Programme choice for perimetry in neurological conditions (PoPiN): a systematic review of perimetry options and patterns of visual field loss

Abstract

BackgroundVisual field loss occurs frequently in neurological conditions and perimetry is commonly requested for patients with suspected or known conditions. There are currently no guidelines for how visual fields in neurological conditions should be assessed. There is a wide range of visual field programs available and the wrong choice of program can potentially fail to detect visual field loss. We report the results of a systematic review of the existing evidence base for the patterns of visual field loss in four common neurological conditions and the perimetry programs used, to aid the design of future research and clinical practice guidelines.MethodsA systematic search of the literature was performed. The inclusion criteria required studies testing and/or reporting visual field loss in one or more of the target conditions; idiopathic intracranial hypertension, optic neuropathy, chiasmal compression and stroke. Scholarly online databases and registers were searched. In addition articles were hand searched. MESH terms and alternatives in relation to the four target conditions and visual fields were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second.ResultsThis review included 330 studies; 51 in relation to idiopathic intracranial hypertension, 144 in relation to optic neuropathy, 105 in relation to chiasmal compression, 21 in relation to stroke and 10 in relation to a mixed neuro-ophthalmology population.ConclusionsBoth the 30–2 and 24–2 program using the Humphrey perimeter were most commonly reported followed by manual kinetic perimetry using the Goldmann perimeter across all four conditions included in this review. A wide variety of other perimeters and programs were reported. The patterns of visual field defects differ much more greatly across the four conditions. Central perimetry is used extensively in neurological conditions but with little supporting evidence for its diagnostic accuracy in these, especially considering the peripheral visual field may be affected first whilst the central visual field may not be impacted until later in the progression. Further research is required to reach a consensus on how best to standardise perimetry for neurological conditions.Electronic supplementary materialThe online version of this article (10.1186/s12886-018-0912-1) contains supplementary material, which is available to authorized users.

Short-Listing the Program Choice for Perimetry in Neurological Conditions (PoPiN) Using Consensus Methods

“…The Goldmann perimeter was reported as the second most commonly used perimeter for manual kinetic perimetry. This systematic review also found that the patterns of visual field defects varied greatly across the four conditions (Hepworth & Rowe 2018). The 24-2 program has been found to be used extensively in neurological conditions (Hepworth & Rowe 2018).…”

“…The FF-120 program selected in the other conditions was replaced by the monocular Esterman program for stroke; the reason being the distribution of stimuli locations are clustered closely in the nasal visual field but more sparsely located in the temporal visual field in the FF-120. A systematic review reported both the static 30-2 program and manual kinetic perimetry were commonly used in studies across all four conditions (Hepworth & Rowe 2018).…”

“…Forty-seven perimetry programs were included in the survey, outlined in Table 1, identified from a systematic review and manufacturer perimeter manuals (Hepworth & Rowe 2018). Participants were asked to select the perimetry programs important for use in each of the four neurological conditions, with the stipulation these did not have to be the programs they currently use.…”

“…This systematic review also found that the patterns of visual field defects varied greatly across the four conditions (Hepworth & Rowe 2018). The 24-2 program has been found to be used extensively in neurological conditions (Hepworth & Rowe 2018). This is despite a lack of supporting evidence for the diagnostic accuracy of this program for neurological conditions, and especially concerning for conditions where the peripheral visual field is affected first and the central visual field is only affected after significant progression.…”

“…The first stage of this programme of research on Perimetry in Neurological Conditions (PoPiN) was a systematic review which identified a wide range of perimetry programs used and current lack of standardisation in perimetry assessment for four commonly occurring neurological conditions (Hepworth & Rowe 2018). It found the most commonly used static perimetry programs to be the 30-2 and 24-2 on the Humphrey II-i, both of which assess the central visual field.…”