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）： 周边视野在很大程度上是我们目前的临床测试方法，静态 阈值自动视野检查。直到35年前计算机视野检查（视野定量）的出现，临床实践是通过动力学手动测试整个视野 （移动目标）戈德曼视野检查。随着计算机化静态视野检查的发展，焦点转移到中心30 °。这个很少测试的区域，在中央视野之外，是目前评估的区域的3倍以上。这一点很重要，因为周边视野对于环境导航（功能性视觉）至关重要，可能是视野缺损的最早部位，可能是跟踪需要干预的患者的最合适区域，并提供更详细和全面的视力评估。 我们的试点数据表明，我们过去的优点审查知识的进步加上新的方法，现在将允许我们开发测试的全视野使用静态刺激在一个时间效率精确和准确的方式。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有效、准确和精确的视野测量方法，使得全视野的测试是实用的并且产生改善的视力评估。 具体目标1。静态刺激下视神经病变远周边视野缺损的定位特征。我们将在120名稳定型青光眼和特发性颅内高压受试者中测试全视野，这些受试者具有广泛的视神经损伤，以确定在静态自动化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，在每只眼睛不到10分钟的时间内测试整个视野。我们将根据视野缺陷最常发生的位置，在中央和周边视野中制定一种测试位置模式。通过仅使用提供优异可重复性的刺激大小和强度， 贝叶斯测试策略，并从看到曲线的频率的结果，我们将开发一种新的视野检查。具体目标3。使用新的贝叶斯策略视野检查法进行全视野检查。将对60名健康观察员进行两次检测，并计算新检测的标准限值。将对120例视神经病变受试者进行复检并比较结果。具体目标4。使用光学相干断层扫描（OCT）与全视野的视网膜神经纤维层的结构和功能（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检查正常的病例中发现周边视野的视野缺损，并开发一种能更好地评估视功能的测试。这将允许更准确的结果，从而更早地检测青光眼等疾病，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更低的重复测试变异性和更早地检测视野变化。此外，对于中度至重度视力丧失的病例， 全视野将提供更大的区域来监视视力的变化。最后，使用较大的刺激将导致测试的有效动态范围几乎加倍，这将导致 对视力不佳的退伍军人进行更好的评估。这些测试属性应允许改善青光眼和其他视神经病变退伍军人的功能性视觉评估，并改善VA康复研究方案的结局指标。