Third International Visual Field Symposium - Imaging and Perimetry ...

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INTRODUCTION ERIK L. GREVE Docum. Ophthal. Proc. Series, Vol. 19 The 3rd International Visual Field Symposium was held on the 4th till the 6th of May 1978 in Tokyo for the members and guests of the International Perimetric Society. The Proceedings of this symposium follow the general lines of the pro- gramme with some minor alterations. This symposium was a so-called topic-symposium where selected topics were introduced by experts in the field. These topics were: Neuro-ophthalmology. 1. Funduscopic correlates of visual field defects. 2. Visual field defects due to tumors of the sellar region. Glaucoma. 1. The earliest visual field defects in glaucoma. 2. The reversibility of glaucomatous visual field defects. Methodology. 1. Automation. 2. The relation between the position of a lesion in the fundus and in the visual field. Apart from the introductory papers, free papers were given on the topics and also some non-topic free papers. Much attention has been given to the discussion. Most of the discussion remarks in this Proceedings are the original taped remarks of the discussion- speakers. We have choosen this form of presentation to take to the reader the athmosphere of the discussion and to preserve originality. The chairman of the sessions have presented a summary or even better an interpretation of the trends in their topics. This introduction gives a short overview of the main themes of the symposium. In the first section on Neuro-ophthalmology Frisen gave an introduction about fundoscopic correlates of visual field defects (V.F.D.) in lesions of the anterior visual pathway. Visible defects in the retinal nerve fiber layer (R.N.L.) were shown to exist in several diseases. Local R.N.L. defects usually show a good correspondence with V.F.D. while a generalized reduction 1
of the R.N.L. may not be accompanied by a detectable V.F.D. More data are needed to clarify their discrepancy. Similar correlations were presented by Tagami who studies the papillomacular bundle in optic nerve disease by fundus controlled maculometry. They found a correlation between visual acuity, visual field and the visible atrophy of the papillomacular bundle, and use their method to predict the prognosis of optic nerve disease. Isayama introduced the topic of chiasmal defects and showed in complete correspondence between the V.F.D. and the location of tumors. It was stressed again that often chiasmal V.F.D. do not show the typical bitempo- ral pattern and are frequently misdiagnosed as optic neuritis. Similar find- ings were presented by Dannheim who used supraliminal stimuli. He found early V.F.D. changes also when a pituitary tumor was intrasellar. Aulhom and Hayreh presented their results on VFD in anterior ischaemic optic neurophthy (AION). The type of defect is the same as in glaucoma but the distribution is different. These defects show a consider- able reversibility. Further research should clarify why nerve fiber bundle defects (NFBD) in AION show a behaviour different from glaucomatous NFBD. A highly interesting Glaumcoma session discussed the topics of early VFD and reversibility. We have to differentiate the VFD as found by our present methods and those shown by new experimental methods. The now classical method of combined kinetic and static perimetry dealing with NFBD was introduced by Lichter, Drance, Greve and Endo. It was agreed that early manifestation of NFBD can be relative defects in the paracentral VF or peripheral nasal steps. These relative defects should preferably be demonstrated in the course of the NF. It is not sure that every glaucomatous defect goes through a stage of relative defects. Early defects have to exceed the normal variation of thresholds. Nasal steps of more than 5 degrees are rare in the normal population. The investigation of glaucomatous VFD should be divided in a first detection phase and a second assessment phase which provides the basis for accurate follow-up. The best way for the detection of early defects seems to be the presentation of a sufficient number of evenly distributed stimuli in the paracentral field, the nasal field and some in the temporal field. The presentation should be static. The nasal periphery can also be examined by means of kinetic perimetry. Other possibilities of examination were shown by Dannheim: supraliminal stimuli, and Enoch: Westheimer functions and wind-mill target, and Lakowski: colour vision. The future may show that these techniques detect glaucomatous VFD in an even earlier stages than present methods and may also show that the N.F.B.D. is not the only significant defect in glaucoma. Reversibility of G.V.F.D. was introduced by Armaly, Phelps, Greve and Ernest. It was shown that reversibility does exist be it not as frequent as deterioration. It occurs specialy in the early stages of GVFD, in younger patients and after large reductions of IOP. Changes of GVFD have to be 2
Page 1 and 2: Third International Visual Field Sy
Page 3 and 4: Third International visual i: ii~,d
Page 5 and 6: CONTENTS E.L. Greve: Introduction .
Page 7: Session IV. Methodology Chairman: H
Page 11 and 12: Docum. Ophthal. Proc. Series, Vol.
