Abstracts Blau-Gelb Perimetrie (bis Aug 2002)

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1 Abstracts Blau-Gelb Perimetrie (bis Aug 2002) Johnson CA, Sample PA, Cioffi GA, Liebmann JR, Weinreb RN. Structure and function evaluation (SAFE): I. criteria for glaucomatous visual field loss using standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). Am J Ophthalmol 2002 Aug;134(2): Discoveries in Sight Research Labs, Devers Eye Institute, Portland, Oregon 97210, USA. cajhonso@discoveriesinsight.org PURPOSE: To develop criteria for detecting glaucomatous visual field loss for standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). DESIGN: Longitudinal observational study.methods: Three populations were evaluated: (1) 348 normal subjects (348 eyes) were tested to develop normative databases and statistical analysis packages for SAP and SWAP. (2) An independent group of 47 normal subjects (94 eyes) with 4 years of longitudinal follow-up was evaluated to determine specificity of different criteria. (3) A group of 298 patients (479 eyes) with elevated intraocular pressure and normal baseline SAP visual fields were evaluated to determine the sensitivity of different criteria for detecting early glaucomatous visual field loss. RESULTS: Six criteria demonstrated high specificity for correctly identifying eyes with normal visual fields (98%-100%) for both SAP and SWAP: (1) a pattern standard deviation (PSD) worse than the normal 1% level, (2) a glaucoma hemifield test (GHT) "outside normal limits," (3) one hemifield cluster worse than the normal 1% level, (4) two hemifield clusters worse than the normal 5% level, (5) four abnormal (P <.05) locations, (6) five abnormal locations (P <.05) on the pattern deviation probability plot. For all criteria, confirmation on a second visual field was required for high specificity. The GHT "outside normal limits," two hemifield clusters worse than the normal 5% level and four abnormal (P <.05) test locations on the pattern deviation probability plot provided the highest percentages of conversion from a normal to a glaucomatous visual field. CONCLUSIONS: Criteria based on the GHT, GHT hemifield clusters, and the pattern deviation probability plot provide high sensitivity and specificity for detecting early glaucomatous visual field changes. Cubbidge P, Hosking L, Embleton S. Statistical modelling of the central 10-degree visual field in short-wavelength automated perimetry. Graefes Arch Clin Exp Ophthalmol 2002 Aug;240(8):650-7 Neurosciences Research Institute, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK, R.P.Cubbidge@aston.ac.uk BACKGROUND. Reports of short-wavelength pathway dysfunction in retinal eye disease suggest that short-wavelength automated perimetry may be a useful technique for the investigation of central visual function. The aim of this study was to adapt existing statistical procedures used for the investigation of 30-2 short-wavelength automated perimetry to the 10-2 program of the Humphrey Field Analyser. METHODS. A four- or six-point linear interpolation procedure was used to calculate normal visual field sensitivity for each of the 68 stimulus locations of the 10-2 program using empirical normal data from 51 normal subjects examined using the 30-2 program. Prediction limits for normality were derived at each stimulus location, enabling the calculation of age-corrected global perimetric indices and

2 construction of probability maps for diffuse and focal visual field loss. The normal database was validated by empirical data from five normal subjects, stratified for age. RESULTS. The pointwise distribution of normal sensitivity exhibited a Gaussian distribution at the majority of stimulus locations. The pointwise coefficient of variation did not vary significantly across the visual field. Examples of diabetic pseudophakic patients and a patient with age-related macular degeneration are presented to illustrate the effectiveness of SWAP at detecting visual field abnormality in the central visual field. CONCLUSION. Ten-degree SWAP is able to effectively detect focal visual field loss in central retinal eye disease which may precede those found using conventional perimetry. SWAP may prove to be an invaluable technique for the investigation of central retinal eye disease. Mistlberger A, Liebmann JM, Greenfield DS, Hoh ST, Ishikawa H, Marmor M, Ritch R. Assessment of optic disc anatomy and nerve fiber layer thickness in ocular hypertensive subjects with normal short-wavelength automated perimetry. Ophthalmology 2002 Jul;109(7): Department of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA. PURPOSE: To compare optic disc topography and nerve fiber layer thickness in ocular hypertensive eyes and normal subjects. DESIGN: Prospective, case-controlled study. PARTICIPANTS AND CONTROLS: One eye in each of 20 normal and 27 ocular hypertensive patients was enrolled. METHODS: Consecutive normal and ocular hypertensive patients were enrolled. Each patient underwent complete ophthalmic examination, achromatic automated perimetry, short-wavelength automated perimetry, confocal scanning laser ophthalmoscopy, confocal scanning laser polarimetry, and optical coherence tomography. The intraocular pressure was 21 mmhg or less for normal subjects and at least 25 mmhg on two separate occasions in ocular hypertensive eyes. Structural parameters were compared between the two groups. Eyes with evidence of glaucomatous optic neuropathy, achromatic visual field loss, or evidence of focal visual field injury during short-wavelength automated perimetry were excluded. MAIN OUTCOME MEASURES: Optic nerve head topography and nerve fiber layer thickness. RESULTS: The three imaging technologies could not detect differences in optic disc or nerve fiber layer anatomy between the two groups. Ocular hypertensive eyes had a greater corrected pattern standard deviation than normal eyes during short-wavelength automated perimetry (P = 0.04). CONCLUSIONS: Ocular hypertensive eyes with normal achromatic automated perimetry and short-wavelength automated perimetry could not be distinguished from normal subjects with confocal scanning laser ophthalmoscopy, confocal scanning laser polarimetry, and optical coherence tomography. Bayer AU, Maag KP, Erb C. Detection of optic neuropathy in glaucomatous eyes with normal standard visual fields using a test battery of short-wavelength automated perimetry and pattern electroretinography. Ophthalmology 2002 Jul;109(7): Department of Ophthalmology, Hospital of Weilheim-Schongau, Puetrichstrasse 32, Weilheim, Germany. PURPOSE: To evaluate the clinical use of a test battery of short-wavelength automated perimetry (SWAP), frequency-doubling technology (FDT) perimetry, and patternelectroretinography (PERG) in patients with definite primary open-angle glaucoma (POAG)

