The value of visual field testing in the era of advanced imaging: clinical and psychophysical perspectives

Abstract

White‐on‐white standard automated perimetry (SAP) is widely used in clinical and research settings for assessment of contrast sensitivity using incremental light stimuli across the visual field. It is one of the main functional measures of the effect of disease upon the visual system. SAP has evolved over the last 40 years to become an indispensable tool for comprehensive assessment of visual function. In modern clinical practice, a range of objective measurements of ocular structure, such as optical coherence tomography, have also become invaluable additions to the arsenal of the ophthalmic examination. Although structure‐function correlation is a highly desirable determinant of an unambiguous clinical picture for a patient, in practice, clinicians are often faced with discordance of structural and functional results, which presents them with a challenge. The construction principles behind the development of SAP are used to discuss the interpretation of visual fields, as well as the problem of structure‐function discordance. Through illustrative clinical examples, we provide useful insights to assist clinicians in combining a range of clinical results obtained from SAP and from advanced imaging techniques into a coherent picture that can help direct clinical management.

Development of a Spatial Model of Age-Related Change in the Macular Ganglion Cell Layer to Predict Function From Structural Changes

“…Forty participants experienced at undertaking VFs also underwent HFA VF testing using full threshold 10-2 and 30-2 testing strategies with the commonly used Goldman III (GIII) stimulus size as well as Goldman II (GII), which satisfies complete spatial summation criteria in the macula. [6][7][8][25][26][27] Each combination of stimulus size and testing grid was repeated, totaling 8 VFs for the eye that had undergone structural analyses, and the order in which VFs using different stimulus sizes and testing strategies were performed was randomized to minimize the influence of potential systematic order effects. Rest breaks were offered to all participants between each VF to limit the potential effects of fatigue on VF results.…”

Consistency of Structure-Function Correlation Between Spatially Scaled Visual Field Stimuli and In Vivo OCT Ganglion Cell Counts

“…2 The associated functional loss mirrors the spatial pattern of the structural loss on psychophysical assessments such as visual field testing, and the concordance between structural and functional loss is considered diagnostic of glaucoma. 3,4 However, discordance between structural and functional aspects is commonly observed 5,6 and may hinder the early clinical detection of glaucoma. 7,8 Hence, the relationship between GC population (structure) and visual sensitivity (function) in glaucoma has been an ongoing topic of investigation.…”

“…20,21 The white-on-white Goldmann size III stimulus (GIII) is widely accepted as the standard stimulus size for clinical and scientific measurement of differential light sensitivity (DLS). While the choice of this stimulus size is based on historical rather than psychophysical origins, 4,15,22 it has been utilized in numerous structure-function investigations. [10][11][12][13][14]16,17 One such study by Swanson et al 13 modeled structure-function relationships between DLS measured with GIII and histologically derived GC count per stimulus area (GCc; modulated by retinal eccentricity) on a log-log plot as a two-stage linear regression with a distinct ''tipping point.…”

An evidence‐based approach to the routine use of optical coherence tomography

“…This further reinforces the idea of glaucoma as a disease of statistical abnormality (for example, statistically depressed visual field or OCT results) . As alluded to above, other optic nerve head appearances or variations may mimic glaucomatous damage, and provide a false impression of pathological changes that may be better assessed using alternative clinical techniques (for example, tilted disc syndrome or myopic optic discs) . OCT in isolation, therefore, does not clearly provide a conclusive diagnosis of glaucoma.…”