Mapping structural to functional damage in glaucoma with standard automated perimetry and confocal scanning laser ophthalmoscopy

doi:10.1016/S0002-9394(99)80183-4

American Journal of Ophthalmology

Volume 125, Issue 4, April 1998, Pages 436-446

https://doi.org/10.1016/S0002-9394(99)80183-4 Get rights and content

Purpose

To develop a quantitative method for analysis of the topographic relationship between structural and functional damage in patients with glaucoma.

Methods

We studied 26 patients with primary open-angle glaucoma, focal optic disk damage, and focal visual field loss. The visual field was evaluated with automated perimetry, and the optic disk topography was assessed with a confocal scanning laser ophthalmoscope. Topographic measurements were calculated in 10-degree sectors and compared with a normative database (n = 52). The topographic relationship of structural damage and functional loss was analyzed.

Results

Rim area ratio was defined as the ratio of rim area in each 10-degree sector divided by the total rim area. This ratio resulted in the identification of one (46%) or more (54%) clusters of optic disk sectors as outside normal limits in all 26 patients (12 and 14 patients, respectively). Twenty-two patients (84%) with superior hemifield sensitivity loss tended to have inferior rim defects, and vice versa. Nasal visual field defects close to the horizontal midline were matched with damaged rim areas close to the vertical midline.

Conclusions

This mapping method allows an objective and quantitative evaluation of the optic disk and visual field in patients with glaucoma and focal damage. Although the topographic relationship between structure and function is characterized by considerable interindividual variability, the identification of certain patterns may be useful to aid in the evaluation of glaucomatous damage.

