correlated with the s-OCR amplitude (R2≥0.94, p<0.0001). A head tilt greater than 20° with imo causes interference between adjacent test areas. CONCLUSIONS: Both the s-OCR amplitude and the rotation angle of the blind spot were correlated with the head-tilt angle by sinusoidal regression. The rotated VF was correlated with the s-OCR amplitude. During perimetry using imo, the change in the subject's head tilt should be limited to 20°.

Evaluation of kinetic programs in various automated perimeters.

PURPOSE: Kinetic programs in four automated perimeters were evaluated and compared for their clinical usefulness using four simulated visual field (VF) patterns. METHODS: Using the results of conventional Goldmann manual kinetic perimetry (MKP), simulated fields with concentric contraction, a temporal residual island only, a small central island with a temporal island, and a ring scotoma were created. Four kinetic programs, Humphrey 750i Kinetic Test (Humphrey), OCULUS Twinfield 2 Kinetic Perimetry (OCULUS), OCTOPUS 900 Goldmann Kinetic Perimetry (OCTOPUS GKP), and Kowa AP-7000 Isopter (Kowa) were tested by the 4 simulated defect patterns using stimuli of V/4e, I/4e, I/3e, I/2e, and I/1e at speeds of 3 and 5°/s. RESULTS: Except Humphrey, OCULUS, OCTOPUS GKP, and Kowa could obtain isopters nearly comparable to those of Goldmann MKP. However, their results were considerably influenced by the examiner's skill. Besides, Humphrey had restrictions on target presentation, and OCULUS and Kowa had problems in isopter drawing and in filling in the scotoma. OCTOPUS GKP was the only method that could correctly detect and depict all four defect patterns. It also had relatively shorter test durations among the three methods excluding Humphrey, which did not have a built-in function for test duration measurement. The perimeters' test ranges for the periphery were 90° for Humphrey, OCULUS, and OCTOPUS GKP, and 80° for Kowa. CONCLUSION: To assess kinetic fields with various defect patterns, OCTOPUS GKP seems to be the most useful method.

Visual Field Testing with Head-Mounted Perimeter 'imo'.

PURPOSE: We developed a new portable head-mounted perimeter, "imo", which performs visual field (VF) testing under flexible conditions without a dark room. Besides the monocular eye test, imo can present a test target randomly to either eye without occlusion (a binocular random single eye test). The performance of imo was evaluated. METHODS: Using full HD transmissive LCD and high intensity LED backlights, imo can display a test target under the same test conditions as the Humphrey Field Analyzer (HFA). The monocular and binocular random single eye tests by imo and the HFA test were performed on 40 eyes of 20 subjects with glaucoma. VF sensitivity results by the monocular and binocular random single eye tests were compared, and these test results were further compared to those by the HFA. The subjects were asked whether they noticed which eye was being tested during the test. RESULTS: The mean sensitivity (MS) obtained with the HFA highly correlated with the MS by the imo monocular test (R: r = 0.96, L: r = 0.94, P < 0.001) and the binocular random single eye test (R: r = 0.97, L: r = 0.98, P < 0.001). The MS values by the monocular and binocular random single eye tests also highly correlated (R: r = 0.96, L: r = 0.95, P < 0.001). No subject could detect which eye was being tested during the examination. CONCLUSIONS: The perimeter imo can obtain VF sensitivity highly compatible to that by the standard automated perimeter. The binocular random single eye test provides a non-occlusion test condition without the examinee being aware of the tested eye.

Detectability of Visual Field Defects in Glaucoma With High-resolution Perimetry.

