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):177-85 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

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):1362-6 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):1350-61 Department of Ophthalmology, Hospital of Weilheim-Schongau, Puetrichstrasse 32, 82362 Weilheim, Germany. PURPOSE: To evaluate the clinical use of a test battery of short-wavelength automated perimetry (SWAP), frequency-doubling technology (FDT) perimetry, and pattern-electroretinography (PERG) in patients with definite primary open-angle glaucoma (POAG)

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 < 0.0001), SWAP-MD (P = 0.0003), FDT-MD (P = 0.0008), and PERG amplitudes (P < 0.0001). When comparing between POAG eyes with normal results on SAP and normal controls, Student's t test showed significant differences for SWAP-MD (P < 0.0001), FDT-MD (P = 0.0006), PERG N1P1-amplitude (P = 0.0486) and P1N2-amplitude (P < 0.0001); receiver operating characteristic analysis revealed promising accuracy for SWAP-MD of 73.6% (P < 0.0001). SWAP-MD (P < 0.0001) and FDT-MD (P < 0.0001) correlated significantly with SAP-MD and with each other (range, P < 0.0001 to P = 0.0020). 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 blue-sensitive pathway. Invest Ophthalmol Vis Sci 2002 Jun;43(6):1828-34 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 blue-on-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.

Bayer AU, Erb C. Short wavelength automated perimetry, frequency doubling technology peri-metry, and pattern electroretinography for prediction of progressive glauco-matous standard visual field defects. Ophthalmology 2002 May;109(5):1009-17 Department of Ophthalmology, Eberhard-Karls-University, Tuebingen, Germany. andreasubayer@yahoo.de 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 follow-up 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, 50004 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

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 follow-up, 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):444-54 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

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 0.0001 and 0.0001, respectively) and 1% (P values were 0.0001 and 0.0001, 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):145-50 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):154-61 Discoveries in Sight, Devers Eye Institute, Legacy Clinical Research and Technology Center, 1225 NE Second Ave, PO Box 3950, Portland, OR 97208-3950, USA. OBJECTIVE: To examine short-wavelength sensitivity in patients with migraine using short-wavelength 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 short-wavelength sensitivity pathways or a generalized loss to multiple pathways. RESULTS: No statistically significant differences between migraine patients and controls were found for

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

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-to-disk 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 410011, China (Email: 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

the defected testing points, which showed the defected points were significantly more in B/Y perimetry than that in W/W perimetry (chi(2) = 226.72, 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):546-59 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):1432-6 Department of Ophthalmology, Medical School of the Technical University of Aachen, Pauwelsstrasse 30, 52057 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:

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 92093-0946, 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 short-wavelength 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.

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):2332-7 School of Optometry, University of Waterloo, Ontario, Canada. nhutchin@sciborg.uwaterloo.ca 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 12.75 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):217-20 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 -6.88 dB to -3.36 dB, P <.0001) and blue-on-yellow perimetry (from -12.22 dB to -3.64 dB, P <.0001, paired t test). However, the mean difference between preoperative and postoperative mean deviation in blue-on-yellow perimetry (8.58 +/- 3.96 dB) was significantly higher than that of white-on-white perimetry (3.52 +/- 2.69 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-on-white perimetries, and the general reduction of blue-on-yellow sensitivity is far greater than that of white-on-white sensitivity.

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):1993-2003 Glaucoma Center, Department of Ophthalmology, University of California San Diego, La Jolla 92093-0946, 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):1425-36 Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts 02114-2500, USA. The sensitivity of short-wavelength-sensitive (SWS) cone pathways was measured in the

central fields of 74 normal subjects, aged 17-86 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-cone-free area and the peak macular pigment, determined in 11 subjects. Sensitivity declined 0.019 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):709-15 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

Departamento de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana. jlarrosa@encomix.es 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

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. Short-wavelength 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):419-27 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

change (less than 50%, but crossing both hemifields). RESULTS: Using pointwise analysis, 32 (37.6%) patients did not change; 23 (27.1%) patients had focal worsening; 8 (9.4%) patients had diffuse worsening; and 22 (25.9%) patients had focal and diffuse worsening. Significant differences were found among the groups in the number of deteriorating locations (P < 0.0001, analysis of variance). The ranges of deteriorating locations identified by RTD analysis for focal change and diffuse change did not overlap. A significant correlation was found between the numbers of locations with decreased threshold by both analyzes (r2 = 0.83, P < 0.0001). CONCLUSION: For evaluation of possible SWAP progression, RTD analysis is closely related with pointwise analysis and is useful for visualizing a diffuse component of change in the field. McCulley TJ, Lam BL, Marmor MF, Hoffman KB, Luu JK, Feuer WJ. Acute effects of sildenafil (viagra) on blue-on-yellow and white-on-white Humphrey perimetry. J Neuroophthalmol 2000 Dec;20(4):227-8 Bascom Palmer Eye Institute, University of Miami, Florida, USA. OBJECTIVE: To study the effects of sildenafil on blue-on-yellow and white-on-white Humphrey visual field (HVF). MATERIALS AND METHODS: Healthy subjects, ages 20 to 38 years, were prospectively randomized to active drug (n = 5) or placebo (n = 3) groups. Blue-on-yellow and white-on-white HVF testing was performed before and 1 hour after masked dosing of sildenafil 200 mg or placebo. Changes in mean deviation (MD) were compared between groups. RESULTS: Three of three placebo and four of five sildenafil subjects had no change on HVF. One of five sildenafil subjects had a decrease in MD of 17.9 dB and 4.7 dB on blue-on-yellow and white-on-white HVF testing, respectively. This subject reported more systemic side effects than other subjects. CONCLUSIONS: Sildenafil has no effect on HVF testing in most persons; however, sildenafil caused an acute abnormality of HVF testing in one subject, who experienced pronounced non-visual systemic symptoms; this effect was greater on blue-on-yellow than white-on-white HVF. Remky A, Arend O. Intra-individual variability of blue-yellow perimetry [Article in German] Ophthalmologe 2000 Nov;97(11):774-80 Augenklinik, RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen. BACKGROUND: Short wavelength automated perimetry (SWAP) is a sensitive method in detection of early glaucomatous damage. In this study, we compared intra-subject variability of global indices of SWAP and conventional white-on-white perimetry (WWP) in normal clinical conditions (without correction for lens yellowing). METHODS: SWAP and WWP (Humphrey field analyzer, 24-2 field, full threshold strategy) was performed in 68 eyes with glaucoma or glaucoma suspect and at the same day. The tests were repeated within 45 days (mean follow-up 16 +/- 13 days). RESULTS: At the follow-up test the mean defect was significantly reduced for both conditions, more pronounced for SWAP. Pattern standard deviation remained statistically equal for both conditions. The coefficient of correlation of baseline to follow-up was for SWAP PSD 0.88 with a slope of 1.05, for WWP PSD 0.7 with a slope of 0.83. The coefficient of variation for PSD was 17% for SWAP and 34% for WWP. CONCLUSIONS: The low intraindividual variability of SWAP enables early detection of glaucomatous field damage in the follow-up.

Mok KH, Lee VW. Nerve fiber analyzer and short-wavelength automated perimetry in glaucoma suspects: a pilot study. Ophthalmology 2000 Nov;107(11):2101-4 Eye Centre, Hong Kong Adventist Hospital, Hong Kong, People's Republic of China. PURPOSE: To test the relationship between the results of short-wavelength automatic perimetry (SWAP) and retinal nerve fiber layer (RNFL) measurements with scanning laser polarimetry (Nerve Fiber Analyzer, NFA) in age-matched normal subjects, glaucoma suspects, and early glaucoma patients. DESIGN: Case-control study. PARTICIPANTS AND METHODS: Thirty-eight normal subjects, 32 glaucoma suspects, and 14 early glaucoma patients were recruited. All subjects underwent RNFL assessment by NFA, achromatic visual field testing (24-2 threshold), and repeated SWAP (24-2 threshold blue-on-yellow). MAIN OUTCOME MEASURES: Mean deviation (MD) of visual field testing and RNFL values were obtained. RESULTS: Glaucoma suspects were divided into two groups according to their SWAP results: high risk (with SWAP abnormalities) and low risk (with normal SWAP result). No statistically significant difference in SWAP MD and RNFL values were observed between normal and low-risk groups (P > 0.05), but these values were found to be significantly lower in high-risk and early glaucoma groups (P < 0.01). CONCLUSIONS: This study suggests that RNFL examination by NFA may be a useful test for the early detection of glaucomatous damage of glaucoma suspects. It appears to provide agreement with SWAP abnormalities and is more sensitive than conventional standard automated perimetry. Girkin CA, Emdadi A, Sample PA, Blumenthal EZ, Lee AC, Zangwill LM, Weinreb RN. Short-wavelength automated perimetry and standard perimetry in the detection of progressive optic disc cupping. Arch Ophthalmol 2000 Sep;118(9):1231-6 Glaucoma Center, University of California-San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0946, USA. OBJECTIVE: To compare progression in short-wavelength automated perimetry (SWAP) and white-on-white (standard) perimetry in eyes with progressive glaucomatous changes of the optic disc detected by serial stereophotographs. METHODS: Forty-seven glaucoma patients with at least 2 disc stereophotographs more than 2 years apart, along with standard perimetry and SWAP examinations within 6 months of each disc photo of the same eye, were included in the study. The mean follow-up time was 4.1 years (range, 2.0-8.9 years). Baseline and follow-up stereophotographs were then graded and compared for the presence of progression. Progression in standard perimetry and SWAP, using the Advanced Glaucoma Intervention Study scoring system and a clinical scoring system, was compared between eyes with progressive change on stereophotographs and those without. RESULTS: Twenty-two of 47 eyes showed progressive change by stereophotographs. There was a statistically significant difference in the mean change in Advanced Glaucoma Intervention Study scores for both standard perimetry (P<.004) and SWAP (P<.001) between the progressed and nonprogressed groups. The sensitivity, specificity, and area under the receiver operator characteristic curve were higher using SWAP than standard perimetry when evaluated by either algorithm. This was statistically significant only in the area under the receiver operator characteristic curve for the Advanced Glaucoma Intervention Study scoring system (P =.04). CONCLUSIONS: Short-wavelength automated perimetry identified more patients than standard perimetry as

having progressive glaucomatous changes of the optic disc. Compared with standard perimetry, SWAP may improve the detection of progressive glaucoma. Landers J, Goldberg I, Graham S. A comparison of short wavelength automated perimetry with frequency doubling perimetry for the early detection of visual field loss in ocular hypertension. Clin Experiment Ophthalmol 2000 Aug;28(4):248-52 Eye Associates, Sydney, New South Wales, Australia. rauaroha@raco.org.au BACKGROUND: Achromatic automated perimetry (AAP) is limited in its ability to detect very early visual field loss in ocular hypertensive patients. Tests targeting axons that are selectively damaged, or have low redundancy, may detect visual field losses before they are seen on AAP. It has been claimed that short wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP) are two tests that provide early detection. METHODS: Patients (n = 62) were selected on the basis that they had raised intraocular pressure but normal visual fields detected by AAP. A SWAP and an FDP was performed on each of the patients and the results compared. Fields were scored as either normal or abnormal based on criteria used in previous studies. RESULTS: On comparing FDP with SWAP as the 'gold standard', a sensitivity of 88.9% and a specificity of 96.2% was found, showing a high concordance between the two tests. CONCLUSION: These results suggest that as SWAP may be predictive of AAP visual field loss, FDP may be similarly predictive. Sample PA Short-wavelength automated perimetry: it's role in the clinic and for understanding ganglion cell function. Prog Retin Eye Res 2000 Jul;19(4):369-83 Glaucoma Center and Visual Function Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla, USA. Short-wavelength automated perimetry (SWAP) is a more sensitive test than standard achromatic perimetry for early loss of vision due to glaucoma and other ocular and neurological diseases. SWAP is also more successful for detecting changes in vision as glaucoma progresses. Results from various visual function-specific tests, including SWAP, suggest that there are individual differences in ocular hypertensive and glaucoma eyes in the subtype of ganglion cell first affected. However, the disease targets the same retinal area for all function-specific tests that show a deficit in a given individual. Psychophysical tests of vision are critical to understand glaucoma's effect on retinal ganglion cells, to verify the success or failure of treatment including new neuroprotective agents, and to determine the relationship of genetic markers for glaucoma to the presence and progress of the disease. Korth MJ, Junemann AM, Horn FK, Bergua A, Cursiefen C, Velten I, Budde WM, Wisse M, Martus P. Synopsis of various electrophysiological tests in early glaucoma diagnosis--temporal and spatiotemporal contrast sensitivity, light- and color-contrast pattern-reversal electroretinogram, blue-yellow VEP. Klin Monatsbl Augenheilkd 2000 Jun;216(6):360-8 Augenklinik mit Poliklinik, Univ. Erlangen-Nürnberg.

BACKGROUND: Of the three glaucoma-defining criteria intraocular pressure, optic-nerve damage, and visual field damage, the latter is a late symptom. Therefore, in order to improve an early sensory diagnosis, new tests are necessary. It is the aim of the present paper to test new sensory methods, to rank them in an order of sensitivity, and to base them on possible pathophysiological mechanisms. PATIENTS AND METHODS: The tests were carried out in subjects of the Erlangen Glaucoma registry: Normals, patients with ocular hypertension, and patients with open-angle glaucoma without or with field defects. The tests are designed to preferentially probe the function of different groups of ganglion cells. Psychophysical methods: Temporal contrast sensitivity in a ganzfeld as "Erlangen flicker test" and spatio-temporal contrast sensitivity to test Magno-cell function. Electrophysiological methods: Pattern-reversal electroretinogram with a luminance-contrast pattern to test Magno-cell function, color-contrast pattern electroretinogram for Parvo-cell function, and blue-on-yellow visual evoked potential to test the "blue-sensitive" pathway. RESULTS: The most sensitive test is the temp.CS, it is significantly reduced in OHT (p < 0.01). The spatio-temp.CS is reduced in perimetric stages (p < 0.01). The BY-VEP is altered in the preperimetric stage (p < 0.01), the PR-ERG in perimetric stages (p < 0.01). The CC-ERG is reduced in even later stages. These results are in agreement with the hypothesis that tests selective for non-redundant neurons are of early diagnostic value. Multivariate analyses increase the early diagnostic value when different functions are tested in combination. CONCLUSIONS: When a particular test is taylored to the the special needs of certain groups of ganglion cells sensory defects can be observed before the occurrence of optic-nerve damage (OHT). The most sensitive psychophysical test is the "Erlangen flicker test" which is a screening test selective for M cells. The most sensitive electrophysiological test is the BY-VEP testing the blue-sensitive ganglion cells. Polo Llorens V, Larrosa Poves JM, Pinilla Lozano I, Pablo Julvez L, Honrubia Lopez FM Perimetric probability maps for short wavelength automated perimetry [Article in Spanish] Arch Soc Esp Oftalmol 2000 Jun;75(6):403-8 Servicio de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana. PURPOSE: To develop a statistical visual field analysis model (ANESTCAV) suitable for short-wavelength automated perimetry (SWAP), from the probability maps (PM). METHODS: 128 eyes of 128 subjects without ophthalmic pathology were considered. A SWAP test was performed with a modified Humphrey visual field analyzer. To determine the PM (1) we developed a <<Standard Visual Field>> (CVNR) corrected for age, (2) we assessed the differences between the CVNR and the visual field of each subject, and (3) from the distribution of the deviations, we determined the confident interval with 4 levels of statistical signification (95, 98, 99 and 99.5%) at each point of the visual field. RESULTS: A regression analysis calculates the <<standard value>> (VNR) corrected for age at each point of the visual field. The 74 VNR of the visual field constitutes the CVNR corrected for age. Each point has a confident interval for each level of signification which determines the range and probability of value to be normal. CONCLUSIONS: The development of ANESTCAV obtained a precise instrument for perimetric analysis which establishes the ranges of normal results in these exploratory procedures. Sample PA, Bosworth CF, Blumenthal EZ, Girkin C, Weinreb RN

