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Detecting deterioration of visual field sensitivity measurements is important for the diagnosis and management of glaucoma. This review surveys the current methods for assessing progression that are implemented in clinical devices, which have been used in clinical trials, alongside more recent advances proposed in the literature. Advice is also offered to clinicians on what they can do to improve the collection of perimetric data to help analytical progression methods more accurately predict change. This advice includes a discussion of how frequently visual field testing should be undertaken, with a view towards future developments, such as digital healthcare outside the standard clinical setting and more personalised approaches to perimetry.

Purpose: To report baseline dimension of the autofluorescent (AF) ring in a large cohort of retinitis pigmentosa (RP) patients and to evaluate models of ring progression., Design: Cohort study., Participants: Four hundred and forty-five eyes of 224 patients with clinical diagnosis of RP., Methods: Autofluorescent rings from near-infrared AF (NIRAF) and short-wavelength AF (SWAF) imaging modalities in RP eyes were segmented with ring area and horizontal extent extracted from each image for cross-sectional and longitudinal analyses. In longitudinal analysis, for each eye, ring area, horizontal extent, and natural logarithm of the ring area were assessed as the best dependent variable for linear regression by evaluating R 2 values. Linear mixed-effects modeling was utilized to account for intereye correlation., Main Outcome Measures: Autofluorescent ring size characteristics at baseline and ring progression rates., Results: A total of 439 eyes had SWAF imaging at baseline with the AF ring observed in 206 (46.9%) eyes. Mean (95% confidence interval) of ring area and horizontal extent were 7.85 (6.60 to 9.11) mm 2 and 3.35 (3.10 to 3.60) mm, respectively. In NIRAF, the mean ring area and horizontal extent were 7.74 (6.60 to 8.89) mm 2 and 3.26 (3.02 to 3.50) mm, respectively in 251 out of 432 eyes. Longitudinal analysis showed mean progression rates of -0.57 mm 2 /year and -0.12 mm/year in SWAF using area and horizontal extent as the dependent variable, respectively. When ln(Area) was analyzed as the dependent variable, mean progression was -0.07 ln(mm 2 )/year, which equated to 6.80% decrease in ring area per year. Similar rates were found in NIRAF (area: -0.59 mm 2 /year, horizontal extent: -0.12 mm/year and ln(Area): -0.08 ln(mm 2 )/year, equated to 7.75% decrease in area per year). Analysis of R 2 showed that the dependent variable ln(Area) provided the best linear model for ring progression in both imaging modalities, especially in eyes with large overall area change., Conclusions: Our data suggest that using an exponential model to estimate progression of the AF ring area in RP is more appropriate than the models assuming linear decrease. Hence, the progression estimates provided in this study should provide more accurate reference points in designing clinical trials in RP patients., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the validity of visual field (VF) results from the Iowa Head-Mounted Display (HMD) Open-Source Perimeter and to test the hypothesis that VF defects and test-retest repeatability are similar between the HMD and Octopus 900 perimeters., Methods: We tested 20 healthy and nine glaucoma patients on the HMD and Octopus 900 perimeters using the Open Perimetry Interface platform with size V stimuli, a custom grid spanning the central 26° of the VF, and a ZEST thresholding algorithm. Historical data from the Humphrey Field Analyzer (HFA) were also analyzed. Repeatability was analyzed with the repeatability coefficient (RC), and VF defect detection was determined through side-by-side comparisons., Results: The pointwise RCs were 2.6 dB and 3.4 dB for the HMD and Octopus 900 perimeters in ocular healthy subjects, respectively. Likewise, the RCs were 4.2 dB and 3.5 dB, respectively, in glaucomatous patients. Limits of agreement between the HMD and Octopus 900 perimeters were ±4.6 dB (mean difference, 0.4 dB) for healthy patients and ±8.9 dB (mean difference, 0.1 dB) for glaucomatous patients. Retrospective analysis showed that pointwise RCs on the HFA2 perimeter were between 3.4 and 3.7 dB for healthy patients and between 3.9 and 4.7 dB for glaucoma patients. VF defects were similar between the HMD and Octopus 900 for glaucoma subjects., Conclusions: The Iowa Virtual Reality HMD Open-Source Perimeter is as repeatable as the Octopus 900 perimeter and is a more portable and less expensive alternative than traditional perimeters., Translational Relevance: This study demonstrates the validity of the visual field results from the Iowa HMD Open-Source Perimeter which may help expand perimetry access.

Purpose: Measuring the spatial extent of defects may be advantageous in advanced glaucoma where conventional perimetric sensitivity measurements are unreliable. We test whether suprathreshold tests on a higher density grid can more efficiently map advanced visual field loss., Methods: Data from 97 patients with mean deviation < -10 dB were used in simulations comparing two suprathreshold procedures (on a high-density 1.5° grid) to interpolated Full Threshold 24-2. Spatial binary search (SpaBS) presented 20-dB stimuli at locations bisecting seen/unseen points until the seen status of all neighbors matched or until tested points were adjacent. The SupraThreshold Adaptive Mapping Procedure (STAMP) presented 20-dB stimuli where entropy was maximal and modified the status of all points after each presentation, stopping after a fixed number of presentations (estimated as 50%-100% of the presentation number of a current procedure)., Results: With typical response errors, SpaBS had worse mean accuracy and repeatability than Full Threshold (both P < 0.0001). Compared to Full Threshold, mean accuracy (Full Threshold: median, 91%; interquartile range [IQR], 87%-94%) was slightly better with STAMP for all stopping criteria, although this was not statistically significant until 100% of conventional test presentations were used. Mean repeatability for STAMP was similar for all stopping criteria (P ≥ 0.02) compared to Full Threshold (Full Threshold: median, 89%; IQR, 82%-93%)., Conclusions: STAMP accurately and repeatably maps the spatial extent of advanced visual field defects in as few as 50% of conventional perimetric test presentations. Further work is needed to test STAMP in human observers and in progressive loss., Translational Relevance: New perimetric approaches may improve information available for advanced glaucoma management and may potentially be more acceptable to patients.

