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Translational Vision Science &... May 2023Microperimetry provides an accurate assessment of central retinal sensitivity due to its fundus-tracking capability, but it has limited reliability indicators. One...
PURPOSE
Microperimetry provides an accurate assessment of central retinal sensitivity due to its fundus-tracking capability, but it has limited reliability indicators. One method currently employed, fixation loss, samples the optic nerve blind spot for positive responses; however, it is unclear if these responses arise from unintentional button presses or from tracking failure leading to stimuli misplacement. We investigated the relationship between blind spot scotoma positive responses (termed scotoma responses) and fixation.
METHODS
Part 1 of the study involved a custom grid of 181 points centered on the optic nerve that was constructed to map physiological blind spots in primary and simulated eccentric fixation positions. Scotoma responses and the 63% and 95% fixation bivariate contour ellipse areas (BCEA63 and BCEA95) were analyzed. In Part 2, fixation data from controls and patients with retinal diseases (234 eyes from 118 patients) were collected.
RESULTS
Part 1, a linear mixed model of 32 control participants, demonstrated significant (P < 0.001) correlation between scotoma responses and BCEA95. In Part 2, the upper 95% confidence intervals for BCEA95 were 3.7 deg2 for controls, 27.6 deg2 for choroideremia, 23.1 deg2 for typical rod-cone dystrophies, 21.4 deg2 for Stargardt disease, and 111.3 deg2 for age-related macular degeneration. Incorporating all pathology groups into an overall statistic resulted in an upper limit BCEA95 = 29.6 deg2.
CONCLUSIONS
Microperimetry reliability is significantly correlated to fixation performance, and BCEA95 provides a surrogate marker for test accuracy. Examinations of healthy individuals and patients with retinal disease are deemed unreliable if BCEA95 > 4 deg2 and BCEA95 > 30 deg2, respectively.
TRANSLATIONAL RELEVANCE
Microperimetry reliability should be assessed using fixation performance as summarized by BCEA95 rather than the level of fixation losses.
Topics: Humans; Scotoma; Reproducibility of Results; Visual Field Tests; Retinal Diseases; Fundus Oculi
PubMed: 37219509
DOI: 10.1167/tvst.12.5.21 -
Graefe's Archive For Clinical and... Jul 2022To investigate retinal sensitivity changes in eyes with pure cuticular drusen.
PURPOSE
To investigate retinal sensitivity changes in eyes with pure cuticular drusen.
METHODS
Multimodal imaging and microperimetry (37-loci grid) data were examined retrospectively to evaluate functional changes in eyes with pure cuticular drusen. Mean sensitivity in the cuticular drusen cohort was compared to age-matched normals. An age- and loci-specific normative reference was created to analyse localised sensitivity deviation.
RESULTS
The mean number loci with relative scotoma in the cuticular drusen cohort (n = 27, mean [SD] age: 48.5 [12.4] years) referenced to normal eyes (n = 80, 53.5 [14.6] years) was 5.5 (95% confidence interval 3.0 to 8.1). However, mean sensitivity was not statistically different to the age-matched normal cohort (95% CI, - 2.3 to + 3.4 dB). The 37-loci grid was stratified into three rings of the approximately same number of loci, and the percentage of cuticular drusen eyes with pointwise deviation was significantly lower in the inner compared to the middle ring (12.3 [5.3]% vs. 17.3 [5.1]%, p < 0.05).
CONCLUSIONS
Eyes with cuticular drusen demonstrated relative scotoma, but mean sensitivity was not affected. Pointwise sensitivity provides a more robust measure of retinal sensitivity than mean sensitivity in cuticular drusen and should be assessed both in the clinic and in future clinical trials.
Topics: Bruch Membrane; Eye Diseases, Hereditary; Humans; Middle Aged; Retinal Drusen; Retrospective Studies; Scotoma; Tomography, Optical Coherence
PubMed: 35129629
DOI: 10.1007/s00417-022-05570-4 -
Optometry and Vision Science : Official... Dec 2018This article shows a successful concept for simulating central scotoma, which is associated with age-related macular degeneration (AMD), in healthy subjects by an...
SIGNIFICANCE
This article shows a successful concept for simulating central scotoma, which is associated with age-related macular degeneration (AMD), in healthy subjects by an induced dark spot at the retina using occlusive contact lenses. The new concept includes a control mechanism to adjust the scotoma size through controlling pupil size without medication. Therefore, a miniaturized full-field adaptation device was used.
PURPOSE
The aim of this study was to design a novel concept to simulate AMD scotoma in healthy subjects using occlusive contact lenses.
METHODS
To define an optimal set of lens parameters, we constructed an optical model and considered both the anatomical pupil diameter and the opaque central zone diameter of the contact lens. To adjust the scotoma size, we built a miniaturized full-field adaptation device. We demonstrate the validity of this novel concept by functional measurements of visual fields using automated threshold perimetry. Finally, we conducted a perception study including two tasks, consisting of pictograms and letters. The stimuli were presented at different eccentricities and magnifications.
