Testing of the Peripheral Visual Field - Obtaining the Full View

 描述(由申请人提供)： 周边视野在很大程度上没有探索到我们目前的临床测试方法，静态 阈值自动视野检查。直到35年前计算机化视野检查(视野的量化)出现之前，临床实践是通过动态视野检查来手动测试整个视野 (移动目标)戈德曼视野检查。随着计算机静态视野检查的发展，焦点转移到了中心30°。这个很少测试的区域，在中央视野之外，代表了目前评估领土的3倍以上。这一点很重要，因为外围视野对于导航环境(功能视力)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。我们的试验数据表明，过去功绩评估中知识的进步，加上新的方法，现在将使我们能够以一种时效、精确和准确的方式使用静态刺激来开发全视野测试。这将给出一个全面的视野评估。主要假设：在周边视野中使用更大的视野刺激和贝叶斯测试策略将允许一种高效、准确和精确的视野检查方法，从而使整个视野的测试切实可行，并产生更好的视力评估。具体目的1.确定视神经病变对静态刺激的远周视野缺陷的位置。我们将对120例稳定性青光眼和特发性高颅压视神经损害患者进行全视野检测，以确定发生远周边视野缺陷的部位，进行静态自动化检测。具体目标2.开发一种贝叶斯策略，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见的位置，开发中央和外围视野中测试位置的模式。通过仅使用可提供极佳重复性的刺激大小和强度， 贝叶斯测试策略，并根据测试结果看到曲线的频率，我们将开发一种新的视野测试。具体目标3.使用新的贝叶斯策略视野测试验证全视野测试。60名健康的观察者将接受两次测试，并计算新测试的标准限值。120名视神经疾病患者将重新进行测试，并对结果进行比较。具体目的4.使用光学相干断层扫描(OCT)将视网膜神经纤维层的结构和功能(视野)与全视野相关联，将提供比仅中心视野更强的相关性。我们希望在中心视野测试正常的情况下，在周边视野发现视野缺陷，并开发一种能够更好地评估视觉功能的TES。这将允许更准确的结果导致更早地发现青光眼等疾病，更早的疾病干预和更好的结构/ 函数关联。改进的测试精度将导致较低的重测变异性和更早地检测到视野变化。此外，对于中度到重度视力丧失的病例，评估 全视野将提供更大的区域来监测视力的变化。最后，使用更大的刺激将导致测试的有效动态范围几乎翻倍，这将导致 更好地评估视力不佳的退伍军人。这些测试属性应该可以改善对患有青光眼和其他视神经疾病的退伍军人的功能视觉评估，并改善VA康复研究方案的结果衡量标准。

 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.