PURPOSE: To extrapolate the optimal test point resolution for assessment of glaucomatous visual field (VF) defects including subtle functional defects, we performed high-resolution perimetry with the 0.5 degrees test point resolution. SUBJECTS AND METHODS: Subjects were 11 eyes of 11 normal volunteers and 16 eyes of 16 glaucomatous patients. Octopus 900 custom test was used to measure 61 points with the test point resolution of 0.5 degrees on the temporal meridian of 45 degrees within the eccentricity of 30 degrees. In the glaucoma cases, VF profiles were extracted in 17 patterns of the test point resolutions that ranged from 0.5 to 8.5 degrees and the mean defect (MD), square root of loss variance (sLV), and maximum sensitivity loss (Max loss) were calculated. The influence of the test point resolution on MD, sLV, and Max loss was examined. In addition, the test range from the fixation point to the eccentricity of 30 degrees was divided into 3 zones. Similarly, each zone was investigated if the test point resolution exerted influence on the MD, sLV, and Max loss. RESULTS: Our glaucoma cases did not show any significant differences in MD and sLV regardless of the resolution. Max loss showed significant difference at resolution ≥1.0 degree. MD and sLV did not show significant differences by the change of resolution in each zone. Max loss showed significant differences at resolution ≥1.5 degrees within the central 10 degrees. CONCLUSIONS: To detect subtle VF defects within the eccentricity of 10 degrees, high-resolution perimetry with the test point resolution of <1.5 degrees is necessary.

Development of a new fully automated kinetic algorithm (program k) for detection of glaucomatous visual field loss.

PURPOSE: In Program K, a new automated kinetic algorithm that we developed, the frequency distributions of the number of patients' response points were obtained for external angles to distinguish normal and abnormal isopters. We also assessed the agreement between the results of Program K and Goldmann manual kinetic perimetry (MKP). METHODS: Program K detected abnormalities in isopters by using the external angles of patients' response points. In experiment 1, a normal external angle range and endpoint for the algorithm were determined by using visual field (VF) results of 100 data sets. In experiment 2, the results of Program K and Goldmann MKP were compared in 63 virtual patients. Visual field loss was assessed by using stimuli of V/4e, III/4e, I/4e, I/3e, I/2e, and I/1e at a speed of 3 deg/s. The isopters by Program K and Goldmann MKP were overlapped and the area of intersection was expressed as a percentage of the union area. The intersection percentages and test durations were evaluated. RESULTS: A normal external angle range between 150° and 240° and phase 3 as the appropriate endpoint for the algorithm were determined. The intersection percentages for the six isopters were 84% (V/4e), 83% (III/4e), 78% (I/4e), 71% (I/3e), 60% (I/2e), and 50% (I/1e) (average, 71%). The average examination duration for Program K was 16.0 ± 3.2 minutes. The results of Program K and Goldmann MKP were comparable. CONCLUSIONS: Program K is clinically efficient and useful for detection and evaluation of abnormalities in a kinetic VF.

CLOCK CHART(®): a novel multi-stimulus self-check visual field screener.

PURPOSE: CLOCK CHART(®) is a multi-stimulus-type self-check visual field screening sheet developed by our group. The test chart is rotated during the examination, and the visual field abnormalities are pointed out by the patients themselves. In this study, we evaluated the clinical usefulness of this chart in patients with glaucoma. METHODS: We studied 114 eyes of 114 glaucoma patients (average age 60.0 ± 11.1 years) and 45 eyes of 45 normal individuals (average age 45.0 ± 16.4 years) using CLOCK CHART(®). The static visual fields were obtained using the Octopus 101 G2 program and classified using the Aulhorn classification as modified by Greve (stages 0-I to IV) and by mean defect (MD; early <6 dB; moderate 6 ≤ MD ≤12 dB; severe >12 dB).The sensitivity and specificity of CLOCK CHART(®) for detecting visual field abnormalities were evaluated within the entire 25° field and at the 5°, 10°, 15°, 20°, and 25° eccentricity zones. The visual field agreement between the results of CLOCK CHART(®) and the static visual fields were also evaluated. RESULTS: In glaucomatous eyes, the sensitivity of CLOCK CHART(®) was 85, 93, and 100 % for Greve stages I, II and III-VI, respectively, and 87, 93, and 97 % for the MD value in early, moderate, and severe eyes, respectively. The agreement of the visual field defect area in CLOCK CHART(®) with the static fields was 85 and 100 % with Greve stages 0-I to I and II-VI, respectively, and 91, 96, and 96 % in early, moderate and severe glaucomatous eyes according to MD, respectively. The specificity of CLOCK CHART(®) was 89 %. CONCLUSION: CLOCK CHART(®) is a simple and reliable self-check screening chart for detecting visual field abnormalities in patients with glaucoma.

