Citations

Background This study aimed to provide methodology to create a facial contour-informed normative 60-4 visual field and to apply the reference field to a glaucoma cohort to derive facial contour-informed 60-4 global indices. Methods Participant recruitment was completed at a tertiary medical centre. 60 eyes from 30 participants with no ocular pathology by clinical exam or optical coherence tomography were recruited for the healthy cohort. For the glaucoma cohort, 86 eyes from 43 patients diagnosed with glaucoma by clinical exam were recruited, with 30-2 visual field mean deviation used to stratify glaucoma severity. Results The median (range) age of the healthy participants was 33 (24–61) years old. A facial contour-informed 60-4 visual field reference field was developed. 43 glaucoma patients were recruited with a resulting median (range) age of 65 (30–84). Three algorithms compensating for facial contour were used for the derivation of 60-4 mean deviation and pattern SD. All mean deviation algorithms correlated with 30-2 mean deviation severity (ρ≤−0.62, p<0.0001) and retinal nerve fibre layer thickness (ρ≥0.36, p<0.05). For pattern SD, consideration of inferior nasal defects allowed correlation with both 30-2 mean deviation severity (ρ≥0.49, p<0.001) and retinal nerve fibre layer thickness (ρ≤−0.47, p<0.01). Conclusion This study provides methodology for deriving a facial contour-informed 60-4 reference field and illustrates the feasibility of applying facial contour information to refine global indices of the 60-4 visual field. Obtained metrics compensated for facial contour and correlated with functional and structural disease metrics.

Précis: Using a CNN-enhanced platform, 60-4 visual fields identified peripheral glaucomatous defects missed by central testing in mild cases; facial contour correction showed these defects occurred exclusively outside the temporal visual field. Purpose: To develop a methodology to separate facial contour-induced visual field defects from defects related to glaucoma in patients with peripheral field defects. Methods: Ninety-seven eyes from 50 patients previously diagnosed with glaucoma were enrolled in the study. Thirty-one (62%) participants were male, and 86% were white. The study involved patients with glaucoma who underwent visual field testing using standard automated perimetry, including 10-2, 24-2, 30-2, and 60-4 visual fields. A convolutional neural network (CNN)-enhanced platform, previously developed to identify facial contour-dependent defects in healthy subjects, was used to analyze the visual field data. Patients: The study included 97 eyes from 50 patients with glaucoma, with the majority having primary open angle glaucoma. Results: In 90 out of 97 eyes, there were 60-4 visual field defects. However, 20 (22%) of these eyes did not have glaucomatous defects on the 10-2 or 30-2 visual fields. All patients with 60-4 defects in the absence of more central defects had mild glaucoma, and these eyes comprised 38% of the mild glaucoma group. 60-4 visual field increased the sensitivity of identifying glaucoma in mild disease. Without facial contour, the 60-4 visual field mean threshold summation was 1099.6±346.6 dB, and decreased to 1057±331 dB when accounting for facial contour, which affected 8.03%±4.02% of test points. Facial contour-dependent visual field defects were exclusively found outside the temporal visual field. Conclusion: The study demonstrated the potential utility of 60-4 visual fields for identifying early functional glaucomatous changes that may not be detected by more central visual field tests (10-2 or 30-2). It may be important to consider peripheral visual field defects, which can be affected by facial contour, in the diagnosis and monitoring of glaucoma, particularly in mild cases.

AbstractPurpose: Evaluation of an adjustable chin rest apparatus for visual field machine.Methods: The HFA 60‐4 visual field test was performed in the primary position and then repeated in the optimum head turn angle using an adjustable chin rest to maximize a visual field for each subject. The optimum head turn angle was calculated using a 3D face model. A 3D model of the face of the subjects was reconstructed using a single facial photo and a Convolutional Neural Networks (CNN), which is a deep learning algorithm. The angles between visual axis and all points around it on the face surface were calculated and the points on the 3D face model with the angle less than 60 degrees was used to predict the optimal head turn angle. A chin rest apparatus for a visual field system was made by 3D printing. The chin rest apparatus includes a moveable chin rest insert coupled to the base and configured to be adjusted to one of a plurality of head turn angles.Results: Three eyes from three healthy subjects (2 female and 1 male) with the mean age of 27.33, CI: 7.37 were enrolled. The visual field defects cause by the facial contour of the subject was decreased by turning the subject's head relative to a vertical axis away from (nasally) the eye being tested using a visual field system with the adaptive chin rest. The mean threshold of the visual field tests of all eyes in the primary angle and optimized angle was 1496, CI: 380.22 and 1567.67, CI: 295.37 respectively. Mean of the degree of head turn to maximize the visual field for all individuals was 6.67 degrees, CI: 2.88.Conclusions: The described adaptive chin rest can be used to position a subject's head at an optimal head turn angle that minimizes the visual field defects caused by the facial contours and maximizes the measured visual field of the subject. This technology can be used in far peripheral visual field tests for early detection of glaucoma as well as accurate follow up of disease progression.

