Kinetic Perimetry on Virtual Reality Headset.

OBJECTIVE: We present a portable automatic kinetic perimeter based on a virtual reality (VR) headset device as an innovative and alternative solution for the screening of clinical visual fields. We compared the performances of our solution with a gold standard perimeter, validating the test on healthy subjects. METHODS: The system is composed of an Oculus Quest 2 VR headset with a clicker for participant response feedback. An Android app was designed in Unity to generate moving stimuli along vectors, following a standard Goldmann kinetic perimetry approach. Sensitivity thresholds are obtained by moving centripetally three different targets (V/4e, IV/1e, III/1e) along 24 or 12 vectors from an area of non-seeing to an area of seeing and then transmitted wirelessly to a PC. A Python real-time algorithm processes the incoming kinetic results and displays the hill of vision in a two-dimensional map (isopter). We involved 21 subjects (5 males and 16 females, age range 22-73 years) for a total of 42 eyes tested with our proposed solution, and results were compared with a Humphrey visual field analyzer to test reproducibility and efficacy. RESULTS: isopters generated with the Oculus headset were in good agreement with those acquired with a commercial device (Pearson's correlation values r > 0.83 for each target). CONCLUSIONS: we demonstrate the feasibility of VR kinetic perimetry by comparing performances between our system and a clinically used perimeter in healthy subjects. SIGNIFICANCE: proposed device leads the way for a portable and more accessible visual field test, overcoming challenges in current kinetic perimetry practices.

Visual outcomes of audio-luminous biofeedback training for a child with idiopathic nystagmus / Desfechos visuais de treinamento de biofeedback audioluminoso em criança com nistagmo idiopático

ABSTRACT Microperimetry biofeedback training is a vision rehabilitation method that involves the training of attention and oculomotor control, and the rehabilitation of poorly located and non-functional preferred retinal loci. It can significantly improve distance and near visual acuity in age-related macular degeneration. Previous studies have shown that biofeedback training using electrical nystagmography can reduce nystagmus amplitude and increase foveation time. However, these improvements have not been sustained following training sessions. We hereby report a pediatric case of idiopathic nystagmus in an 11-year old patient treated with microperimetric biofeedback to improve visual acuity and fixation stability. The training had a beneficial impact, positively affecting fixation stability as well as distance and near reading vision. Subjectively, improvement in quality of life was also reported. Conversely to previous studies, the positive effects in this case were maintained for as long as twelve months following therapy. To the best of our knowledge, this is the first case with long-term benefits to be reported in the literature.(AU)

RESUMO O treinamento de biofeedback por microperimetria é um método de reabilitação da visão que envolve treinamento de atenção, controle oculomotor e reabilitação do locus preferencial de fixação da retina. Esse treinamento pode melhorar significativamente a acuidade visual para longe e perto na degeneração macular relacionada à idade. Estudos anteriores mostraram que o treinamento de biofeedback usando a nistagmografia elétrica pode reduzir a amplitude do nistagmo e aumentar o período de foveação. Entretanto, os resultados não se mantiveram após o término das sessões. Aqui é relatado um caso de tratamento com biofeedback por microperimetria para melhorar a acuidade visual e a estabilidade de fixação em uma criança de 11 anos de idade. O treinamento teve impacto benéfico e afetou positivamente a estabilidade da fixação e a visão para longe, para perto e de leitura. Subjetivamente, foi relatada melhoria da qualidade de vida. Em contraste com estudos anteriores, os efeitos positivos foram mantidos até 12 meses após a terapia. Até onde sabemos, este é o primeiro caso na literatura que relata benefícios de longo prazo.(AU)

Optical coherence tomography angiography and Humphrey field analyser for macular capillary non-perfusion evaluation in branch retinal vein occlusion.

We non-invasively evaluated macular non-perfused areas (m-NPAs) of branch retinal vein occlusion (BRVO) using optical coherence tomography (OCT) angiography and the Humphrey visual field analyser 10-2 programme (HFA 10-2). We enrolled 30 patients (30 eyes) with macular oedema secondary to BRVO. OCT angiography was used to photograph the macula at 6 × 6-mm; sizes of m-NPAs in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were measured in four areas. For HFA 10-2, we divided the actual measurement threshold of 68 points into four areas and calculated the mean central visual field sensitivity (CVFS). The correlation between the mean m-NPA and mean CVFS (dB) in each area was examined. There was a strong correlation between the m-NPA of each region detected in SCP and DCP, and the mean CVFS of each corresponding area (SCP: r = - 0.83, r = - 0.64, r = - 0.73, and r = - 0.79; DCP: r = - 0.82, r = - 0.71, r = - 0.71, and r = - 0.70), p values were < 0.001 for all. m-NPAs were associated with decreased visual field sensitivity in BRVO. Non-invasive m-NPA evaluation was possible using OCT angiography and HFA 10-2.