3 but normal results on standard automated perimetry (SAP). STUDY DESIGN: Prospective, comparative, observational case series. PARTICIPANTS: Thirty-six patients with POAG with standard visual field defects in one eye and normal standard visual fields in the contralateral eye and 36 normal controls were enrolled. MAIN OUTCOME MEASURES: SWAP, PERG, FDT, and SAP were performed in all eyes, and global indices and amplitudes were used for statistical analysis. RESULTS: When contralateral POAG eyes with asymmetric glaucomatous damage was compared, a paired t test showed significant differences in SAP mean deviation (MD) (P < ), SWAP-MD (P = ), FDT-MD (P = ), and PERG amplitudes (P < ). When comparing between POAG eyes with normal results on SAP and normal controls, Student's t test showed significant differences for SWAP-MD (P < ), FDT-MD (P = ), PERG N1P1-amplitude (P = ) and P1N2-amplitude (P < ); receiver operating characteristic analysis revealed promising accuracy for SWAP- MD of 73.6% (P < ). SWAP-MD (P < ) and FDT-MD (P < ) correlated significantly with SAP-MD and with each other (range, P < to P = ). Regression analysis revealed that PERG P1N2-amplitude could improve the power of SWAP-MD from 73.6% to detect early POAG in eyes with normal results on SAP to an accuracy of 81.9%. CONCLUSIONS: A test battery of SWAP-MD and PERG P1N2-amplitude could detect glaucomatous optic neuropathy in POAG eyes with normal standard visual fields, whereas FDT-MD and SWAP-MD significantly correlated with each other and with SAP-MD. All tests were able to detect the eye with the more severe glaucomatous optic neuropathy in patients with asymmetric POAG. Horn FK, Jonas JB, Budde WM, Junemann AM, Mardin CY, Korth M. Monitoring glaucoma progression with visual evoked potentials of the bluesensitive pathway. Invest Ophthalmol Vis Sci 2002 Jun;43(6): Department of Ophthalmology and University Eye Hospital, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany. folkert.horn@augen.imed.uni-erlangen.de PURPOSE: To determine the value of visual evoked potentials with blue-on-yellow pattern stimulation in follow-up of glaucoma. METHODS: This prospective longitudinal concurrent study included a heterogeneous cohort of two groups, perimetric (n = 161) and preperimetric (n = 118), of patients with chronic open-angle glaucoma and 113 healthy control subjects. In the preperimetric glaucoma group, patients showed glaucomatous abnormalities of the optic disc, maximum intraocular pressure higher than 21 mm Hg, and unremarkable computerized visual field examination results. Patients underwent up to three VEP measurements with blueon-yellow pattern stimulation, as well as qualitative and morphometric evaluation of color stereo optic disc photographs. Mean follow-up time between measurements was 24 months. VEP measurements were separately analyzed in preperimetric subjects, with and without progression of optic nerve damage. Progression of glaucoma was defined as increasing loss of neuroretinal rim. RESULTS: A separate analysis of VEP peak times in patients in the preperimetric group, with and without progression of glaucomatous optic nerve damage, showed no significant difference at baseline but a significant prolongation (P = 0.01) in patients with progressive disease, 2 years before morphologic changes were evident. VEPs in patients with nonprogressive disease were statistically unchanged during the observation period. The perimetric group and both preperimetric groups showed significantly prolonged VEP peak times in comparison with the control group (P < 0.001). CONCLUSIONS: In addition to photographic evaluation to detect glaucomatous disc atrophy, the blue-on-yellow VEP may be an objective electrophysiological tool for monitoring patients with glaucoma, because peak times are significantly associated with progression of optic nerve damage.

4 Bayer AU, Erb C. Short wavelength automated perimetry, frequency doubling technology perimetry, and pattern electroretinography for prediction of progressive glaucomatous standard visual field defects. Ophthalmology 2002 May;109(5): Department of Ophthalmology, Eberhard-Karls-University, Tuebingen, Germany. PURPOSE: To evaluate the clinical use of a test battery of short wavelength automated perimetry (SWAP), frequency doubling technology perimetry (FDT), and pattern electroretinography (PERG) in predicting progressive glaucomatous visual field defects on standard automated perimetry (SAP). STUDY DESIGN: A prospective, longitudinal, observational case series. PARTICIPANTS: One hundred and fifty-two patients with primary open-angle glaucoma (POAG) with bilateral glaucomatous visual field defects on SAP were followed at 6-month intervals over a period of 30 months. MAIN OUTCOME MEASURES: Short wavelength automated perimetry, FDT, and PERG results were compared between POAG eyes with and without progressive field loss on SAP. These two groups were used to evaluate whether PERG, SWAP, and/or FDT is predictive of future progression of field loss on SAP. RESULTS: Using the criteria of progressive field loss on SAP defined by the Collaborative Normal Tension Glaucoma Study, 54 eyes (study group) of 54 POAG patients showed progressive defects, whereas 84 eyes (control group) of 84 POAG patients showed no progression. Only 11.1% (6 of 54) of the eyes with a progression of field loss on SAP showed no increase of deficits on the three functional tests before progression. Short wavelength automated perimetry detected early progressive defects on SAP in 43 of the 54 eyes (79.6%). Of these 54 POAG eyes, FDT showed progressive deficits in 40 eyes (74.1%), whereas PERG amplitude P1N2 showed progressive deficits in 35 eyes (64.8%) before progression of field loss on SAP. A test battery consisting of SWAP and PERG P1N2-amplitude was able to detect 88.9% of eyes before a prediction of field loss on SAP. When comparing the results of the two functional tests, SWAP and FDT in the 84 eyes without progression of field loss on SAP between baseline and at 30 months, SWAP and FDT showed progressive deficits in 34.5% and 35.7%, respectively. CONCLUSIONS: All three tests (SWAP, FDT, and PERG) have been successful in detecting glaucoma eyes with a future progression of standard visual field defects. A test battery of SWAP and PERG P1N2-amplitude improved the power to predict these progressive defects on SAP. It remains to be seen whether the long-term followup in POAG eyes will improve the false-positive rate of SWAP and FDT. Polo V, Larrosa JM, Pinilla I, Perez S, Gonzalvo F, Honrubia FM. Predictive value of short-wavelength automated perimetry: a 3-year follow-up study. Ophthalmology 2002 Apr;109(4):761-5 Department of Ophthalmology, Miguel Servet University Hospital, P. Isabel La Catolica, Zaragoza, Spain. PURPOSE: To determine whether structural changes in the retinal nerve fiber layer (RNFL) and functional abnormalities in short-wavelength automated perimetry (SWAP) can predict the onset of functional losses in standard automated perimetry patients suspected of having glaucoma. DESIGN: Prospective observational case series. PARTICIPANTS: A total of 160 eyes of ocular hypertensive subjects (intraocular pressure greater than 21 mmhg and normal

