William H. Swanson

Contrast matching data predicted from contrast increment thresholds

Predictions for contrast matches were generated using a model with all parameters fixed, and gave fits to contrast matching data gathered using spatially localized 0.79 octave bandwidth patterns. The model has four mechanisms, each composed of a medium-bandwidth spatial filter followed by a contrast transfer function (a nonlinear function relating mechanism response to physical contrast). Parameters for the contrast transfer functions were fixed by fitting contrast increment threshold data. The success of the predictions shows that a small number of medium-bandwidth mechanisms can account for contrast matching results. Spatial pooling was shown to become insignificant at high contrasts. Relative spatial phase was found to be important in contrast matches using sums of frequencies one octave apart. This model shows that four mechanisms are sufficient to predict contrast matches, but does not rule out the possibility of additional mechanisms or of small changes in the mechanism bandwidths.

‘Structure–function relationship’ in glaucoma: past thinking and current concepts

An understanding of the relationship between functional and structural measures in primary open‐angle glaucoma is necessary for both grading the severity of disease and for understanding the natural history of the condition. This article outlines the current evidence for the nature of this relationship and highlights the current mathematical models linking structure and function. Large clinical trials demonstrate that both structural and functional change are apparent in advanced stages of disease, and at an individual level, detectable structural abnormality may precede functional abnormality in some patients, whereas the converse is true in other patients. Although the exact nature of the ‘structure–function’ relationship in primary open‐angle glaucoma is still the topic of scientific debate and the subject of continuing research, this article aims to provide the clinician with an understanding of the past concepts and contemporary thinking in relation to the structure–function relationship in primary open‐angle glaucoma.

Extracting thresholds from noisy psychophysical data.

Psychophysical studies with infants or with patients often are unable to use pilot data, training, or large numbers of trials. To evaluate threshold estimates under these conditions, computer simulations of experiments with small numbers of trials were performed by using psychometric functions based on a model of two types of noise:stimulus-related noise (affecting slope) andextraneous noise (affecting upper asymptote). Threshold estimates were biased and imprecise when extraneous noise was high, as were the estimates of extraneous noise. Strategies were developed for rejecting data sets as too noisy for unbiased and precise threshold estimation; these strategies were most successful when extraneous noise was low for most of the data sets. An analysis of 1,026 data sets from visual function tests of infants and toddlers showed that extraneous noise is often considerable, that experimental paradigms can be developed that minimize extraneous noise, and that data analysis that does not consider the effects of extraneous noise may underestimate test-retest reliability and overestimate interocular differences.

Visual field defects after macular hole surgery. A new finding.

PURPOSE The purpose of the study is to report the problem of a temporal visual field defect occurring after macular hole surgery. METHODS The authors reviewed the records of 13 patients found to have visual field defects after vitrectomy for macular holes. Fluorescein angiograms (13 patients), optic nerve photographs (13 patients), focal electroretinograms (3 patients), and nerve fiber analyses (8 patients) were performed in patients with visual field defects. RESULTS An absolute, temporal, usually inferior field defect was noted in 13 patients. In eight patients, the defect was detected because of specific reports or retrospective field examination results. Five patients examined in a prospective manner were found to have field defects. No history of abnormal intraocular pressure or direct trauma to the optic nerve or retinal vessels was identified. Four patients showed optic nerve pallor and three had an anomalous-appearing disc. Focal electroretinograms were of similar amplitude in the involved retina compared to corresponding areas in the healthy fellow eye. Nerve fiber analysis showed a reduction in nerve fiber layer thickness correlating to the visual field defect in those eight patients in which this test was used. CONCLUSION A significant temporal field defect may occur in patients after otherwise uncomplicated surgery for macular holes. The cause is unclear; however, reductions in nerve fiber layer thickness from the superior and nasal peripapillary area suggest that acute surgical release of the posterior hyaloid and the use of long-acting intraocular gas may in certain patients result in visual field defects.