Page 13 and 14: conduction disturbances. Their caus
Page 15 and 16: Sofue 1975, Sommer, Miller, Pollack
Page 17 and 18: areas but they can occur also in ot
Page 19 and 20: ut only thinning of the arcuate bun
Page 21 and 22: metric strategies, it affords an ob
Page 25 and 26: Table 1. Atrophic stages of maculop
Page 27 and 28: VS=20/60 Fig. 3. Red-free fundus ph
Page 29 and 30: I 20/20 l- 1.0 1.2- 20/25 ,- 20/30
Page 31 and 32: It could be observed, in red-free f
Page 33 and 34: VISUAL FIELD DEFECTS DUE TO TUMORS
Page 35 and 36: 1. FIRST GROUP: THE SYMMETRIC TYPE
Page 37 and 38: Table 4. Visual field defects due t
Page 39 and 40: chiasm and above either of the opti
Page 41 and 42: and 20/40 for the respective eyes t
Page 43 and 44: advantages of applying other perime
Page 45 and 46: Fig. 7. The pseud-macular sparing:
Page 47 and 48: defect due to central integration o
Page 51 and 52: disturbance of perception is visibl
Page 53 and 54: Supraliminal stimuli still show a b
Page 55 and 56: tion (Dannheim 1977, 1978). These f
Page 57 and 58: Huber, A. Chiasmasyndrome - Klinik.
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Table 1. Incidence of age, sex and
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Table 3. Time interval between the
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Table 5. Initial and final visual a
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Table 7. State of the optic disc at
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Visual field defects. Table 12 summ
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Effect of the time lag between the
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Table IS. Effect of systemic cortic
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In contrast to Group I, usually no
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series. The following case vividly
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Docum. Ophthal Proc. Series, Vol. 1
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well as cases due to Diabetes. As c
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a- b - ht:Mii,H Fig. 4. Typical def
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of both diseases, just as the infer
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of minor ONH therefore include a de
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Fig. 2. Visual field defect due to
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less complete lesions certainly are
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probably congenital hydrocephalus w
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area was involved as well. In 4 fie
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chiasma. Although transient papillo
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REFERENCES Bynke, H. & Heijl, A. Au
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*U. y: R-• 01.. 1Q69. V..T DY.ST
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98 y=’ -’ 40 cl.0 ,,' .4 ,' 3'
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REFERENCES Matsuda, H. & Nakabayash
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Perhaps we can bring this up in a c
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there have been no visual symptoms
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could understand supra-se&r meningi
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I found in pituitary adenoma and in
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Docum. Ophthal. Proc. Series, Vol.
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tided to compare the two eyes to se
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Fig. 4. (Lichter). Nucleus of a def
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Fig. 6. (Lichter). Nucleus of a def
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THE EARLY VISUAL FIELD DEFECT IN GL
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central tests were done with the be
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Fig, 4. Earliest field defect showi
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ences were normally distributed aro
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was found. The first patients of th
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fibre bundle. This group has been f
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On the one hand the w.s.d. may be r
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REFERENCES Armaly, M.F. Selective p
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followed over a one-year period. So
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RESULTS Forty-nine out of 49 open a
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DISCUSSION AND CONCLUSIONS 1. 1. Al
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Table I. JR OD Month I.O.P. mm HG 1
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was almost always abnormal if the s
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perties. II. Dichoptic properties o
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until now had to watch for the appe
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In the following time pressure cont
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matous perimetric changes (Aulhorn
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genital or closed angle glaucoma or
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60 50 40 30 20 10 0 MEDIANS bsx OHn
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those who developed glaucoma with t
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that did not yet show a break-throu
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CASE REPORTS Case 1.: a 52-year-old
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172 Goldmann-field Tiibinger nasal
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174 Friedman-fidd New Front Plate f
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Leblanc, R. Peripheral nasal field
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types of defects described, Goldman
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similar areas of the field. Additio
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Fig. 2. Visual field of the right e
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Table 1. The same type of defects s
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tion tonometer) at time of initial
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treated eyes (5/61 or 8.2%) than in
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was not quite statistically signifi
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early, disappeared entirely. Howeve
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The results of this investigation e
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30’ a) asb 32 10 32 100 320 1000
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OVER-ALL CONCLUSIONS Some degree of
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eye with a modified Goldmann-Weeker
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flow of axoplasm in the optic nerve
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Vanderburg, D. & Drance, S.M. Studi
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naga, Endo & Matsuo 1976). We initi
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up examinations. AU the eyes withou
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41 among 69 (59%), were located in
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oped relative field defects. In the
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utilizing the static method of peri
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CASE PRESENTATIONS For the first tw
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DISCUSSION As a bundle of nerve fib
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REVERSIBILITY OF VISUAL FIELD DEFEC
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glaucoma with use of some agents bu
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lyzer showed paracentral slight spo
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no disappearance. In 9 eyes progres
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closure glaucoma, in early stage id
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(Isayama & Tagami, 1977) in order t
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fiber bundle defects did not corres
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However, after the ocular pressure