5 standard automated perimetry) were included in the study. INTERVENTIONS: The subjects underwent RNFL photographic evaluation and SWAP. Standard automated perimetries were repeated after 3 years to evaluate glaucomatous losses. MAIN OUTCOME MEASURES: Onset of glaucomatous defects in conventional automated perimetry after 3 years of followup, with or without prior glaucomatous defects in RNFL and SWAP. RESULTS: At the beginning of the study, 77 eyes showed RNFL losses (48%), and 58 eyes showed abnormalities in SWAP (36%). After the 3-year follow-up period, 14 of 77 eyes with RNFL losses had standard automated perimetry abnormalities (predicting sensitivity 93%), whereas 11 of 58 eyes with abnormal SWAP had standard automated perimetry losses (73% sensitivity). CONCLUSIONS: RNFL and SWAP losses are signs of early glaucomatous damage and can predict functional losses in standard automated perimetry. Johnson CA. Recent developments in automated perimetry in glaucoma diagnosis and management. Curr Opin Ophthalmol 2002 Apr;13(2):77-84 Discoveries in Sight Research Labs, Devers Eye Institute, Portland, Oregon 97210, USA. cajohnso@discoveriesinsight.org Recently, there have been several new developments in automated perimetry that have contributed to enhanced diagnosis and management of glaucoma. This paper will briefly review four of the latest advances in automated perimetry: (1) efficient test strategies that reduce the testing time and variability of automated perimetric testing, in particular, the Swedish Interactive Threshold Algorithm (SITA) and Tendency Oriented Perimetry (TOP) test strategies will be described; (2) Frequency Doubling Technology (FDT) perimetry, which has been shown to be a rapid, effective method of detecting glaucomatous visual field loss; (3) Short Wavelength Automated Perimetry (SWAP), which has demonstrated the ability to predict the onset and progression of glaucomatous visual field deficits; (4) The Multifocal Electroretinogram (mferg) and the Multifocal Visual Evoked Potential (mfvep), which provide an objective measurement of the visual field. Each of these techniques has presented distinct advantages for the diagnosis and management of glaucoma. Soliman MA, de Jong LA, Ismaeil AA, van den Berg TJ, de Smet MD. Standard achromatic perimetry, short wavelength automated perimetry, and frequency doubling technology for detection of glaucoma damage. Ophthalmology 2002 Mar;109(3): Ophthalmology Department, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt. Mohamed.Soliman@egypt.net OBJECTIVE: Reevaluation of the relationship between short wavelength automated perimetry (SWAP), standard achromatic perimetry (SAP), and frequency doubling technology (FDT) in glaucoma and ocular hypertensive patients and in glaucoma suspects. DESIGN: Prospective comparative observational study. PARTICIPANTS: Four age-matched groups were evaluated (42 patients with early to moderate glaucoma, 34 ocular hypertensives, 22 glaucoma suspects, and 25 normal controls) using SAP, SWAP, and FDT. INTERVENTION: All participants underwent full clinical ophthalmologic evaluation followed by SWAP, SAP, and FDT perimetry within a period of not more than 3 months. Mean defect (MD), pattern standard deviation (PSD), visual field (VF) indices, and the percentage of depressed visual field points with P value <5% and <1% in the pattern deviation plot were evaluated. MAIN

