William E. Sponsel

Prevent blindness America visual field screening study

Purpose To assess the screening efficacy and practical use of two portable devices to detect moderate to severe visual field loss rapidly in population screening. Methods Henson visual field analysis and Damato campimetry for glaucoma were performed in a healthy adult population, to determine false-positive rates; in established glaucoma patients and suspects, to determine false-negative rates; and in a general adult population, to assess practical use in actual screenings. Results There were no false-positive test failures among the 82 normal subjects who completed the Henson two-step screening. Eighty of 83 normal subjects passed Damato campimetry, resulting in a false-positive rate of 3.6%. Among 83 glaucoma suspects and patients, the Henson test identified 49 (84%) of 58 subjects whose full-threshold fields from Humphrey perimetry were abnormal, 38 (97%) of 39 of whom had moderate to severe visual field loss. The Damato campimeter detected 55 (81%) of 68 subjects with any pathologic loss on full-threshold visual fields, 44 (92%) of 48 of whom had moderate to severe visual field loss. Among 1,278 subjects tested in general population screenings, 55 subjects (4.3%) failed either or both tests. Conclusions The Henson visual field analyzer can discriminate moderately to severely diseased from normal visual fields with high sensitivity and specificity. The Damato campimeter can reliably detect moderate to severe visual field loss with a tolerably low false-positive rate. To overcome the weakness of glaucoma screening by tonometry alone, some forms of visual field testing may be acceptably brief (cost effective) and accurate (sensitive and specific).

Correlation of Visual Function and Retinal Leukocyte Velocity in Glaucoma

Twelve subjects with glaucoma or ocular hypertension underwent measurement of visual fields (Humphrey perimeter and the Henson CFS2000 perimeter), contrast sensitivity (Vistech wall charts), and perimacular leukocyte velocity (Oculix BFS-1000 blue field entoptic technique). Significant positive correlations were seen between asymmetry of visual function and asymmetry of retinal leukocyte velocity in the study population. The eye with the higher velocity of retinal leukocyte flow tended to have better visual function as measured by Humphrey mean deviation (P less than .05), Henson Score (P less than .06), and Vistech contrast sensitivity score at 6 cycles/degree (P less than .001). An association of borderline significance was found between the asymmetries of intraocular pressure and retinal leukocyte velocity (P = .06). No significant intraocular pressure:visual field correlations were found on asymmetry analysis, although the inverse relationship between intraocular pressure and contrast sensitivity was significant (P less than .05). Significant correlations were obtained between visual field scores derived from the Henson data and Humphrey parameters mean deviation (P less than .001) and corrected pattern standard deviation (P less than .05) on both asymmetry and single eye analysis.

Evaluation of the Keeler Pulsair non-contact tonometer

Abstract. The recently‐introduced Pulsair non‐contact tonometer (Keeler Instruments, Inc, Broomall, PA) was evaluated against the Goldmann applanation tonometer in cannulated post mortem human eyes, and in living subjects at three clinical centers. Statistical analysis of the findings revealed strong linear relationships between Goldmann or manometric and Pulsair intraocular pressure readings, with correlation coefficients ranging from 0.79 to 0.97. However, with the Pulsair reading as the dependent variable, the slope of the relationship in each case was significantly less than 1.0 (range 0.65 to 0.83), while the intercept was positive (range 1.31 to 2.33 mmHg). Thus, the Pulsair tended to read low at intraocular pressure above the normal range. Conversion factors and a calibration table allowing intraocular pressure estimates more comparable to Goldmann tonometry using the current (J‐series) Pulsair are provided herein. A calibration algorithm could be integrated into the circuitry of future production models of the Pulsair instrument.

Retinal Capillary Hemodynamics and VEP/Pressure Tolerance: Evidence of Retinal Microcirculatory Compromise in Treated Glaucomatous Eyes

Measurements of retinal leukocyte velocity were made in single eyes of 6 glaucomatous adults and 9 normal subjects at each of 4 discrete levels of IOP elevation assigned according to the characteristics of prior pattern-evoked cortical potential pressure tolerance measurements. Glaucomatous eyes failed to demonstrate any stabilization in retinal leukocyte velocity at pressures above 45 mm Hg, with velocities 33% lower than normal for a comparable degree of IOP elevation (p < 0.012). Even at baseline IOP, leukocyte velocity was 27.2% slower in the treated glaucomatous eyes than in normal control eyes (p < or = 0.013), despite comparable baseline IOP levels in both groups.