Visual function-specific perimetry for indirect comparison of different ganglion cell populations in glaucoma. Invest Ophthalmol Vis Sci 2000 Jun;41(7):1783-90 Department of Ophthalmology, University of California at San Diego, La Jolla, USA. PURPOSE: To compare short-wavelength automated perimetry, frequency-doubling technology perimetry, and motion-automated perimetry, each of which assesses different aspects of visual function, in eyes with glaucomatous optic neuropathy and ocular hypertension. METHODS: One hundred thirty-six eyes from 136 subjects were evaluated with all three tests as well as with standard automated perimetry. Fields were not used in the classification of study groups to prevent bias, because the major purpose of the study was to evaluate each field type relative to the others. Seventy-one of the 136 eyes had glaucomatous optic neuropathy, 37 had ocular hypertension, and 28 served as age-matched normal control eyes. Glaucomatous optic neuropathy was defined by assessment of stereophotographs. Criteria were asymmetrical cupping, the presence of rim thinning, notching, excavation, or nerve fiber layer defect. Ocular hypertensive eyes had intraocular pressure of 23 mm Hg or more on at least two occasions and normal-appearing optic disc stereophotographs. Criteria for abnormality on each visual field test were selected to approximate a specificity of 90% in the normal eyes. Thresholds for each of the four tests were compared, to determine the percentage that were abnormal within each patient group and to assess the agreement among test results for abnormality, location, and extent of visual field deficit. RESULTS: Each test identified a subset of the eyes with glaucomatous optic neuropathy as abnormal: 46% with standard perimetry, 61% with short-wavelength automated perimetry, 70% with frequency-doubling perimetry, and 52% with motion-automated perimetry. In the ocular hypertensive eyes, standard perimetry was abnormal in 5%, short wavelength in 22%, frequency doubling in 46%, and motion in 30%. Fifty-four percent (38/71) of eyes with glaucomatous optic neuropathy were normal on standard fields. However, 90% were identified by at least one of the specific visual function tests. Combining tests improved sensitivity with slight reductions in specificity. The agreement in at least one quadrant, when a defect was present with more than one test, was very high at 92% to 97%. More extensive deficits were shown by frequency-doubling perimetry followed by short-wavelength automated perimetry, then motion-automated perimetry, and last, standard perimetry. However, there were significant individual differences in which test of any given pairing was more extensively affected. Only 30% (11/37) of the ocular hypertensive eyes showed no deficits at all compared with 71% (20/28) of the control eyes (P < 0.001). CONCLUSIONS: For detection of functional loss standard visual field testing is not optimum; a combination of two or more tests may improve detection of functional loss in these eyes; in an individual, the same retinal location is damaged, regardless of visual function under test; glaucomatous optic neuropathy identified on stereophotographs may precede currently measurable function loss in some eyes; conversely, function loss with specific tests may precede detection of abnormality by stereophotograph review; and short-wavelength automated perimetry, frequency-doubling perimetry, and motion-automated perimetry continue to show promise as early indicators of function loss in glaucoma. Vihanninjoki K, Teesalu P, Burk ROW, Läärä E, Tuulonen A, Airaksinen PJ Search for an optimal combination of structural and functional parameters for the diagnosis of glaucoma. Multivariate analysis of confocal scanning laser tomograph, blue-on-yellow visual field and retinal nerve fiber layer data J Glaucoma 2000, 238 (6): 477-481 Department of Ophthalmology, University of Oulu, Finland

The purpose of this study was to evaluate which of the structural and functional parameters - the Heidelberg Retina Tomograph (HRT), white-on-white (W/W) and blue-on-yellow (B/Y) visual fields and semiquantitative retinal nerve fiber layer (RNFL) scoring parameters - can give the best separation between non-glaucomatous and glaucomatous eyes. Methods: Fifty-five subjects were included in this study: 32 non-glaucomatous subjects with mean age of 54 years, and 23 patients with ocular hypertension or glaucoma and mean age of 59 years. The HRT with software 1.11, the Humphrey 30-2 W/W and lens coloration- corrected B/Y visual fields, and semiquantitative RNFL scores were utilized. Stepwise logistic regression analysis was used in finding, from a given set of parameters, a best discriminating parsimonious subset to a logistic model, the discriminatory performance of which was evaluated by the area under the ROC curve. Results: When all the structural and functional variables were considered, the RNFL total overall score gave the best separation between glaucomatous and non-glaucomatous eyes (ROC area 0.98). Without the RNFL scores and optic disc size-dependent HRT parameters in the model, the cup shape measure was selected first (ROC area 0.88). In the second step the RNFL thickness was selected (ROC area 0.91), and in the third step the corrected B/Y mean deviation (MD) was selected (ROC area 0.91). With only the HRT parameters in the model, the cup/disc ratio was selected first (ROC area 0.88). However, when the groups were matched for optic disc size, all disc size-dependent HRT variables lost their discriminant power. Conclusion: Cup shape measure and RNFL thickness, together with age- and lens coloration-corrected MD of the B/Y perimetry provided good discrimination between healthy individuals and patients with glaucoma. Gau M, Faude F, Weber J, Wiedemann P Blau-Gelb-Perimetrie bei rhegmatogener Amotio retinae Ophthalmologe 2000 May;97(5):347-52 Universitäts-Augenklinik, Leipzig. INTRODUCTION: Disturbance of the blue light perceptance in rhegmatogenous retinal detachment was demonstrated by Kollner 1907 with the help of colour-perimetries. We examined the blue- and white-function after retinal reattachment by blue-on-yellow-perimetry compared with white-on-white-perimetry. PATIENTS AND METHODS: 10 Patients with rhegmatogenous retinal detachment and a visual acuity > or = 0.1 were examined preoperatively, 4 days and 6 weeks after successfull buckling procedure. We performed a white-on-white-perimetry as also perimetries with blue stimuli on a yellow luminance background (program 30-2 of the Humphrey Field Analyzer 750). RESULTS: Four days after surgery the increase in sensitivity was significantly less for the blue-function compared with the white-function. Preoperatively and 6 weeks postoperatively the sensitivities were not significantly different. Between these time-points function recovered in average for both methods from MD -15 dB to MD -5 dB. CONCLUSION: After successful retinal detachment surgery the blue- and white-function increased. Blue-on-yellow-perimetry showed more retinal sensitivity loss than white-on-white-perimetry immediately after surgery. Blue-on-yellow-perimetry measured the same retinal sensitivity loss as white-on-white-perimetry preoperatively and 6 weeks postoperatively. Ugurlu S, Hoffman D, Garway-Heath DF, Caprioli J Relationship between structural abnormalities and short-wavelength perimetric defects in eyes at risk of glaucoma. Am J Ophthalmol 2000 May;129(5):592-8

Glaucoma Division, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, USA. PURPOSE: To determine the relative prevalence of blue-yellow perimetric defects and structural abnormalities of the optic nerve and nerve fiber layer in eyes at risk of glaucoma. METHODS: Seventy-two eyes (of 72 patients) at risk of glaucoma, with normal white-on-white full threshold perimetry, were examined prospectively with blue-yellow full-threshold perimetry (Humphrey). Structural evaluations were conducted with qualitative assessment of stereoscopic color optic disk photographs and monochromatic nerve fiber layer photographs performed independently by three masked examiners (a glaucoma specialist and two glaucoma fellows), and statistical analysis of summary parameters was obtained with scanning confocal laser tomography (abnormal defined as values outside 95% confidence limits established in normal control subjects). RESULTS: Kappa values for interobserver agreement were 0.64, 0.88, and 0.79 for optic disk evaluation and 0.59, 0.60, and 0.61 for nerve fiber layer evaluation. Thirteen (18%) of 72 eyes had blue-yellow abnormalities. A total of 30 eyes (42%) were identified as having a structural abnormality; 29 (40%) had qualitatively determined optic disk abnormalities, 21 (29%) had qualitatively determined nerve fiber layer defects, and 26 (36%) had statistically significant structural abnormalities. Twelve of 13 eyes with blue-yellow defects had a detectable structural abnormality; all 12 had abnormalities identified with disk photography, nine with nerve fiber layer photography, and 12 by scanning laser tomography. CONCLUSIONS: Clinically detectable structural abnormalities frequently coexist with blue-yellow perimetric defects in patients with ocular hypertension. A substantial proportion of patients with ocular hypertension with normal blue-yellow perimetry has early detectable glaucomatous structural abnormalities. Larrosa JM, Polo V, Pablo L, Pinilla I, Fernandez FJ, Honrubia FM Short-wavelength automated perimetry and neuroretinal rim area. Eur J Ophthalmol 2000 Apr-Jun;10(2):116-20 Department of Ophthalmology, "Miguel Servet" Hospital, Zaragoza, Spain. PURPOSE: To determine the correlation between neuroretinal rim area and functional losses detected by short-wavelength automated perimetry (SWAP) in a population of patients with suspected glaucoma. METHODS: Forty-two eyes of 42 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm of Hg and normal conventional visual fields) were studied. A planimetric optic nerve head study was performed, determining the total and sectorized neuroretinal rim areas. SWAP was also done, with a modified Humphrey field analyzer. RESULTS: There were no significant correlations between the neuroretinal rim areas and the global perimetric parameters. However, the correlations between the inferotemporal neuroretinal rim area and some superonasal visual field regions (areas 3 and 4) were significant. CONCLUSIONS: There is a relation in the topography of some visual field areas assessed by SWAP and the inferotemporal neuroretinal rim area, which may play a role in the diagnosis and follow-up of suspected glaucoma. Nomura R, Terasaki H, Hirose H, Miyake Y Blue-on-yellow perimetry to evaluate S cone sensitivity in diabetics. Ophthalmic Res 2000 Mar-Jun;32(2-3):69-72 Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. PURPOSE: Blue-on-yellow (B/Y) perimetry was performed on 31 patients with non-insulin-dependent diabetes mellitus to study the loss of sensitivity to short wavelengths. Of these

patients, 21 were without retinopathy (NDR) and 10 had early background retinopathy (SDR). Eleven normal subjects served as controls. The results were compared to white-on-white (W/W) perimetry. Foveal sensitivity determined by B/Y and W/W perimetry showed no significant difference between NDR, SDR and normals. However, the mean sensitivity in the central 30-degree area and that in the upper half of the central 20- to 30-degree concentric circular field were significantly decreased in B/Y perimetry in SDR patients (p < 0.05, p < 0.01, respectively). No significant sensitivity loss was detected in the W/W test. We conclude that there is a blue cone system sensitivity loss in the central 30-degree area, particularly in the upper half of the visual field and the paracentral area in diabetic patients with early background retinopathy. Blumenthal EZ, Sample PA, Zangwill L, Lee AC, Kono Y, Weinreb RN Comparison of long-term variability for standard and short-wavelength automated perimetry in stable glaucoma patients. Am J Ophthalmol 2000 Mar;129(3):309-13 Glaucoma Center and Visual Function Laboratory, Department of Ophthalmology, USA. PURPOSE:To quantify and compare, on a point-by-point basis, the long-term variability of standard and short-wavelength automated perimetry in a group of stable glaucoma patients.METHODS:From a group of 53 glaucoma patients experienced in visual field testing, we identified one eye, randomly chosen, from each of 25 glaucoma patients whose condition was found to be stable, based on both standard and short-wavelength automated perimetry visual field criteria. On each of three visits during a period of up to 3 months, each patient performed one standard and one short-wavelength automated perimetry 24-2 visual field in a random order on a Humphrey visual field analyzer. The long-term variability (also referred to as test-retest variability) was defined as the SD of the three threshold decibel values at each test location. The long-term variability for each test point (mean +/- SD) was determined separately for both standard visual fields and short-wavelength automated perimetry.RESULTS:With all 52 test locations of the 24-2 field averaged, the global long-term variability, mean (+/- SD) for standard visual fields and short-wavelength automated perimetry was 2.37 +/- 2.03 dB (95% confidence interval, 2.26-2.48 dB) and 2.92 +/- 2.03 dB (95% confidence interval, 2.81-3.03 dB), respectively (P <.0001). In 16 of the 52 visual field locations, long-term variability on short-wavelength automated perimetry was significantly higher than long-term variability on standard visual fields. In addition, the long-term variability increased with greater distance from the point of fixation for both standard visual fields and short-wavelength automated perimetry. The long-term variability decreased closer to fixation, more for standard visual fields than for short-wavelength automated perimetry.CONCLUSIONS:In a group of stable glaucoma patients, mean long-term variability was 0.55 dB higher for short-wavelength automated perimetry than for standard visual fields. This needs to be taken into consideration when serial visual fields are evaluated for change. Polo Llorens V, Larrosa Poves JM, Pablo Julvez LE, Pinilla Lozano I, Honrubia Lopez FM. Short-wavelength automated perimetry and retinal nerve fiber layer evaluation in glaucoma suspects [Article in Spanish] Arch Soc Esp Oftalmol 2000 Mar;75(3):179-84 Servicio de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana.