Objective: To assess the accuracy of probabilistic deep learning models to discriminate normal eyes and eyes with glaucoma from fundus photographs and visual fields., Design: Algorithm development for discriminating normal and glaucoma eyes using data from multicenter, cross-sectional, case-control study., Subjects and Participants: Fundus photograph and visual field data from 1,655 eyes of 929 normal and glaucoma subjects to develop and test deep learning models and an independent group of 196 eyes of 98 normal and glaucoma patients to validate deep learning models., Main Outcome Measures: Accuracy and area under the receiver-operating characteristic curve (AUC)., Methods: Fundus photographs and OCT images were carefully examined by clinicians to identify glaucomatous optic neuropathy (GON). When GON was detected by the reader, the finding was further evaluated by another clinician. Three probabilistic deep convolutional neural network (CNN) models were developed using 1,655 fundus photographs, 1,655 visual fields, and 1,655 pairs of fundus photographs and visual fields collected from Compass instruments. Deep learning models were trained and tested using 80% of fundus photographs and visual fields for training set and 20% of the data for testing set. Models were further validated using an independent validation dataset. The performance of the probabilistic deep learning model was compared with that of the corresponding deterministic CNN model., Results: The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and combined modalities using development dataset were 0.90 (95% confidence interval: 0.89-0.92), 0.89 (0.88-0.91), and 0.94 (0.92-0.96), respectively. The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and both modalities using the independent validation dataset were 0.94 (0.92-0.95), 0.98 (0.98-0.99), and 0.98 (0.98-0.99), respectively. The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and both modalities using an early glaucoma subset were 0.90 (0.88,0.91), 0.74 (0.73,0.75), 0.91 (0.89,0.93), respectively. Eyes that were misclassified had significantly higher uncertainty in likelihood of diagnosis compared to eyes that were classified correctly. The uncertainty level of the correctly classified eyes is much lower in the combined model compared to the model based on visual fields only. The AUCs of the deterministic CNN model using fundus images, visual field, and combined modalities based on the development dataset were 0.87 (0.85,0.90), 0.88 (0.84,0.91), and 0.91 (0.89,0.94), and the AUCs based on the independent validation dataset were 0.91 (0.89,0.93), 0.97 (0.95,0.99), and 0.97 (0.96,0.99), respectively, while the AUCs based on an early glaucoma subset were 0.88 (0.86,0.91), 0.75 (0.73,0.77), and 0.92 (0.89,0.95), respectively., Conclusion and Relevance: Probabilistic deep learning models can detect glaucoma from multi-modal data with high accuracy. Our findings suggest that models based on combined visual field and fundus photograph modalities detects glaucoma with higher accuracy. While probabilistic and deterministic CNN models provided similar performance, probabilistic models generate certainty level of the outcome thus providing another level of confidence in decision making., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Huang, Sun, Gupta, Montesano, Crabb, Garway-Heath, Brusini, Lanzetta, Oddone, Turpin, McKendrick, Johnson and Yousefi.)

Purpose: Information regarding the views of patients, on visual field testing is limited, and no information exists regarding their preferences for test developments. This study aimed to increase knowledge of patients' experiences of visual field assessment and to explore their opinions and priorities regarding current areas of research and development., Design: Online questionnaire with purposive sampling design., Participants: Adults who regularly undergo visual field tests in Australia who report having glaucoma or being at glaucomatous risk., Methods: An anonymous survey, implemented using the Qualtrics webtool, with both closed- and-open ended questions designed to explore opinions regarding visual field testing, visit attendance for perimetry, as well as priorities for developments., Main Outcome Measures: The survey assessed 3 domains: (1) opinions regarding test duration and visit frequency, (2) subjective experience, and (3) perspectives on future developments., Results: One hundred fifty-two complete survey responses were obtained. The median age of participants was 66 years (interquartile range [IQR], 60-72 years). Most participants (70%) had experience of undergoing more than 11 visual field tests. Participants recalled that they completed visual field tests in median of 6 minutes (IQR, 5-8 minutes) and were willing to accept additional time (median, 5 minutes; IQR, 3-6 minutes) to obtain more information. Participants were prepared to increase both the number of visual field tests per eye and the frequency of visual field tests (median, 3 visits per year; IQR, 2-4 visits per year) to gain more information about their visual status. Regarding future developments, the most preferred option was "similar test times but an increase in the level of information about my visual field," which ranked significantly higher than all other options, including "shorter test times that maintain the currently available level of information about my visual field.", Conclusions: Our study confirms, in a different population and health care system, previous research reporting patient perspectives on visual field assessment. We further revealed that health care consumers show a strong preference for accurate information about their vision and report being prepared to undergo longer visual field tests or more visual field tests to achieve that outcome., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

The Open Perimetry Initiative was formed in 2010 with the aim of reducing barriers to clinical research with visual fields and perimetry. Our two principal tools are the Open Perimetry Interface (OPI) and the visualFields package with analytical tools. Both are fully open source. The OPI package contains a growing number of drivers for commercially available perimeters, head-mounted devices, and virtual reality headsets. The visualFields package contains tools for the analysis and visualization of visual field data, including methods to compute deviation values and probability maps. We introduce a new frontend, the opiApp, that provides tools for customization for visual field testing and can be used as a frontend to run the OPI. The app can be used on the Octopus 900 (Haag-Streit), the Compass (iCare), the AP 7000 (Kowa), and the IMO (CREWT) perimeters, with permission from the device manufacturers. The app can also be used on Android phones with virtual reality headsets via a new driver interface, the PhoneHMD, implemented on the OPI. The use of the tools provided by the OPI library is showcased with a custom static automated perimetry test for the full visual field (up to 50 degrees nasally and 80 degrees temporally) developed with the OPI driver for the Octopus 900 and using visualFields for statistical analysis. With more than 60 citations in clinical and translational science journals, this initiative has contributed significantly to expand research in perimetry. The continued support of researchers, clinicians, and industry are key in transforming perimetry research into an open science.

Purpose: To introduce a new method (ARBON) for decreasing the test time of psychophysical procedures and examine its application to perimetry., Methods: ARBON runs in parallel with an existing psychophysical procedure injecting occasional responses of seen or unseen into that procedure. Using computer simulation to mimic human responses during perimetry, we assess the performance of ARBON relative to an underlying test procedure and a version of that procedure truncated to be faster. Simulations used 610 normal eyes (age 20 to 80 years) and 163 glaucoma eyes (median mean deviation = -1.81 dB, 5th percentile = +2.14 dB, 95th percentile = -22.55 dB). Outcome measures were number of presentations and mean absolute error in threshold estimation. We also examined the probability distribution of measured thresholds., Results: ARBON and the Truncated procedure reduced presentations by 16% and 18%, respectively. Mean error was increased by 8% to 10% for the Truncated procedure but decreased by 5% to 7% for ARBON. The probability distributions of measured thresholds using ARBON overlapped with the Underlying procedure by over 80%, whereas the Truncated procedure overlapped by 50%., Conclusions: ARBON offers a principled method for reducing test time. ARBON can be added to any existing psychophysical procedure without requiring any change to the logic or parameters controlling the procedure, resulting in distributions of measured thresholds similar to those of the underlying procedure., Translational Relevance: ARBON can be added to a perimetry test procedure to speed up the test while largely preserving the distribution of returned sensitivities, thus producing normative data similar to the data for the original, underlying perimetric test.