Background Despite, the potential clinical utility of 60–4 visual fields, they are not frequently used in clinical practice partly, due to the purported impact of facial contour on field defects. The purpose of this study was to design and test an artificial intelligence-driven platform to predict facial structure-dependent visual field defects on 60–4 visual field tests. Methods Subjects with no ocular pathology were included. Participants were subject to optical coherence tomography, 60–4 Swedish interactive thresholding algorithm visual field tests and photography. The predicted visual field was compared with observed 60–4 visual field results in subjects. Average and point-specific sensitivity, specificity, precision, negative predictive value, accuracy, and F1-scores were primary outcome measures. Results 30 healthy were enrolled. Three-dimensional facial reconstruction using a convolution neural network (CNN) was able to predict facial contour-dependent 60–4 visual field defects in 30 subjects without ocular pathology. Overall model accuracy was 97%±3% and 96%±3% and the F1-score, dependent on precision and sensitivity, was 58%±19% and 55%±15% for the right eye and left eye, respectively. Spatial-dependent model performance was observed with increased sensitivity and precision within the far inferior nasal field reflected by an average F1-score of 76%±20% and 70%±29% for the right eye and left eye, respectively. Conclusions This pilot study reports the development of a CNN-enhanced platform capable of predicting 60–4 visual field defects in healthy controls based on facial contour. Further study with this platform may enhance understanding of the influence of facial contour on 60–4 visual field testing.

Précis: Surgical and clinical success rates were similar among Ahmed FP7, and Baerveldt 250 and 350 glaucoma drainage devices at three years. Purpose: To compare rates of surgical and clinical success in patients with Ahmed FP7 (FP7), Baerveldt 250 (B250), or Baerveldt 350 (B350) glaucoma drainage devices (GDDs). Design: A retrospective cohort study. Methods: A total of 157 eyes of 129 adult patients with FP7, B250, B350 GDDs, and 190 eyes of 99 medically controlled glaucoma patients were enrolled at a tertiary care institution from August 2017 through July 2019. They were followed through April 2020. The main outcome measures included surgical and clinical failure. Surgical failure was defined as intraocular pressure (IOP) outside 5–21 mm Hg, IOP reduced <20% below baseline, additional glaucoma surgery, GDD removal, or no light perception. Eyes that did not meet their goal IOP ranges or required secondary glaucoma interventions were deemed clinical failures. Results: A total of 43 (12.4%) FP7, 36 (10.4%) B250, 78 (22.5%) B350, and 190 (54.8%) medically treated control eyes were enrolled. By the postoperative year 3 visit, 10 (23.2%) FP7, 11 (30.6%) B250, and 32 (41.0%) B350 eyes had met a surgical failure criterion (P=0.127). There were no significant differences in the numbers of eyes meeting their IOP target ranges (P=0.510), and rates of secondary glaucoma surgeries (P=0.270). Overall clinical success was attained among 83.3% FP7, 81.8% B250, and 68.0% B350 eyes (P=0.447). Conclusions: The GDD groups were similar in their rates of success, based on both the surgical and clinical success definitions.

Precis: Diplopia was present in ~20% of patients with Ahmed FP7 (FP7) or Baerveldt 350 (B350), compared with 5% to 6% in those with Baerveldt 250 (B250) or controls, suggesting risk of diplopia should be included in preoperative counseling. Purpose: The purpose of this study was to examine the prevalence of diplopia and strabismus in patients with B250, B350, or FP7 glaucoma drainage devices (GDD). Materials and Methods: In this cohort study, glaucoma patients 18 years and above who had received, or would be receiving, a B250, B350, or FP7 GDD, and medically treated controls were consecutively enrolled from August 8, 2017, through July 31, 2019. The Diplopia Questionnaire was administered ≥30 days postoperatively, and upon enrollment to the controls. All diplopic patients underwent orthoptic measurements, which were reviewed by a strabismus specialist. Patients with GDDs in quadrants other than superotemporal, multiple GDDs, or scleral buckles were excluded. Bonferroni correction was applied for pairwise comparisons. Results: Diplopia was reported in 23/129 (17.8%) GDD patients and 5/99 (5.1%) control patients (P=0.003): 8/35 (22.9%) FP7, 2/32 (6.3%) B250, and 13/62 (21.0%) B350, with significant differences between FP7 versus controls (P=0.014) and B350 versus controls (P=0.011). Diplopia was attributable to GDD in 2 FP7 (5.9%, 95% confidence interval: 0.7-19.2), 0 B250, and 4 B350 (6.5%, 95% confidence interval: 1.7-15.2) patients, without significant differences between the GDDs. Conclusions: Patients with the larger (B350) or the higher profile plate (FP7) GDDs were more likely to experience diplopia than controls, and diplopia was attributable to the GDD in ~6% of patients with either a FP7 or a B350 GDD. Since diplopia can affect patients’ quality of life, preoperative counseling for GDD surgery, particularly B350 and FP7, should include a discussion of the risk of diplopia.

Purpose: There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. Methods: A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. Results: Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. Conclusions: Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.