PURPOSE: To determine the correlation between the structural changes in the Retinal Nerve Fiber Layer (RNFL) and functional losses detected with ShortWavelength Automated Perimetry (SWAP) in a population of patients with suspected glaucoma. METHODS: 49 eyes of 49 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm of Hg and normal standard visual fields) were studied. SWAP was performed with a modified Humphrey Field Analyzer. Visual field indexes (MD, CPSD) were calculated for SWAP. Semiquantitative RNFL scores were given separately to diffuse and localized defects of the RNFL. RESULTS: The MD increased significantly (p<0.001) with higher Diffuse and Total RNFL scores, with good correlation coefficients. A small correlation was found between the CPSD and the RNFR scores (Diffuse, Total and Localized RNFL scores). CONCLUSIONS: Diffuse retinal nerve fiber layer losses are associated with diffuse field loss (MD) while focal structural damage showed no correlation with visual field losses. Demirel S, Johnson CA Isolation of short-wavelength sensitive mechanisms in normal and glaucomatous visual field regions. J Glaucoma 2000 Feb;9(1):63-73 Department of Ophthalmology, University of California, Davis, School of Medicine, USA. PURPOSE: To determine whether "isolation" of short wavelength sensitive mechanisms (i.e., exclusive detection of a threshold stimulus by a short wavelength sensitive mechanism) is maintained in areas of glaucomatous visual field damage as measured with short-wavelength automated perimetry (SWAP). METHODS: Data from conventional automated perimetry and SWAP were analyzed for both eyes of 60 normal control subjects, 38 patients with ocular hypertension, and 22 patients with early to moderate glaucomatous field damage (mean defect better than -12 dB). Comparisons of results of SWAP and conventional perimetry were performed by determining the deviation from the mean normal sensitivity for the two procedures. Locations with sensitivity <3 dB for either procedure were rejected, as 3 dB is near the maximum stimulus luminance and may have introduced a bias by underestimating defects. The interval between deviation from normal (the isolation interval) on conventional perimetry and SWAP was examined to determine the likelihood of short wavelength mechanism isolation loss for different levels of glaucomatous visual field damage. RESULTS: Using normal isolation estimates of 13 dB and 10 dB as bases for determining the likelihood that isolation of short wavelength sensitive mechanisms may have been lost, it was found that this was an infrequent possibility, as low as 0.39 to 1.63% for normal control subjects and 2.53 to 10.44% for patients with glaucoma. CONCLUSION: Analyses indicate that isolation of short wavelength sensitive mechanisms is mostly maintained for SWAP, even in areas of moderate glaucomatous field damage. One limitation of SWAP for evaluating extensive glaucomatous damage is its dynamic range. This could be overcome by using a more intense stimulus light source. Autor ? Study of the contralateral eye in patients with glaucoma and a unilateral perimetric defect. J Glaucoma 2000 Feb;9(1):34-7 Department of Ophthalmology, University of Sao Paulo, SP, Brazil. PURPOSE: To study the unaffected fellow eye in patients with glaucoma and unilateral visual field defect, using conventional automated achromatic perimetry, blue-yellow short-

wavelength automated perimetry (SWAP), and a nerve fiber layer analyzer (GDx; Laser Diagnostic Technologies, San Diego, CA). METHODS: Eighteen patients in whom a unilateral visual field defect was detected on conventional computerized threshold perimetry were selected. The contralateral eyes of these patients were studied with normal conventional threshold perimetry using blue-yellow perimetry and also were studied with the nerve fiber layer analyzer. Also, 18 eyes of 18 sex- and age- (+/-3 years) matched persons without glaucoma were selected as a control group. RESULTS: Of the 18 contralateral eyes, seven (38.8%) showed a visual field defect on blue-yellow conventional perimetry, and 10 (55.5%) showed a defect of the nerve fiber layer when evaluated with the nerve fiber analyzer. Of the 10 eyes with abnormal visual fields on the nerve fiber analyzer, six (60.0%) also showed a defect on blue-yellow perimetry. In the control group, no eyes showed visual field defect on SWAP, but three eyes (16.6% false positive rate) showed a visual field defect on the nerve fiber layer analyzer. CONCLUSION: These findings suggest that what appeared to be unilateral visual field defects may in fact have been bilateral in at least 33.3% of our patients (n = 6) for whom there was agreement between results of SWAP and the nerve fiber layer analyzer. Polo Llorens V, Pablo Julvez LE, Pinilla Lozano I, Larrosa Poves JM, Ruiz Moreno O, Honrubia Lopez FM. Short-wavelength automated perimetry (SWAP) in patients with suspected glaucoma (II): correlation with a probabilistic multifactorial model of risk for developing glaucomatous damage [Article in Spanish] Arch Soc Esp Oftalmol 2000 Feb;75(2):97-102 Servicio de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana. PURPOSE: To evaluate the efficiency and predictability of a multifactorial probability model to assess the risk of developing glaucomatous visual field defects and to determine the correlation between retinal nerve fiber layer (RNFL) photographs and short-wavelength automated perimetry (SWAP) in a population of patients suspected of having glaucoma. METHODS: One hundred and sixty eyes belonging to 83 patients with ocular hypertension [ocular pressure figures over 21 mmHg and normal conventional automated perimetry (AP) (white-white)] were included in the study. The risk of developing glaucomatous defects was assessed by a multifactorial model that includes intraocular pressure. vertical cup-to-disk ratio, age and family background. RNFL photographs and SWAP tests were also performed. RESULTS: SWAPs were pathological in 57 cases (35.6% of the sample); 23% of the perimetries were abnormal in the low-risk group while the moderate and high risk groups showed abnormal perimetries 38% and 56% respectively. The RNFL defects at the different risk levels were consistent with the SWAP results. The multiple regression analysis of the four variables included in the model showed the relationship among the risk factors, evaluated globally, and the presence of glaucomatous damage evaluated by RNFL and SWAP (p<0.001). CONCLUSIONS: The usefulness of this probability model as predictive indicator of subsequent glaucomatous damage is based on the good correlation between the risk scale and the RNFL and SWAP assessments. These techniques evaluate structural (RNFL) and functional (SWAP) changes in early stages of the glaucomatous disease. Polo Llorens V, Pinilla Lozano I, Pablo Julvez LE, Larrosa Poves JM, Abecia Martinez E, Cuevas Andres R, Rojo Aragues A, Honrubia Lopez FM. Short-wavelength automated perimetry (SWAP) in subjects with suspected glaucoma

(I): assessment of sensitivity thresholds [Article in Spanish] Arch Soc Esp Oftalmol 2000 Feb;75(2):91-6 Servicio de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana. PURPOSE: To evaluate the threshold values of short-wavelength-sensitive (SWS, or S-cone pathways) mechanisms, throughout the 30 degrees central visual field, in a glaucoma suspect population, and to compare the results with those obtained in the Retinal Nerve Fiber Layer study. METHODS: We studied the central visual field from 288 eyes of 211 subjects classified as ocular hypertensives (160 eyes) or age-matched normal controls (128 eyes). A modified Humphrey Field Analyser was used to isolate and measure the sensitivity of the SWS mechanisms. Monochromatic red-free photographs (RNFL) were taken with a wideangle fundus camera at the same period. RESULTS: Comparing normal and OHT eyes, we found significant differences in sensitivity for SWS cone pathways in the superior and inferior nasal quadrants, paracentral and peripheral region, and in the superior hemifield (p<0.05). Based on the perimetric criteria described, the SWAP was pathological in 57 cases. which represents 35.6% of the total sample. Using RNFL as early glaucoma diagnostic criterion, SWAP sensitivity and specificity values were 62% and a 89% respectively. CONCLUSIONS: SWAP is a useful test for the early detection of visual field losses. It is more sensitive than, standard automated perimetry and gives a high correlation with RNFL assessment, which has proved capable of detecting signs of glaucomatous damage several years before the onset of the typical visual field defects. Polo Llorens V, Larrosa Poves JM, Pinilla Lozano I, Pablo Julvez L, Rojo Aragues A, Cuevas Andres R, Ruiz Moreno O, Honrubia Lopez FM. Variability of sensitivity thresholds in short-wavelength automated perimetry (SWAP) in the central vision field [Article in Spanish] Arch Soc Esp Oftalmol 2000 Feb;75(2):85-90 Servicio de Oftalmologia, Hospital Miguel Servet, Zaragoza, Espana. PURPOSE: To determine the distribution of sensitivity thresholds of short-wavelength automated perimetry (SWAP) in the central visual field, analysing their variability depending on the eccentricity, in normal subjects. METHODS: 128 eyes of 128 normal subjects were analyzed. They underwent a SWAP examination. A lineal regression model was used to establish a <<standard visual field>> (SVF). The SVF determines the threshold distribution and its variability. RESULTS: The regression analysis obtained a SVF, age-corrected, which considers the influence of age in the different points of the visual field. The threshold distribution showed higher inter-subject deviations as eccentricity increased (p<0.001). CONCLUSIONS: The determination of variability of the threshold sensitivity deviations in the different points of the central visual field allows future development of perimetric algorythms for SWAP. Remky A, Arend O, Hendricks S Short-wavelength automated perimetry and capillary density in early diabetic maculopathy Invest Ophthalmol Vis Sci 2000 Jan;41(1):274-81

Department of Ophthalmology, Medical School of the Technical University of Aachen, Germany. PURPOSE: To correlate short-wavelength cone-mediated sensitivity (SWS) assessed by blue-on-yellow perimetry with alterations of the perifoveal vascular bed in early diabetic maculopathy. METHODS: Thirty-one patients (21 M, 10 F; mean age, 35 +/- 12 years; no lens opacities) with no clinically significant macular edema were included in this study. All patients underwent short-wavelength automated perimetry (SWAP) and conventional white-on-white perimetry (Humphrey, 10-2). In digitized video fluorescein angiograms (Scanning Laser Ophthalmoscope), the size of the foveal avascular zone (FAZ) and the mean perifoveal intercapillary area (PIA) as a measure of capillary density were quantified interactively. RESULTS: Mean thresholds of SWAP were significantly correlated with increasing size of FAZ (r = -0.51, P = 0.003) and PIA (r = -0.47, P = 0.01), whereas visual acuity expressed by log MAR (FAZ: r = 0.15, P = 0.41; PIA: r = 0.06, P = 0.76) and mean thresholds assessed with white-on-white perimetry (FAZ: r = -0.25, P = 0.20; PIA: r = -0.31, P = 0.14) were unrelated to diabetic changes of the perifoveal capillary network. CONCLUSIONS: The alterations of the perifoveal network are related to selective disturbances of visual function as measured by blue-on-yellow-perimetry. SWAP may act as an early detector of visual function loss in early diabetic maculopathy and serve as a helpful technique to predict early ischemic damage of the macula and to monitor therapy. Donahue SP Perimetry techniques in neuro-ophthalmology. Curr Opin Ophthalmol 1999 Dec;10(6):420-8 Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Advances in technology have produced several new techniques for evaluating the visual field. The standard Humphrey perimeter now has programs for SWAP (Short-wavelength automated perimetry) and SITA (Swedish interactive thresholding algorithm). SITA seems particularly promising as an automated test that decreases testing time without sacrificing sensitivity or increasing variability. In addition, separate tests have been developed that may selectively evaluate particular pathways of the afferent visual system. This paper summarizes major advances in perimetry published in 1998 and 1999. Mansberger SL, Sample PA, Zangwill L, Weinreb RN Achromatic and short-wavelength automated perimetry in patients with glaucomatous large cups. Arch Ophthalmol 1999 Nov;117(11):1473-7 Glaucoma Center and Department of Ophthalmology, University of California, San Diego , USA. OBJECTIVE: To evaluate visual function and optic disc features in patients with large cup-disc ratios (C/Ds). METHODS: One eye of 86 patients with vertical C/Ds by contour of at least 0.8, who had undergone both standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) testing, was selected retrospectively. Two masked glaucoma specialists independently graded stereoscopic photographs for vertical C/Ds, rim thinning, notching, excavation, optic disc hemorrhages, and nerve fiber layer defects. Visual

fields were classified as abnormal if the glaucoma hemifield test result, corrected pattern standard deviation, or mean deviation was outside age-specific normal limits. Confocal scanning laser ophthalmoscopy was used to determine disc area. RESULTS: SAP and SWAP results were abnormal in 44 (51%) and 52 (60%) of 86 patients, respectively. In patients with normal SAP results, SWAP results were abnormal in 14 (33%) of 42 patients. In patients with normal SWAP results, SAP results were abnormal in 6 (18%) of 34 patients. Small discs are associated with an abnormal SAP result (P = .01) and an abnormal SWAP result (P = .09). An increased vertical C/D greater than the qualifying level of 0.8 was associated with an abnormal SAP or SWAP result (P< or =.001). Rim thinning (P = .01) and disc hemorrhages (P = .04) were associated with an abnormal SAP result. CONCLUSIONS: Many patients with large C/Ds have normal SAP and SWAP results. Compared with SAP, SWAP results were abnormal in a higher percentage of these patients. If a patient has a large C/D and normal SAP results, SWAP testing may detect functional loss earlier. If glaucoma is defined by both structural and functional loss, patients with large vertical C/Ds, normal SAP results, and abnormal SWAP results may have glaucoma. Longitudinal studies are needed to assess this hypothesis and determine whether these patients subsequently develop abnormal SAP results as well. Terasaki H, Miyake Y, Nomura R, Horiguchi M, Suzuki S, Kondo M Blue-on-yellow perimetry in the complete type of congenital stationary night blindness. Invest Ophthalmol Vis Sci 1999 Oct;40(11):2761-4 Department of Ophthalmology, Nagoya University School of Medicine, Japan. PURPOSE: To resolve the discrepancy between nonrecordable full-field short wavelength cone electroretinograms (S-cone ERGs) and the presence of normal color vision in patients with the complete type of congenital stationary night blindness (CSNB1). METHODS: Conventional white-on-white (W-W) perimetry, blue-on-yellow (B-Y) perimetry, and the Farnsworth-Munsell 100-hue test were performed in five patients with CSNB1. Diagnosis of CSNB1 was made by clinical and electrophysiological examinations. Twelve normal, age-matched control subjects and an additional 7 normal, highly myopic subjects were tested. RESULTS: Color vision was normal in all the CSNB1 patients by the Farnsworth-Munsell 100-hue test. B-Y perimetry demonstrated that blue cone sensitivity in CSNB1 was normal in the fixation area, but the mean sensitivities of the entire 60 degrees field, the central 0 degrees-to-15 degrees, and 15 degrees-to-30 degrees ring were significantly decreased compared with the normal and myopic subjects. The sensitivity difference between 15 degrees-to-30 degrees and 0 degrees-to-15 degrees in B-Y perimetry increased significantly in CSNB1 compared with both normal and myopic control subjects. CONCLUSIONS: Our perimetric results demonstrated that the S-cone function in CSNB1 is preserved only in the fovea and becomes abnormal toward the peripheral retina. This accounts for the normal color vision that tests mainly foveal function and the nonrecordable S-cone ERGs that arise mainly from peripheral retina. Daneshvar H, Racette L, Coupland SG, Kertes PJ, Guberman A, Zackon D Symptomatic and asymptomatic visual loss in patients taking vigabatrin. Ophthalmology 1999 Sep;106(9):1792-8 The University of Ottawa Eye Institute, Ontario, Canada. PURPOSE: To investigate the clinical, perimetric, and electrophysiologic findings in patients with visual field loss on long-term treatment with the antiepileptic medication vigabatrin.

DESIGN: Consecutive observational case series. PARTICIPANTS: Forty-one consecutive subjects taking vigabatrin referred for screening ophthalmologic assessment were studied. Twelve subjects with evidence of peripheral visual field constriction are presented. METHODS: Twelve subjects with evidence of peripheral visual field constriction on 60-4 perimetry underwent central 30-2 and blue-on-yellow (B/Y) perimetry, as well as electroretinography (ERG), electro-oculography (EOG), and visual-evoked potential (VEP) testing. MAIN OUTCOME MEASURES: Visual acuity; fundus abnormalities; visual field loss; and ERG, EOG, or VEP abnormalities were the main outcome measures. RESULTS: Eight of the 12 subjects with constricted visual fields were asymptomatic. The central 30-2 perimetry demonstrated bilateral visual field constriction in 9 of 12 patients and the B/Y perimetry in 8 of 9 patients tested. Of the ten patients tested electrophysiologically, four had abnormal ERGs, five had abnormal EOGs, and three had delayed VEPs. CONCLUSIONS: The incidence of visual field constriction in patients taking vigabatrin may be higher, and asymptomatic visual field loss more common, than reported previously. The authors postulate a possible Muller cell dysfunction in the peripheral retina. Patients taking vigabatrin should have regular peripheral visual field examinations. Teesalu P Blue-on-yellow perimetry in the diagnosis of glaucoma. Acta Ophthalmol Scand 1999 Jun;77(3):364-5 Department of Ophthalmology, University of Oulu, Finland. Polo V, Larrosa JM, Pablo LE, Pinilla I, Honrubia FM Correlation of functional and structural measurements in eyes suspected of having glaucoma. J Glaucoma 1999 Jun;8(3):172-6 Department of Ophthalmology, Miguel Servet Hospital, Zaragoza, Spain. PURPOSE: This study was conducted to determine the correlation between structural changes in the retinal nerve fiber layer (RNFL) and functional loss detected on short-wavelength automated perimetry (SWAP) in a population of patients with suspected glaucoma. METHODS: With a selection criteria of intraocular pressure (IOP) more than 21 mmHg and normal results of conventional automated perimetry, 49 eyes of 49 patients with ocular hypertension were enrolled in the study. The SWAP was performed with a modified Humphrey field analyzer, and visual field indexes (mean deviation [MD], corrected pattern standard deviation [CPSD]) were calculated. Semiquantitative RNFL scores were given separately to diffuse and localized defects of the RNFL. RESULTS: The MD increased significantly with higher diffuse and total RNFL scores, with good correlation coefficients. A weak correlation was found between CPSD and diffuse, total, and localized RNFL scores. CONCLUSION: Diffuse RNFL loss are associated with abnormalities in visual field indexes (MD), whereas focal structural damage showed no correlation with visual field loss. Kono Y, Zangwill L, Sample PA, Jonas JB, Emdadi A, Gupta N, Weinreb RN Relationship between parapapillary atrophy and visual field abnormality in primary open-angle glaucoma. Am J Ophthalmol 1999 Jun;127(6):674-80 Glaucoma Center and Research Laboratories, University of California at San Diego, USA.

