Testing of the Peripheral Visual Field - Obtaining the Full View

周边视野测试——获取完整视野

• 批准号: 9172209
• 负责人: Michael Wall
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9172209
• 关键词: Agreement; Algorithms; Area; Blindness; Coupled; Data; Defect; Disease; Disease Outcome; Early Diagnosis; Early Intervention; Environment; Evaluation; Evolution; Eye; Frequencies; Glaucoma; Hour; Intervention; Investigation; Kinetics; Knowledge; Location; Manuals; Methodology; Methods; Monitor; Octopus; Optic Nerve; Optical Coherence Tomography; Outcome Measure; Papilledema; Patients; Pattern; Performance; Perimetry; Peripheral; Physiologic Intraocular Pressure; Positioning Attribute; Process; Protocols documentation; Pseudotumor Cerebri; Rehabilitation Research; Research; Running; Scotoma; Site; Stimulus; Structure; Suspect Glaucomas; Techniques; Test Result; Testing; Time; United States National Institutes of Health; Veterans; Vision; Visual; Visual Fields; advanced disease; base; central visual field; clinical practice; computerized; field study; improved; improved outcome; optic nerve disorder; public health relevance; research clinical testing; retinal nerve fiber layer

 DESCRIPTION (provided by applicant): The peripheral visual field is largely unexplored to our current method of clinical testing, static threshold automated perimetry. Until the advent of computerized perimetry (quantitation of the visual field) 35 years ago, clinical practice was to test the full visual field manually by kinetic (moving target) Goldmann perimetry. With the evolution to computerized static perimetry, the focus shifted to the central 30°. This seldom tested area, outside the central visual field, represents over 3 times the territory currently evaluated. This is important because the peripheral field is critical for navigation of the environment (functional vision), can be the earlest site of visual field defects, may be the most appropriate territory to follow patients needing changes in intervention and gives a more detailed and full evaluation of vision. Our pilot data shows that advances in knowledge from our past Merit Reviews coupled with new methodology will now allow us to develop testing of the full visual field using static stimuli in a time-efficint precise and accurate way. This will give a comprehensive assessment of the visual field. Main Hypothesis: Using larger perimetric stimuli in the peripheral visual field along with a Bayesian testing strategy will allow an efficient, accurate and precise perimetry method so that testing of the full visual field is practical and produces an improved assessment of vision. Specific Aim 1. Characterize the location of far peripheral visual field defects of optic neuropathies to static stimuli. We will test the full visual field in 120 stable glaucoma and idiopathic intracranial hypertension subjects with a broad range of optic nerve damage to determine where defects occur in the far peripheral visual field to static automated testing. Specific Aim 2. Develop a Bayesian strategy to test the full visual field in less than 10 minutes per eye. We will develop a pattern of test locations in the central and peripheral field based on where visual field defects most often occur. By only using stimulus sizes and intensities that give excellent repeatability, a Bayesian test strategy, and results from frequency of seeing curves, we will develop a new perimetry test. Specific Aim 3. Validate the full visual field testing using the new Bayesian strategy perimetry test. Sixty healthy observers will be tested twice and normative limits for the new test calculated. The 120 optic neuropathy subjects will be retested and the results compared. Specific Aim 4. Correlation of structure of the retinal nerve fiber layer and function (perimetry) using Optical Coherence Tomography (OCT) with the full visual field will provide stronger correlations than only the central visual field. We expect to find visual field defects i the peripheral visual field in cases where central visual field testing is normal and develop a tes that will give a better assessment of visual function. This will allow more accurate results leadin to earlier detection of diseases like glaucoma, earlier disease intervention and better structure / function correlations. Improved test precision will lead to lower retest variability and earlier detection of visual field change. Also, with cases of moderate to severe visual loss, evaluation of the full visual field will provide a larger area to monitor for changes in vision. Lastly, using lager stimuli will lead to almost a doubling of the effective dynamic range of the test that will lead to better assessment of veterans with poor vision. These test attributes should allow improved functional visual assessment for veterans with glaucoma and other optic neuropathies and improved outcome measures for VA rehabilitation research protocols.

 描述（由申请人提供）： 我们目前的临床测试方法，静态的，周边视野在很大程度上尚未被探索过。 阈值自动视野检查。直到 35 年前计算机化视野检查（视野定量）出现之前，临床实践都是通过动态手动测试整个视野。 （移动目标）戈德曼视野计。随着计算机化静态视野计的发展，焦点转移到中央 30°。这个很少测试的区域位于中央视野之外，占当前评估区域的 3 倍以上。这很重要，因为周边视野对于环境导航（功能性视力）至关重要，可能是视野缺陷的最早部位，可能是跟踪需要干预变化的患者的最合适区域，并给出更详细和全面的视力评估。 我们的试点数据表明，我们过去的优点评审知识的进步加上新的方法论现在将使我们能够以一种省时、精确和准确的方式使用静态刺激来开发整个视野的测试。这将对视野进行全面评估。 主要假设：在周边视野中使用更大的视野刺激以及贝叶斯测试策略将允许高效、准确和精确的视野测量方法，从而使整个视野的测试切实可行并产生改进的视力评估。 具体目标 1. 表征视神经病变远周边视野缺损对静态刺激的位置。我们将测试 120 名患有广泛视神经损伤的稳定型青光眼和特发性颅内高压受试者的完整视野，以确定静态自动测试中远周边视野中发生缺陷的位置。具体目标 2. 制定贝叶斯策略，在每只眼睛 10 分钟内测试整个视野。我们将根据视野缺损最常发生的位置，制定中央和周边视野的测试位置模式。通过仅使用具有出色重复性的刺激大小和强度， 贝叶斯测试策略，以及看到曲线的频率的结果，我们将开发一种新的视野检查测试。具体目标 3. 使用新的贝叶斯策略视野检查测试验证完整视野测试。六十名健康观察者将接受两次测试，并计算新测试的规范限值。 120 名视神经病变受试者将接受重新测试并比较结果。具体目标 4. 使用光学相干断层扫描 (OCT) 与整个视野的视网膜神经纤维层结构和功能（视野检查）的相关性将提供比仅中央视野更强的相关性。 我们期望在中央视野测试正常的情况下发现周边视野的视野缺陷，并开发一种测试来更好地评估视功能。这将带来更准确的结果，从而更早地发现青光眼等疾病、更早地进行疾病干预和更好的结构/ 函数相关性。提高测试精度将导致重新测试变异性降低并更早检测视野变化。此外，对于中度至重度视力丧失的病例，评估 完整的视野将提供更大的区域来监测视力变化。最后，使用更大的刺激将导致测试的有效动态范围几乎加倍，从而导致 更好地评估视力不佳的退伍军人。这些测试属性应该能够改善患有青光眼和其他视神经病变的退伍军人的功能性视觉评估，并改善退伍军人管理局康复研究方案的结果测量。