Purpose: Previous studies show that some visual field (VF) defects are detectable from visual search behavior; for example, when watching video. Here, we developed and tested a VF testing approach that measures the number of fixations to find targets on a background with spatial frequency content similar to natural scenes., Methods: Twenty-one older controls and 20 people with glaucoma participated. Participants searched for a Gabor (6 c/°) that appeared in one of 25 possible locations within a 15° (visual angle) 1/f noise background (RMS contrast: 0.20). Procedure performance was assessed by calculating sensitivity and specificity for different combinations of control performance limits (p = 95%, 98%, 99%), number of target locations with fixations outside control performance limits (k = 0 to 25) and number of repeated target presentations (n = 1 to 20)., Results: Controls made a median of two to three fixations (twenty-fifth to seventy-fifth percentile: two to four) to locate the target depending on location. A VF was flagged "abnormal" when the number of fixations was greater than the p = 99% for k = 3 or more locations with n = 2 repeated presentations, giving 85% sensitivity and 95.2% specificity. The median test time for controls was 85.71 (twenty-fifth to seventy-fifth percentile: 66.49-113.53) seconds., Conclusion: Our prototype test demonstrated effective and efficient screening of abnormal areas in central vision., Translational Relevance: Visual search behavior can be used to detect central vision loss and may produce results that relate well to performance in natural visual environments.

Purpose: It has been suggested that the detection of visual field progression can be improved by modeling statistical properties of the data such as the increasing retest variability and the spatial correlation among visual field locations. We compared a method that models those properties, Analysis with Non-Stationary Weibull Error Regression and Spatial Enhancement (ANSWERS), against a simpler one that does not, Permutation of Pointwise Linear Regression (PoPLR)., Methods: Visual field series from three independent longitudinal studies in patients with glaucoma were used to compare the positive rate of PoPLR and ANSWERS. To estimate the false-positive rate, the same visual field series were randomly re-ordered in time. The first dataset consisted of series of 7 visual fields from 101 eyes, the second consisted of series of 9 visual fields from 150 eyes, and the third consisted of series of more than 9 visual fields (17.5 on average) from 139 eyes., Results: For a statistical significance of 0.05, the false-positive rates for ANSWERS were about 3 times greater than expected at 15%, 17%, and 16%, respectively, whereas for PoPLR they were 7%, 3%, and 6%. After equating the specificities at 0.05 for both models, positive rates for ANSWERS were 16%, 25%, and 38%, whereas for PoPLR they were 12%, 33%, and 49%, or about 5% greater on average (95% confidence interval = -1% to 11%)., Conclusions: Despite being simpler and less computationally demanding, PoPLR was at least as sensitive to deterioration as ANSWERS once the specificities were equated., Translational Relevance: Close control of false-positive rates is key when visual fields of patients are analyzed for change in both clinical practice and clinical trials.

Purpose: To evaluate the ability of additional central testing locations to improve detection of macular visual field (VF) defects in glaucoma., Design: Prospective cross-sectional study., Participants: Four hundred forty healthy people and 499 patients with glaucomatous optic neuropathy (GON) were tested with a fundus tracked perimeter (CMP; CenterVue) using a 24-2 grid with 12 additional macular locations (24-2+)., Methods: Glaucomatous optic neuropathy was identified based on expert evaluation of optic nerve head photographs and OCT scans, independently of the VF. We defined macular defects as locations with measurements outside the 5% and 2% normative limits on total deviation (TD) and pattern deviation (PD) maps within the VF central 10°. Classification was based on the total number of affected macular locations (overall detection) or the largest number of affected macular locations connected in a contiguous cluster (cluster detection). Criteria based on the number of locations and cluster size were used to obtain equivalent specificity between the 24-2 grid and the 24-2+ grids, calculated using false detections in the healthy cohort. Partial areas under the receiver operating characteristic curve (pAUCs) were also compared at specificities of 95% or more., Main Outcome Measures: Matched specificity comparison of the ability to detect glaucomatous macular defects between the 24-2 and 24-2+ grids., Results: At matched specificity, cluster detection identified more macular defects with the 24-2+ grid compared with the 24-2 grid. For example, the mean increase in percentage of detection was 8% (95% confidence interval [CI], 5%-11%) and 10% (95% CI, 7%-13%) for 5% TD and PD maps, respectively, and 5% (95% CI, 2%-7%) and 6% (95% CI, 4%-8%) for the 2% TD and PD maps, respectively. Good agreement was found between the 2 grids. The improvement measured by pAUCs was also significant but generally small. The percentage of eyes with macular defects ranged from about 30% to 50%. Test time for the 24-2+ grid was longer (21% increase) for both cohorts. Between 74% and 98% of defects missed by the 24-2 grid had at least 1 location with sensitivity of < 20 dB., Conclusions: Visual field examinations with additional macular locations can improve the detection of macular defects in GON modestly without loss of specificity when appropriate criteria are selected., (Copyright © 2021 American Academy of Ophthalmology. All rights reserved.)

Purpose: The purpose of this study was to compare visual field results of the COMPASS fundus perimeter (CMP) and the Humphrey Field Analyzer (HFA) in the same eyes; to compare structure-function concordance between circumpapillary retinal nerve fiber layer (Cp-RNFL) profiles and the two perimetry results; and to evaluate whether differences between the two results reflect postulated advantages of real-time eye movement compensation during perimetry., Methods: We retrospectively analyzed 24-2 visual field data measured with CMP and HFA together with Cp-RNFL optical coherence tomography (OCT) scan data from 95 eyes of 65 people with glaucoma. We defined visual field locations with total deviation (TD) less than -5 dB as defective. The CMP and HFA fields were compared on measures of: spatial extent (number of defective locations); depth (TD values); and sharpness of scotomata edges (maximum TD difference between defective locations and their neighbors). Structure-function concordance between Cp-RNFL profile and respective visual field was also compared., Results: Compared to the HFA, scotomata measured by CMP were of reduced spatial extent (mean difference = -3.14 locations, p < 0.001), greater depth (median TD of CMP = -17 dB versus HFA = -13 dB, p = 0.029) and steeper edges (median of maximum TD difference of CMP = 10.6 dB versus HFA = 6 dB, p < 0.001). Structure-function concordance between Cp-RNFL profile and either visual field were comparable despite the reduced scotoma spatial extent measured by CMP., Conclusions: Glaucomatous visual fields measured by CMP displayed characteristics consistent with expected effects of using real-time eye movement compensation technology compared to the widely used HFA., Translational Relevance: Glaucomatous visual field defects measured by the CMP are more localized, deeper, and steeper than those of the HFA.