RESULTS
The visual fields of all 10 volunteers exhibited absolute scotomas. The loss of contrast sensitivity ranged within 27 and 36 dB (P < .05), and the scotoma localizations were nearly centered to the macula (mean variation, 2.0 ± 4.8° horizontally; 3.5 ± 4.7° vertically). The eccentric perception of letters showed the largest numbers of correctly identified stimuli. The perception of pictograms showed significantly reduced numbers (P < .0001) and revealed a dependency on magnification. The results suggest that best perception is possible for magnified stimuli near the scotoma.
CONCLUSIONS
We demonstrated that the creation of an absolute simulated AMD scotoma is possible using occlusive contact lenses combined with a miniaturized full-field adaptation device.
Topics: Adult; Contact Lenses; Contrast Sensitivity; Female; Healthy Volunteers; Humans; Macular Degeneration; Male; Models, Biological; Patient Simulation; Retina; Scotoma; Visual Field Tests; Visual Fields
PubMed: 30451808
DOI: 10.1097/OPX.0000000000001310 -
Ophthalmic & Physiological Optics : the... Nov 2021Dynamic text presentation methods may improve reading ability in patients with central vision loss (CVL) by eliminating the need for accurate eye movements. We compared...
PURPOSE
Dynamic text presentation methods may improve reading ability in patients with central vision loss (CVL) by eliminating the need for accurate eye movements. We compared rapid serial visual presentation (RSVP) and horizontal scrolling text presentation (scrolling) on reading rate and reading acuity in CVL observers and normally-sighted controls with simulated CVL (simCVL).
METHODS
CVL observers' (n = 11) central scotomas and preferred retinal loci (PRL) for each eye were determined with MAIA microperimetry and fixation analysis. SimCVL controls (n = 16) used 4° inferior eccentric viewing, enforced with an Eyelink eye-tracker. Observers read aloud 4-word phrases randomly drawn from the MNREAD sentences. Six font sizes (0.50-1.30 logMAR) were tested with the better near acuity eye and both eyes of CVL observers. Three font sizes (0.50-1.00 logMAR) were tested binocularly in simCVL controls. Text presentation duration of each word for RSVP or drift speed for scrolling was varied to determine reading rate, defined as 50% of words read correctly. In a subset of CVL observers (n = 7), relationships between PRL eccentricity, reading threshold and rate were explored.
RESULTS
SimCVL controls demonstrated significantly faster reading rates for RSVP than scrolling text (p < 0.0001), and there was a significant main effect of font size (p < 0.0001). CVL patients demonstrated no significant differences in binocular reading rate between font sizes (p = 0.12) and text presentation (p = 0.25). Similar results were seen under monocular conditions. Reading acuity for RSVP and scrolling worsened with increasing PRL eccentricity (μ = 4.5°, p = 0.07). RSVP reading rate decreased significantly with increasing eccentricity (p = 0.02).
CONCLUSIONS
Consistent with previous work, reading acuity worsened with increasing PRL eccentricity. RSVP and scrolling text presentations significantly affected reading rate in simCVL, but not in CVL observers, suggesting that simCVL results may not generalise to pathological CVL.
Topics: Blindness; Eye Movements; Humans; Reading; Scotoma; Vision, Ocular
PubMed: 34519359
DOI: 10.1111/opo.12881 -
Journal of Vision Nov 2021Reading with central vision loss (CVL), as caused by macular disease, may be enhanced by presenting text using dynamic formats such as horizontally scrolling text or...
Reading with central vision loss (CVL), as caused by macular disease, may be enhanced by presenting text using dynamic formats such as horizontally scrolling text or rapid serial visual presentation (RSVP). The rationale for these dynamic text formats is that they can be read while holding gaze away from the text, potentially supporting reading while using the eccentric viewing strategy. This study was designed to evaluate the practice of reading with CVL, with passages of text presented as static sentences, with horizontal scrolling sentences, or as single-word RSVP. In separate studies, normally sighted participants with a simulated (artificial) central scotoma, controlled by an eye-tracker, or participants with CVL resulting from macular degeneration read passages of text using the eccentric viewing technique. Comprehension was better overall with scrolling text when reading with a simulated CVL, whereas RSVP produced lower overall comprehension and high error rates. Analysis of eye movement behavior showed that participants consistently adopted a strategy of making multiple horizontal saccades on the text itself. Adherence to using eccentric viewing was better with RSVP, but this did not translate into better reading performance. Participants with macular degeneration and an actual CVL also showed the highest comprehension and lowest error rates with scrolling text and the lowest comprehension and highest errors with RSVP. We conclude that scrolling text can support effective reading in people with CVL and has potential as a reading aid.