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Chong et al. (2014, 2016) leverage the spatial relations of individual locations to improve the overall accuracy of visual fields. These methods rely on the fact that anatomical structures and pathological factors are indicators of the co-dependency between values at different locations (Weber et al., 1990; Anton et al., 1998). While potentially more precise, these methods remain slow, as each location still needs to be evaluated.
Perimetry is a non-invasive clinical psychometric examination used for diagnosing ophthalmic and neurological conditions. At its core, perimetry relies on a subject pressing a button whenever they see a visual stimulus within their field of view. This sequential process then yields a 2D visual field image that is critical for clinical use. Perimetry is painfully slow however, with examinations lasting 7–8 minutes per eye. Maintaining high levels of concentration during that time is exhausting for the patient and negatively affects the acquired visual field. We introduce PASS, a novel perimetry testing strategy, based on reinforcement learning, that requires fewer locations in order to effectively estimate 2D visual fields. PASS uses a selection policy that determines what locations should be tested in order to reconstruct the complete visual field as accurately as possible, and then separately reconstructs the visual field from sparse observations. Furthermore, PASS is patient-specific and non-greedy. It adaptively selects what locations to query based on the patient’s answers to previous queries, and the locations are jointly selected to maximize the quality of the final reconstruction. In our experiments, we show that PASS outperforms state-of-the-art methods, leading to more accurate reconstructions while reducing between 30% and 70% the duration of the patient examination.
Will Perimetry Be Performed to Monitor Glaucoma in 2025?
2017, Ophthalmology
Citation Excerpt :
Structure and function measures also can be coanalyzed more easily as they are assimilated in hybrid instruments. Our understanding of the interrelation between structural and functional parameters continues to grow.50–52 In the future, algorithms likely will incorporate data from both structural and functional tests to provide a more robust understanding of glaucoma.53
Visual field testing has played an essential role in the diagnosis and management of glaucoma for more than a century. Methods to examine the visual field have been refined from early kinetic perimetry to current standard automated perimetry (SAP). Clinicians now use SAP for the diagnosis and management of glaucoma throughout the world. Various testing paradigms and analytic methods have been developed to simplify the diagnosis of glaucoma and the interpretation of progression. Moreover, strategies have been implemented to improve patient experience with visual field testing and to increase reliability. Objective functional tests, such as electroretinography, provide an alternative to subjective visual field testing but are not yet ready for widespread adoption. Standard automated perimetry is being adapted and improved constantly. New devices may allow patients to complete visual field tests at home, which could relieve patients and clinicians from in-office testing and allow for more frequent examinations. Glaucoma detection and progression analysis also are incorporating progressively more information and will be improved as deep learning strategies are applied. Finally, perimetric and structural testing likely will become more closely intertwined as testing platforms and progression analysis incorporate both of these measures. Visual field testing will continue to have an important role in the diagnosis and management of glaucoma.
Relationship Between Central Retinal Vessel Trunk Location and Visual Field Loss in Glaucoma
2017, American Journal of Ophthalmology
To study the relationship between horizontal central retinal vessel trunk location (CRVTL) on glaucomatous optic discs and sector-specific visual field (VF) loss.
Retrospective cross-sectional study.
CRVTL of 421 eyes from 421 patients was manually tracked on the horizontal optic disc axis on fundus images. Focal circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measurements were extracted from optical coherence tomography (OCT). The relationship between focal visual field (VF) loss and CRVTL and focal cpRNFLT was studied by linear regression models. Furthermore, we related central VF loss to CRVTL and focal cpRNFLT separately for mild (VF mean deviation [MD] ≥−6 dB), moderate (−12 dB ≤ MD <−6 dB), and severe (MD <−12 dB) glaucoma.
CRVTL nasalization was significantly correlated only to central VF loss (Garway-Heath scheme [central 6 locations, C6]: correlation: r = −0.16, P < .001; macular vulnerability zone [central 2 locations, C2]: r = −0.14, P = .003; central 4 locations [C4]: r = −0.17, P < .001). While focal cpRNFLT at the sectors corresponding to C2 and C6 was significantly correlated to the respective VF sectors as well (C2: r = 0.15, P = .002; C6: r = 0.10, P = .03), multivariate models combining cpRNFLT and CRVTL substantially improved structure-function models compared with cpRNFLT alone (likelihood ratio tests, C2 and C6: P < .001). The correlations between CRVTL and central VF loss of C4 were −0.11 (P = .04), −0.39 (P = .01), and −0.63 (P = .002) for mild, moderate, and severe glaucoma, respectively.
CRVTL nasalization is significantly and exclusively correlated to central VF loss for all glaucoma severities independent of cpRNFLT, and thus might be a structural biomarker of central VF loss.
Enhancing Structure-Function Correlations in Glaucoma with Customized Spatial Mapping
2015, Ophthalmology
To determine whether the structure–function relationship in glaucoma can be strengthened by using more precise structural and functional measurements combined with individualized structure–function maps and custom sector selection on the optic nerve head (ONH).
Cross-sectional study.
One eye of each of 23 participants with glaucoma.
Participants were tested twice. Visual fields were collected on a high-resolution 3° × 3° grid (164 locations) using a Zippy Estimation by Sequential Testing test procedure with uniform prior probability to improve the accuracy and precision of scotoma characterization relative to standard methods. Retinal nerve fiber layer (RNFL) thickness was measured using spectral-domain optical coherence tomography (OCT; 4 scans, 2 per visit) with manual removal of blood vessels. Individualized maps, based on biometric data, were used. To customize the areas of the ONH and visual field to correlate, we chose a 30° sector centered on the largest defect shown by OCT and chose visual field locations using the individualized maps. Baseline structure–function correlations were calculated between 24-2 locations (n = 52) of the first tested visual field and RNFL thickness from 1 OCT scan, using the sectors of the Garway-Heath map. We added additional data (averaged visual field and OCT, additional 106 visual field locations and OCT without blood vessels, individualized map, and customized sector) and recomputed the correlations.
Spearman correlation between structure and function.
The highest baseline correlation was 0.52 (95% confidence interval [CI], 0.13–0.78) in the superior temporal ONH sector. Improved measurements increased the correlation marginally to 0.58 (95% CI, 0.21–0.81). Applying the individualized map to the large, predefined ONH sectors did not improve the correlation; however, using the individualized map with the single 30° ONH sector resulted in a large increase in correlation to 0.77 (95% CI, 0.47–0.92).
Using more precise visual field and OCT measurements did not improve structure–function correlation in our cohort, but customizing the ONH sector and its associated visual field points substantially improved correlation. We suggest using customized ONH sectors mapped to individually relevant visual field locations to unmask localized structural and functional loss.
A method to estimate the amount of neuroretinal rim tissue in glaucoma: Comparison with current methods for measuring rim area
2014, American Journal of Ophthalmology
To test whether the minimum rim area assessed by spectral domain optical coherence tomography (SD-OCT), based on the shortest distance from the Bruch membrane opening (BMO) to the inner limiting membrane, corresponds more closely to retinal nerve fiber layer (RNFL) thickness and visual field mean deviation (MD) than current rim measures in early glaucoma.
Prospective cross-sectional study.
We studied 221 participants with non-endstage glaucoma or high-risk ocular hypertension and performed standard automated perimetry. We received SD-OCT and confocal scanning laser ophthalmoscopy (CSLO) scans on the same day. Rim area measured by CSLO was compared with 3 SD-OCT rim measures from radial B-scans: horizontal rim area between BMO and inner limiting membrane within the BMO plane; mean minimum rim width (BMO-MRW); and minimum rim area (BMO-MRA) optimized within sectors and then summed. Correlations between these measures and either MD from perimetry or RNFL thickness from SD-OCT were compared using the Steiger test.
RNFL thickness was better correlated with BMO-MRA (r = 0.676) or BMO-MRW (r = 0.680) than with either CSLO rim area (r = 0.330, P < 0.001) or horizontal rim area (r = 0.482, P < 0.001). MD was better correlated with BMO-MRA (r = 0.534) or BMO-MRW (r = 0.546) than with either CSLO rim area (r = 0.321, P < 0.001) or horizontal rim area (0.403, P < 0.001). The correlation between MD and RNFL thickness was r = 0.646.
Minimum rim measurements from SD-OCT are significantly better correlated to both RNFL thickness and MD than rim measurements within the BMO plane or based on the clinical disc margin. They provide new structural parameters for both diagnostic and research purposes in glaucoma.
Comparison of Peripapillary Retinal Nerve Fiber Layer Thickness, Functional Subzones, and Macular Ganglion Cell-Inner Plexiform Layer in Differentiating Patients with Mild, Moderate, and Severe Open-angle Glaucoma
2020, Journal of Glaucoma

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^*: Supported in part by National Eye Institute grants EY11008 (Dr Zangwill), EY08208 (Dr Sample), and EY11158 (Dr Weinreb); grant 95/5039 from the Fondo de Investigaciones Sanitarias, Madrid, Spain (Dr Anton); a grant from the Foundation for Eye Research, Rancho Santa Fe, California (Dr Anton); and an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York.

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Mapping structural to functional damage in glaucoma with standard automated perimetry and confocal scanning laser ophthalmoscopy*

Purpose

Methods

Results

Conclusions

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The topographical relationship between optic disc and visual field in glaucoma

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Effect of repetitive imaging on topographic measurements of the optic nerve head

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