[Problems of visual field disturbance criteria in visual impairment grade 5].

PURPOSE: In 1995, the Act on Welfare of Physically Disabled Persons was revised and the visual impairment grading methods were modified. In this revision, the target size for peripheral visual field measurements was changed from V/4 to I/4. We compared the area of I/4 and V4 visual fields in normal eyes and evaluated its influence on the decision of the visual impairment grade 5. SUBJECTS AND METHODS: Goldmann kinetic perimetry results obtained from 137 eyes of 137 subjects (age 10-79, average ± SD: 47.0 ± 17.5) at Kinki University Hospital were retrospectively evaluated. The V/4 and I/4 isopter areas were calculated using Image J and compared with the normal visual field range in the visual impairment criteria. RESULTS: The V/4 isopter area decreased from age 70 and the I/4 isopter area decreased significantly from age 50. The aging slope of the isopter areas were significantly larger in I/4 than in V/4. In age 60 to 69, 19% showed a smaller I/4 isopter area than that of the grade 5 criteria. In age 70 to 79, 75% showed a smaller I/4 isopter area than that of the grade 5 criteria. CONCLUSION: In some elderly people, the binocular I/4 isopter area is smaller than the visual impairment grade 5 criteria.

Correlations between M-CHARTS and PHP findings and subjective perception of metamorphopsia in patients with macular diseases.

PURPOSE: To assess the correlations between a patient's subjective perception of metamorphopsia and the clinical measurements of metamorphopsia by M-CHARTS and PreView PHP (PHP). METHODS: The authors designed a 10-item questionnaire focusing on the symptoms of metamorphopsia and verified its validity with a Rasch analysis. M-CHARTS measured the minimum visual angle of a dotted line needed to detect metamorphopsia, and PHP used the hyperacuity function for detection. Subjects were 39 patients with idiopathic epiretinal membrane (ERM), 22 patients with idiopathic macular hole (M-hole), 19 patients with age-related macular degeneration (AMD), and 51 healthy controls. RESULTS: Rasch analysis suggested the elimination of one question. The nine-item questionnaire score significantly correlated to the M-CHARTS score in ERM (r = 0.59; P = 0.0004) but not in M-hole and to the PHP result in AMD (r = -0.29; P = 0.04) but not in ERM. Eighty percent of ERM patients with greater horizontal M-CHARTS score subjectively perceived horizontal metamorphopsia more often. M-CHARTS showed better sensitivities than PHP in both ERM (89% vs. 42%) and AMD (74% vs. 68%) and better specificity (100% vs. 71%) in healthy controls. Rasch analysis indicated that the present form of the questionnaire is better suited for moderate to severe cases of metamorphopsia than for mild cases. CONCLUSIONS: The questionnaire appears to be a valid assessment of patient subjective perception of metamorphopsia and can be used to supplement the clinical measurements of metamorphopsia by M-CHARTS and PHP in patients with macular diseases.

Intravitreal bevacizumab injection and carotid artery stent replacement for neovascular glaucoma in internal carotid artery occlusion.

Neovascular glaucoma (NVG) secondary to internal carotid artery (ICA) occlusion is usually resistant to treatment. We report a case of NVG with ICA occlusion improved by intravitreal bevacizumab (IVB) injection and carotid artery stent replacement (CAS), even though we did not perform panretinal photocoagulation. A 67-year-old male with NVG noted visual loss in his left eye. Magnetic resonance angiography showed left ICA occlusion. He was diagnosed with NVG secondary to ICA occlusion. The next day, we carried out IVB injection in his left eye, following which the iris and angle neovascularization regressed, and the intraocular pressure decreased to normal within a day after the injection. CAS was performed on his left ICA at a month post injection. Two months later, we reinjected bevacizumab in his left eye. His condition remained stable with no recurrence over two years. This case indicates that IVB injection and CAS are useful for early-stage NVG secondary to ICA occlusion.