The Stiles-Crawford effect of the first kind (SCE) is the phenomenon in which light entering the eye near the center of the pupil appears brighter than light entering near the edge. Previous investigations have found an increase in the directionality (steepness) of the effect as the testing location moves from the center of the visual field to parafoveal positions, but the effect of central field size has not been considered. The influence of field size on the SCE was investigated using a uniaxial Maxwellian system in which stimulus presentation was controlled by an active-matrix liquid crystal display. SCE directionality increased as field size increased from 0.5° to 4.7° diameter, although this was noted in four mild myopes and not in two emmetropes. The change with field size was supported by a geometric optics absorption model., Competing Interests: The authors report no conflicts of interest and have no proprietary interest in any of the materials mentioned in this article., (© 2021 Optical Society of America under the terms of the OSA Open Access Publishing Agreement.)

Significance: Contrast sensitivity changes across the visual field with age and is often measured clinically with various forms of perimetry on plain backgrounds. In daily life, the visual scene is more complicated, and therefore, the standard clinical measures of contrast sensitivity may not predict a patient's visual experience in more natural environments., Purpose: This study aims to determine whether contrast thresholds in older adults are different from younger adults when measured on a 1/f noise background (a nonuniform background whose spatial frequency content is similar to those present in the natural vision environments)., Methods: Twenty younger (age range, 20 to 35 years) and 20 older adults (age range, 61 to 79 years) with normal ocular health were recruited. Contrast thresholds were measured for a Gabor patch of 6 cycles per degree (sine wave grating masked by a Gaussian envelope of standard deviation 0.17°) presented on 1/f noise background (root-mean-square contrast, 0.05 and 0.20) that subtended 15° diameter of the central visual field. The stimulus was presented at four eccentricities (0°, 2°, 4°, and 6°) along the 45° meridian in the noise background, and nine contrast levels were tested at each eccentricity. The proportion of correct responses for detecting the target at each eccentricity was obtained, and psychometric functions were fit to estimate the contrast threshold., Results: Older adults demonstrate increased contrast thresholds compared with younger adults. There was an eccentricity-dependent interaction with age, with the difference between groups being highest in the fovea compared with other eccentricities. Performance was similar for the two noise backgrounds tested., Conclusions: Our results revealed a strong eccentricity dependence in performance between older and younger adults, highlighting age-related differences in the contrast detection mechanisms between fovea and parafovea for stimuli presented on nonuniform backgrounds., Competing Interests: Conflict of Interest Disclosure: Authors AMM and AT receive research support from Haag-Streit AG for work unrelated to the content of this article., (Copyright © 2021 American Academy of Optometry.)

Purpose: The purpose of this study was to isolate and quantify the effects of observer response criterion on perimetric sensitivity, response variability, and maximum response probability., Methods: Twelve people with glaucoma were tested at three locations in the visual field (age = 47-77 years, mean deviation = -0.61 to -14.54 dB, test location Humphrey field analyzer [HFA] sensitivities = 1 to 30 dB). Frequency of seeing (FoS) curves were measured using a method of constant stimuli with two response paradigms: a "yes-no" paradigm similar to static automated perimetry and a criterion-free two interval forced choice (2IFC) paradigm. Comparison measures of sensitivity, maximum response probability, and response variability were derived from the fitted FoS curves., Results: Sensitivity differences between the tasks varied widely (range = -11.3 dB to 21.6 dB) and did not correlate with visual field sensitivity nor whether the visual field location was in an area of steep sensitivity gradient within the visual field. Due to the wide variation in differences between the methods, there was no significant difference in mean sensitivity between the 2IFC task relative to the yes-no task, but a trend for higher sensitivity (mean = 1.9 dB, SD = 6.0 dB, P = 0.11). Response variability and maximum response probability did not differ between the tasks ( P > 0.99 and 0.95, respectively)., Conclusions: Perimetric sensitivity estimates are demonstrably altered by observer response criterion but the effect varies widely and unpredictably, even within a single test. Response bias should be considered a factor in perimetric test variability and when comparing sensitivities to nonperimetric data., Translational Relevance: The effect of response criterion on perimetric response variability varies widely and unpredictably, even within a single test., Competing Interests: Disclosure: N.J. Rubinstein, None; A. Turpin, Heidelberg Engineering GmBH (F), Haag-Streit AG (F), CentreVue SpA (C); J. Denniss, None; A.M. McKendrick, Heidelberg Engineering GmBH (F), Haag-Streit AG (F), CentreVue SpA (C), (Copyright 2021 The Authors.)

Purpose: Maps are required to relate visual field locations to optic nerve head regions. We compare individualized structure-to-function mapping (CUSTOM-MAP) to a population-derived mapping schema (POP-MAP)., Methods: Maps were compared for 118 eyes with glaucomatous field loss, circumpapillary retinal nerve fiber layer (cpRNFL) thickness measured using spectral domain optical coherence tomography (OCT), and two landmarks: the optic nerve head (ONH) position relative to the fovea and the temporal raphe angle. Locations with visual field damage (total deviation < -6 dB) were mapped to 30° ONH sectors centered on the angle given by each mapping schema. The concordance between damaged function and damaged structure was determined per location for various cpRNFL damage probability levels, with the number of concordant locations divided by the total number of damaged field locations providing a concordance ratio per eye., Results: For the strictest concordance criteria (minimum cpRNFL thickness < 1% of normal), CUSTOM-MAP had higher mean concordance ratio than POP-MAP (60.5% c.f. 57.0% paired Wilcoxon, P = 0.005), with CUSTOM-MAP having a higher ratio in 43 eyes and POP-MAP having a higher ratio in 21 eyes. For all cpRNFL probability levels <20% of normal, more locations concorded for CUSTOM-MAP than POP-MAP. Inspection of the spatial patterns of differences revealed that CUSTOM-MAP often performed better in the arcuate regions, whereas POP-MAP had benefits inferior to the macula., Conclusions: Anatomic parameters required for individualized structure-function mapping are readily measured with OCT and can provide improved concordance for some eyes., Translational Relevance: Personalizing structure-function mapping may improve concordance between these measures. We provide a web-based tool for creating customized maps., Competing Interests: Disclosure: A. Turpin, Heidelberg Engineering GmBH (F); A.M. McKendrick, Heidelberg Engineering GmBH (F), (Copyright 2021 The Authors.)