Assessment of the Reliability of Standard Automated Perimetry in Regions of Glaucomatous Damage

PURPOSE Visual field testing uses high-contrast stimuli in areas of severe visual field loss. However, retinal ganglion cells saturate with high-contrast stimuli, suggesting that the probability of detecting perimetric stimuli may not increase indefinitely as contrast increases. Driven by this concept, this study examines the lower limit of perimetric sensitivity for reliable testing by standard automated perimetry. DESIGN Evaluation of a diagnostic test. PARTICIPANTS A total of 34 participants with moderate to severe glaucoma; mean deviation at their last clinic visit averaged -10.90 dB (range, -20.94 to -3.38 dB). A total of 75 of the 136 locations tested had a perimetric sensitivity of ≤ 19 dB. METHODS Frequency-of-seeing curves were constructed at 4 nonadjacent visual field locations by the Method of Constant Stimuli (MOCS), using 35 stimulus presentations at each of 7 contrasts. Locations were chosen a priori and included at least 2 with glaucomatous damage but a sensitivity of ≥ 6 dB. Cumulative Gaussian curves were fit to the data, first assuming a 5% false-negative rate and subsequently allowing the asymptotic maximum response probability to be a free parameter. MAIN OUTCOME MEASURES The strength of the relation (R(2)) between perimetric sensitivity (mean of last 2 clinic visits) and MOCS sensitivity (from the experiment) for all locations with perimetric sensitivity within ± 4 dB of each selected value, at 0.5 dB intervals. RESULTS Bins centered at sensitivities ≥ 19 dB always had R(2) >0.1. All bins centered at sensitivities ≤ 15 dB had R(2) <0.1, an indication that sensitivities are unreliable. No consistent conclusions could be drawn between 15 and 19 dB. At 57 of the 81 locations with perimetric sensitivity <19 dB, including 49 of the 63 locations ≤ 15 dB, the fitted asymptotic maximum response probability was <80%, consistent with the hypothesis of response saturation. At 29 of these locations the asymptotic maximum was <50%, and so contrast sensitivity (50% response rate) is undefined. CONCLUSIONS Clinical visual field testing may be unreliable when visual field locations have sensitivity below approximately 15 to 19 dB because of a reduction in the asymptotic maximum response probability. Researchers and clinicians may have difficulty detecting worsening sensitivity in these visual field locations, and this difficulty may occur commonly in patients with glaucoma with moderate to severe glaucomatous visual field loss.

Responses of Primate Retinal Ganglion Cells to Perimetric Stimuli

PURPOSE Perimetry is used clinically to assess glaucomatous ganglion cell loss. It has been proposed that frequency-doubling stimuli are better than the conventional size III perimetric stimulus in preferentially stimulating magnocellular (M) versus parvocellular (P) ganglion cells. However, little is known about how primate ganglion cells respond to perimetric stimuli. The authors recorded contrast responses of M and P ganglion cells to size III and frequency-doubling stimuli and compared contrast gain of M and P cells to these stimuli to assess the ability of these stimuli to preferentially stimulate M versus P cells. METHODS Data were recorded from 69 macaque retinal ganglion cells, by an in vivo preparation, at eccentricities of 5° to 15°. The size III stimulus was a circular luminance increment 26 min arc in diameter, 200 ms in duration. The frequency-doubling stimulus was a sinusoidal grating (0.5 cyc/deg) temporally modulated in counterphase at 13 Hz. A Michaelis-Menten function was fit to each cells contrast responses to assess contrast gain. RESULTS For both size III and frequency-doubling stimuli, ganglion cell responses increased linearly at low contrasts, and then the increase slowed at high contrasts (saturation). The mean (± SE) difference in estimated log contrast gain between M and P cells for the size III stimulus was significantly higher than that for the frequency-doubling stimulus (1.24 ± 0.09 vs. 0.89 ± 0.13; P < 0.01). CONCLUSIONS The size III stimulus was superior to the frequency-doubling stimulus in preferentially stimulating M cells versus P cells.

Hyperacuity deficits in anisometropic and strabismic amblyopes with known ages of onset

In order to evaluate the influence of etiology of amblyopia and of age at onset of amblyopia on the resulting constellation of spatial vision deficits, resolution/vernier and recognition/resolution acuity ratios were measured in groups of children with either strabismic amblyopia or anisometropic amblyopia with known ages of onset. Strabismic amblyopia with infantile onset (<9 months) and strabismic amblyopia with late onset (18-30 months) were both associated with abnormally low resolution/vernier and abnormally high recognition/resolution acuity ratios. Among amblyopes with infantile onset (<9 months), moderate amblyopia was associated with different resolution/vernier and recognition/resolution acuity ratios in anisometropic and strabismic groups. Infantile amblyopes with poor acuity outcomes included children who initially presented with anisometropia but later developed strabismus and children who initially presented with esotropia but later developed anisometropia; both subgroups with mixed amblyopia had poor resolution/vernier acuity ratios. Data from moderate amblyopes support the hypothesis that anisometropia and strabismus disrupt visual maturation in fundamentally different ways rather than simply at different stages in visual development.

