Standard automated perimetry for glaucoma and diseases of the retina and visual pathways: current and future perspectives.

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY
Jack Phu, Sieu K Khuu, Lisa Nivison-Smith, Michael Kalloniatis
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Abstract

Static automated perimetry (SAP) remains a mainstay of functional assessment of the visual field in diseases of the visual pathway, such as glaucoma and age-related macular degeneration. The fundamental psychophysical task of responding to stimuli of different levels of contrast has remained minimally changed since its inception in the 1980s, and this is potentially the root of several unresolved issues involving the technique. Enduring issues include the optimisation of SAP parameters for maximising defect detection, the influence of subjective behaviour on the response, structure-function discordance, and ageing- and disease-related changes of the visual pathway. Addressing these issues has been a focus of our research program and is the subject of this manuscript. We will review some of the basic psychophysical principles and methods that have contributed to the development of SAP and their contributions to its output measurements. Parameters that are interrogated include stimulus size and background luminance and their modification to improve defect defection in glaucoma and age-related macular degeneration. We propose frameworks for optimising testing parameters and leveraging the results for changing clinical care. In our pursuit of optimising the structure-function relationship in the eye, several areas of research have been developed and explored, including: the reconciliation of subjective responses in perimetry; by minimising sources of biases, such as Method of Limits we have been able to equate static and kinetic perimetry outputs in relation to underlying structural loci. This also formed the basis for our clustering framework, which groups together statistically similar structural and functional test locations to maximise structure-function concordance. Throughout the manuscript, we review the scientific underpinnings of clinical measurements, framing application into real-world patients to improve clinical practice.

青光眼及视网膜和视觉通路疾病的标准自动周边测量法:当前和未来展望。
静态自动周边测量法(SAP)仍然是视觉通路疾病(如青光眼和老年性黄斑变性)视野功能评估的主要方法。自 20 世纪 80 年代诞生以来,对不同对比度刺激做出反应的基本心理物理任务一直保持着最小的变化,这可能是涉及该技术的几个未决问题的根源所在。长期存在的问题包括如何优化 SAP 参数以最大限度地检测出缺陷、主观行为对反应的影响、结构与功能的不一致性以及视觉通路与年龄和疾病相关的变化。解决这些问题一直是我们研究计划的重点,也是本手稿的主题。我们将回顾一些促进 SAP 发展的基本心理物理学原理和方法,以及它们对 SAP 输出测量的贡献。研究的参数包括刺激大小和背景亮度,以及对它们进行修改以改善青光眼和老年性黄斑变性的缺损情况。我们提出了优化测试参数和利用结果改变临床护理的框架。为了优化眼球结构与功能之间的关系,我们开发并探索了多个研究领域,其中包括:调节视力测试中的主观反应;通过最大限度地减少偏差来源(如极限法),我们能够将静态和动态视力测试的输出结果等同于潜在的结构位置。这也为我们的聚类框架奠定了基础,该框架将统计上相似的结构和功能测试位置集中在一起,以最大限度地提高结构与功能的一致性。在整个手稿中,我们回顾了临床测量的科学依据,并将其应用于现实世界中的患者,以改善临床实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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