Purpose: The Australian Reduced Range Extended Spatial Test (ARREST) approach was designed to improve visual field spatial resolution while maintaining a similar test duration to clinically used testing algorithms. ARREST does not completely threshold visual field locations with sensitivity < 17 dB, and uses the presentations saved to test new locations in areas of steep gradient within the visual field. Previous assessments of ARREST's performance have used computer simulation. In this study, we cross-sectionally assessed the performance of ARREST in people with visual field loss., Methods: We tested 23 people with glaucoma (mean age: 71 ± 8 years) with established visual field loss. Three visual field procedures were performed using the Open Perimetry Interface: cZEST and ARREST on the Octopus 900 perimeter (Haag-Streit AG, Switzerland), and a reference standard (best available estimate [BAE]) on the Compass perimeter (CenterVue SpA, Italy). ARREST was compared against the cZEST and the BAE., Results: On average, ARREST added seven new locations (range = 0-15) to a visual field test. There was no significant difference in the number of stimulus presentations between procedures (mean = 259 ± 25 [ARREST] vs. 261 ± 25 [cZEST], P = 0.78). In classifying threshold values < 17 dB, ARREST performed similarly when compared against BAE., Conclusions: This study provides empirical evidence to support conclusions from previous computer simulations that ARREST can be used to increase spatial sampling in regions of interest without increasing test time., Translational Relevance: ARREST is a new approach that augments current visual field testing procedures to provide better spatial description of visual field defects without increasing test duration., Competing Interests: Disclosure: V. Muthusamy, None; A. Turpin, Haag-Streit AG (R), Heidelberg Engineering GmBH (R), and CenterVue SpA (R, C); M.J. Walland, None; B.N. Nguyen, None; A.M. McKendrick, Haag-Streit AG (R), Heidelberg Engineering GmBH (R), and CenterVue SpA (R, C), (Copyright 2020 The Authors.)

Aims: To investigate the effect of fundus tracking perimetry on structure-function relationship in glaucoma., Methods: Perimetric data were acquired with the Humphrey Field Analyzer (HFA) and the Compass fundus perimeter (CMP, equipped with fundus tracking). We included data from 696 eyes from 360 healthy people and 711 eyes from 434 patients with glaucoma from the original study, for which the circumpapillary retinal nerve fibre layer optical coherence tomography scan (Cp-RNFL) was available. We explored the structure-function relationship using both global indices (mean deviation and average Cp-RNFL thickness loss) and anatomically defined visual field clusters comparing the R 2 values from mixed-effect models. We then measured the diagnostic ability of a combined Structure Function Index (SFI) using perimetric data from either perimeter. The comparisons were based on partial receiver operating characteristic curves with a minimum specificity of 75% and their areas under the curve., Results: The R 2 for the global structure-function relationship was 0.50 for the CMP and 0.48 for the HFA. When visual field clusters were included in the model, the R 2 was 0.29 for CMP and 0.30 for HFA. Overall, the discrimination ability of the SFI was not significantly higher than the Cp-RNFL for either the CMP (p=0.07) or the HFA (p=0.14). However, it was significantly better in eyes with perimetric damage (p<0.001), in which the CMP-SFI performed significantly better than the HFA-SFI (p=0.03)., Conclusions: Structure-function relationship is similar between the two perimeters. Fundus tracking might improve discrimination ability with a combined SFI., Trial Registration Number: ISRCTN13800424., Competing Interests: Competing interests: LR, AMM, AT, PF, FO, PL, PB, CJ, DFG-H and DPC are consultants for CenterVue. AMM, AT and DFG-H received research funding from Heidelberg Engineering., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate the association among optic disc hemorrhage (ODH) recurrence, location, and visual field (VF) progression., Design: Prospective, observational study., Participants: Patients with bilateral glaucoma or unilateral glaucoma with a fellow glaucoma suspect eye were enrolled., Methods: Patients received optic disc photography every 3 months and VF testing every 4 months. The disc was partitioned into 8 sectors to match 8 visual field (VF) sectors. The frequency of ODH in each sector was quantified over an average of 64 months. Global VF progression rate was calculated using linear regression on mean deviation. Sectoral progression rate was calculated using linear regression on the sensitivity at each VF location over time and then selecting the largest and second largest significant (P < 0.05) negative slope within that sector. The association between ODH and VF progression rate globally and within a sector was calculated using linear mixed modeling., Main Outcome Measures: Global and sectoral VF progression, ODH frequency, and ODH recurrence (globally and sectoral) and its association with VF progression rate., Results: A total of 151 eyes from 77 patients completed the study with mean follow-up of 64 months, 20 disc photographs, and 16 VF tests. With global VF analysis, eyes with ODH in 2 different sectors of the disc had worse progression rate than eyes with ODH in 1 sector (P = 0.012) and eyes with no ODH (P < 0.001). Regarding the largest sectoral VF progression, sectors with 1 ODH had a faster VF progression rate than those with no ODH (P < 0.017) and progressed at a similar rate to those with 2 to 8 ODH (P = 0.592). Sectors with >8 ODH had faster VF progression than all other groups (all P < 0.001)., Conclusions: High-frequency ODH within optic disc sectors, equivalent to detecting ODH in 45% of 3 monthly eye examination visits, was associated with significantly worse VF progression than sectors with moderate or only 1 observed ODH. In addition, ODH occurring in different sectors in the same eye was more strongly associated with greater global VF progression compared with those occurring within the same sector., (Copyright © 2020 American Academy of Ophthalmology. All rights reserved.)

Precis: We used the Open Perimetry Interface (OPI) to design a static automated perimetry test of the full visual field. About half of our glaucoma cohort had defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc., Aims: To test the hypothesis that in glaucoma patients with mild visual loss, perimetric nerve fiber bundle defects present outside 30 degrees will correlate well with areas of Cirrus ocular coherence tomography (OCT) retinal nerve fiber layer thinning., Methods: We tested 27 consecutive glaucoma subjects with mild vision loss (mean deviation better than -4 dB) with a SITA standard test, 2 size V custom OPI tests (OPI 30-2 and OPI Peripheral) and Cirrus OCT. Two observers assigned qualitative grades to each type of visual field test based on their level of correlation with OCT retinal nerve fiber layer and ganglion cell thickness., Results: Discrete temporal wedge defects were found on the OPI peripheral V test in 26% of cases whereas more extensive inferior temporal loss (including inferior temporal wedge defect region) was present in 22% of other cases. OCT data correlated best with the OPI peripheral test for 8 glaucoma subjects. The OPI central 30-2 test correlated best for 9 glaucoma subjects; the remainder of subjects had equal central/peripheral correlations., Conclusions: About half of our glaucoma cohort have defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. Adding a threshold automated perimetry test of the far periphery improves structure/function correlations and adds useful clinical information.