PURPOSE: To investigate the relationship of parapapillary atrophy measured by confocal scanning laser ophthalmoscopy to visual field sensitivity measured with standard automated perimetry and short-wavelength automated perimetry in patients with primary open-angle glaucoma. METHODS: Forty-seven eyes of 47 primary open-angle glaucoma patients with increased intraocular pressure (> or = 22 mm Hg) were enrolled. Optic nerve head topography and parapapillary atrophy (beta and alpha zones) were assessed by confocal scanning laser ophthalmoscopy. Mean deviation and corrected pattern SD were assessed with standard automated perimetry and short-wavelength automated perimetry. RESULTS: Beta and alpha zones were found in 23 (49%) and 47 (100%) eyes with primary open-angle glaucoma, respectively. The area of beta zone showed significant correlations with MD of standard automated perimetry, corrected pattern SD of standard automated perimetry, and corrected pattern SD of short-wavelength automated perimetry (Spearman r = -0.366, P = .012; r = 0.327, P = .025; and r = 0.436, P = .002, respectively). The area of alpha zone showed a significant correlation with mean deviation of standard automated perimetry (r = -0.378, P = .009). Mean MD of standard automated perimetry, mean corrected pattern SD of standard automated perimetry, and mean corrected pattern SD of short-wavelength automated perimetry were significantly worse in eyes with beta zone than in eyes without beta zone. CONCLUSIONS: Parapapillary atrophy measured by confocal scanning laser ophthalmoscopy, especially beta zone, is associated with glaucomatous visual field loss demonstrated by standard automated perimetry and short-wavelength automated perimetry. Plummer DJ, Marcotte TD, Sample PA, Wolfson T, Heaton RK, Grant I, Freeman WR Neuropsychological impairment-associated visual field deficits in HIV infection. Invest Ophthalmol Vis Sci 1999 Feb;40(2):435-42 Department of Ophthalmology, University of California, San Diego, La Jolla, USA. PURPOSE: To examine the relationship between loss in peripheral visual sensitivity and neuropsychological functioning in seropositive patients with human immunodeficiency virus (HIV) without infectious retinopathy. METHODS: Subjects carefully screened for retinal disease and well-matched across demographic and medical variables were grouped according to normal (perimetry-nl) versus abnormal (perimetry-abnl) performance on achromatic automated perimetry and short-wavelength automated perimetry, standard clinical ophthalmologic measures of visual function. All subjects completed a detailed neuropsychological test battery and were classified as impaired or unimpaired, globally and across eight neurocognitive domains. Subjects were also classified according to whether they met diagnostic criteria for minor cognitive/motor disorder (MCMD) or HIV-associated dementia (HAD). RESULTS: Visual field loss was associated with lower performance in the abstraction, perceptual-motor, learning, and motor domains. Significant group differences were also found on numerous individual neuropsychological tests. Based on clinical ratings, we found deficits in learning and motor functioning. No perimetry-nl subjects met criteria for MCMD or HAD, whereas 32% of perimetry-abnl subjects met diagnostic criteria for syndromic cognitive disorders (five MCMD and one HAD). In a subset of subjects who underwent a lumbar puncture, there was a trend for the perimetry-abnl group to have a higher concentration of beta2 microglobulin, a marker for central nervous system immune activation. CONCLUSIONS: These results suggest that in some HIV-infected people reduced visual function may be caused by nonretinal disease, and perimetry may present a sensitive measure of HIV-related brain dysfunction. Takahashi G, Aoki Y, Kitahara K

Short-term fluctuation of blue-on-yellow perimetry in normal eyes. Nippon Ganka Gakkai Zasshi 1999 Feb;103(2):108-11 Department of Ophthalmology, Jikei University School of Medicine, Japan PURPOSE: To evaluate short term fluctuation (SF) of blue-on-yellow perimetry (B/Y) as compared with white-on-white perimetry (W/W) in normal eyes. SUBJECTS AND METHOD: One eye each of 25 healthy persons underwent B/Y and W/W perimetry repeated 5 times each. The test subjects had no previous experience of perimetry. An automated perimeter, Humphrey Field Analyzer, model 750, was used throughout. RESULTS: The SF at the first session of B/Y perimetry averaged 2.02 dB. This value was significantly different from those of the subsequent 4 sessions. Each of SF of B/Y perimetry at the first two sessions was significantly different from that of W/W perimetry at the first two sessions. The SF of B/Y perimetry showed wider fluctuations than those of W/W perimetry at each session. CONCLUSION: B/Y perimetry in normal eyes showed individual differences as well as fluctuations between the initial and consecutive sessions. This feature has to be considered in interpretation of the findings. Maeda H; Tanaka Y; Nakamura M; Yamamoto M Blue-on-yellow perimetry using an Armaly glaucoma screening program. Ophthalmologica, 1999, 213:2, 71-5 Department of Ophthalmology, Kobe University School of Medicine, Kobe, Japan. The purpose of the present investigation was to determine whether blue-on-yellow (B/Y) perimetry using a screening program can detect early glaucomatous change before it is evident with standard white-on-white (W/W) screening tests. The subjects included 25 normal, 20 ocular-hypertensive and 27 early glaucomatous eyes. From our results, even in normal subjects, B/Y perimetry alone demonstrated abnormal points in the nasal field in 10 eyes (40%). The Armaly central screening program was thought to be superior to the Armaly full-field program, because the former has less probabilities to detect a false-positive scotoma in the nasal field than the latter. In glaucomatous eyes, more abnormal points were detected by B/Y perimetry than by W/W perimrtry. Hudson C, Flanagan JG, Turner GS, Chen HC, Young LB, McLeod D Influence of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on short-wavelength and conventional automated perimetry. Diabetologia 1998 Nov;41(11):1283-92 University Department of Ophthalmology, Manchester Royal Eye Hospital, UK. The aim of the study was to determine the effect of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on macular visual function as assessed by conventional and short-wavelength automated static threshold perimetry. The sample comprised 24 patients who required laser photocoagulation for clinically significant DMO (mean age 59.75 years, range 45-75 years). One eye of each patient was selected for the study. Patients underwent conventional and short-wavelength perimetry using programme 10-2 of the Humphrey Field Analyser on two separate occasions prior to treatment and subsequently within 1 week of, and at 1, 2, 4 and 12 weeks after, treatment. The pointwise pattern deviation plot was analysed for conventional perimetry and a pointwise horizontal and vertical hemifield asymmetry analysis was derived for short-wavelength perimetry (thereby negating the influence of pre-receptoral absorption). The extent of sensitivity loss was determined by

counting the number of stimulus locations with statistical probability levels of p less than 0.05. Group mean log minimum angle of resolution (logMAR) visual acuity was largely unchanged over the course of the study. Conventional perimetry showed an increase in the group mean number of abnormal contiguous stimulus locations from 2.4 (SD 4.3, range 0-14) immediately prior to treatment, to 12.4 (SD 7.8, range 0-30) within 1 week of treatment; at 3 months post-treatment, the group mean number of abnormal contiguous stimulus locations was 8.1 (SD 6.5, range 0-20). A similar but less pronounced change was found for short-wavelength perimetry. The spatial position of the post-treatment localised sensitivity loss corresponded with the area of retinal photocoagulation. Despite proven benefit in the stabilisation of visual acuity, laser photocoagulation for clinically significant DMO invariably results in a localised loss of perimetric sensitivity within 10 degrees eccentricity of the fovea. Evidence for the value of laser therapy for clinically significant DMO must be re-examined. Teesalu P, Airaksinen PJ, Tuulonen A Blue-on-yellow visual field and retinal nerve fiber layer in ocular hypertension and glaucoma. Ophthalmology 1998 Nov;105(11):2077-81 Department of Ophthalmology, University of Oulu, Finland. BACKGROUND AND OBJECTIVE: It has been suggested that the clinically detectable changes of the blue-on-yellow (B/Y) visual field and retinal nerve fiber layer (RNFL) may precede standard white-on-white (W/W) visual field defects in the progression of glaucoma. The aim of this study was to test the relationship between the results of B/Y visual fields and semiquantitative RNFL evaluation in corresponding areas and to determine how the B/Y visual fields and RNFL scores label the normal W/W perimetry hemifields in patients with glaucoma and ocular hypertension. DESIGN: A cohort study. PARTICIPANTS AND METHODS: Monochromatic RNFL photographs of 32 normal subjects and 29 patients with ocular hypertension and different stages of glaucoma were assessed in a masked fashion. The B/Y and W/W visual fields (program 30-2) were examined with a Humphrey perimeter. The results of both visual fields were adjusted for the patients' age and lens transmission index measured with a lens fluorometer. MAIN OUTCOME MEASURE: Mean deviation (MD) of visual field and semiquantitative score of RNFL loss were measured. RESULTS: The total and hemifield MD values of B/Y and W/W visual field showed a statistically significant correlation with diffuse and overall score of RNFL loss in corresponding areas. The hemifield MD values of B/Y perimetry obtained from "normal" W/W hemifields of patients with early glaucoma were well correlated (r = -0.56) with respective RNFL loss scores found to be abnormal in 84% of hemispheres. The difference between the hemifield MD values of B/Y perimetry obtained from normal W/WAN hemifields of patients with ocular hypertension and patients with early glaucoma was not statistically significant (analysis of variance). The respective B/Y hemifield data of normal subjects were statistically significantly different from the data of patients with ocular hypertension and early glaucoma. CONCLUSIONS: The hemifield MD values of B/Y perimetry correlate well with semiquantitative scores of RNFL loss obtained from the corresponding hemisphere. The B/Y perimetry as well as RNFL assessment may show glaucomatous defects in a hemifield found to be normal on W/W perimetry. In subjects with ocular hypertension, the functional damage detected by B/Y perimetry may, in some cases, precede RNFL defects on conversion to glaucoma. Lobefalo L, Verrotti A, Mastropasqua L, Della Loggia G, Cherubini V, Morgese G, Gallenga PE, Chiarelli F

Blue-on-yellow and achromatic perimetry in diabetic children without retinopathy. Diabetes Care 1998 Nov;21(11):2003-6 Institute of Ophthalmology, University G. D'Annunzio, Chieti, Italy. OBJECTIVE: We compared blue-on-yellow perimetry with achromatic perimetry to determine whether the first was more sensitive in detecting visual field defects. RESEARCH DESIGN AND METHODS: We studied 50 children and adolescents (22 male, 28 female) with IDDM, ranging in age from 10.1 to 16.3 years (mean 13.3+/-2.1 years), with a disease duration of 5.2-10.0 years (mean 7.1+/-1.9 years). Patients were divided into subgroups according to the presence of persistent microalbuminuria. No one had signs of diabetic retinopathy when studied with fluorescein angiography. RESULTS: By achromatic perimetry, the analysis of subareas of the central 30 degrees of the visual field (0-9 degrees; 10-18 degrees; out of 18 degrees) showed no differences between diabetic subgroups in the central 18 degrees of the visual field, while a significant difference between the same subgroups was found outside the 18 degrees of the 24-2 program of the Humphrey perimeter (P = 0.027). By blue-on-yellow perimetry, in all three of the perimetric subareas evaluated, the sensitivity was lower in microalbuminuric patients than in normoalbuminuric ones. The differential sensitivity between the perimetric tests performed with blue-on-yellow and with achromatic stimuli showed statistically significant data, with a higher level of significance in the central 18 degrees (P < 0.0001) than outside the 18 degrees (P = 0.033). CONCLUSIONS: Our study suggests that blue-on-yellow perimetry is more useful and more sensitive than achromatic perimetry in the detection of preclinical visual field defects in diabetic children with microalbuminuria but without clinically detectable retinopathy. Polo V; Abecia E; Pablo LE; Pinilla I; Larrosa JM; Honrubia FM Short-wavelength automated perimetry and retinal nerve fiber layer evaluation in suspected cases of glaucoma. Arch Ophthalmol, 1998 Oct, 116:10, 1295-8 Department of Ophthalmology, Hospital Miguel Servet, Zaragoza, Spain OBJECTIVES: To determine if short-wavelength automated perimetry (SWAP) provides evidence that indicates early functional losses in ocular hypertensive subjects and to establish a direct comparison with early structural abnormalities in the retinal nerve fiber layer (RNFL). METHODS: A total of 160 eyes belonging to 83 patients with ocular hypertension (intraocular pressure >21 mm Hg and normal results on standard automated perimetry evaluation), on which a SWAP and RNFL study were performed, were examined. One hundred twenty-eight age-matched subjects without ocular hypertension were evaluated to establish the 95% and 99% confidence intervals at each of the 76 exploration points of the SWAP test. RESULTS: The RNFL study results were normal in 83 cases (51.8%) and pathologic in 77 cases (48.1%). The SWAP results were pathologic in 57 cases (35.6%). Significant differences (P<.001) were observed when comparing the distribution of normal and pathologic SWAP results among the types of defects in the RNFL (focal wedge, diffuse atrophy, and mixed atrophy). CONCLUSIONS: Short-wavelength automated perimetry is a useful test for the early detection of visual field losses. It is more sensitive than standard automated perimetry and provides a high association with RNFL assessment, which has proved capable of detecting signs of glaucomatous damage several years before the onset of the typical visual field defects. Hudson C, Flanagan JG, Turner GS, Chen HC, Young LB, McLeod D