Low-cost, smartphone-based frequency doubling technology visual field testing using a head-mounted display.

BACKGROUND: Current visual field screening machines are bulky and expensive, limiting their accessibility, affordability and use. We report the design and evaluation of a novel, portable, cost-effective system for glaucoma screening using smartphone-based visual field screening using frequency doubling technology (FDT) and a head-mounted display. METHODS: Nineteen eyes of 10 subjects with new-onset or chronic primary open angle glaucoma were tested and compared with the Humphrey Zeiss FDT and the newly developed Mobile Virtual Perimetry (MVP) FDT with the C-20 testing pattern. Mann-Whitney, Bland-Altman and linear regression analyses were performed to assess statistical difference, agreement and correlation, respectively, between the two devices. RESULTS: The average age of the participants was 58±15 years. No statistically significant difference was found between the MVP FDT and the Humphrey Zeiss FDT (p>0.05). Bland-Altman and linear regression analyses demonstrated good agreement and correlation between the two devices. CONCLUSION: The MVP FDT is a low-cost, portable visual field screening device that produces comparable results to the Humphrey Zeiss FDT and may be used as an easily accessible screening tool for glaucoma.

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months.

PURPOSE: To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma. DESIGN: Prospective longitudinal feasibility and reliability study. METHODS: Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye). RESULTS: All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320). CONCLUSIONS: Home monitoring of VFs is viable for some patients and may provide clinically useful data.

Using an open-source tablet perimeter (Eyecatcher) as a rapid triage measure for glaucoma clinic waiting areas.

BACKGROUND: Glaucoma services are under unprecedented strain. The UK Healthcare Safety Investigation Branch recently called for new ways to identify glaucoma patients most at risk of developing sight loss, and of filtering-out false-positive referrals. Here, we evaluate the feasibility of one such technology, Eyecatcher: a free, tablet-based 'triage' perimeter, designed to be used unsupervised in clinic waiting areas. Eyecatcher does not require a button or headrest: patients are simply required to look at fixed-luminance dots as they appear. METHODS: Seventy-seven people were tested twice using Eyecatcher (one eye only) while waiting for a routine appointment in a UK glaucoma clinic. The sample included individuals with an established diagnosis of glaucoma, and false-positive new referrals (no visual field or optic nerve abnormalities). No attempts were made to control the testing environment. Patients wore their own glasses and received minimal task instruction. RESULTS: Eyecatcher was fast (median: 2.5 min), produced results in good agreement with standard automated perimetry (SAP), and was rated as more enjoyable, less tiring and easier to perform than SAP (all p<0.001). It exhibited good separation (area under receiver operating characteristic=0.97) between eyes with advanced field loss (mean deviation (MD) < -6 dB) and those within normal limits (MD > -2 dB). And it was able to flag two thirds of false-positive referrals as functionally normal. However, eight people (10%) failed to complete the test twice, and reasons for this limitation are discussed. CONCLUSIONS: Tablet-based eye-movement perimetry could potentially provide a pragmatic way of triaging busy glaucoma clinics (ie, flagging high-risk patients and possible false-positive referrals).

Wide-field direct ocular straylight meter.

The impact of the intraocular straylight (IOS) on the visual performance and retinal imaging is still a challenging topic. Direct optical methods to measure IOS avoid psychophysical approaches and interaction with the patient. In this work, we developed an optical instrument providing direct imaging measurement of IOS based on the double-pass technology. The system was tested in an artificial eye IOS model constructed with holographic diffusers and validated with theoretical simulations.

Reproducibility of Microperimeter 3 (MP-3) Microperimetry in Open-Angle Glaucoma Patients.