Purpose: Visual fields (VF) are measured monocularly at a single depth, yet real-life activities require people to interact with objects binocularly at multiple depths. To better characterize visual functioning in clinical vision conditions such as glaucoma, analyzing visual impairment in a depth-dependent fashion is required. We developed a depth-dependent integrated VF (DD-IVF) simulation and demonstrated its usefulness by evaluating DD-IVF defects associated with 12 glaucomatous archetypes of 24-2 VF., Methods: The 12 archetypes included typical variants of superior and inferior nasal steps, arcuate and altitudinal defects, temporal wedge, biarcuate, and intact VFs. DD-IVF simulation maps the monocular 24-2 VF archetypes to binocular ones as a function of depth by incorporating three parameters of fixation, object, and interpupillary distances. At each location and depth plane, sensitivities are linearly interpolated from corresponding locations in monocular VF and returned as the higher value of the two., Results: The simulation produced 144 DD-IVFs for multiple depths from combinations of 12 glaucomatous archetypes. The DD-IVFs are included as a Shiny app in the binovisualfields package. The number of impaired locations in the DD-IVFs varied according to the overlap of VF loss between eyes., Conclusions: Our DD-IVF program revealed binocular functional visual defects associated with glaucomatous archetypes of the 24-2 pattern and is designed to do the same for empirically measured VFs. The comparison of identified visual impairments across depths may be informative for future empirical exploration of functional visual impairments in depth in glaucoma and other conditions leading to bilateral VF loss., Translational Relevance: Our DD-IVF program can reveal depth-dependent functional visual defects for clinical vision conditions where 24-2 test patterns are available., Competing Interests: Disclosure: P. Liu, None; A. McKendrick, Haag-Streit AG (F), Heidelberg Engineering GmBH (F), Centervue SpA (F); A. Ma-Wyatt, None; A. Turpin, Haag-Streit AG (F), Heidelberg Engineering GmBH (F), Centervue SpA (F), (Copyright 2020 The Authors.)

Purpose: The geometry of retinal nerve fibers may be altered with myopia, a known risk factor for glaucoma. Recent developments in high resolution imaging have enabled direct visualization of nerve fiber bundles at the temporal raphe with clinical hardware, providing evidence that this area is sensitive to glaucomatous damage. Here, we test the hypothesis that nerve fiber geometry is altered by myopia, both at the temporal raphe and surrounding the optic nerve head., Methods: Seventy-eight healthy individuals participated, with refractive errors distributed between emmetropia and high myopia (+0 to -13 DS). Custom high-density OCT scans were used to visualize RFNL bundle trajectory at the temporal raphe. A standard clinical OCT protocol was used to assess papillary minimum rim width (MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness., Results: Measures of raphe shape-including position, orientation, and width-did not depend significantly on axial length. In 7.5% of subjects, the raphe was rotated sufficiently that inversion of structure-function mapping to visual field space is predicted in the nasal step region. Low concordance to ISNT and related rules was observed in myopia (e.g., for RNFL, 8% of high axial myopes compared with 67% of emmetropes). Greater robustness to refractive error was observed for the IT rule., Conclusions: High density OCT scans enabled visualization of marked interindividual variation in temporal raphe geometry; however, these variations were not well predicted by degree of myopia as represented by axial length. That said, degree of myopia was associated with abnormal thickness profiles for the papillary and peripapillary nerve fiber layer.

Precis: The authors used the Open Perimetry Interface to design a static automated perimetry test of the full field. Abnormal test locations in the nasal midperiphery and temporal inferior sector area best separated glaucomas from normals., Purpose: The peripheral visual field in glaucoma outside 30 degrees is largely unexplored with static perimetry. Their goal was to use threshold static automated perimetry to characterize the visual loss in glaucoma of the central 30 degrees and the far periphery., Patients and Methods: The authors administered the 30-2 perimetric test to 27 patients with early stage glaucoma (with mean deviation better than -4 dB) with the Goldmann III and V stimulus sizes and a custom test from 30 to up to 87 degrees with the size V stimulus twice within a month. The authors quantified (1) the retest variability, (2) the proportion of patients flagged as abnormal (at level 0.05) on the basis of pointwise probability distributions obtained from 63 ocular healthy observers, (3) the pointwise statistical distance using the Kullback-Leibler divergence between normal and glaucoma eyes, and (4) the effect of eccentricity on visual loss., Results: Size V 30-2 testing identified significantly more abnormal test locations (36%) than size III 30-2 (30%; P=0.004). Kullback-Leibler divergence between healthy and glaucoma distributions was greatest for the nasal midperipheral test locations and the inferior temporal sector area. A more pronounced decrease was found in visual sensitivity with eccentricity in the patients with glaucoma compared with the ocular healthy participants across the full visual field (P<0.001)., Conclusions: Patients with glaucoma demonstrate a systematic decrease in sensitivity with eccentricity across the full visual field. Goldmann size V stimuli better detected visual loss in patients with glaucoma with mild loss than size III.

Purpose: People enjoy supervision during visual field assessment, although resource demands often make this difficult. We evaluated outcomes and subjective experience of methods of receiving feedback during perimetry, with specific goals to compare a humanoid robot to a computerized voice in participants with minimal prior perimetric experience. Human feedback and no feedback also were compared., Methods: Twenty-two younger (aged 21-31 years) and 18 older (aged 52-76 years) adults participated. Visual field tests were conducted using an Octopus 900, controlled with the Open Perimetry Interface. Participants underwent four tests with the following feedback conditions: (1) human, (2) humanoid robot, (3) computer speaker, and (4) no feedback, in random order. Feedback rules for the speaker and robot were identical, with the difference being a social interaction with the robot before the test. Quantitative perimetric performance compared mean sensitivity (dB), fixation losses, and false-positives. Subjective experience was collected via survey., Results: There was no significant effect of feedback type on the quantitative measures. For younger adults, the human and robot were preferred to the computer speaker ( P < 0.01). For older adults, the experience rating was similar for the speaker and robot. No feedback was the least preferred option of 77% younger and 50% older adults., Conclusions: During perimetry, a social robot was preferred to a computer speaker providing the same feedback, despite the robot not being visible during the test. Making visual field testing more enjoyable for patients and operators may improve compliance and attitude to perimetry, leading to improved clinical outcomes., Translational Relevance: Our data suggest that humanoid robots can replace some aspects of human interaction during perimetry and are preferable to receiving no human feedback.

Combining information from optical coherence tomography (OCT) imaging and visual field testing is useful in the clinical assessment and monitoring of patients with glaucoma. Measurements of retinal nerve fibre layer thickness or neuroretinal rim width taken around the optic nerve head may be related to the visual field using a structure-function map. In this review, the structure-function mapping methods in clinical use are discussed. Typical clinical maps provide a population average, 'one size fits all' representation, but in recent years methods for customising structure-function maps to individual eyes have been developed and these are reviewed here. In the macula, visual field stimuli stimulate photoreceptors for which associated retinal ganglion cells are peripherally displaced. Recently developed methods that relate OCT measurements to visual field test locations in the macula are therefore also reviewed. The use of structure-function maps to relate OCT measurements to localised visual field sensitivity in new applications is also explored. These new applications include the selection of visual field test locations and stimulus intensities based on OCT data, and the formal post-test combination of results across modalities. Such applications promise to exploit the structure-function relationship in glaucoma to improve disease diagnosis and monitoring of progression. Limitations in the validation and use of current structure-function mapping techniques are discussed., (© 2018 Optometry Australia.)