Development and Evaluation of a Contrast Sensitivity Perimetry Test for Patients with Glaucoma

PURPOSE To design a contrast sensitivity perimetry (CSP) protocol that decreases variability in glaucomatous defects while maintaining good sensitivity to glaucomatous loss. METHODS Twenty patients with glaucoma and 20 control subjects were tested with a CSP protocol implemented on a monitor-based testing station. In the protocol 26 locations were tested over the central visual field with Gabor patches with a peak spatial frequency of 0.4 cyc/deg and a two-dimensional spatial Gaussian envelope, with most of the energy concentrated within a 4 degrees circular region. Threshold was estimated by a staircase method: Patients and 10 age-similar control subjects were also tested on conventional automated perimetry (CAP), with the 24-2 pattern with the SITA Standard testing strategy. The neuroretinal rim area of the patients was measured with a retinal tomograph (Retina Tomograph II [HRT]; Heidelberg Engineering, Heidelberg, Germany). A Bland-Altman analysis of agreement was used to assess test-retest variability, compare depth of defect shown by the two perimetric tests, and investigate the relations between contrast sensitivity and neuroretinal rim area. RESULTS Variability showed less dependence on defect depth for CSP than for CAP (z = 9.3, P < 0.001). Defect depth was similar for CAP and CSP when averaged by quadrant (r = 0.26, P > 0.13). The relation between defect depth and rim area was more consistent with CSP than with CAP (z = 9, P < 0.001). CONCLUSIONS The implementation of CSP was successful in reducing test-retest variability in glaucomatous defects. CSP was in general agreement with CAP in terms of depth of defect and was in better agreement than CAP with HRT-determined rim area.

Variability of visual field measurements is correlated with the gradient of visual sensitivity.

Conventional static automated perimetry provides important clinical information, but its utility is limited by considerable test-retest variability. Fixational eye movements during testing could contribute to variability. To assess this possibility, it is important to know how much sensitivity change would be caused by a given eye movement. To investigate this, we have evaluated the gradient, the rate at which sensitivity changes with location. We tested one eye each, twice within 3 weeks, of 29 patients with glaucoma, 17 young normal subjects and 13 older normal subjects. The 10-2 test pattern with the SITA Standard algorithm was used to assess sensitivity at locations with 2 degrees spacing. Variability and gradient were calculated at individual test locations. Matrix correlations were determined between variability and gradient, and were substantial for the patients with glaucoma. The results were consistent with a substantial contribution to test-retest variability from small fixational eye movements interacting with visual field gradient. Successful characterization of the gradient of sensitivity appears to require sampling at relatively close spacing, as in the 10-2 test pattern.

Assessment of contrast gain signature in inferred magnocellular and parvocellular pathways in patients with glaucoma

PURPOSE Contrast gain signatures of inferred magnocellular and parvocellular postreceptoral pathways were assessed for patients with glaucoma using a contrast discrimination paradigm developed by Pokorny and Smith. The potential causes for changes in contrast gain signature were investigated using model simulations of ganglion cell contrast responses. METHODS Foveal contrast discrimination thresholds were measured with a pedestal-Delta-pedestal paradigm developed by Pokorny and Smith [Pokorny, J., & Smith, V. C. (1997). Psychophysical signatures associated with magnocellular and parvocellular pathway contrast gain. Journal of the Optical Society of America A, 14(9), 2477-2486]. Stimuli were 27 ms luminance increments superimposed on 227 ms pulsed Delta-pedestals. Contrast thresholds and contrast gain signatures mediated by the inferred magnocellular (MC) and parvocellular (PC) pathways were assessed using linear fits to contrast discrimination thresholds at either lower or higher Delta-pedestal contrasts, respectively. Twenty-seven patients with glaucoma were tested, as well as 16 age-similar control subjects free of eye disease. RESULTS Contrast sensitivity and contrast gain signature mediated by the inferred MC pathway were lower for the glaucoma group, and reduced contrast gain signature was correlated with reduced contrast sensitivity (r(2)=45%, p<.0005). These two parameters mediated by the inferred PC pathway were little affected for the glaucoma group. Model simulations suggest that the reduced contrast sensitivity and contrast gain signature were consistent with the hypothesis that reduced MC ganglion cell dendritic complexity can lead to reduced effective retinal illuminance, and hence increased semi-saturation contrast of the ganglion cell contrast response functions. CONCLUSIONS The contrast sensitivity and contrast gain signature of the inferred MC pathway were reduced in patients with glaucoma. The results were consistent with a model of ganglion cell dysfunction due to reduced synaptic density.