PURPOSE: Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy, leading to degeneration of retinal ganglion cells and characteristic morphological changes at the optic disc. In advanced stages of the disease, functional tests, such as standard automated perimetry (SAP), are the main diagnostic tools to detect progression. Compared to SAP, microperimetry offers fundus imaging with motion tracking to ensure precise stimulation of certain locations of the retina. Aim of the study was to assess reproducibility of microperimetry compared to SAP in patients with POAG. METHODS: This prospective monocenter study included patients suffering from POAG with visual field defects in the central 20° zone. After inclusion into the study, 3 consecutive study visits were scheduled within 1 month, assessing microperimetry and SAP at each visit. RESULTS: From 19 patients recruited, data from 18 patients could be analyzed. No significant difference between study visits could be detected in mean retinal sensitivity in microperimetry and SAP (microperimetry p = 0.401; SAP p = 0.644; Friedman's 2-way analysis of variance). The intraclass-correlation coefficient was 0.981 (95% CI 0.978-0.984) for microperimetry and 0.948 (95% CI 0.941-0.955) for SAP. Absolute agreement between deep scotoma points was found in 81 test locations (79%) in microperimetry and in 35 test locations (20%) in SAP (p = 0.003, chi-square test). CONCLUSIONS: Microperimetry and conventional perimetry showed high reproducibility, with slightly better performance of microperimetry. However, the reduced angle of visual field in microperimetry limits its application to central glaucomatous field damage.

Validation of a Head-mounted Virtual Reality Visual Field Screening Device.

PRéCIS:: The C3 fields analyzer (CFA) is a moderately reliable perimeter preferred by patients to standard perimetry. While it does not approximate the gold standard, it was sensitive and specific for clinically defined glaucoma (area under the receiving operator characteristic curve=0.77 to 0.86). PURPOSE: Testing the visual field is a vital sign for diagnosing and managing glaucoma. The current gold standard, the Humphrey visual field analyzer (HFA), is large, expensive and can be uncomfortable for some patients. The current study investigated the CFA, a virtual reality head-mounted visual field testing device, as a possible subjective field test for glaucoma screening and eventually glaucoma monitoring. PATIENTS AND METHODS: The CFA presented stimuli in the same 54 positions as the HFA 24-2 SITA Standard test using a suprathreshold algorithm approximating an 18 dB deficit. A total of 157 patients (both controls and glaucoma patients) at the Aravind Eye Hospital, Pondicherry, India, were tested with both devices. RESULTS: The number of stimuli missed on the CFA correlated with HFA mean deviation (r=0.62, P<0.001), and with pattern standard deviation (r=0.36, P<0.001). The area under the receiving operator characteristic curve was 0.77±0.06 for mild glaucoma (HFA mean deviation ≥-6 dB) and 0.86±0.04 for moderate-advanced glaucoma (HFA mean deviation <-6 dB). Patients with an 18 dB or worse deficit at a point in the visual field on the HFA failed to see the CFA stimulus at the same position 38% of the time. CONCLUSIONS: While the CFA did not reliably identify deficits that matched the HFA, it was moderately effective at identifying glaucoma subjects. Further refinements to the device will be required to improve point by point testing performance and screening performance.

Testing the visual field of children and adults with Rarebit: The role of task repetition on sensitivity.

Rarebit is a simple and user-friendly perimetry that tests the visual field by using tiny supra-threshold dot stimuli. It appears to be especially useful for examining the visual field of children who are under 12 years of age. However, previous data showed that the number of errors was higher in children than adults. We ask whether the different number of errors in these two groups depended on task learning and whether it may be accounted for by sensitivity differences or a response bias. Thirty-one children between 9 and 12 years of age and thirty-nine adults were tested three times with Rarebit perimetry. A bias-free sensitivity index, d', rather than the simple hit rate, revealed a group difference that remained after extensive task repetition. Indeed, d' increased with task learning in a similar way in the two groups so that group difference remained after practice. The response bias differed in the two groups, being conservative in the older group (criterion C >0) and liberal in the younger (criterion C < 0). Both biases disappeared with task learning in the third session, suggesting that response bias cannot account for the group difference in sensitivity after practice. When bias-free measures of sensitivity are used and task learning effects are minimized, Rarebit perimetry may be a more valuable method than simple mean hit rate (MHR) to enlighten sensitivity differences in the visual field assessment within the pediatric population.

Accuracy of kinetic perimetry assessment with the Humphrey 850; an exploratory comparative study.

