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Improving Visual Field Examination of the Macula Using Structural Information.

Giovanni Montesano1,2,3, Luca M Rossetti2, Davide Allegrini4

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This study introduces MacS-ZEST, a new method for glaucoma visual field testing. It improves speed and accuracy, especially for patients with unreliable responses, by integrating optical coherence tomography (OCT) data.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Computational Biology

Background:

  • Glaucoma diagnosis and monitoring rely heavily on visual field testing.
  • Current visual field testing methods can be time-consuming and less accurate in certain patient groups.
  • Integrating structural information may enhance the efficiency and reliability of functional testing.

Purpose of the Study:

  • To develop and evaluate a novel structure-function model for macular visual field testing in glaucoma.
  • To improve the speed and accuracy of visual field testing by incorporating optical coherence tomography (OCT) data.
  • To compare the performance of the new macular structure-function Zippy Estimation by Sequential Testing (MacS-ZEST) strategy against standard ZEST.

Main Methods:

  • Acquired OCT scans for macular ganglion cell density estimation in healthy and glaucomatous eyes.
  • Performed fundus-tracked perimetry using a 10-2 grid, mapping tested locations to OCT structural data.
  • Developed a structure-function model using binary responses to generate priors for a Bayesian ZEST strategy, tested via simulation.

Main Results:

  • MacS-ZEST reduced the number of stimulus presentations by 13-14% compared to standard ZEST in simulated subjects.
  • Error reduction was observed with increasing rates of unreliable responses (≥10% at 30% error rate).
  • No significant reduction in mean absolute error was found for reliable subjects.

Conclusions:

  • Incorporating detailed macular OCT structural information into visual field testing models can enhance speed and accuracy.
  • The MacS-ZEST strategy shows promise for improving efficiency and reliability in clinical glaucoma practice, particularly for poor responders.