Short-wavelength sensitive visual field loss in patients with clinically significant diabetic macular oedema. Diabetologia 1998 Aug;41(8):918-28 University Department of Ophthalmology, Manchester Royal Eye Hospital, UK. The aim of the study was to compare the sensitivity of short-wavelength and conventional automated static threshold perimetry for the psychophysical detection of abnormality in patients with clinically significant diabetic macular oedema. The sample comprised 24 patients with clinically significant diabetic macular oedema (mean age 59.75 years, range 45-75 years). One eye of each patient was selected. Exclusion criteria included the presence of lenticular opacity. The sensitivity of the macular visual field of each patient was determined with programme 10-2 of the Humphrey Field Analyser on two occasions, using both short-wavelength and conventional stimulus parameters; the results of the second session were analysed to minimise learning effects. A pointwise horizontal hemifield asymmetry analysis was derived for short-wavelength perimetry (thereby negating the influence of pre-receptoral absorption); the pointwise pattern deviation probability plot was analysed for conventional perimetry. Abnormality was defined as 3 or more contiguous stimulus locations with negative asymmetries (short-wavelength) or reduced sensitivity values (conventional) that resulted in a statistical probability level of p less than 0.05. The fields of 8 patients were abnormal as assessed by conventional perimetry while all were classified as abnormal using short-wavelength perimetry. In the 8 patients who exhibited both abnormal conventional and abnormal short-wavelength perimetry results, the extent of field loss was generally greater using short-wavelength perimetry. The position of the localised field loss (i.e. as distinct from field loss that was generalised across the visual field) assessed by short-wavelength perimetry corresponded with the clinical mapping of the area of diabetic macular oedema but the extent of this loss was generally greater than that suggested by clinical assessment. Short-wavelength automated perimetry offers improved sensitivity for the psychophysical detection of clinically significant diabetic macular oedema. Kwon YH, Park HJ, Jap A, Ugurlu S, Caprioli J Test-retest variability of blue-on-yellow perimetry is greater than white-on-white perimetry in normal subjects. Am J Ophthalmol 1998 Jul;126(1):29-36 Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA. PURPOSE: To compare long-term fluctuation of blue-on-yellow automated perimetry with white-on-white automated perimetry in normal subjects. METHODS: White-on-white and blue-on-yellow automated perimetry were performed on a Humphrey Visual Field Analyzer and an Octopus perimeter, both modified for blue-on-yellow perimetry. The study sample consisted of 31 eyes of 31 normal subjects for the Humphrey perimeter and 33 eyes of 33 normal subjects for the Octopus perimeter. After one practice session, each subject completed four testing sessions over a period of 2 to 8 weeks, each separated by at least 1 day. Each testing session consisted of both white-on-white and blue-on-yellow perimetry performed on one eye; the order of the tests was alternated for successive sessions. Long-term fluctuation (expressed as statistical variance) was calculated for each test location. Intersubject variability (expressed as statistical variance) across all subjects was determined for each test location. RESULTS: On the Humphrey perimeter, the long term fluctuation for blue-on-yellow perimetry (4.07 +/- 3.07 dB2) was significantly greater than that for white-on-white perimetry (1.97 +/- 0.99 dB2; P < .001). Long-term fluctuation increased as a function of eccentricity

for both blue-on-yellow and white-on-white perimetry. Short-term fluctuation was significantly greater for blue-on-yellow (0.46 +/- 0.25 dB) than that for white-on-white perimetry (0.29 +/- 0.19 dB; P < .02). Finally, the intersubject variability was significantly greater in blue-on-yellow (13.2 +/- 2.8 dB2) than it was in white-on-white perimetry (4.25 +/- 1.13 dB2; P < .001). Similar results were found with the Octopus perimeter. CONCLUSIONS: Long-term fluctuation and short-term fluctuation of blue-on-yellow perimetry are greater than those of white-on-white perimetry in normal subjects. The increased long-term fluctuation requires appropriate statistical approaches when evaluating serial change of blue-on-yellow perimetry. Fujimoto N, Adachi-Usami E Use of blue-on-yellow perimetry to demonstrate quadrantanopia in multiple sclerosis. Arch Ophthalmol 1998 Jun;116(6):828-9 Teesalu P, Vihanninjoki K, Airaksinen PJ, Tuulonen A Hemifield association between blue-on-yellow visual field and optic nerve head topographic measurements. Graefes Arch Clin Exp Ophthalmol 1998 May;236(5):339-45 Department of Ophthalmology, University of Oulu, Finland. BACKGROUND: Blue-on-yellow (B/Y) perimetry can reveal visual field defects earlier and larger in extent than white-on-white (W/W) perimetry. The Heidelberg Retina Tomograph (HRT) produces a three-dimensional image of the optic disc. The aim of this study was to compare the strength of the association of the B/Y and W/W visual hemifield mean deviation (HMD) variables with the optic nerve head (ONH) morphological variables of the respective area. METHODS: We evaluated one randomly chosen eye of 40 normal subjects and 37 patients with ocular hypertension and different stages of glaucoma. The B/Y and W/W visual fields (program 30-2) were obtained with a Humphrey perimeter. Results of both visual fields were adjusted for the patient's age and lens transmission index measured with a lens fluorometer. HMD was calculated as the difference between the measured and expected hemifield mean sensitivity values, predicted by the regression model fitted in our nonglaucomatous subject data. The HRT with the software version 1.11 was used to acquire and evaluate the topographic measurements of the optic disc. RESULTS: The B/Y and W/W visual field HMDs showed statistically significant correlation with ONH parameters such as cup shape measure (CSM), rim volume, rim area, mean retinal nerve fiber layer (RNFL) thickness and RNFL cross-sectional area. With forward stepwise logistic regression analysis using B/Y hemifield data 38% of the glaucoma patient's normal W/W hemifields were classified abnormal. With the CSM alone in the model 52% of the cases were classified abnormal. CONCLUSIONS: B/Y visual field hemifield mean deviation values correlate well with ONH parameters examined with the HRT. Maeda H, Tanaka Y, Sugiura T, Nakamura M, Yamamoto M Distribution of retinal sensitivity with blue on yellow perimetry in ocular hypertension. Nippon Ganka Gakkai Zasshi 1998 Feb;102(2):111-6 Department of Opthalmology, Kobe University School of Medicine, Hyougo-ken, Japan. We evaluated the visual field pattern with Blue-on-Yellow perimetry in 22 eyes of 22 persons with ocular hypertension. Another series of 20 normal eyes served as controls. All the

subjects underwent central field perimetry with a Humphrey automated perimeter (Model 640) using White-on-White targets. Blue-on-Yellow perimetry was performed within one week later. Both groups showed no difference in White-on-White perimetry, but the ocular hypertensive group showed a diffuse reduction in central sensitivity to Blue-on-Yellow perimetry by an average of 2.5 dB compared with the controls. These findings show the possibility that ocular hypertension causes fragility of the blue-yellow transmission system including the blue cones. Wild JM; Cubbidge RP; Pacey IE; Robinson R Statistical aspects of the normal visual field in short-wavelength automated perimetry. Invest Ophthalmol Vis Sci, 1998 Jan, 39:1, 54-63 Department of Vision Sciences, Aston University, Birmingham, United Kingdom. PURPOSE: To determine the intraindividual and interindividual characteristics of normal sensitivity derived by short-wavelength automated perimetry (SWAP) as a function of threshold algorithm. To determine also the influence of ocular media absorption on the magnitude of the interindividual variation in normal sensitivity, and hence the confidence limits, derived by SWAP. METHODS: The sample comprised 51 normal subjects, stratified for age by decade (mean age, 55.5 years; range, 24-83 years) and experienced in white-on-white (W-W) perimetry and SWAP. One randomly assigned eye of each subject was examined on three occasions with Program 30-2 of the 640 Humphrey Field Analyzer using the Full Threshold and FASTPAC strategies for SWAP and W-W perimetries. Ocular media absorption (OMA) was assessed by the difference in scotopic sensitivity to stimuli of 410 and 560 nm. RESULTS: The group mean examination time (P < 0.001) was greater for SWAP than for W-W perimetry for both the Full Threshold (15.0% longer) and FASTPAC strategies (16.8% longer). The gradient of the age-decline in Mean Sensitivity for SWAP was approximately 25% less steep when corrected for OMA than when uncorrected. The interindividual normal variability, expressed as the coefficient of variation, for SWAP without correction for OMA was 2.7 times greater (range 2.0-3.9), and with correction 1.9 times greater (range 1.4-2.9), than that for W-W perimetry. CONCLUSIONS: The increased interindividual normal variability of SWAP, exacerbated by the lack of correction for OMA, currently limits the utility of SWAP in that the reduction in sensitivity required to indicate abnormality was proportionately greater than for W-W perimetry. Mastropasqua L, Ciancaglini M, Carpineto P, Zuppardi E, Falconio G, Gallenga PE Effects of brimonidine 0.2% on blue-yellow perimetry of glaucomatous patients. Acta Ophthalmol Scand Suppl 1998;(227):36 Institute of Ophthalmology, Gabriele D'Annunzio University, Chieti. A cross-over double-blind study was performed to evaluate the effect of acute administration of brimonidine on the blue-yellow perimetry. Thirty patients with primary open-angle glaucoma were admitted. After brimonidine administration, IOP and pupil diameter showed a significant reduction (p < 0.01) without modification in systolic and diastolic blood pressure. Blue-on-yellow perimetry showed a significant reduction in CPSD from 3.81 +/- 1.60 to 2.71 +/- 1.92 (p < 0.05). This result suggests that brimonidine improves ocular perfusion via a reduction of IOP. Serra A; Zucca I; Tanda A; Piras V; Fossarello M

Blue-yellow perimetry in patients with ocular hypertone. Acta Ophthalmol Scand Suppl, 1998, :227, 24-7 Eye Clinic, University of Cagliari. The authors report the data of the blue-yellow (B-Y) perimetry compared with the Standard perimetry in normal subjects with endocular hypertension or with initial glaucoma. With the aim of evaluating the relationship with chromatic sense deficits, precociously found in glaucoma, the F-M 100 Hue test and Lanthony D 15 Desaturé test were done. Checks were made of refraction, visual acuity, pupil diameter and assumption of medications. Sensitivity reduction in eyes with initial glaucoma is highly significant with the B-Y perimetry. Pupil diameter reduction is quite uninfluential while the chromatic sense shows some quantitative and qualitative deficits. Palacz O; Lubinski W; Penkala K; Szmatoch K; Lak D The significance and interpretation of the electrophysiological and psychophysiological analyses in the diagnosis of glaucoma Klin Oczna, 1998, 100:6, 407-12 Katedry i Kliniki Okulistyki (WS) PAM w Szczecinie. The goal of this paper is to discuss and indicate which electrophysiological and psychophysical tests are useful for diagnosis and monitoring of glaucoma patients. In diagnosis of glaucoma, among electrophysiological methods, the authors perform mainly transient and steady-state pattern electroretinogram (PERG). Steady-state as well as transient PERG have the best sensitivity and specificity in diagnosis of this disease even in its early stages. Pattern visual evoked potentials (PVEPs) are less sensitive and specific, that is why this examination is rare in practical use. The authors describe the method of PERG, discuss most frequent mistakes in the method and interpretation of the obtained results. Among psychophysical tests the authors emphasize the significance of short-wave-length perimetry (blue-on-yellow) and standard static perimetry in early diagnosis of glaucoma. On the basis of literature, the authors present also other psychophysical methods, which can be applied in diagnosis of glaucoma. Teesalu P; Vihanninjoki K; Airaksinen PJ; Tuulonen A; Läärä E Correlation of blue-on-yellow visual fields with scanning confocal laser optic disc measurements. Invest Ophthalmol Vis Sci, 1997 Nov, 38:12, 2452-9 Department of Ophthalmology, University of Oulu, Finland. PURPOSE: Visual field defects and changes in the optic nerve head are signs of glaucoma. It has been shown that blue-on-yellow (B-Y) perimetry can reveal visual field defects earlier and shows them larger than does white-on-white (W-W) perimetry. The Heidelberg retina tomograph (HRT) can produce three-dimensional images of the optic disc. The aim of this study was to find out how B-Y perimetry results correlate with optic disc parameters in comparison with W-W perimetry results. METHODS: One randomly chosen eye was evaluated in each of 40 normal subjects and 37 patients with ocular hypertension and different stages of glaucoma. B-Y and W-W visual fields (program 30-2) were obtained with a Humphrey perimeter. B-Y perimetry results were adjusted for the patient's age and lens transmission index measured with a lens fluorometer. The B-Y visual field adjusted mean deviation (MD) was calculated as the difference between the measured and expected mean

sensitivity values, predicted by the regression model fitted in normal subjects. The HRT with software version 1.11 was used to acquire and evaluate topographic measurements of the optic disc. RESULTS: The cup shape measure showed strongest correlation with the MD of both the B-Y and W-W visual fields. The multiple correlation coefficients from quadratic regression were 0.65 for both visual fields. Except for peripapillary retinal nerve fiber layer measurements, the statistically significant correlations of the B-Y visual field indexes with other HRT parameters were equal to or better than those of W-W perimetry. CONCLUSIONS: B-Y perimetry MDs are well correlated with optic nerve head parameters measured with the HRT. In early stages of glaucoma, most HRT variables were better correlated with the B-Y MD than with the W-W MD. Sample PA; Bosworth CF; Weinreb RN Short-wavelength automated perimetry and motion automated perimetry in patients with glaucoma Arch Ophthalmol, 1997 Sep, 115:9, 1129-33 Glaucoma Center, University of California, San Diego, La Jolla, USA. OBJECTIVE: To compare short-wavelength automated perimetry (SWAP), a test favoring the detection of the target by the parvocellular pathways of vision, with motion automated perimetry (MAP), a test favoring detection by the magnocellular pathways, in the same eyes. PARTICIPANT: Thirty-three individuals in whom glaucoma was suspected (glaucoma suspects) and 17 patients with primary open-angle glaucoma were compared with 30 age-matched normal control subjects. INTERVENTIONS: Short-wavelength automated perimetry was done with the usual protocol (program 24-2). Motion coherence thresholds were measured with 14 random do targets that covered the 24-2 field area. Short-wavelength automated perimetry test locations corresponding to each of the 14 motion automated perimetry locations were averaged to compare 14 locations for each text. RESULTS: Short-wavelength automated perimetry and motion automated perimetry were correlated by visual field location (whole field r = -0.40, P < .001), especially in the superior field (r = -0.45, P < .001). Overlap for defective locations was present in 16 (94%) of the 17 eyes with glaucoma, although in the glaucoma suspect eyes each test showed the earliest deficit in a percentage of individuals with overlap in only 3 (21%) of the 14 eyes. An analysis of variance showed a significant effect of diagnosis for both tests (SWAP and MAP, P < .001); the eyes of patients with glaucoma were significantly different from those of the normal controls. The results for glaucoma suspects were significantly different on SWAP only in the superior temporal field (Tukey-Kramer test). CONCLUSIONS: Both tests successfully identified eyes with glaucoma and a percentage of the glaucoma suspect eyes; both were correlated by field location. These results suggest that damage due to glaucoma is nonselective for either the parvocellular or the magnocellular ganglion cell axons, that there may be individual differences in which type of ganglion cell shows damage first, and that when standard visual field loss is present the results of SWAP and MAP are defective. Kawabata H; Fujimoto N; Adachi Usami E Sensitivity loss of short wavelength sensitive cones in myopic eyes by blue-on-yellow perimetry Nippon Ganka Gakkai Zasshi, 1997 Aug, 101:8, 648-55 Department of Ophthalmology, Chiba University School of Medicine, Japan.