AIM: To compare kinetic perimetry on the Humphrey 850 and Octopus 900 perimeters for assessment of visual fields, uniocular rotations and fields of binocular single vision. METHODS: Prospective cross section study comparing Humphrey 850 kinetic perimetry to kinetic perimetry using the Octopus 900. Results were compared for both perimeters for the measurement of visual field boundaries, uniocular rotations and fields of binocular single vision in subjects with normal visual function, with comparisons of mean vector extremity values and duration of testing. A visual field boundary overlay was used to assess detection potential of Humphrey 850 kinetic perimetry using I4e and I2e targets in results of known abnormal visual fields. RESULTS: Fifteen subjects (30 eyes) with normal parameters of visual function underwent dual perimetry assessment. Mean visual field boundaries and ocular rotation extremity values were similar for Humphrey and Octopus kinetic perimetry along horizontal meridians. Measurements for Humphrey perimetry were significantly smaller for superior and inferior visual field and rotations with ceiling effects at approximately 40 and 50 degrees, respectively. Use of visual field boundary overlays for 140 patient results showed high detection of the known abnormal visual field results by the Humphrey 850 perimeter (91.4% with I4e target; 95% with I2e target) but with notable exceptions for peripheral superior visual field defects. CONCLUSIONS: The Humphrey perimeter's aspheric bowl introduces a ceiling effect for measurements in the superior and inferior visual field at approximately 40 and 50 degrees respectively. This results in potential diagnostic accuracy issues when measuring uniocular rotations, fields of binocular single and visual field boundaries in conditions that specifically impair superior and/or inferior ocular motility (e.g., thyroid eye disease) or visual fields (e.g., chiasmal compression).

Context Association in Glaucoma Patients Using a Touch Screen.

PRECIS: The results showed that people with glaucoma are able to perform with high accuracy a context-association task on a touch screen. This device could be a new possibility for communication and for clinical assessment. BACKGROUND: The present study was designed to investigate the ability of patients with glaucoma to use a touch screen to find and associate pictures with limited text. METHODS: Eighty-four volunteers were recruited in 3 groups and tested binocularly or monocularly. Twenty-eight patients with binocular glaucoma (M=68.5 y) were selected with a visual acuity of 0.4 log MAR or better in each eye and visual field defects, with a mean deviation equal to or less than -6 dB in each eye. Twenty-eight age-matched controls (M=68.8 y) and 28 young controls (M=22.1 y) were also recruited (normal acuity; exclusion of ocular disease). The participants had to associate, by moving their index on a 22″ touch screen, a target on the unique scene (between 3 other distractor images) with a consistent background related to the target (eg, to match a fish with the sea). RESULTS: The performances of the glaucomatous patients were significantly (P<0.01) impaired in monocular vision compared with binocular vision with regard to the exploration duration (+2 s), accuracy (-3% of correct response), and peak speed (-10 cm/s). However, with binocular vision, representing daily life conditions, exploration duration, deviation, movement duration, peak speed, and accuracy were not affected by glaucoma, as demonstrated by comparison with the age-matched group. CONCLUSIONS: People with glaucoma are able to perform with high accuracy a context-association task on a touch screen. Many applications involving touch screen devices should provide new tools with limited text to help patients with visual disabilities.

Evaluation of Pupil Fields Using a Newly Developed Perimeter in Glaucoma Patients.

PURPOSE: To evaluate objective pupil fields using a newly developed perimeter for the detection of glaucomatous damage. MATERIALS AND METHODS: Forty-three eyes of 32 glaucoma patients (42-69 years) were examined. Glaucomatous eyes were classified into three stages using the Hodapp-Anderson-Parrish grading scale (early, 16; moderate, 14; and severe, 13 eyes). The head-mounted perimeter "imo" was used to measure the percentage pupil constriction (PPC) of the pupil fields at 36 test points. A stimulus target size of Goldmann V with 0 decibels (dB) light under 31.4 apostilbs (asb) background was presented. Visual fields were measured with the Humphrey Field Analyzer 10-2 program. Using the 3D OCT-2000, 10 × 10 grid of the macular thickness were also obtained. Median correlation coefficients (r) of each examined eye were analyzed between the PPC and visual field sensitivity (dB), and the thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL)+ (GCL + inner plexiform layer [IPL]), and GCL++ (RNFL + GCL + IPL), respectively. RESULTS: Moderate correlations between the PPC and dB (r = 0.44-0.55), and GCL++ (r = 0.43-0.45) were obtained in the correspondence analysis of 12 test points. There were no significant differences in glaucoma severity (P = 0.924-1.000). However, some patients with extremely early stage glaucoma (visual field index ≥90%) tended to have poor correlation. CONCLUSIONS: Pupil fields of the imo generally corresponded to the visual fields and the RNFL + GCL + IPL thickness, even in early glaucoma; however, the examiner must clearly understand the criteria of patient selection.