Purpose: To characterize visual loss across the full visual field in idiopathic intracranial hypertension (IIH) patients with mild central visual loss., Methods: We tested the full visual field (50° nasal, 80° temporal, 30° superior, 45° inferior) of 1 eye of 39 IIH patients by using static perimetry (size V) with the Open Perimetry Interface. Participants met the Dandy criteria for IIH and had at least Frisén grade 1 papilledema with better than -5 dB mean deviation (MD) centrally. Two observers (MW and AS) evaluated the visual field defects, adjudicated any differences, and reviewed optical coherence tomography data., Results: We found a greater MD loss peripherally than centrally (central 26°). The median MD (and corresponding median absolute deviations) was -1.37 dB (1.61 dB) for the periphery and -0.77 dB (0.87 dB) for the central 26°, P < 0.001. There were about 30% more abnormal test locations identified in the periphery (P = 0.12), and the mean defect depth increased with eccentricity (P < 0.001). The most frequent defect found was a temporal wedge (23% of cases) in the periphery with another 23% that included this sector with inferior temporal loss. Although the presence of papilledema limited correlation, 55% of the temporal wedge defects had optical coherence tomography retinal nerve fiber layer deficits in the corresponding superonasal location. Other common visual field defects were inferonasal loss, superonasal loss, and superior and inferior arcuate defects. Seven patients (18%) had visual field defects in the periphery with normal central visual field testing., Conclusion: In IIH patients, we found substantial visual loss both outside 30° of the visual field and inside 30° with the depth of the defect increasing linearly with eccentricity. Temporal wedge defects were the most common visual field defect in the periphery. Static threshold perimetry of the full visual field appears to be clinically useful in IIH patients.

Purpose: To evaluate relative diagnostic precision and test-retest variability of 2 devices, the Compass (CMP, CenterVue, Padova, Italy) fundus perimeter and the Humphrey Field Analyzer (HFA, Zeiss, Dublin, CA), in detecting glaucomatous optic neuropathy (GON)., Design: Multicenter, cross-sectional, case-control study., Participants: We sequentially enrolled 499 patients with glaucoma and 444 normal subjects to analyze relative precision. A separate group of 44 patients with glaucoma and 54 normal subjects was analyzed to assess test-retest variability., Methods: One eye of recruited subjects was tested with the index tests: HFA (Swedish interactive thresholding algorithm [SITA] standard strategy) and CMP (Zippy Estimation by Sequential Testing [ZEST] strategy), 24-2 grid. The reference test for GON was specialist evaluation of fundus photographs or OCT, independent of the visual field (VF). For both devices, linear regression was used to calculate the sensitivity decrease with age in the normal group to compute pointwise total deviation (TD) values and mean deviation (MD). We derived 5% and 1% pointwise normative limits. The MD and the total number of TD values below 5% (TD 5%) or 1% (TD 1%) limits per field were used as classifiers., Main Outcome Measures: We used partial receiver operating characteristic (pROC) curves and partial area under the curve (pAUC) to compare the diagnostic precision of the devices. Pointwise mean absolute deviation and Bland-Altman plots for the mean sensitivity (MS) were computed to assess test-retest variability., Results: Retinal sensitivity was generally lower with CMP, with an average mean difference of 1.85±0.06 decibels (dB) (mean ± standard error, P < 0.001) in healthy subjects and 1.46±0.05 dB (mean ± standard error, P < 0.001) in patients with glaucoma. Both devices showed similar discriminative power. The MD metric had marginally better discrimination with CMP (pAUC difference ± standard error, 0.019±0.009, P = 0.035). The 95% limits of agreement for the MS were reduced by 13% in CMP compared with HFA in participants with glaucoma and by 49% in normal participants. Mean absolute deviation was similar, with no significant differences., Conclusions: Relative diagnostic precision of the 2 devices is equivalent. Test-retest variability of MS for CMP was better than for HFA., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Correctly classifying progression in moderate to advanced glaucoma is difficult. Pointwise visual field test-retest variability is high for sensitivities below approximately 20 dB; hence, reliably detecting progression requires many test repeats. We developed a testing approach that does not attempt to threshold accurately in areas with high variability, but instead expends presentations increasing spatial fidelity., Methods: Our visual field procedure Australian Reduced Range Extended Spatial Test (ARREST; a variant of the Bayesian procedure Zippy Estimation by Sequential Testing [ZEST]) applies the following approach: once a location has an estimated sensitivity of <17 dB (a "defect"), it is checked that it is not an absolute defect (<0 dB, "blind"). Saved presentations are used to test extra locations that are located near the defect. Visual field deterioration events are either: (1) decreasing in the range of 40 to 17 dB, (2) decreasing from >17 dB to "defect", or (3) "defect" to blind. To test this approach we used an empirical database of progressing moderate-advanced 24-2 visual fields (121 eyes) that we "reverse engineered" to create visual field series that progressed from normal to the end observed field. ARREST and ZEST were run on these fields with test accuracy, presentation time, and ability to detect progression compared., Results: With specificity for detecting progression matched at 95%, ZEST and ARREST showed similar sensitivity for detecting progression. However, ARREST used approximately 25% to 40% fewer test presentations to achieve this result in advanced visual field damage. ARREST spatially defined the visual field deficit with greater precision than ZEST due to the addition of non-24-2 locations., Conclusions: Spending time trying to accurately measure visual field locations that have high variability is not productive. Our simulations indicate that giving up attempting to quantify size III white-on-white sensitivities below 17 dB and using the presentations saved to test extra locations should better describe progression in moderate-to-advanced glaucoma in shorter time., Translational Relevance: ARREST is a new visual field test algorithm that provides better spatial definition of visual field defects in faster test time than current procedures. This outcome is achieved by substituting inaccurate quantification of sensitivities <17 dB with new spatial locations.

Purpose: We determine the feasibility of using a home-based tablet device to monitor retinal sensitivity (RS) in intermediate age-related macular degeneration (iAMD), the benefits of weekly reminders, and the comparison with clinic-based results., Methods: A customized test for tablets was designed to measure RS (within central 2°) in individuals with iAMD at weekly intervals in their home, with remote data collection. Half of the participants were randomized to receive weekly test reminders. Clinic-based microperimetric macular sensitivity results were compared to tablet results. Participation rates were analyzed at 2 months., Results: Of 38 participants (mean age, 70.3 years) with iAMD enrolled in the study, 21 (55%) were using the tablet-based test at 2 months. Common reasons for inactivity were noncompatible devices (41.1%) or other technology access issues (35.3%). Participants with weekly reminders completed tests more regularly (6.6 ± 3.9 vs. 8.7 ± 4.1 days, P = 0.01), but weekly reminders showed no effect on participation rates ( P = 0.69). Mean RS from the tablet device (25.03 ± 2.41 dB) was not significantly different from the clinic-based microperimetry performance (25.21 ± 2.20 dB; P = 0.58)., Conclusions: Regular monitoring of retinal function on a tablet device in a home setting in individuals with iAMD is feasible with results comparable to those of clinic-based microperimetry. Weekly reminders resulted in more frequent testing. Seamless ability to access technology will be important for higher participation rates., Translational Relevance: The use of home-monitoring on a tablet-device is promising, but adequate support for an older cohort to take up technology is required if such a tool is to be useful for long-term home monitoring.

