Identification of functional visual field loss by automated static perimetry. 2014

Lars Frisén
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

OBJECTIVE Diagnosis of functional visual field loss, that is, field loss lacking objective corollaries, has long relied on kinetic visual field examinations using tangent screens or manual perimeters. The modern dominance of automated static perimeters requires the formulation of new diagnostic criteria. METHODS Retrospective review of automated perimetry records from 36 subjects meeting clinical and tangent screen criteria for functional visual field loss. Thirty-three normal eyes and 57 eyes with true lesions, including optic nerve compression, glaucoma, anterior ischaemic optic neuropathy and vigabatrin toxicity, served as controls. RESULTS Standard automated perimetry statistics were unable to reliably discriminate organic versus non-organic visual field loss. Subjective evaluation of perimetric maps indicated that functional fields generally could be identified by the presence of severe and irregular contractions and depressions that did not conform to the visual system's neuro-architecture. Further, functional fields generally presented one or more isolated threshold 'spikes', that is, isolated locations showing much better than average sensitivity. On repeated examinations, threshold spikes always changed locations. Visual evaluation for spikes proved superior to an objective computational algorithm. Fairly reliable objective discrimination of functional fields could be achieved by point-wise correlations of repeated examinations: median intertest correlation coefficients equalled 0.47 compared with 0.81 for true lesions. CONCLUSIONS Functional visual loss can be identified by automated static perimetry. Useful criteria include severe and irregular contractions and depressions, the presence of isolated threshold spikes and poor intertest correlations.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009901 Optic Nerve Diseases Conditions which produce injury or dysfunction of the second cranial or optic nerve, which is generally considered a component of the central nervous system. Damage to optic nerve fibers may occur at or near their origin in the retina, at the optic disk, or in the nerve, optic chiasm, optic tract, or lateral geniculate nuclei. Clinical manifestations may include decreased visual acuity and contrast sensitivity, impaired color vision, and an afferent pupillary defect. Cranial Nerve II Diseases,Foster-Kennedy Syndrome,Optic Disc Disorders,Optic Disk Disorders,Optic Neuropathy,Second Cranial Nerve Diseases,Cranial Nerve II Disorder,Neural-Optical Lesion,Disc Disorder, Optic,Disk Disorder, Optic,Disorder, Optic Disc,Foster Kennedy Syndrome,Lesion, Neural-Optical,Neural Optical Lesion,Neural-Optical Lesions,Neuropathy, Optic,Optic Disc Disorder,Optic Disk Disorder,Optic Nerve Disease,Optic Neuropathies,Syndrome, Foster-Kennedy
D005260 Female Females
D005403 Fixation, Ocular Positioning and accommodation of eyes that allows the image to be brought into place on the FOVEA CENTRALIS of each eye. Focusing, Ocular,Ocular Fixation,Eye Gaze,Eye Gazes,Gaze, Eye,Gazes, Eye,Ocular Focusing
D005901 Glaucoma An ocular disease, occurring in many forms, having as its primary characteristics an unstable or a sustained increase in the intraocular pressure which the eye cannot withstand without damage to its structure or impairment of its function. The consequences of the increased pressure may be manifested in a variety of symptoms, depending upon type and severity, such as excavation of the optic disk, hardness of the eyeball, corneal anesthesia, reduced visual acuity, seeing of colored halos around lights, disturbed dark adaptation, visual field defects, and headaches. (Dictionary of Visual Science, 4th ed) Glaucomas
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D012680 Sensitivity and Specificity Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed) Specificity,Sensitivity,Specificity and Sensitivity

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