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer.

PURPOSE: To evaluate relative diagnostic precision and test-retest variability of 2 devices, the Compass (CMP, CenterVue, Padova, Italy) fundus perimeter and the Humphrey Field Analyzer (HFA, Zeiss, Dublin, CA), in detecting glaucomatous optic neuropathy (GON). DESIGN: Multicenter, cross-sectional, case-control study. PARTICIPANTS: We sequentially enrolled 499 patients with glaucoma and 444 normal subjects to analyze relative precision. A separate group of 44 patients with glaucoma and 54 normal subjects was analyzed to assess test-retest variability. METHODS: One eye of recruited subjects was tested with the index tests: HFA (Swedish interactive thresholding algorithm [SITA] standard strategy) and CMP (Zippy Estimation by Sequential Testing [ZEST] strategy), 24-2 grid. The reference test for GON was specialist evaluation of fundus photographs or OCT, independent of the visual field (VF). For both devices, linear regression was used to calculate the sensitivity decrease with age in the normal group to compute pointwise total deviation (TD) values and mean deviation (MD). We derived 5% and 1% pointwise normative limits. The MD and the total number of TD values below 5% (TD 5%) or 1% (TD 1%) limits per field were used as classifiers. MAIN OUTCOME MEASURES: We used partial receiver operating characteristic (pROC) curves and partial area under the curve (pAUC) to compare the diagnostic precision of the devices. Pointwise mean absolute deviation and Bland-Altman plots for the mean sensitivity (MS) were computed to assess test-retest variability. RESULTS: Retinal sensitivity was generally lower with CMP, with an average mean difference of 1.85±0.06 decibels (dB) (mean ± standard error, P < 0.001) in healthy subjects and 1.46±0.05 dB (mean ± standard error, P < 0.001) in patients with glaucoma. Both devices showed similar discriminative power. The MD metric had marginally better discrimination with CMP (pAUC difference ± standard error, 0.019±0.009, P = 0.035). The 95% limits of agreement for the MS were reduced by 13% in CMP compared with HFA in participants with glaucoma and by 49% in normal participants. Mean absolute deviation was similar, with no significant differences. CONCLUSIONS: Relative diagnostic precision of the 2 devices is equivalent. Test-retest variability of MS for CMP was better than for HFA.

Semi-automated kinetic perimetry: Comparison of the Octopus 900 and Humphrey visual field analyzer 3 versus Goldmann perimetry.

PURPOSE: To evaluate the clinical usefulness and reproducibility of (semi-)automated kinetic perimetry of the Octopus 900 and Humphrey field analyzer 3 (HFA3) compared to Goldmann perimetry as reference technique. METHODS: A prospective interventional study of two study groups, divided into three subgroups. The first study group consisted of 28 patients, performing one visual field examination on each of the three devices. A second group of 30 patients performed four examinations, one on Goldmann and three on Octopus 900 with the following testing strategies: (1) with reaction time (RT) vector, no headphone; (2) without RT vector, no headphone; and (3) without RT vector, with headphone. Comparisons for V4e and I4e stimuli were made of the mean isopter radius (MIR) and of the distances of the isopter to the central visual axis in four directions. Statistical analysis was made with the R software version 3.2.2. RESULTS: For V4e stimuli, the mean isopter radius showed no statistic significant difference comparing Goldmann to HFA3 [p-value = 0.144; confidence interval (CI) -0.152 to 0.019] and comparing Goldmann to Octopus 900 without RT vector, either with (p-value = 0.347; CI -0.023 to 0.081) or without headphone (p-value = 0.130; CI -0.011 to 0.095). Octopus 900 with RT vector produced a significantly larger MIR for V4e stimuli in comparison to Goldmann (p-value < 0.001). I4e stimuli produced statistically significantly larger visual field areas when comparing HFA3 and Octopus 900 to Goldmann perimetry. CONCLUSION: Humphrey field analyzer 3 and Octopus 900 without RT vector are promising successors of Goldmann perimetry.

