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      Pattern Recognition Analysis Reveals Unique Contrast Sensitivity Isocontours Using Static Perimetry Thresholds Across the Visual Field

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          Abstract

          Purpose

          To determine the locus of test locations that exhibit statistically similar age-related decline in sensitivity to light increments and age-corrected contrast sensitivity isocontours (CSIs) across the central visual field (VF). We compared these CSIs with test point clusters used by the Glaucoma Hemifield Test (GHT).

          Methods

          Sixty healthy observers underwent testing on the Humphrey Field Analyzer 30-2 test grid using Goldmann (G) stimulus sizes I-V. Age-correction factors for GI-V were determined using linear regression analysis. Pattern recognition analysis was used to cluster test locations across the VF exhibiting equal age-related sensitivity decline (age-related CSIs), and points of equal age-corrected sensitivity (age-corrected CSIs) for GI-V.

          Results

          There was a small but significant test size–dependent sensitivity decline with age, with smaller stimuli declining more rapidly. Age-related decline in sensitivity was more rapid in the periphery. A greater number of unique age-related CSIs was revealed when using smaller stimuli, particularly in the mid-periphery. Cluster analysis of age-corrected sensitivity thresholds revealed unique CSIs for GI-V, with smaller stimuli having a greater number of unique clusters. Zones examined by the GHT consisted of test locations that did not necessarily belong to the same CSI, particularly in the periphery.

          Conclusions

          Cluster analysis reveals statistically significant groups of test locations within the 30-2 test grid exhibiting the same age-related decline. CSIs facilitate pooling of sensitivities to reduce the variability of individual test locations. These CSIs could guide future structure-function and alternate hemifield asymmetry analyses by comparing matched areas of similar sensitivity signatures.

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          Most cited references51

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          A clustering technique for summarizing multivariate data.

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            Aging of the human retina. Differential loss of neurons and retinal pigment epithelial cells.

            The impact of aging on cell loss in the human retina was examined in foveal and temporal equatorial regions in eyes from 35 donors with ages spanning a 78-yr period from the second to the ninth decade of life. Equatorial cones and retinal pigment epithelial cells (RPE) decreased at uniform rates from the second to the ninth decade, 16 and 14 cells/mm2/yr, respectively. Equatorial rods and cells in the ganglion cell layer (GCL) showed nonuniform rate decreases with age. The rates of rod and GCL cell loss were faster between the second and fourth decades (970 and 9 cells/mm2/yr, respectively) than between the fourth and ninth decades (570-330 and 6-3 cells/mm2/yr). The rod and GCL cell densities at the temporal equator maintained a constant ratio (rods-GCL cell ratio = 103 +/- 0.4, mean +/- standard deviation) and the same reduction slope ratio at different times during aging. Thus, the equatorial rod and GCL cell losses were correlated statistically. The ratio of equatorial photoreceptors to RPE cells showed no significant change with age, suggesting parallel loss of these closely apposed cells. At the foveal center, the variability of cone density between individuals in each decade grouping was large (1.7- to threefold). No significant differences were found in cone or RPE cell densities at the foveal center from the second to ninth decade, suggesting that the densities of foveal cones and RPE cells were stable throughout this period. Foveal RPE density was significantly higher than equatorial RPE density in each age group. No significant difference was found between the equatorial photoreceptor-RPE ratio and foveal cone-RPE ratio in any age group. Cells in the GCL in the fovea decreased by approximately 16% from the second to the sixth decade. These results indicated that (1) rod photoreceptors and cells in the GCL were more vulnerable to loss during aging than cones; (2) photoreceptors and RPE cells showed parallel changes during aging; and (3) the photoreceptor loss accompanying aging was less pronounced in the fovea than in the peripheral retina.
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              Properties of perimetric threshold estimates from Full Threshold, SITA Standard, and SITA Fast strategies.

              To investigate the distributions of threshold estimates with the Swedish Interactive Threshold Algorithms (SITA) Standard, SITA Fast, and the Full Threshold algorithm (Humphrey Field Analyzer; Zeiss-Humphrey Instruments, Dublin, CA) and to compare the pointwise test-retest variability of these strategies. One eye of 49 patients (mean age, 61.6 years; range, 22-81) with glaucoma (Mean Deviation mean, -7.13 dB; range, +1.8 to -23.9 dB) was examined four times with each of the three strategies. The mean and median SITA Standard and SITA Fast threshold estimates were compared with a "best available" estimate of sensitivity (mean results of three Full Threshold tests). Pointwise 90% retest limits (5th and 95th percentiles of retest thresholds) were derived to assess the reproducibility of individual threshold estimates. The differences between the threshold estimates of the SITA and Full Threshold strategies were largest ( approximately 3 dB) for midrange sensitivities ( approximately 15 dB). The threshold distributions of SITA were considerably different from those of the Full Threshold strategy. The differences remained of similar magnitude when the analysis was repeated on a subset of 20 locations that are examined early during the course of a Full Threshold examination. With sensitivities above 25 dB, both SITA strategies exhibited lower test-retest variability than the Full Threshold strategy. Below 25 dB, the retest intervals of SITA Standard were slightly smaller than those of the Full Threshold strategy, whereas those of SITA Fast were larger. SITA Standard may be superior to the Full Threshold strategy for monitoring patients with visual field loss. The greater test-retest variability of SITA Fast in areas of low sensitivity is likely to offset the benefit of even shorter test durations with this strategy. The sensitivity differences between the SITA and Full Threshold strategies may relate to factors other than reduced fatigue. They are, however, small in comparison to the test-retest variability.
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                Author and article information

                Journal
                Invest Ophthalmol Vis Sci
                Invest. Ophthalmol. Vis. Sci
                iovs
                Invest Ophthalmol Vis Sci
                IOVS
                Investigative Ophthalmology & Visual Science
                The Association for Research in Vision and Ophthalmology
                0146-0404
                1552-5783
                October 2017
                : 58
                : 11
                : 4863-4876
                Affiliations
                [ 1 ]Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
                [ 2 ]School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
                [ 3 ]Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
                Author notes
                Corresponding author: Michael Kalloniatis, Centre for Eye Health, University of New South Wales, Sydney 2052, Australia; m.kalloniatis@ 123456unsw.edu.au .
                Article
                iovs-58-11-13 IOVS-17-22371
                10.1167/iovs.17-22371
                5624776
                28973333
                994305ea-7331-4efc-9536-96738994da15
                Copyright 2017 The Authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 7 June 2017
                : 17 August 2017
                Categories
                Visual Psychophysics and Physiological Optics

                humphrey visual field analyzer,spatial summation,retinal ganglion cells,hierarchical clustering,retinal nerve fiber layer,structure-function

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