Resorcin[4]arene cavitand with 1,3,2-benzodiazaborolyl walls as a fluorescence receptor for ammonium cations.

Resorcin[4]arene cavitand 1 with 1,3,2-benzodiazaborolyl walls was newly synthesized. It showed a large blue shift in the fluorescence spectra upon selective complexation with alkyltrimethylammonium salts in CH(2)Cl(2)-DMSO (9 : 1 v/v); this shift was detectable with the naked eye.

Amine-triggered molecular capsules using dynamic boronate esterification.

Boron-contained molecular capsules triggered by amines are described for the first time; when Et3N was employed as a chemical stimulus the Lewis acid Et3NH+, produced by solvolysis reaction on the boron, was found to be encapsulated in the internal cavity, whereas use of nBu3N led to the related dynamic capsule capable of accommodating several guest species including Cs+.

Detectability of glaucomatous changes using SAP, FDT, flicker perimetry, and OCT.

PURPOSE: To compare the detectability between glaucomatous visual field changes using standard automated perimetry (SAP), frequency doubling technology (FDT), short-wavelength automated perimetry (SWAP), and flicker perimetry and structural changes using optical coherence tomography (OCT). PARTICIPANTS: Fifty-nine eyes of fifty-nine patients with open-angle glaucoma, 24 eyes of 24 glaucoma suspects (GSs), and 40 eyes of 40 healthy age-matched subjects. METHODS: All subjects underwent Humphrey visual field analyzer II 24-2 full threshold (SAP), Swedish interactive threshold algorithm-SWAP, FDT (30-1, 30-5, 24-2-1, 24-2-5), flicker perimetry on Octopus 311 (4-zone probability 38S), and Stratus OCT [fast retinal nerve fiber layer thickness (NFLT) and fast optic disc]. To evaluate the visual field, FDT and flicker used the number of abnormal points, whereas SAP used mean deviation (MD) and SWAP used both the number of abnormal points and MD. The areas under the receiver operating characteristic curves [area under the curve (AUCs)] and sensitivities at fixed specificities were used to assess the detectability of glaucoma. RESULTS: The AUC for FDT 30-1, 30-5, 24-2-1, 24-2-5, flicker perimetry, SWAP (MD), and SWAP (number of abnormal points) were 0.95, 0.94, 0.88, 0.89, 0.99, 0.88, and 0.88 in the early glaucoma group and 0.67, 0.69, 0.65, 0.70, 0.80, 0.64, and 0.66 in the GS group, respectively. In the early glaucoma and GS groups, all OCT parameters had an AUC >0.81 except the disc area parameter. Especially, average NFLT had the highest AUC of 0.94 in the OCT parameters. CONCLUSIONS: FDT, SWAP, flicker perimetry, and OCT are all useful methods for discriminating between healthy eyes and eyes with early glaucoma. Among all 10 OCT parameters, NFLT has the highest sensitivity for detecting early glaucomatous changes in GS patients.

Quantification of metamorphopsia in a macular hole patient using M-CHARTS.

PURPOSE: In cases of macular hole, metamorphopsia is one of the most important symptoms, along with decreased visual acuity and a central scotoma. We investigated the relationship between the degree of metamorphopsia and the morphological appearance of macular holes. METHODS: Using M-CHARTS developed by ourselves, we quantified the metamorphopsia scores in 35 eyes with an idiopathic macular hole in 35 patients. Metamorphopsia in eyes with macular hole was characterized by straight lines recognized by the subject as bending toward the central scotoma. We also evaluated best corrected visual acuity (VA) and the central 10 degrees of differential light sensitivity using the Octopus 101 program M2. The size of the macular hole and the fluid cuff were measured using a scanning laser ophthalmoscope. We also evaluated the improvement in metamorphopsia scores after surgical treatment for macular hole in 22 patients. RESULTS: A significant correlation was found between metamorphopsia score and fluid cuff size, but not diameter of the macular hole. After vitrectomy, VA improved in 14 of 22 patients and metamorphopsia scores improved in 19 of 22 patients. M-CHARTS is a simple and useful method for the quantification and follow-up of metamorphopsia in patients with macular hole.