Qualidade de vida de pessoas com glaucoma: análise conforme o defeito no campo visual / Quality of life among people with glaucoma: analysis according to the defect in the visual field

Resumo Objetivo: Analisar a qualidade de vida de pessoas com glaucoma conforme o defeito no campo visual. Métodos: Trata-se de estudo transversal, analítico, conduzido em unidade de atenção especializada em oftalmologia, Projeto Glaucoma, em Montes Claros, Minas Gerais, Brasil. A qualidade de vida dos pacientes foi avaliada por meio do National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). Utilizou- se o parâmetro Mean Deviation (MD) do melhor olho para classificar os defeitos de campo visual em leve, moderado e severo. Resultados: Participaram 400 pacientes, 60,5% do sexo feminino. A idade dos participantes variou de 19 a 80 anos, sendo a maioria acima de 60 anos (55,8%). A maioria dos pacientes apresentou defeito leve no campo visual, independente de ter sido referenciado pelo setor público ou privado (p=0,840). O escore médio de qualidade de vida foi 77,62(±18,007) pontos. O subdomínio com pior média foi 'dor ocular' (53,06±26,088) e com melhor média foi 'visão de cores' (94,13±19,207). Destacou-se uma correlação linear negativa entre os escores de qualidade de vida e o MD do campo visual, tanto do olho direito (MD-OD) como do esquerdo (MD-OE). Entre os subdomínios de qualidade de vida, 'dependência' foi a que melhor explica a variação do defeito de campo visual e vice-versa, com fator de determinação igual a 7,2% para o MD-OD e 8,4% para o MD-OE. Conclusão: A perda de campo visual foi relacionada à pior qualidade de vida entre pessoas com glaucoma. Recomenda-se propiciar o diagnóstico precoce para favorecer o tratamento e o retardo na progressão da doença.

Abstract Objective: To analyze the quality of life among people with glaucoma according to the visual field defect. Methods: This is a cross-sectional, analytical study carried out in an ophthalmology unit, Glaucoma Project, in Montes Claros, Minas Gerais, Brazil. Patients' quality of life was assessed using the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). The Mean Deviation (MD) parameter of the best eye was used to classify the visual field defects in mild, moderate and severe. Results: Four-hundred patients participated, 60.5% female. The participants' ages ranged from 19 to 80 years, the majority being over 60 (55.8%). The majority of patients presented a visual defect, regardless of whether they were referred by the public or private sector (p = 0.840). The mean quality of life score was 77.62 (± 18.007) points. The subdomain with worse mean was 'ocular pain' (53.06 ± 26.088) and with better mean was 'color vision' (94.13 ± 19.207). A negative linear correlation was observed between the quality of life scores and the visual field MD, both of the right (MD-OD) and left eye (MD-OE). Among the subdomains of quality of life, 'dependency' was the one that best explains the variation of the visual field defect and vice versa, with a determination factor equal to 7.2% for MD-OD and 8.4% for MD-OE. Conclusion: Visual field loss was related to poor quality of life among people with glaucoma. It is recommended to provide early diagnosis to favor treatment and delay in disease progression.

Comparisons of Two Microperimeters: The Clinical Value of an Extended Stimulus Range.

SIGNIFICANCE: Fundus-guided perimetry is a common clinical tool used to measure visual field sensitivities. Comparisons between perimeters are often made despite relative differences in hardware parameters. We directly compared two perimeters using Weber contrast, which allowed us to assess the clinical gain associated with the extended stimulus range of the macular integrity assessment (MAIA). PURPOSE: The purpose of this study was to directly compare sensitivity thresholds for two microperimeters, the MAIA and Optos optical coherence tomography/scanning laser ophthalmoscope, using Weber contrast values. We also examined the clinical utility of the extended stimulus range of the MAIA. METHODS: Six normally sighted adults with no visual field loss and 16 adults with low vision were recruited. Thresholds were measured on the MAIA and Optos using the same threshold algorithm and test points. To compare equivalent units, decibel thresholds were converted to light increments in apostilbs and then to delta increment intensities relative to each instrument's background luminance. Repeatability was assessed for normally sighted adults by testing both instruments on 3 separate days. RESULTS: For normally sighted observers, mean thresholds were similar on both instruments, and repeatability within microperimeters was high. The MAIA has a 0.3-log lower contrast range and 1.37 higher contrast range. The lower contrast values did not result in lower thresholds for the normally sighted observers on the MAIA. There was a 25% increase in the number of measurable thresholds owing to the higher contrast values in low-vision observers. CONCLUSIONS: The higher contrast range in the MAIA yielded only a small increase in detectable thresholds for participants with visual field loss.