A decrease of the short wavelength sensitive cone (S-cone) sensitivity has been reported in myopic eyes in addition to glaucoma and retinal diseases such as retinal detachment and diabetic retinopathy. In order to investigate early changes of visual function in myopic eyes, blue-on-yellow perimetry (B on Y) which could detect S-cone sensitivity and white-on-white perimetry (W on W) were measured with a computed perimeter program. Young subjects with good visual acuity, normal color vision, and normal intraocular pressure were selected. They had no other ophthalmoscopic abnormalities except for tigroid fundus. Mean deviations of W on W were reduced in mild and high myopic groups. In both tests, the sensitivities decreased as the refractive errors increased in all the tested areas (p < 0.0001). The sensitivity in B on Y decreased more remarkably than in W on W with an increase of refractive error (p < 0.05). We concluded that B on Y perimetry was significantly sensitive to identify early changes of visual function in myopic eyes. Yamagishi N; Anton A; Sample PA; Zangwill L; Lopez A; Weinreb RN Mapping structural damage of the optic disk to visual field defect in glaucoma. Am J Ophthalmol, 1997 May, 123:5, 667-76 Department of Ophthalmology, University of California, San Diego, La Jolla, USA. PURPOSE: To evaluate the relation between the location of focal visual field defects and optic disk damage in eyes with glaucoma by short-wavelength automated perimetery and confocal scanning laser ophthalmoscopy. METHODS: In 14 patients (14 eyes) with open-angle glaucoma, focal optic disk damage, and focal visual field loss, we obtain visual fields with short-wave-length automated perimetry. The short-wavelength automated perimetry visual field was divided into 21 zones, representing retinal nerve fiber layer arcuate bundles. Test points were compared with a normative database. The optic disk was assessed with a confocal scanning laser ophthalmoscope. Optic disk measurements were calculated in 10-degree sectors and compared with a normative database using a new measure, the rim area ratio, which adjusts for individual differences in disk size. RESULTS: The mean number (+/-SD) of damaged visual field zones was 3.9 (+/-1.9), and the mean number of damaged rim sectors was 5.0 (+/-2.9). Focal defects on the optic disk and on short-wavelength automated perimetry were topographically related with specific damaged visual field zones corresponding to specific damaged rim sectors. CONCLUSIONS: In patients with open-angle glaucoma with focal optic disk damage and focal visual field loss, defects in optic disk and short-wavelength automated perimetry are topographically related. The rim area ratio can be used to identify focal optic nerve defects. Teesalu P; Airaksinen PJ; Tuulonen A; Nieminen H; Alanko H Fluorometry of the crystalline lens for correcting blue-on-yellow perimetry results. Invest Ophthalmol Vis Sci, 1997 Mar, 38:3, 697-703 Department of Ophthalmology, University of Oulu, Finland. PURPOSE: Optical and neural sources of short wavelength sensitivity should be separated in the assessment of the results of blue-on-yellow (B/Y) perimetry. It has been shown previously that lens autofluorescence is related directly to lens yellowing and age. The aim of this study was to find out if B/Y perimetry results can be better corrected by using lens fluorometry than by age. METHODS: The authors evaluated one randomly chosen eye of 40 normal subjects and 39 age-matched patients with ocular hypertension and different stages of glaucoma. The authors obtained the mean sensitivity (MS) of the 24-2 B/Y visual fields with a Humphrey perimeter and determined the lens transmission index (LTI) from the ratio between posterior and anterior autofluorescence peaks measured with their fluorometer. A multiple regression

analysis was used to evaluate the variability of the B/Y MS by age and LTI in normal subjects. RESULTS: The authors found a statistically highly significant linear correlation of B/Y MS to LTI in healthy subjects (R = 0.83; P < 0.0001). The 95% prediction interval of the normal subjects was determined. The majority of the MS values of the ocular hypertensives were inside the prediction limits, whereas approximately half of the patients (4 of 9) with early glaucoma and the majority of patients (14 of 15) with moderate and advanced glaucoma were below the prediction interval. The residual standard deviation of the B/Y MS with age alone was larger than that with LTI alone in the model (3.66 dB and 3.22 dB, respectively). CONCLUSIONS: The interindividual variation of the lens transmission properties increases with age. The reference level for correcting B/Y perimetry results can be determined more precisely using fluorometry of the lens than with age alone. Kitazawa Y; Yamamoto T Glaucomatous visual field defects: their characteristics and how to detect them. Clin Neurosci, 1997, 4:5, 279-83 Department of Ophthalmology, Gifu University School of Medicine, Japan. Functional defects of glaucomatous optic neuropathy are reviewed and summarized. Glaucomatous visual field defects are basically comprised of four major patterns: an isolated scotoma, an arcuate scotoma, a nasal step, and generalized depression. The field loss progresses conforming to the optic nerve head and retinal nerve fiber changes. Interpretation of the visual field and some tips of the interpretation are outlined in addition to describing differential diagnosis. Lastly, blue-on-yellow perimetry and high-pass resolution perimetry, both of which are promising tools for early detection of glaucoma, are introduced. Graham SL; Drance SM; Chauhan BC; Swindale NV; Hnik P; Mikelberg FS; Douglas GR Comparison of psychophysical and electrophysiological testing in early glaucoma. Invest Ophthalmol Vis Sci, 1996 Dec, 37:13, 2651-62 University of British Columbia, Vancouver, Canada. PURPOSE: To compare the sensitivity and specificity of a wide range of psychophysical and electrophysiological tests in the detection of early glaucomatous damage. METHODS: Forty-three normals and 43 patients with early glaucoma, some still without field defects, were tested with differential light threshold perimetry, short-wavelength automated perimetry, high-pass resolution perimetry, motion detection, flicker contrast sensitivity, flickering and isoluminantly matched letter tests, and pattern and flash electroretinography, including photopic, scotopic, oscillatory potentials, and 30 Hz flicker. Receiver operating characteristic analysis was applied to continuous variables derived from each of the tests. RESULTS: Most parameters reflected glaucomatous loss to some degree, even though only single variables were analyzed separately in the receiver operating characteristic analysis. The pattern electroretinogram and some of the letter acuity tests had the best sensitivity and specificity, followed by short-wavelength automated perimetry and high-pass resolution-perimetry. Motion detection, flicker contrast, and flash electroretinogram parameters scored poorly. Six patients with normal results on the Humphrey field test had abnormal results on many of the other tests. CONCLUSIONS: Applying different psychophysical and electrophysiological tests may add to our ability to detect early glaucomatous damage. Sample PA; Johnson CA; Haegerstrom Portnoy G; Adams AJ

Optimum parameters for short-wavelength automated perimetry. J Glaucoma, 1996 Dec, 5:6, 375-83 Department of Ophthalmology, University of California, San Diego, La Jolla. PURPOSE: To determine the optimum parameters for short-wavelength automated perimetry (SWAP) and to recommend these for standardization of the procedure. METHODS: We used a variety of stimulus and background configurations to determine the optimum background spectral distribution and luminance, and the optimum target spectral distribution, maximum luminance, and duration. We measured threshold versus intensity curves to determine which combination provided (a) the greatest isolation of the short-wavelength sensitive mechanisms and (b) the largest dynamic range for perimetry. We also evaluated the effect of lens absorption and cataract on these two factors. RESULTS: A broad-band yellow background at 100 candela/m2 with a narrow-band 440-nm (27-nm half-bandwidth), 1.8 degrees diameter (Goldmann size V) stimulus presented for 200 ms was optimum at all retinal eccentricities. Specific recommendations for how to modify existing perimeters are given. CONCLUSION: Agreement regarding the optimum parameters for SWAP should lead to standardization of the test that will facilitate comparison of results from different centers. Normative data can be collected at several sites and incorporated into statistical analysis packages currently available with various perimeters. This will greatly improve the clinical utility of this test. Remky A; Beausencourt E; Elsner AE Angioscotometry with the scanning laser ophthalmoscope. Comparison of the effect of different wavelengths. Invest Ophthalmol Vis Sci, 1996 Oct, 37:11, 2350-5 Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA. PURPOSE: Angioscotomas are scotomata caused by vessel shadows. Their extent may be influenced by physiological and pharmacologic conditions and disease. In this study, the authors quantified angioscotomas in normal subjects using a fundus perimetry technique with a scanning laser ophthalmoscope. They further investigated the influence of two different wavelengths on scotoma depth. METHODS: For blue-on-yellow perimetry, the authors used two different lasers—an argon laser (lambda = 458 nm) for stimuli and a low background and a HeNE (lambda = 594 nm) for a superimposed yellow background. For red-on-red perimetry, the authors used another HeNe laser (lambda = 633 nm). Fundus illumination was provided by an infrared light. Five healthy subjects were examined. Twenty-one to 24 stimuli (200 msec duration, 0.4 degree x 0.4 degree) were presented at different intensities in randomized order in a 5 degrees x 2.5 degrees retinal test field, directly inferior and adjacent to the disk. RESULTS: The depth of scotomas caused by major vessels varied in all subjects and depended on perimetry condition. To quantify the influence of vessels on sensitivity, the authors analyzed psychometric functions for stimuli projected on the vessels and for those far from the vessels. The authors found a significant difference for targets on the vessel compared to those far, which was more pronounced for the blue-on-yellow condition. CONCLUSIONS: Angioscotomas are detected better with blue targets on a yellow background than with red-on-red perimetry. The greater light absorption by hemoglobin and oxyhemoglobin at short wavelengths compared to longer wavelengths is not compensated for by visual mechanisms. Lachenmayr B Informative value of psychophysical examinations aside from conventional white-white perimetry

Ophthalmologe, 1996 Aug, 93:4, 389-95 In addition to routine light-sense perimetry testing, elementary visual function, i.e., light difference sensitivity, numerous methods and procedures were developed to test more complex psychophysical threshold criteria in glaucoma patients in order to detect functional glaucomatous loss earlier. The various methods differ with respect to the area of the visual field tested (central, perimetric, global or Ganzfeld stimulation) and the psychophysical threshold criteria (spatial and/or temporal transfer, color, complex criteria including form perception, etc.). Two domain proved to be of special interest: examination of the temporal transfer properties (flicker stimulation, motion perception, "motion-defined-form") and testing of the short-wave-length cone system (blue/yellow perimetry). The blue cone system is part of the parvocellular pathway, criteria in the field of temporal transfer may be allocated to the magnocellular pathway. There is histopathological evidence that ganglion cell axons of the magnocellular system are prone to glaucomatous damage in an earlier stage of the disease. There may even be some kind of specific damage. The role of various psychophysical procedures are discussed with reference to data in the literature and own experience with special emphasis on the practical applicability for early diagnosis of functional glaucomatous damage. Demirel S; Johnson CA Short wavelength automated perimetry (SWAP) in ophthalmic practice. J Am Optom Assoc, 1996 Aug, 67:8, 451-6 Department of Ophthalmology, University of California, USA. BACKGROUND: Short Wavelength Automated Perimetry (SWAP) uses a two-color increment threshold procedure (blue-on-yellow) to assess the functional status of short-wavelength-sensitive (SWS) mechanisms. This functional test has been shown to detect visual field abnormalities in patients at high risk of developing glaucoma and in patients with optic neuritis when standard (white-on-white) visual fields are still within normal limits. Often times, damage uncovered by SWAP precedes standard field loss by three or more years. SWAP also reveals a greater spatial extent of visual field damage in glaucoma patients than standard perimetry and can herald progression of standard visual field damage into the areas already classified as abnormal by SWAP. METHODS/RESULTS: This paper describes the SWAP technique and briefly discusses the current theories that account for SWAP's ability to detect visual field damage at an earlier stage than standard perimetry. Several cases that demonstrate the usefulness of this technique are reported. CONCLUSIONS: SWAP testing appears to be the most sensitive functional test for early detection of glaucomatous damage currently available. Although SWAP testing has a few disadvantages, none of them significantly restrict the clinical application of SWAP for glaucoma evaluation. Wild JM; Moss ID Baseline alterations in blue-on-yellow normal perimetric sensitivity. Graefes Arch Clin Exp Ophthalmol, 1996 Mar, 234:3, 141-9 Department of Vision Sciences, Aston University, Birmingham, UK. BACKGROUND: the extent of any learning and fatigue effects in blue-on-yellow (B-Y) perimetry is unknown. The within- and between-eye changes in B-Y normal sensitivity at a single visit and between visits was investigated as a function of previous experience in white-on-white (W-W) perimetry and of subject age. METHODS: Sixty-one normal subjects 22

young (range 20-34 years) and 39 elderly (range 51-80 years)-- assigned to one of four groups based upon perimetric experience and age underwent B-Y perimetry on four separate occasions using Program 30-2 of a modified Humphrey Field Analyser 640. Perimetry was performed for both eyes on three consecutive days and again one week later. Global, hemifield and annular mean sensitivities and global short-term fluctuation were calculated for each eye at each visit. RESULTS: Mean sensitivity was higher in the first eye examined and increased over the 3 days. The increase in mean sensitivity was similar for each eye and was independent of perimetric experience and age. Short-term fluctuation decreased over the 3 days, regardless of eye and experience, but was more pronounced for the younger age group. The extent of all improvements varied considerably between subjects. CONCLUSIONS: Improvements in B-Y perimetric performance occurred as the familiarity with the test increased, regardless of previous W-W experience. Failure to account for such improvement could reduce the efficiency of B-Y perimetry. Felius J; de Jong LA; van den Berg TJ; Greve EL Functional characteristics of blue-on-yellow perimetric thresholds in glaucoma. Invest Ophthalmol Vis Sci, 1995 Jul, 36:8, 1665-74 Graduate School of Neurosciences, University of Amsterdam, Netherlands. PURPOSE. Blue-on-yellow (B-on-Y) perimetry assesses the S-cone visual field under yellow adaptation. Glaucomatous field defects have been shown to appear earlier and to be larger in B-on-Y perimetry than in standard perimetry. An upper limit to the use of B-on-Y perimetry is set by the separation of the S-cones from the M- and L-cones. But, because the S-cones may also input to the luminance channel, the actual separation of the color and luminance channels is unknown. Here, the relative sensitivities of the color and luminance channels under B-on-Y test conditions are measured. METHODS. In 15 eyes with early glaucoma, 19 risk eyes, and 10 normal eyes, B-on-Y thresholds were measured from 0 degrees to 20 degrees eccentric and were compared to pure chromatic (B-in-Y) and achromatic (Y-on-Y) thresholds, obtained under identical yellow adaptation. RESULTS. In normals, B-on-Y thresholds were found to coincide with B-in-Y thresholds; Y-on-Y values were 0.5 log (at 20 degrees) to 0.9 log (at 0 degrees) higher. In the pathologic groups, the differences between B-in-Y and Y-on-Y thresholds were smaller. Pathologic threshold elevation is on average 1.8 times larger for chromatic than for achromatic stimuli. In some cases, the luminance channel takes over detection of the B-on-Y stimulus. CONCLUSIONS. In normals, the B-on-Y stimulus is mediated by the color channel. Takeover of detection by the luminance channel might impose limits on following color defects with B-on-Y perimetry. This takeover may occur before the S-cones become less sensitive than the M- and L-cones and might indicate S-cone input to the luminance channel. Wild JM; Hudson C The attenuation of blue-on-yellow perimetry by the macular pigment. Ophthalmology, 1995 Jun, 102:6, 911-7 Department of Vision Sciences, Aston University, Birmingham, United Kingdom. PURPOSE: To determine the influence of macular pigment absorption on blue-on-yellow perimetry using a technique suitable for application with the Humphrey Field Analyzer. METHODS: The sample comprised one eye from each of 46 healthy subjects (age range, 20-80 years). Macular pigment absorption was assessed by measuring medium-wavelength sensitive cone sensitivity for 460- and 570-nm narrowband stimuli at the fovea, at 5.5 degrees