6 OUTCOME MEASURES: For each of the four study groups, the MD, PSD, and the percentage of abnormal points significantly depressed <5% and <1% were compared for the three VF testing modalities. RESULTS: In the glaucoma group, the mean percentage of the total number of abnormal points in SWAP was significantly less than abnormal points in SAP and FDT, both for 5% (P values were and , respectively) and 1% (P values were and , respectively). The same applied to the ocular hypertensives group. However, in the suspects group, no significant difference was detected. In normal controls, the abnormal points in SWAP were significantly lower than those in SAP for 5% (P value was 0.01) and 1% (P value was 0.05). FDT detected significantly larger defects (percentage of points <5%) than SAP in ocular hypertensives and suspects (P values were 0.01 and 0.004, respectively). CONCLUSIONS: SWAP in its existing condition is markedly less efficient than either SAP or FDT in detecting VF defects, especially in glaucoma patients and ocular hypertensives (defects detected with SWAP are less than both SAP and FDT). Defects detected with FDT are equivalent to SAP and sometimes larger, especially in ocular hypertensives and glaucoma suspects; this makes it a useful tool for picking up early glaucomatous defects in populations at risk. Polo Llorens V, Larrosa Poves JM, Pinilla Lozano I, Pablo Julvez L, Fernandez Tirado FJ, Rojo Aragues A, Cuevas Andres R, Honrubia Lopez FM. Glaucomatous damage pattern in swap in the early stages of glaucoma [Article in Spanish] Arch Soc Esp Oftalmol 2002 Mar;77(3): PURPOSE: To determine with Short-Wavelength Automated Perimetry (SWAP) the patterns of early glaucomatous damage and to compare frequency of diffuse defects to localized defects. METHODS: One hundred and sixty eyes from 83 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm Hg and normal standard visual fields) were studied. SWAP was performed with a modified Humphrey Field Analyser. Total (TD) and pattern deviation (PD) probability maps were calculated to evaluate the pattern of visual field loss. RESULTS: The frequency of defects was higher in TD than in PD for all levels of defects (p<0.001). There was also a relative topographical distribution of glaucomatous defects. CONCLUSIONS: We documented the existence of predominantly diffuse visual field defects for all depth levels at early glaucoma stages. McKendrick AM, Cioffi GA, Johnson CA. Short-wavelength sensitivity deficits in patients with migraine. Arch Ophthalmol 2002 Feb;120(2): Discoveries in Sight, Devers Eye Institute, Legacy Clinical Research and Technology Center, 1225 NE Second Ave, PO Box 3950, Portland, OR , USA. OBJECTIVE: To examine short-wavelength sensitivity in patients with migraine using shortwavelength automated perimetry (SWAP) and Stiles 2-color increment threshold procedures. METHODS: Twenty-five subjects with migraine with (n = 11) and without (n = 14) aura and 20 age-matched headache-free subjects underwent testing. All subjects underwent standard automated perimetry (SAP) and SWAP (using a Humphrey field analyzer; 24-2 presentation pattern). In 2 migraine patients (one with and another without aura), the 2-color increment threshold procedure was used to determine whether sensitivity losses were specific to shortwavelength sensitivity pathways or a generalized loss to multiple pathways. RESULTS: No statistically significant differences between migraine patients and controls were found for

7 mean deviation (MD) or pattern-standard deviation (PSD) for SAP. However, for SWAP, MD and PSD were worse for the migraine group (P =.04). Twelve migraine patients had more than 4 locations with sensitivity worse than the 5% probability level (reference value). Increment threshold determinations in the 2 selected migraine patients indicated a selectively greater loss for short-wavelength sensitivity mechanisms. CONCLUSIONS: Approximately 50% of subjects with migraine (with or without aura) demonstrate SWAP sensitivity losses, at times between migraine events. These findings, in conjunction with previous results for SAP and flicker perimetry, suggest that migraine patients should be excluded from normative databases of visual function, and warrant further investigations of the relationship between migraine and glaucoma. Yamazaki Y, Mizuki K, Hayamizu F, Tanaka C. Correlation of blue chromatic macular sensitivity with optic disc change in early glaucoma patients. Jpn J Ophthalmol 2002 Jan-Feb;46(1):89-94 Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan. PURPOSE: To investigate the relationship between morphological changes of the optic nerve head (ONH) and macular sensitivity determined with blue on yellow (B on Y) and white on white (W on W) perimetry in normal subjects and patients with glaucoma. METHODS: One randomly chosen eye was evaluated in each of 28 healthy subjects, 23 patients with ocular hypertension (OH), and 23 patients with early primary open-angle glaucoma (POAG). The mean macular sensitivity determined with B on Y and W on W perimetry was obtained by a macular program using a modified Humphrey field analyzer. The Heidelberg retina tomograph with software version 2.01 was used to evaluate the temporal topographic measurements of ONH. RESULTS: There was no significant difference in temporal ONH parameters among the three clinical groups. The mean macular sensitivity of B on Y and W on W perimetry in early POAG patients was significantly lower than that in healthy subjects and in patients with OH. The mean macular sensitivity of W on W perimetry showed no significant correlation with temporal ONH parameters in any clinical groups. In patients with early POAG, the mean macular sensitivity of B on Y perimetry was significantly related to cup area and volume, cup/disc area ratio, and rim volume in the temporal sector of the ONH. CONCLUSION: The measurement of the mean macular sensitivity of B on Y perimetry might make it possible to detect functional damage prior to morphological changes in the ONH due to elevated intraocular pressure in glaucoma. Polo V, Larrosa JM, Pinilla I, Gonzalvo F, Ferreras A, Honrubia FM. Glaucomatous damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects. Eur J Ophthalmol 2002 Jan-Feb;12(1):49-54 Department of Ophthalmology, Hospital Universitario Miguel Servet, Zaragoza, Spain. PURPOSE: To determine the glaucomatous visual field damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects, and to compare the frequency of diffuse visual field losses and localized defects. METHODS: 157 eyes of 157 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm Hg and normal standard visual fields) were studied. SWAP was done with a modified Humphrey Field Analyzer. Total (TD) and Pattern Deviation (PD) probability maps were calculated for SWAP. The frequency of abnormlities in the TD and PD were determined, analyzing the