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FllE3UENCY of FIWDIN6 EMly 6LAUCOYA
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gression. Each visual field was div
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DISCUSSIONS AND COMMENTS Aulhom dev
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we 10 - 8- 0 eye 10 - 5- J-J o4 10
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REFERENCES Aulhom, E. & Harms, H. E
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no major effect of the water drinki
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Case b, right eye, 45" meridian +-+
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REFERENCES Aoyama, T. Pupillographi
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These authors of the second group d
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The behaviour of type 1) must be co
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isolated defect of the Bjerrum area
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choosing the direction of your prof
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How does one explain contraction on
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adequate way if we could understand
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analyse, you can see how well they
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(L. Ron&i and L. Barca. biological
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with a way to teach the clinician t
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The relevant quantities are defined
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The average number n of false scoto
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criteria will suffice for the separ
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Let us consider the two arrangement
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esults of an initial low-resolution
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practical applications, for patholo
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examination phase also provides inf
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Section: 1. Characters ‘READY’
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In order not to disturb the subject
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A B Fig. 5. Result with the semi-au
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3 Fig. 2. Left visual field in a pa
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In the remaining 8 fields of 5 case
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Docum. OphthaI. Proc. Series, Vol.
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ROLE OF STANDARDISATION IN AUTOMATE
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REFERENCES Aulhorn, E Ueber die Aut
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Matsuo. Any other comment on Dr. Fa
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need an infinite number; I don’t
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not separate clearly between normal
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SUMMARY OF SESSION III: AUTOMATION
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RESULTS Visual fields were measured
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etinal edema was seen. The visual a
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DISCUSSION In the new fundus contro
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Fig. 8. Occlusion of arterial branc
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ACKNOWLEDGEMENTS The authors would
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NEW FUNOUS PHOTO PERIMITER-OPTICAL
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354 Fig. 4. Heredodegeneration of m
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_No. 9 Diag.NeuritiS optica retrobu
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Fig. 7 shows caecocentral scotoma p
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360 Fig. 1. (See text) Fig. 2. (See
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were obtained from several cases of
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significance of eye-rotation in per
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through an actual change in sensiti
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Docum. Ophthal. Proc Series, Vol 19
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angiography (FFA) and differential
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Fig. 2a. Results of FFA of case 2 (
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Case 4: A woman of 68 years was see
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-.. 378 Fig. 4.5. Results of FFA in
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3. indicating very sensitively the
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added distorting components are pre
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INVERSION Fig. 1. A tangent screen
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Case History VC is a 42-year-old Ca
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a=# 0 OTHERS * REDUCED SENSITIVITY
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gential errors has been made. In es
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that a functional anomaly is prefer
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In the cases of this group, hemorra
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399
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are mainly represented by the PCS g
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oquine retinopathy, 2 eyes of centr
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Table 2. FVFA Profiles of PRD. 406
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REFERENCES Friedmann, AL The assesm
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stimulus used by Verriest and Israe
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In Figure 3, threshold gradients ar
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Matsuo: I would like to proceed to
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SUMMARY OF SESSION IV: METHODOLOGY
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puts in work all the processus inhe
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to the luminous conditions of backg
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MEASURES OF HOW WELL A PROCEDURE DI
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A general idea or model about the c
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enough to understand the test. Fig.
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visual function is normal. Therefor
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ackground field up to 50’ of visu
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clearly isolated with this perimete
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15’ nasal IO 5’ 0’ 5” tempo
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Fig 2, A new attachment (left) and
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and 6000 asb. in rabbit No. 2. Fig.
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Case 2. Cihoretinal occlusion. Male
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detected by kinetic perimetry were
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Fig. 6. The thresholds of two prese
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Docum. Ophthal. PIOC. Series, Vol.
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peripheral parts of the retina, the
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2. Characteristics of Vertex Potent
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Regarding the characteristics of th
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changes could be detected without P
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An isolated nasal PVF defect in the
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Docum. Ophthal. PIOC. Series, Vol.
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determination of the achromatic inc
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field ‘and also other methods, fo
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REPORT OF THE IPS RESEARCH GROUP ON
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white or colour perimetry. Lakowski
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heard. I am not a neophyte in Japan
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T. Aoyama, 265 M.F. Armaly, 177 E.
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