and at 8 degrees eccentricity. The differences in sensitivities recorded between the fovea and 8 degrees eccentricity and between 5.5 degrees and 8 degrees eccentricity for the 460-nm stimulus relative to a value of zero at 570 nm were attributed to absorption by the macular pigment. Blue-on-yellow perimetry was undertaken using a 460-nm narrowband blue Goldmann size V stimulus and a yellow 330-cdm-2 background. RESULTS: Group macular pigment absorption (mean +/- standard error) was 0.40 +/- 0.03 log units foveally and 0.00 +/- 0.03 log units at 5.5 degrees eccentricity. The group mean foveal macular pigment absorption was significantly different from zero (P < 0.01). The coefficient of repeatability for the macular pigment absorption procedure (based on test-retest data for 16 subjects) was +/- 0.28 log units at the fovea and +/- 0.35 log units at 5.5 degrees eccentricity. CONCLUSION: The net effect of ocular media and macular pigment absorption relative to 460 nm was to attenuate the blue-on-yellow visual field at the fovea by approximately 0.80 log units and elsewhere by 0.40 log units. Wild JM; Moss ID; Whitaker D; ONeill EC The statistical interpretation of blue-on-yellow visual field loss. Invest Ophthalmol Vis Sci, 1995 Jun, 36:7, 1398-410 Department of Vision Sciences, Aston University, United Kingdom. PURPOSE. To evaluate short-wavelength-sensitive perimetry in the detection of glaucomatous field loss. METHODS. The sample consisted of 27 normal subjects, 24 patients with primary open angle glaucoma (POAG), and 27 patients with ocular hypertension (OHT). Blue-on-yellow (B-Y) and standard (W-W) perimetry was undertaken with a modified Humphrey Field Analyzer 640 on one eye of each subject and patient. The B-Y data were corrected for individual ocular media absorption. Results were compared to an age-matched normal database of 50 subjects (age range, 60 to 82 years; mean age, 70.0 years; SD, 6.4 years). Visual field indices and total and pattern deviation probability maps were calculated for both W-W and B-Y fields. RESULTS. The B-Y normal database exhibited increased between-subject variability compared to the W-W normal database (P < 0.001). The greater variability increased with the increase in eccentricity (P < 0.001) and with the increase in age (P = 0.032). All patients with POAG exhibited B-Y field loss; 11 demonstrated greater B-Y loss than the corresponding W-W field. In advanced POAG, the B-Y and the W-W fields were similar. Twenty-five of the 27 normal subjects exhibi ted normal B-Y fields. Five of the 27 patients with OHT manifested B-Y focal abnormality and a normal W-W field: in two, W-W focal loss subsequently developed. CONCLUSIONS. Short-wavelength-sensitive perimetry can identify visual field loss before that detected by W-W perimetry. However, the increased between-subject variability necessitates stringent statistical analysis in the definition of abnormality. Johnson CA The Glenn A. Fry Award Lecture. Early losses of visual function in glaucoma. Optom Vis Sci, 1995 Jun, 72:6, 359-70 Department of Ophthalmology, University of California, Davis, Sacramento, USA. Getting back to the questions raised by Dr. Enoch 12 years ago, I believe that we have made significant progress in the early psychophysical detection of glaucoma and that we are either on the right track or considerably closer to it. The continuing progress in conventional automated perimetry has improved the overall quality of visual field testing in the ophthalmic community, as well as providing standardization and state-of-the-art analysis procedures for

everyone. We have certainly not solved the problem of early detection of glaucoma, but we now have more sensitive procedures that are available for existing clinical instrumentation. SWAP has clearly shown that it is able to detect glaucomatous losses several years before they are evident by conventional automated perimetry, and results from the other test procedures mentioned earlier are also very encouraging. Thus, although we may not yet have the pot of gold, we have been able to pick up a few valuable nuggets along the way. This leads me to believe that the current approaches are on the right track. However, Dr. Enoch's message should also serve to remind us that there are few panaceas for early detection of functional loss in glaucoma. Our progress to date has been influenced by our greater understanding of the properties of visual mechanisms and the pathophysiology of glaucoma. It has also been driven by clever and innovative approaches and new test procedures, as well as advances in technology. However, it has also been based on a considerable amount of research effort in the form of long-term prospective longitudinal studies of large populations of normal observers, patients with various stages of glaucomatous damage, and patients at risk of developing glaucoma. Answers to all of the issues pertaining to the ultimate clinical value of psychophysical procedures for early detection of glaucoma do not come quickly, but they are of vital importance to ocular health care. I hope that my brief discussion of new developments in psychophysical detection of glaucoma has convinced you that significant progress has been made, and that some of you will be motivated to join in this important research endeavor. Keltner JL; Johnson CA Short-wavelength automated perimetry in neuro-ophthalmologic disorders Arch Ophthalmol, 1995 Apr, 113:4, 475-81 [published erratum appears in Arch Ophthalmol 1995 Jul;113(7):852] Dept. of Ophthalmology, School of Medicine, University of California-Davis, Sacramento, USA. OBJECTIVE: To evaluate the efficacy of short-wavelength automated perimetry (SWAP) in the assessment of patients with neuro-ophthalmologic disorders, especially optic neuropathies. METHODS: A modified Humphrey field analyzer was used to perform standard automated perimetry and SWAP, a technique that isolates the activity of short-wavelength-sensitive ("blue") mechanisms. Forty patients (80 eyes) were evaluated by SWAP and standard automated perimetry. Thirteen patients (26 eyes) had recovered from optic neuritis and/or multiple sclerosis, 15 (30 eyes) were in various stages of treatment for pseudotumor cerebri, and 12 (24 eyes) had other miscellaneous neuro-ophthalmologic conditions. Six additional patients (12 eyes) with neuro-ophthalmologic conditions were tested twice on different days during a 2-week period, with the order of SWAP and standard perimetric testing being reversed on the second day. RESULTS: Of the 80 eyes tested, 38 (48%) had SWAP visual fields that were worse than standard automated perimetry results; 29 (36%) showed no difference between standard and SWAP visual fields; and 13 (16%) had standard automated perimetry results that were worse than SWAP visual fields. Of the 26 eyes in patients with optic neuritis and/or multiple sclerosis, 15 (58%) had SWAP results that were worse than standard visual fields. Ten (33%) of the 30 eyes with pseudotumor cerebri had SWAP results worse than standard automated perimetry results, and 13 (54%) of 24 eyes with miscellaneous neuro-ophthalmologic conditions had SWAP results worse than standard automated perimetry results. For the 12 eyes undergoing repeated testing, SWAP visual fields were worse when they were performed last, perhaps indicating that some fatigue effect was present. This was observed for standard visual fields as well, but to a smaller extent. CONCLUSIONS: Preliminary findings suggest that SWAP may be useful in detecting certain neuro-

ophthalmologic deficits more readily than standard automated visual field testing, especially for optic neuritis and multiple sclerosis. Further evaluations will be necessary to define the effects of fatigue for SWAP visual fields in neuro-ophthalmologic disorders. Moss ID; Wild JM; Whitaker DJ The influence of age-related cataract on blue-on-yellow perimetry. Invest Ophthalmol Vis Sci, 1995 Apr, 36:5, 764-73 Department of Vision Sciences, Aston University, Aston Triangle, Birmingham, United Kingdom. PURPOSE. The influence of cataract on the blue-on-yellow visual field is unknown. The aim of the study was to compare the effect of age-related cataract on the normal blue-on-yellow (B-Y), yellow-on-yellow (Y-Y) and white-on-white (W-W) visual field. METHODS. Forty normal subjects (age range, 60 to 81 years) randomly performed B-Y, Y-Y, and W-W perimetry using a modified Humphrey Field Analyser 640 (HFA) (Program 24-2). Twenty age-matched patients with cataract underwent the same testing paradigm. Cataract was classified using the LOCS II system. Ocular media absorption was measured with the HFA by determining the difference in scotopic sensitivity to 410-nm and 560-nm stimuli. Forward light scatter was measured by the direct compensation technique of van den Berg. Unweighted mean deviation (MD), short-term fluctuation, and corrected pattern standard derivation indices were calculated for each patient with cataract for each of the three stimulus combinations. RESULTS. Cataract produced an adverse effect on the MD (i.e., a more negative MD) in all patients for each of the three stimulus combinations. The magnitude depended on the degree and type of cataract and was highly correlated with forward light scatter. The attenuation in sensitivity was greatest for the B-Y and W-W stimulus combinations; the B-Y field was preferentially affected by posterior subcapsular cataract and the W-W field by anterior cortical cataract. CONCLUSIONS. Cataract predominantly causes a general reduction in B-Y sensitivity. Caution therefore needs to be exercised in the interpretation of the B-Y visual field in patients in whom glaucoma and cataract coexist. Johnson CA; Brandt JD; Khong AM; Adams AJ Short-wavelength automated perimetry in low-, medium-, and high-risk ocular hypertensive eyes. Initial baseline results. Arch Ophthalmol, 1995 Jan, 113:1, 70-6 Optics and Visual Assessment Laboratory, Dept. of Ophthalmology, School of Medicine, University of California, USA OBJECTIVE: To examine the relationship between the prevalence of short-wavelength sensitivity losses in the central 30 degrees visual field and risk factors for development of glaucomatous visual field loss in ocular hypertension. DESIGN: A modified Humphrey Field Analyzer was used to perform standard automated perimetry and short-wavelength automated perimetry (SWAP), which is a technique that isolates the activity of short-wavelength-sensitive ("blue") mechanisms. In addition, an assessment of the risk of developing glaucomatous visual field loss was determined, based on a validated model that utilized intraocular pressure, a family history of glaucoma, age, and the vertical cup-to-disc ratio. PATIENTS: Both eyes of 232 ocular hypertensive patients were examined and compared with results from an age-matched control group of normal subjects. Both ocular hypertensive patients and normal subjects had to have normal visual fields on standard automated perimetry, good visual acuity, and no evidence of other ocular or neurologic disease or

surgery. Intraocular pressure in the ocular hypertensive patients was 21 mm Hg or greater OU (without medication), and it was less than 20 mm Hg OU in normal control subjects. RESULTS: Less than 10% of the low-risk ocular hypertensive eyes had a SWAP deficit, as compared with 20% of the moderate-risk and 33% of the high-risk ocular hypertensive eyes. Intraocular pressure and a family history of glaucoma showed no meaningful relationship with the prevalence of SWAP deficits, but both age and the vertical cup-to-disc ratio demonstrated a strong association with the SWAP abnormalities. CONCLUSIONS: The SWAP results that were found in the ocular hypertensive eyes were associated with other risk factors that have been reported to be predictive of the development of glaucomatous visual field loss, especially the vertical cup-to-disc ratio and age. These findings support the notion that the SWAP deficits represent early glaucomatous damage and may be related to early changes that occur at the optic nerve head. Yamagami J; Koseki N; Araie M Color vision deficit in normal-tension glaucoma eyes. Jpn J Ophthalmol, 1995, 39:4, 384-9 Section of Ophthalmology, JR Tokyo General Hospital, Japan. Color vision deficit in 26 eyes with normal-tension glaucoma (NTG) is compared with that in 21 eyes with primary open angle glaucoma (POAG) using the color perimetry method developed by Iijima et al. Subjects had visual field defects confined to either the upper or the lower hemifield as determined by conventional white-on-white perimetry, and the stage of disease was relatively early with an average mean deviation (MD) of -7 dB. Except for intraocular pressure, there were no significant differences between NTG and POAG subjects in age, refraction, MD, and mean total deviation for spared and damaged hemifield. In the spared hemifield, the incidence of blue-yellow abnormality was significantly different between the two diseases (P = 0.01); in only 11% of the present NTG eyes versus 52% of the POAG eyes in the present study. In the damaged hemifield, however, the blue-yellow abnormality was found in about 75% of the eyes, whether NTG or POAG. This finding may further shed light on the pathogenesis of open angle glaucoma. metry. The screening program of B/Y perimetry is more advant Lachenmayr B; Lund OE 15 years automated perimetry--where does the path lead? Klin Monatsbl Augenheilkd, 1994 Dec, 205:6, 325-8 Augenklinik, Universität München. 15 years ago the first fully automated perimeter became available, the Octopus 201, developed by Fankhauser in Bern. Some of the objections which were raised in those days against automated perimeters have turned out true, many, however, not. From todays perspective automated perimetry has brought tremendous advantages for clinical routine diagnosis. The essential power of automated perimetry is ist ability to obtain quantitative data which can be processed statistically. The examination of the central visual field may be performed in a much more sophisticated way than by manual kinetic testing. Automated perimetry, however, also has its draw-backs, which are mostly due to mistakes or errors by the examiner, not so much to the method itself. For routine light-sense perimetry the upcoming years will give us faster and optimized testing strategies. Procedures for automated interpretation of visual field data will be developed. The interest in more complex perimetric test criteria goes on one hand into the direction of independence of disturbancies of the optical

media (e.g. temporal criteria), on the other hand into the differentiation of various cell populations in the visual system (Blue/Yellow-Perimetry; Motion-Defined-Form etc.). For objective perimetry a powerful system for pattern-ERG and pattern-VECP with a spatial resolution comparable to standard perimetric tests is available. Also in these fields of perimetry the coming years will bring interesting and revolutionary new developments which will open new diagnostic dimensions. Sample PA; Martinez GA; Weinreb RN Short-wavelength automated perimetry without lens density testing. Am J Ophthalmol, 1994 Nov, 118:5, 632-41 Glaucoma Center and Visual Function Laboratory, University of California at San Diego, USA Three experiments determined whether an estimate of localized short-wavelength visual field loss could provide enough specificity and sensitivity for glaucoma diagnosis, without correcting the fields for lens density. We used 100 normal, 53 glaucoma suspect, and 95 glaucoma eyes (or a subset of these, where noted). The first two experiments showed that lens density has a diffuse effect on the visual field, which is more linear than the effect of age. The third experiment showed that, with the glaucoma hemifield test, comparable results were obtained for short-wavelength fields either corrected or uncorrected for lens density (sensitivities of 81% and 76% and specificities of 82% and 90%, respectively). We conclude that it is possible to eliminate the lens density measurement with this approach, thereby reducing test time by 40 minutes. This should improve substantially the clinical utility of short-wavelength automated perimetry. Moss ID; Wild JM The influence of induced forward light scatter on the normal blue-on-yellow perimetric profile. Graefes Arch Clin Exp Ophthalmol, 1994 Jul, 232:7, 409-14 Department of Vision Sciences, Aston University, Aston Triangle, Birmingham, UK. The study investigated the effects of induced forward light scatter on the normal blue-on-yellow perimetric profile. Light scatter was induced using 0.00%, 0.08% and 0.16% suspensions of 500-nm-diameter polystyrene microspheres contained in optical cells. White-on-white, yellow-on-yellow and blue-on-yellow perimetry was performed using a modified Humphrey Field Analyser 640. Fifteen subjects performed perimetry with each of the scatter suspensions placed before the eye and in the cell-free situation. The degree of induced scatter for each cell was quantified using the direct compensation technique of van den Berg at small, medium and large angles of scatter. Straylight increased and perimetric sensitivity decreased with increase in scatter concentration. Forward light scatter caused a general reduction in sensitivity for all stimuli, particularly for the blue-on-yellow stimulus. This finding may have implications for the interpretation of the glaucomatous visual field in the presence of forward light scatter. Hudson C; Wild JM; Archer Hall J Maximizing the dynamic range of the humphrey field analyzer for blue-on-yellow perimetry. Ophthalmic Physiol Opt, 1993 Oct, 13:4, 405-8