8 visual field loss components. RESULTS: The involvement of the test points was more frequent on the TD plots than on the PD plots for all levels of defects (p< 0.001). The glaucomatous defects also showed certain topographical distribution. CONCLUSIONS: A diffuse sensitivity component of visual field loss was found at all SWAP defect depths in glaucoma suspects. Polo Llorens V, Larrosa Poves JM, Pablo Julvez LE, Pinilla Lozano I, Marcuello Melendo B, Fernandez Larripa S, Honrubia Lopez FM. Cup-to-disk ratio asymmetry: diagnostic value in glaucoma] [Article in Spanish] Arch Soc Esp Oftalmol 2002 Jan;77(1):17-22 PURPOSE: To assess visual field abnormalities in suspected glaucoma patients showing evident asymmetry in cup-to-disk ratio. MATERIAL AND METHOD: Twenty two hypertensive eyes in 11 subjects evidencing lateral differences in cup-to-disk ratio of more than 2/10 were included in the study. Conventional and short wavelength automated perimetry (SWAP) was performed with a Humphrey field analyser. A retinal nerve fiber layer (RNFL) study was also performed. RESULTS: Differences in IOP were 1.23 mmhg (p<0.05). No differences were evidenced in conventional automated perimetry between both eyes. Average sensitivity (SWAP) showed significantly lower (p<0.05) in those ayes with greater cup-todisk ratio. RNFL showed a higher rate of defects in eyes with a higher cup-to-disk ratio. CONCLUSION: Lateral differences in cup-to-disk ratio indicate structural glaucomatous damage which is related to IOP levels. Associated functional loss was evidenced with SWAP. Qi S, Jiang Y. [Short-wavelength perimetry in diagnosis of early glaucoma: comparison with standard automated perimetry] [Article in Chinese] Chung Hua Yen Ko Tsa Chih 2002 Jan;38(1):31-5 Department of Ophthalmology, The Second Xiang Ya Hospital of Central South University, Changsha , China ( xuhuiye@cs.hn.cn) OBJECTIVE: To assess the value of short-wavelength automated perimetry in the diagnosis of early glaucoma. METHODS: Fourty-six eyes of 36 patients with early open angle glaucoma and a group of 38 normal persons (46 eyes) were examined both by the standard automated (white-on-white, W/W) perimeter and short-wavelength (blue-on-yellow, B/Y) perimeter. The age and sex in two groups were matched. The program 24-2 was performed on both B/Y and W/W fields in two groups. The mean light sensitivity (MS) of the central 25 degrees and in each quadrant from two perimetries was calculated and analyzed statistically by Student t-test and ASNOV. RESULTS: The difference of MS in central 25 degrees between two perimetries in normal group was 1.63 db which showed a statistical significance of difference (t = 3.57, P < 0.001). MS was significantly higher in W/W than that in B/Y either in central 25 degrees or in each corresponding quadrant (t = 3.45, P < 0.001). The MS difference between them was more than 2.87 db and the MS average difference of the corresponding quadrant was more than 2.5 db (t = 4.57, 3.42, P < 0.001). MS from four quadrants were different from one other. The lowest MS was in the superior temporal, the highest MS was in inferior nasal quadrant; the superior nasal and inferior temporal were in between them. The defects in B/Y perimetry were larger and deeper than that in W/W perimetry. The result of corrected deviation points (u = 3.22, P < 0.05) was used to account

9 the defected testing points, which showed the defected points were significantly more in B/Y perimetry than that in W/W perimetry (chi(2) = , P < 0.001). The data revealed that the defected testing points from B/Y perimetry were 2.6 times of that from W/W perimetry. In the early glaucoma group, the positive rate in the abnormal visual field from B/Y perimetry was 87% (40/46) and that from W/W perimetry, 67% (31/46). CONCLUSIONS: A good coincidence is demonstrated between B/Y and W/W perimetries both in normal and in early open angle glaucoma groups. B/Y perimetry is more sensitive than W/W perimetry in detecting early glaucomatous visual field defects. The positive rate is higher and the defects are larger and deeper in B/Y perimetry than that in W/W perimetry. Therefore, B/Y perimetry can detect glaucoma defects earlier. It is suggested that B/Y perimetry be applied in diagnosing early glaucoma. Wild JM. Short wavelength automated perimetry. Acta Ophthalmol Scand 2001 Dec;79(6): Department of Optometry and Vision Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3NB, Wales, UK. wildjm@cardiff.ac.uk Short Wavelength Automated Perimetry (SWAP) utilizes a blue stimulus to preferentially stimulate the blue cones and a high luminance yellow background to adapt the green and red cones and to saturate, simultaneously, the activity of the rods. This review describes the theoretical aspects of SWAP, highlights current limitations associated with the technique and discusses potential clinical applications. Compared to white-on-white (W-W) perimetry, SWAP is limited clinically by: greater variability associated with the estimation of threshold, ocular media absorption, increased examination duration and an additional learning effect. Comparative studies of SWAP and W-W perimetry have generally been undertaken on small cohorts of patients. The conclusions are frequently unconvincing due to limitations for SWAP in the delineation of abnormality and of progressive field loss. SWAP is almost certainly able to identify glaucomatous visual field loss in advance of that by W-W perimetry although the incidence of progressive field loss is similar between the two techniques. Increasing evidence suggests that functional abnormality with SWAP is preceded by structural abnormality of the optic nerve head and/or the retinal nerve fibre layer. SWAP appears to be beneficial in the detection of diabetic macular oedema and possibly in some neuro-ophthalmic disorders. Remky A, Lichtenberg K, Elsner AE, Arend O. Short wavelength automated perimetry in age related maculopathy. Br J Ophthalmol 2001 Dec;85(12): Department of Ophthalmology, Medical School of the Technical University of Aachen, Pauwelsstrasse 30, Aachen, Germany. BACKGROUND/AIMS: Previous studies reported the predictive value of the short wavelength sensitive (SWS) cone mediated sensitivity for visual outcome in age related macular degeneration. In this study SWS sensitivity was measured by commercially available blue on yellow perimetry in patients with non-exudative age related maculopathy (ARM) and compared with the presence of morphological risk factors and the status of the fellow eye. METHODS: In a prospective cross sectional study, 126 patients (57 males, 69 females, mean age 71 (SD 6) years) with ARM (visual acuity >20/50) were tested. Central visual fields (blue on yellow) were obtained with a conventional perimeter. Fundus slides were graded by two independent observers for soft drusen and presence of focal hyperpigmentation. RESULTS:

10 Mean sensitivity and standard deviation of all patients exhibited a significant reduction with age. Patients with soft drusen had significantly lower sensitivity than those without, whereas there were no differences in visual acuity (log MAR). Sensitivity was also reduced in those eyes with fellow eyes having a sight threatening complication of age related macular degeneration (AMD). Eyes with focal hyperpigmentation compared with those without had no loss of sensitivity, but did have a significant decrease in the central part of the field compared with the more eccentric. CONCLUSION: SWS sensitivity loss is associated with common risk factors for progression to AMD. Short wavelength automated perimetry is moderately rapid and readily available. It may serve as a tool in future ARM trials. Tannenbaum DP, Zangwill LM, Bowd C, Sample PA, Weinreb RN. Relationship between visual field testing and scanning laser polarimetry in patients with a large cup-to-disk ratio. Am J Ophthalmol 2001 Oct;132(4):501-6 Glaucoma Center, Department of Ophthalmology, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA , USA. PURPOSE: To determine the relationship between quantitative nerve fiber layer measurements and visual field testing in patients with large cup-to-disk ratios. METHODS: Seventy-six patients with vertical cup-to-disk ratios by contour of at least 0.8 on stereoscopic photographs and 50 normal subjects were included. One eye was randomly selected for study. All patients underwent standard achromatic automated perimetry, short-wavelength automated perimetry, and retinal nerve fiber layer measurements with scanning laser polarimetry. Analysis of variance was used to evaluate differences between the subject groups. Significance of pairwise comparisons was determined using the Tukey-Kramer multiple comparison test. RESULTS: Statistically significant differences in nerve fiber layer measurements between patients with large cup-to-disk ratios and both abnormal standard achromatic automated perimetry and short-wavelength automated perimetry (n = 22) and patients with large cup-to-disk ratios and both normal standard achromatic automated perimetry and short-wavelength automated perimetry (n = 42) were found for superior nasal ratio, maximum modulation, ellipse modulation, and the linear discriminant function (Tukey- Kramer less than.05). There was no significant difference in patients with abnormal shortwavelength automated perimetry only (n = 9) as compared with patients with both normal standard achromatic automated perimetry and short-wavelength automated perimetry and patients with both abnormal standard achromatic automated perimetry and short-wavelength automated perimetry. Statistically significant differences between the normal subjects and patients with large cup-to-disk ratios and both abnormal standard achromatic automated perimetry and short-wavelength automated perimetry were found for all retinal nerve fiber layer parameters, with the exception of symmetry, superior ratio, and inferior ratio. CONCLUSION: Our results show considerable overlap in nerve fiber layer measurements in eyes with large cup-to-disk ratio and abnormal visual fields as compared with eyes with large cup-to-disk ratios and normal visual fields. This may limit the clinical usefulness of scanning laser polarimetry for detection of early glaucoma in patients with large cup-to-disk ratios. Longitudinal studies are needed to determine if patients with large cup-to-disk ratios with normal standard achromatic automated perimetry and abnormal short-wavelength automated perimetry subsequently develop standard achromatic automated perimetry defects and if scanning laser polarimetry can concurrently detect progression of nerve fiber layer damage.

11 Hutchings N, Hosking SL, Wild JM, Flanagan JG. Long-term fluctuation in short-wavelength automated perimetry in glaucoma suspects and glaucoma patients. Invest Ophthalmol Vis Sci 2001 Sep;42(10): School of Optometry, University of Waterloo, Ontario, Canada. PURPOSE: To determine the magnitude of the homogeneous, LF(Ho), and the heterogeneous, LF(He), components of the long-term fluctuation (LF) in glaucoma suspects and in stable primary open angle glaucoma (POAG) patients undergoing short-wavelength automated perimetry (SWAP) and to compare the magnitude of the SWAP LF components with those elicited by standard white-on-white (W-W) perimetry. METHODS: The sample comprised 33 glaucoma suspects and 17 patients with early-to-moderate stable POAG who underwent W-W perimetry and SWAP at each of six visits over a mean period of months (SD, 2.29). The LF(Ho), LF(He), and error components of the long-term fluctuation were determined between the third and seventh visual field examinations. The intervening visual field examinations and the optic nerve head parameters, derived both by stereo observation and by the Heidelberg Retinal Tomograph, were used to confirm stability over the follow-up period. RESULTS: The LF(Ho) and LF(He) components were larger in the POAG patients than in the glaucoma suspects for both W-W perimetry and SWAP; the magnitude was independent of the depth of defect and of the short-term fluctuation. All three components of long-term fluctuation were greater for SWAP than for W-W perimetry, both in the glaucoma suspects and in the POAG patients. CONCLUSIONS: SWAP exhibits greater long-term fluctuation than white-on-white perimetry. The usefulness of SWAP will be limited if the extent of this variability is not overcome in future statistical procedures developed to detect progressive visual field loss. Kim YY, Kim JS, Shin DH, Kim C, Jung HR. Effect of cataract extraction on blue-on-yellow visual field. Am J Ophthalmol 2001 Aug;132(2): Korea University College of Medicine, Seoul, South Korea. PURPOSE: It is assumed that cataract can influence the results of blue-on-yellow perimetry. However, actual sensitivity change in blue-on-yellow perimetry before and after cataract surgery has not been fully demonstrated. METHODS: Prospective. SETTING: Institutional. STUDY POPULATION: Twenty-two eyes of 22 consecutive patients without ocular pathology, other than cataract, known to influence visual field undergoing cataract surgery. OBSERVATION PROCEDURES: Both white-on-white (W-W) and blue-on-yellow (B-Y) perimetries. MAIN OUTCOME MEASURES: Global indexes including mean deviation and other pertinent data of white-on-white and blue-on-yellow perimetries were compared before and after cataract surgery. RESULTS: Mean deviation was improved after cataract surgery in both white-on-white perimetry (from db to db, P <.0001) and blue-on-yellow perimetry (from db to db, P <.0001, paired t test). However, the mean difference between preoperative and postoperative mean deviation in blue-on-yellow perimetry (8.58 +/ db) was significantly higher than that of white-on-white perimetry (3.52 +/ db; P <.0001, unpaired t test). That is, the change in mean deviation was greater in blue-on-yellow perimetry than in white-on-white perimetry by a factor of 2.4 times. CONCLUSION: Cataract causes predominantly a general reduction of sensitivity in both blue-on-yellow and white-onwhite perimetries, and the general reduction of blue-on-yellow sensitivity is far greater than that of white-on-white sensitivity.