Topics: Comprehension; Eye Movements; Humans; Reading; Scotoma; Vision, Ocular
PubMed: 34751737
DOI: 10.1167/jov.21.12.5 -
The New England Journal of Medicine Apr 2019
Topics: Antirheumatic Agents; Color Vision Defects; Female; Humans; Hydroxychloroquine; Lupus Erythematosus, Systemic; Middle Aged; Ophthalmoscopy; Retina; Retinal Diseases; Scotoma; Sjogren's Syndrome
PubMed: 31018072
DOI: 10.1056/NEJMicm1304542 -
BMJ Case Reports Feb 2017
Topics: Abscess; Adult; Anti-Bacterial Agents; Eye Infections, Bacterial; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Retinal Diseases; Scotoma; Staphylococcal Infections; Substance Abuse, Intravenous; Treatment Outcome; Visual Fields
PubMed: 28237951
DOI: 10.1136/bcr-2017-219607 -
The British Journal of Ophthalmology May 2005
Topics: Antirheumatic Agents; Humans; Hydroxychloroquine; Retinal Diseases; Scotoma; Vision Screening
PubMed: 15834072
DOI: 10.1136/bjo.2004.061473 -
Journal of Vision Dec 2022Individuals with macular degeneration typically lose vision in the central region of one or both eyes. A binocular scotoma occurs when vision loss occurs in overlapping...
Individuals with macular degeneration typically lose vision in the central region of one or both eyes. A binocular scotoma occurs when vision loss occurs in overlapping locations in both eyes, but stereopsis is impacted even in the non-overlapping region wherever the visual field in either eye is affected. We used a novel stereoperimetry protocol to measure local stereopsis across the visual field (up to 25° eccentricity) to determine how locations with functional stereopsis relate to the scotomata in the two eyes. Participants included those with monocular or binocular scotomata and age-matched controls with healthy vision. Targets (with or without depth information) were presented on a random dot background. Depth targets had true binocular disparity of 20' (crossed), whereas non-depth targets were defined by monocular cues such as contrast and dot density. Participants reported target location and whether it was in depth or flat. Local depth sensitivity (d') estimates were then combined to generate a stereopsis map. This stereopsis map was compared to the union of the monocular microperimetry estimates that mapped out the functional extent of the scotoma in each eye. The "union" prediction aligned with residual stereopsis, showing impaired stereopsis within this region and residual stereopsis outside this region. Importantly, the stereoblind region was typically more extensive than the binocular scotoma defined by the intersection (overlap) of the scotomata. This explains why individuals may have intact binocular visual fields but be severely compromised in tasks of daily living that benefit from stereopsis, such as eye-hand coordination and navigation.
Topics: Humans; Vision, Binocular; Scotoma; Depth Perception; Vision Disparity; Macular Degeneration
PubMed: 36580297
DOI: 10.1167/jov.22.13.7 -
Investigative Ophthalmology & Visual... Jan 2022The purpose of this study was to investigate the perimetric features and their associations with structural and functional features in patients with RP1L1-associated...
PURPOSE
The purpose of this study was to investigate the perimetric features and their associations with structural and functional features in patients with RP1L1-associated occult macular dystrophy (OMD; i.e. Miyake disease).
METHODS
In this international, multicenter, retrospective cohort study, 76 eyes of 38 patients from an East Asian cohort of patients with RP1L1-associated OMD were recruited. Visual field tests were performed using standard automated perimetry, and the patients were classified into three perimetric groups based on the visual field findings: central scotoma, other scotoma (e.g. paracentral scotoma), and no scotoma. The association of the structural and functional findings with the perimetric findings was evaluated.
RESULTS
Fifty-four eyes (71.1%) showed central scotoma, 14 (18.4%) had other scotomata, and 8 (10.5%) had no scotoma. Central scotoma was mostly noted in both eyes (96.3%) and within the central 10 degrees (90.7%). Among the three perimetric groups, there were significant differences in visual symptoms, best-corrected visual acuity (BCVA), and structural phenotypes (i.e. severity of photoreceptor changes). The central scotoma group showed worse BCVA often with severe structural abnormalities (96.3%) and a pathogenic variant of p.R45W (72.2%). The multifocal electroretinogram (mfERG) groups largely corresponded with the perimetric groups; however, 8 (10.5%) of 76 eyes showed mfERG abnormalities preceding typical central scotoma.
CONCLUSIONS
The patterns of scotoma with different clinical severity were first identified in occult macular dystrophy, and central scotoma, a severe pattern, was most frequently observed. These perimetric patterns were associated with the severity of BCVA, structural phenotypes, genotype, and objective functional characteristics which may precede in some cases.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Electroretinography; Eye Proteins; Asia, Eastern; Female; Genotype; Humans; Macular Degeneration; Male; Middle Aged; Phenotype; Retrospective Studies; Scotoma; Tomography, Optical Coherence; Visual Acuity; Visual Field Tests; Visual Fields; Young Adult
PubMed: 34994768
DOI: 10.1167/iovs.63.1.12