Department of Vision Sciences, Aston University, Aston Triangle, Birmingham, UK. The conditions employed for blue-on-yellow perimetry (i.e. a blue stimulus filter and a high luminance yellow background) are in conflict with those that allow a maximum dynamic range. A modification is described for increasing the dynamic range of the Humphrey Field Analyzer (HFA) for blue-on-yellow perimetry. The position of the HFA stimulus bulb was lowered by reducing the length of both terminals. A concave mirror with a 28 mm radius of curvature was positioned behind the lowered stimulus bulb to give a filament image partly above and partly overlapping the original filament profile within the confines of the size V stimulus patch diameter. The modification achieved a 60% increase in the light output on the default 0 dB value of 10,000 apostilbs and, therefore, a useable dynamic range for blue-on-yellow perimetry of 2.94 log units. The effective increase in voltage supply to the stimulus bulb permitted a filament life of 260 operating hours. Furthermore, the modification ensured the correct calibration of the instrument. Casson EJ; Johnson CA; Shapiro LR Longitudinal comparison of temporal-modulation perimetry with white-on-white and blue-on-yellow perimetry in ocular hypertension and early glaucoma. J Opt Soc Am [A], 1993 Aug, 10:8, 1792-806 University of Ottawa Eye Institute, Ottawa General Hospital, Canada. We obtained data over 3 years on temporal-modulation perimetry (TMP), standard automated [white-on-white (W/W)] perimetry, and short-wavelength-sensitive [blue-on-yellow (B/Y)] perimetry in ocular hypertensive (OH) patients and patients with early glaucomatous visual-field loss (EG). Evidence of visual-field defects was obtained with he use of both B/Y perimetry and TMP in the majority of OH and EG eyes that demonstrated progression on W/W perimetry as well as in all stable EG eyes. Using the nerve-fiber-bundle pattern to compare testing procedures, we determined that these defects were generally as extensive or more extensive than the concurrent W/W abnormalities. In erms of location over the 3 years of testing, TMP and B/Y defects were reasonably consistent in the EG eyes, somewhat less consistent in the OH eyes demonstrating progression, and both inconsistent and nfrequent in the stable OH eyes. The greatest degree of overlap occurred between the location of defects obtained by use of the higher TMP frequencies (8 and 16 Hz) and that of defects obtained by use of B/Y perimetry. Since these two methods are thought to isolate different visual mechanisms subserved by different visual pathways, these results suggest that early glaucomatous visual-field damage as revealed by TMP and B/Y perimetry may not be specific to a single visual pathway. Johnson CA; Adams AJ; Casson EJ; Brandt JD Blue-on-yellow perimetry can predict the development of glaucomatous visual field loss. Arch Ophthalmol, 1993 May, 111:5, 645-50 Department of Ophthalmology, University of California, Davis, Sacramento, USA OBJECTIVE--The purpose of this investigation was to determine whether blue-on-yellow (B/Y) perimetry is capable of predicting the onset and location of impending glaucomatous visual field loss in patients with ocular hypertension. DESIGN--A Humphrey Field Analyzer (Humphrey Instruments, San Leandro, Calif) was modified to perform B/Y perimetry to isolate and measure the sensitivity of short-wavelength-sensitive mechanisms. Participants were tested annually with standard white-on-white (W/W) and B/Y automated perimetry for a

period of 5 years. PATIENTS--The study population consisted of 38 patients with ocular hypertension and 62 age-matched normal control subjects. RESULTS--Initially, all 76 ocular hypertensive eyes had normal W/W automated perimetry results, with 67 eyes having normal and nine eyes having abnormal B/Y test results. Five years later, five of the nine ocular hypertensive eyes with initial B/Y abnormal results developed glaucomatous visual field loss measured by standard W/W automated perimetry, while none of the 67 ocular hypertensive eyes with initially normal B/Y results developed abnormal W/W perimetry results. CONCLUSIONS--Blue-on-yellow perimetry deficits are an early indicator of glaucomatous damage and are predictive of impending glaucomatous visual field loss for standard W/W automated perimetry. To our knowledge, this is the first prospective, long-term longitudinal study that demonstrates the ability to predict the onset of glaucomatous visual field loss in patients with ocular hypertension on the basis of psychophysical testing. Johnson CA; Adams AJ; Casson EJ; Brandt JD Progression of early glaucomatous visual field loss as detected by blue-on-yellow and standard white-on-white automated perimetry. Arch Ophthalmol, 1993 May, 111:5, 651-6 Department of Ophthalmology, University of California, Davis, Sacramento, USA OBJECTIVE--To determine whether blue-on-yellow perimetry reveals progression of glaucomatous damage before it is evident with standard white-on-white perimetry. DESIGN--A Humphrey field analyzer (Humphrey Instruments, San Leandro, Calif) was modified to perform blue-on-yellow perimetry to isolate and measure the sensitivity of short wavelength-sensitive mechanisms. Participants were tested annually with standard white-on-white automated perimetry and blue-on-yellow automated perimetry for 5 years. PATIENTS--Sixteen patients with early glaucomatous visual field loss in one or both eyes and 62 age-matched normal control subjects. RESULTS--At baseline, 25 (78.1%) of the 32 eyes exhibited larger deficits with blue-on-yellow perimetry, five (15.6%) had equivalent loss with both tests, and two (6.3%) had larger deficits with standard white-on-white perimetry. Seven (21.9%) of the 32 eyes demonstrated evidence of progressive visual field loss with standard white-on-white perimetry in 5 years, while he other 25 eyes (78.1%) were relatively stable. Deficits with blue-on-yellow perimetry were twice as large as deficits with white-on-white perimetry in the stable group and were three to four times as large in the group with progressive field loss. CONCLUSIONS--Blue-on-yellow perimetry is effective in predicting which patients with early glaucomatous visual field loss are most likely to have progressive loss. The rate of progressive loss is greater with blue-on-yellow perimetry than with standard white-on-white perimetry. Lewis RA; Johnson CA; Adams AJ Automated perimetry and short wavelength sensitivity in patients with asymmetric intraocular pressures. Graefes Arch Clin Exp Ophthalmol, 1993 May, 231:5, 274-8 Optics and Visual Assessment Laboratory (OVAL), Department of Ophthalmology, University of California, USA Automated visual field testing [white-on-white (W-on-W) perimetry] and perimetry of short wavelength sensitive mechanisms [blue-on-yellow (B-on-Y) perimetry] were conducted in both eyes of patients with large asymmetries in intraocular pressure (IOP) between eyes (average difference = 19.9 mm Hg). Overall visual field sensitivity was significantly (P <

0.05) depressed in the eyes with higher IOP by an average of 2.33 dB, in spite of the fact that all but two of the eyes with higher IOP demonstrated visual field sensitivities that were within normal limits. None of the eyes with lower IOP were outside of normal sensitivity limits. B-on-Y perimetry revealed similar findings, except that three of the fellow eyes with relatively lower IOP also demonstrated abnormalities. Our results are consistent with the hypothesis that the diffuse loss in visual field sensitivity in glaucoma is related to IOP. In addition, it appears that short wavelength sensitive mechanism may reveal early glaucomatous losses in patients with elevated IOP. De Jong LA; Snepvangers CE; van den Berg TJ; Langerhorst CT Blue-yellow perimetry in the detection of early glaucomatous damage. Doc Ophthalmol, 1990 Oct, 75:3-4, 303-14 The Netherlands Ophthalmic Research Institute. A perimetric method using blue stimuli on a yellow background was compared with perimetry using white stimuli on a white background as a method of detecting glaucomatous damage. Meridian perimetry was used with an adapted Tübinger perimeter. The difference between the blue-on-yellow meridian and the white-on-white meridian was subdivided into two parts: the general blue sensitivity loss (GBSL), probably due to optical factors, and the corrected blue sensitivity loss (CBSL), probably due to glaucoma. Nine normals, fourteen primary open angle glaucoma (POAG) patients and nine ocular hypertensives (OHT) were tested. All POAG patients and some of the OHT group showed higher CBSL values than the controls. The blue-yellow meridian showed broader and deeper defects than the white-white meridian in all of the POAG group; some of the OHT group had defects in the blue-yellow meridian that were not present in the white-white meridian. In conclusion, blue on yellow perimetry shows promise as a method for more sensitive detection of early glaucomatous damage. Silverman SE; Hart WM Jr; Gordon MO; Kilo C The dyschromatopsia of optic neuritis is determined in part by the foveal/perifoveal distribution of visual field damage. Invest Ophthalmol Vis Sci, 1990 Sep, 31:9, 1895-902 Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri. USA Most hypotheses of acquired dyschromatopsia invoke the mechanism of selective damage to specific components of the afferent visual system to explain the predominance of red-green and blue-yellow hue-discrimination defects found in neural and retinal disorders, respectively. However, this pattern of hue-discrimination disturbance in ocular disease may vary. There are frequent exceptions which are inadequately explained by existing hypotheses. In an effort to explain the pattern and pathogenesis of acquired dyschromatopsias better, the authors examined patients with nonproliferative diabetic retinopathy (DR) and late-stage retrobulbar neuritis (RBN) using age-corrected Farnsworth-Munsell 100-hue testing and threshold static perimetry. As expected, most DR eyes showed some degree of relative blue-yellow dyschromatopsia (89%) with few showing a greater weighting towards red-green dyschromatopsia (11%). However, an approximately equal number of RBN eyes had a relative blue-yellow (48%) versus red-green dyschromatopsia (52%). For RBN, the authors found a strong association between the spatial distribution of field defect and the type of relative hue-discrimination disturbance. Eyes with greater field depression at the fovea relative to the perifovea showed a relative preponderance of red-green dyschromatopsia

(68%) as opposed to blue-yellow dyschromatopsia (32%), whereas eyes with greater relative perifoveal impairment showed a relative preponderance of blue-yellow dyschromatopsia (100%). This relationship between the relative spatial distribution of visual field damage and the relative hue-discrimination deficit in RBN was statistically significant (P = 0.002). Such an association was not found for DR Sample PA; Weinreb RN Color perimetry for assessment of primary open-angle glaucoma. Invest Ophthalmol Vis Sci, 1990 Sep, 31:9, 1869-75 Department of Ophthalmology, University of California, San Diego, La Jolla, USA The authors report the development of a color perimetry procedure which compares sensitivity of the short-wavelength color-vision mechanism in the peripheral visual field for normal eyes, eyes with ocular hypertension, and eyes with primary open-angle glaucoma. To isolate the short-wavelength cone mechanism, they modified an automatic projection perimeter to blue-on-yellow color perimetry and used a monochromatic 440-nm stimulus and a broad-band bright yellow background. The three groups of subjects were matched for age and lens density. Refraction, pupil size, acuity, and medication were controlled. Under these conditions, most glaucomatous eyes showed reduced sensitivities more than two standard deviations below normal. Normal control eyes were significantly different from eyes with ocular hypertension only in the superior nasal field (P less than 0.05), but normal eyes differed from eyes with primary open-angle glaucoma in all areas of the field (P less than 0.01). Hart WM Jr; Silverman SE; Trick GL; Nesher R; Gordon MO Glaucomatous visual field damage. Luminance and color-contrast sensitivities. Invest Ophthalmol Vis Sci, 1990 Feb, 31:2, 359-67 Dept. of Ophthalmology and Visual Sciences, Washington University School of Med., St. Louis Using a modified Humphrey perimeter, we evaluated 16 eyes with primary open-angle glaucoma and visual field loss (defects 0.5-3.0 log units in depth), and 14 normal eyes. Each eye was tested twice in random order with conventional luminance-increment static perimetry and with the perimeter modified to produce a high-luminance yellow adapting background and a blue test stimulus. The background was a broad-spectrum light of 500 nm and above (yellow), while the stimulus was a broad-spectrum light of 500 nm and below (blue). Paired comparisons were made between conventional and blue/yellow sensitivities for every point examined (1184 points in 16 diseased eyes and 1036 points in 14 normal eyes). Defect depths were determined by using the age-corrected norms distributed in the Humphrey Statpac software. In glaucomatous eyes, blue/yellow sensitivity showed greater impairment than did conventional perimetric sensitivity, in which defect depths were less than 1.0 log unit. However, for defects greater than 1.0 log unit in depth, conventional perimetric sensitivity and blue/yellow sensitivity showed equivalent degrees of damage. Receiver operating characteristic (ROC) analysis was used to compare the ability of blue/yellow and of conventional perimetry in distinguishing between glaucomatous and normal eyes. Results indicated that although blue/yellow color-contrast perimetry may be more sensitive for the detection of incipient glaucomatous damage, in the manifest stages of visual field damage blue/yellow color-contrast perimetry is no more sensitive than is conventional (luminance-increment) perimetry for defining the extent of glaucomatous visual field defects.

Capoferri C, Garavaglia A, Buscemi M, Nassivera C, Brancato R. Threshold testing of the macular area in glaucoma [Article in French] J Fr Ophtalmol 1989;12(10):709-14 Clinica Oculistica dell'Universita di Milano, Italie. The purpose of this study has been to verify whether threshold testing of the central area with a common automated perimeter could detect glaucomatous damage. We selected 31 eyes of 31 patients with primary open angle glaucoma free from defects within the central 5 degrees of the field and 32 eyes of 32 age-matched normal subjects. They underwent the Macula Threshold Test of the Humphrey Field Analyzer using white and blue targets. Statistical analysis of the results obtained showed that threshold sensitivities to both white and blue targets were significantly depressed in glaucomatous eyes (t = 2.44, p = 0.018 and t = 12.59, p less than 0.001 respectively), but only blue thresholds distributed really differently in glaucomatous and normals. Sensitivities to blue stimuli related to age only in normals (r = 0.58; p = 0.0005), while in glaucomatous they were related to cup/disc ratios (r = 0.70, p less than 0.0001 for horizontal C/D; r = 0.52, p = 0.0027 for vertical C/D). These results suggest that it is possible to detect early central functional disturbances from glaucoma using an automated perimeter and its built-in color filters. Capoferri C, Garavaglia A, Buscemi M, Brancato R. Clinical detection of early glaucomatous foveal involvement. Int Ophthalmol 1989 Jul;13(4):259-64 Department of Ophthalmology, San Raffaele Hospital, University of Milan, Italy. The aim of our study was to verify whether threshold testing of the central area with a common automated perimeter could detect early glaucomatous damage. We selected 9 eyes of 9 patients with suspected primary open angle glaucoma and normal visual fields and 18 eyes of 18 age-matched normal subjects. They underwent the Macula Threshold Test of the Humphrey Field Analyzer using white and blue targets. We found no significant difference in retinal sensitivity to white targets between the two groups. Sensitivity to blue targets was significantly lower among glaucoma suspects (18.43 +/- 1.14 dB) than in the control group (22.37 +/- 0.94 dB) p less than 0.001). Blue thresholds related significantly to age only in normals (p = 0.028) while in glaucoma suspects they were strongly related to vertical cup/disc ratios (p less than 0.001). These results suggest that it is possible to detect early central visual disturbances from glaucoma using an automated perimeter and its built-in color filters. Iijima H, Satoh S. A new perimetric color vision analyzer. Jpn J Ophthalmol 1988;32(4):412-22 Department of Ophthalmology, Yamanashi Medical College, Tamaho, Japan. A new apparatus was developed for mapping the extrafoveal color vision, the perimetric color vision analyzer. A yellow test object with varying degrees of saturation is presented on a cathode ray tube color display in a random sequence at one of 10 points around the fixation spot. The background is a mosaic pattern consisting of gray spots of the same size and shape as the test object, with various luminances. Background patterns with or without a test object

are presented alternately. The subject is instructed to press a key when he detects a yellow object in the background pattern. The luminance of the test object is in the same range as the background gray spots. Since the luminance of background spots is changed synchronously at random when the test object appears, the subject can detect the test object only by the difference in color saturation. The results show the color contrast sensitivity at every designated point in the central visual field. The clinical application of the perimetric color vision analyzer revealed extrafoveal color defects which could not be evaluated with conventional color vision tests. It also showed that in some chorioretinal and optic nerve disorders the topographic pattern of color contrast sensitivity disagrees with that of luminance contrast sensitivity measured with automated static perimetry.