12 Bowd C, Zangwill LM, Berry CC, Blumenthal EZ, Vasile C, Sanchez-Galeana C, Bosworth CF, Sample PA, Weinreb RN. Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function. Invest Ophthalmol Vis Sci 2001 Aug;42(9): Glaucoma Center, Department of Ophthalmology, University of California San Diego, La Jolla , USA. PURPOSE: To compare the abilities of scanning laser polarimetry (SLP), optical coherence tomography (OCT), short-wavelength automated perimetry (SWAP), and frequency-doubling technology (FDT) perimetry to discriminate between healthy eyes and those with early glaucoma, classified based on standard automated perimetry (SAP) and optic disc appearance. To determine the agreement among instruments for classifying eyes as glaucomatous. METHODS: One eye of each of 94 subjects was included. Healthy eyes (n = 38) had both normal-appearing optic discs and normal SAP results. Glaucoma by SAP (n = 42) required a repeatable abnormal result (glaucoma hemifield test [GHT] or corrected pattern standard deviation [CPSD] outside normal limits). Glaucoma by disc appearance (n = 51) was based on masked stereoscopic photograph evaluation. Receiver operating characteristic (ROC) curve areas, sensitivities, and specificities were calculated for each instrument separately for each diagnosis. RESULTS: The largest area under the ROC curve was found for OCT inferior quadrant thickness (0.91 for diagnosis based on SAP, 0.89 for diagnosis based on disc appearance), followed by the FDT number of total deviation plot points of < or =5% (0.88 and 0.87, respectively), SLP linear discriminant function (0.79 and 0.81, respectively), and SWAP PSD (0.78 and 0.76, respectively). For diagnosis based on SAP, the ROC curve area was significantly larger for OCT than for SLP and SWAP. For diagnosis based on disc appearance, the ROC curve area was significantly larger for OCT than for SWAP. For both diagnostic criteria, at specificities of > or =90% and > or =70%, the most sensitive OCT parameter was more sensitive than the most sensitive SWAP and SLP parameters. For diagnosis based on SAP, the most sensitive FDT parameter was more sensitive than the most sensitive SLP parameter at specificities of > or =90% and > or =70% and was more sensitive than the most sensitive SWAP parameter at specificity of > or =70%. For diagnosis based on disc appearance at specificity of > or =90%, the most sensitive FDT parameter was more sensitive than the most sensitive SWAP and SLP parameters. At specificity > or = 90%, agreement among instruments for classifying eyes as glaucomatous was poor. CONCLUSIONS: In general, areas under the ROC curve were largest (although not always significantly so) for OCT parameters, followed by FDT, SLP, and SWAP, regardless of the definition of glaucoma used. The most sensitive OCT and FDT parameters tended to be more sensitive than the most sensitive SWAP and SLP parameters at the specificities investigated, regardless of diagnostic criteria. Remky A, Elsner AE, Morandi AJ, Beausencourt E, Trempe CL. Blue-on-yellow perimetry with a scanning laser ophthalmoscope: small alterations in the central macula with aging. J Opt Soc Am A Opt Image Sci Vis 2001 Jul;18(7): Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts , USA. The sensitivity of short-wavelength-sensitive (SWS) cone pathways was measured in the

13 central fields of 74 normal subjects, aged yr, with healthy maculas. The new fundus perimetry technique used a research scanning laser ophthalmoscope with a small entrance pupil to present blue static perimetry targets on a bright yellow background. Simultaneous infrared imaging aided target positioning and rapid assessment of potential pathology in elderly subjects. Targets were positioned peripheral to fixation, avoiding both the SWS-conefree area and the peak macular pigment, determined in 11 subjects. Sensitivity declined log unit per decade, while intraindividual variability across loci increased. The nasal-temporal asymmetry remained constant. Sensitivity of older subjects was relatively less for the most central targets but was unrelated to transmission through macular pigment. Retinal changes with age occur to differing extents or at differing rates and are readily detectable in the central macula. Demirel S, Johnson CA. Incidence and prevalence of short wavelength automated perimetry deficits in ocular hypertensive patients. Am J Ophthalmol 2001 Jun;131(6): School of Optometry, Indiana University, Bloomington, Indiana, USA. PURPOSE: To determine the prevalence and incidence of short wavelength automated perimetry deficits in comparison to standard automated perimetry deficits in patients with ocular hypertension. METHODS: Five hundred eyes of 250 patients with ocular hypertension were recruited into a prospective, longitudinal study and tested with standard automated perimetry and short wavelength automated perimetry annually for 5 years. Both eyes of 60 normal subjects, 21 to 85 years of age, were used to establish normative data for short wavelength automated perimetry and standard automated perimetry. This allowed independent evaluation of left and right eyes of patients. All normal data were corrected for age, and short wavelength automated perimetry results were corrected for lens transmission. The lowest fifth and first percentiles for the normal observers were derived for the 10 glaucoma hemifield test zones for short wavelength automated perimetry and standard automated perimetry. Visual fields were considered outside normal limits if two glaucoma hemifield test zones were below the normal fifth percentile or one glaucoma hemifield test zone was below the normal first percentile. RESULTS: Baseline prevalence of short wavelength automated perimetry and standard automated perimetry deficits were 9.4% and 1.4%, respectively. During the study, incident rates of field loss were 6.2% (1.23% per year) for short wavelength automated perimetry and 5.9% (1.18% per year) for standard automated perimetry. Once abnormal, 80% of short wavelength automated perimetry fields remained abnormal on the next examination, whereas only 45% of abnormal standard automated perimetry fields remained abnormal. New short wavelength automated perimetry deficits in ocular hypertensives were more prominent and more persistent than new standard automated perimetry deficits. CONCLUSIONS: Our findings are consistent with the interpretation that short wavelength automated perimetry deficits occur before standard automated perimetry deficits in glaucoma. The similar incidence rates suggest that both standard automated perimetry and short wavelength automated perimetry are monitoring the same underlying glaucomatous disease process. Larrosa JM, Polo V, Pinilla I, Fernandez FJ, Gonzalvo F, Honrubia FM. [Early glaucomatous changes in neuroretinal rim shape] [Article in Spanish] Arch Soc Esp Oftalmol 2001 May;76(5):285-90

14 Departamento de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana. PURPOSE: To assess the differences in neuroretinal rim shape in ocular hypertensive patients (normal white-white automated perimetry) with and without perimetric injury in the short wave length automated perimetry (blue-yellow). MATERIAL AND METHODS: 72 eyes from 72 hypertensive ocular patients with normal achromatic automated perimetry examination were included. Forty eyes had normal short wave length automated perimetries while 32 subjects presented an abnormal condition. The neuroretinal rim morphology was quantified by means of a planimetric study from the papillary images obtained with confocal laser scanning. RESULTS: The subjects with abnormal blue-yellow perimetry showed a decrease in the neuroretinal rim area in the inferior and temporal positions. The differences were significant (p<0.05) at the 9 o'clock position (below the middle line) and almost significant (p<0.10) at the 10 o'clock position. CONCLUSIONS: There are differences in the neuroretinal rim shape in ocular hypertensive subjects with normal achromatic perimetry according to whether there are abnormalities in the blue-yellow perimetry. Polo V, Abecia E, Pablo LE, Pinilla I, Larrosa JM, Honrubia FM. Functional and structural measurements in a multifactorial glaucoma risk model. Acta Ophthalmol Scand 2001 Feb;79(1):10-4 Department of Ophthalmology, Miguel Servet Hospital, Zaragoza, Spain. PURPOSE: To evaluate the relationship between a multifactorial probability risk model of developing glaucomatous visual field defects and the assessment of the retinal nerve fiber layer (RNFL) and short-wavelength automated perimetry (SWAP) in glaucoma suspects. METHODS: 157 eyes of 157 glaucoma suspects were included in the study. The risk of developing glaucomatous defects was assessed by applying a multifactorial model that included intraocular pressure, vertical cup-to-disk ratio, age and family history. Photographs of the RNFL and SWAP were performed. RESULTS: The SWAP was abnormal in 54 cases (34.3%); 21% of abnormal perimetries were obtained in the low-risk group, 37% in the moderate risk group and 56% in the high risk group. The nerve fiber layer evaluation in the different risk stages showed a pattern similar to the results obtained with SWAP. Multiple regression analyses, performed with the four variables included in the model with SWAP and RNFL evaluation, showed the relationship between the risk factors and the presence of glaucomatous damage--evaluated by RNFL and SWAP (p<0001). CONCLUSIONS: The probability model showed a good correlation between the risk scale and the RNFL and SWAP assessment. Polo V, Larrosa JM, Pinilla I, Pablo L, Honrubia FM. Optimum criteria for short-wavelength automated perimetry. Ophthalmology 2001 Feb;108(2):285-9 Miguel Servet Hospital, Zaragoza, Spain. OBJECTIVE: To determine the optimum perimetric criteria for short-wavelength automated perimetry on the basis of probabilistic maps that best discriminate between normal and glaucoma. DESIGN: Comparative cross-sectional study. PARTICIPANTS: Ninety-five glaucomatous eyes and 128 normal eyes were included in the study. INTERVENTIONS: The

15 subjects underwent retinal nerve fiber layer photographic evaluation and short-wavelength automated perimetry. MAIN OUTCOME MEASURES: A probabilistic map of differential points for short-wavelength automated perimetry was elaborated, and the number of altered points was calculated for each visual field and level of significance (95%, 98%, 99%, and 99.5%). RESULTS: The presence of a cluster of four or more points outside 95% normal probability limit showed a good combination of sensitivity and specificity. At deeper levels, P: < 1% and P: < 0.5%, the best combination is achieved with three points outside the normal probability limits. CONCLUSIONS: The optimum criterion to define glaucomatous abnormalities in short-wavelength automated perimetry is the presence of a cluster of four points lower than P: < 5% or a cluster of three points lower than P: < 1%. Ophthalmic Physiol Opt 2001 Jan;21(1):1-8 The influences of stimulus wavelength and eccentricity on short-wavelength pathway isolation in automated perimetry. Cubbidge RP, Wild JM. Vision Sciences Research Institute, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK. The aim of the study was to determine whether the suggested stimulus and background parameters employed in commercially available short-wavelength sensitive perimetry (SWAP) are clinically appropriate. Threshold versus intensity curves were measured using a modified Humphrey Field Analyser. The reduction in background luminance was achieved using aperture stops in order to avoid changes in the chromaticity of the background. Shortwavelength thresholds were determined for 440, 450 and 460 nm stimuli and were corrected for pre-receptoral absorption. Short-wavelength sensitive pathway isolation was approximately 1.5 log units and decreased with increases in eccentricity and in stimulus wavelength. It would seem that the use of a 450 nm narrowband stimulus filter would offer a compromise between both the physiological requirements and the physical properties of the stimulus. Such an approach would reduce some of the inherent between-subject normal variability associated with SWAP. Kono Y, Sample PA, Emdadi A, Weinreb RN. Comparative study between pointwise and ranked threshold distribution analyses of change in serial fields for short-wavelength automated perimetry. J Glaucoma 2000 Dec;9(6): Glaucoma Center and Visual Function Laboratory, University of California at San Diego, La Jolla, USA. PURPOSE: To assess the validity of ranked threshold distribution (RTD) analysis for longitudinal evaluation of short-wavelength automated perimetry (SWAP). METHODS: Eighty-five patients with glaucoma and with three or more SWAP results were examined. An additional 20 patients with glaucoma and 3 stable standard automated visual fields and 3 stable SWAP fields were assessed to calculate variability. An RTD curve was created. For RTD analysis and pointwise analysis, values that decreased more than the SWAP variability were considered to have worsened. Using pointwise analysis, four groups were defined: no change (without any 2 contiguous points decreasing in threshold); focal change (at least 2 contiguous points with decreased thresholds in either hemifield); diffuse change (more than 50% of the entire 52 locations with significant decrease in thresholds); and focal and diffuse