The data were gathered from 98 eyes of 98 ocular healthy subjects. The subject ages ranged from 18 to 79 years with a mean (and standard deviation) of 47 (17) years. Each subject underwent two visual field tests, one of the central visual field (64 locations within 26° of fixation) and one of the peripheral visual field (64 locations with eccentricity from 26° to up to 81°). Luminance thresholds for the Goldmann size V stimulus (with a diameter of 1.72° of visual angle) were obtained with the ZEST Bayesian test procedure. Each test was conducted twice within 90 days.

Background Several visual tasks have been proposed as indirect assays of the balance between cortical inhibition and excitation in migraine. This study aimed to determine whether daily measurement of performance on such tasks can reveal perceptual changes in the build up to migraine events. Methods Visual performance was measured daily at home in 16 non-headache controls and 18 individuals with migraine using a testing protocol on a portable tablet device. Observers performed two tasks: luminance increment detection in spatial luminance noise and centre surround contrast suppression. Results Luminance thresholds were reduced in migraine compared to control groups ( p < 0.05), but thresholds did not alter across the migraine cycle; while headache-free, centre-surround contrast suppression was stronger for the migraine group relative to controls ( p < 0.05). Surround suppression weakened at around 48 hours prior to a migraine attack and strengthened to approach their headache-free levels by 24 hours post-migraine (main effect of timing, p < 0.05). Conclusions Daily portable testing of vision enabled insight into perceptual performance in the lead up to migraine events, a time point that is typically difficult to capture experimentally. Perceptual surround suppression of contrast fluctuates during the migraine cycle, supporting the utility of this measure as an indirect, non-invasive assay of the balance between cortical inhibition and excitation.

Purpose: To determine the extent to which (1) optic nerve tissue is displaced following mild acute elevation of intraocular pressure, and (2) clinically accessible measures at the anterior eye can be used as a surrogate for such displacements., Methods: We imaged the optic disc of 21 healthy subjects before and after intraocular pressure (IOP) elevation of ~10 mmHg delivered by ophthalmodynamometry. Steady-state tissue displacement during IOP elevation was assessed axially from OCT data, and laterally from SLO data. Recovery from IOP elevation was assessed by tracking a single vertical B-scan through the cup centre. Anatomical structures were demarcated by three masked clinicians to determine lateral shifts for temporal cup edge and central disc vessels, and axial shifts of disc surface and anterior lamina cribrosa. Spatial maps of deformation were constructed within the demarcated cup and disc to assess within-tissue displacement. Measured displacements were correlated with corneal hysteresis, corneal thickness, and IOP., Results: The temporal cup edge moved more temporally with higher baseline IOP (R 2  = 0.33, p = 0.006) and with lesser elevation of IOP (R 2  = 0.43, p = 0.001); it moved more superiorly for thinner corneas (R 2  = 0.35, p = 0.007). Thinner corneas also produced less within-cup deformation, relative to that of the disc (R 2  = 0.39, p = 0.004). Axial displacement of the lamina and lateral displacement of vessels were often substantial (lamina 20 ± 15 μm, range 1-60 μm; vessels 37 ± 25 μm, range 2-102 μm) but did not correlate with measured parameters. Recovery from IOP elevation did not take more than 300-400 ms in any subject., Conclusions: Mild acute elevation of IOP produces large and rapidly reversible shifts in optic nerve tissue in young, healthy eyes. The resulting degree, direction and spatial distribution of cup movement are associated with IOP status and corneal thickness, but not corneal hysteresis., (© 2018 The Authors Ophthalmic & Physiological Optics © 2018 The College of Optometrists.)

Purpose: To determine the feasibility of a tablet-based application to detect changes in retinal sensitivity and correlations with underlying pathology in neovascular age-related macular degeneration (nAMD) eyes undergoing treatment and in at-risk fellow eyes., Method: Participants with nAMD in at least one eye were recruited, examined, and imaged using spectral-domain optical coherence tomography (SD-OCT). Retinal sensitivity was measured within the central 5° at 12 locations using a customized test delivered on an iPad. Test points were superimposed on SD-OCT locations to investigate structure/function relationships., Results: Included in the study were 53 nAMD eyes and 21 at-risk fellow eyes. In nAMD eyes, the mean retinal sensitivity was 24.1 ± 1.8 dB with reduced retinal sensitivity associated with the presence of atrophy ( P < 0.01), retinal pigment epithelium (RPE) disruption ( P < 0.01), and absent ellipsoid zone (EZ) ( P < 0.01), but not with the presence of subretinal fluid ( P = 0.94) nor intraretinal fluid ( P = 0.52). In at-risk eyes, the average retinal sensitivity was 28.8 ± 0.6 dB, with reduced sensitivity significantly associated with the presence of drusen, atrophy, RPE disruption, and absent EZ ( P < 0.01)., Conclusion: The tablet-based test of retinal sensitivity was able to be performed by an elderly cohort with nAMD. The ability to correlate differences in sensitivity with pathology is encouraging when considering using the tablet devices as a home monitoring tool with remote surveillance. Dual pathology often present with retinal fluid confounded our ability to correlate fluid with sensitivity., Translational Relevance: These findings highlight the potential of tablet-based devices in performing visual function measures as a home monitoring tool with remote surveillance for the earlier detection of nAMD.

Purpose: Current perimeters use fixed grid patterns. We test whether a grid based on an individual's retinal nerve fiber layer (RNFL) thickness profile would find more visual field (VF) defects., Methods: We describe the defect-based method for choosing test locations. First, the 26 VF locations with the highest positive predictive value to detect glaucoma from the 24-2 pattern are chosen. An additional 26 locations are chosen from a 2 × 2 degree grid based on RNFL thickness. An individualized map was used to relate VF locations to peripapillary RNFL thickness. To test whether the 52 locations chosen by the defect-based method find more defects than other test grids, we collected a 386-location (2 × 2 degree grid) VF measurement on 23 glaucoma participants and classed each location in the dataset as either abnormal or normal using a suprathreshold test. Using this data, defect-based sampling was compared to: a method that sampled VF locations uniformly around the optic nerve head (ONH); the 24-2 pattern; a polar pattern; and a reduced polar pattern. The outcome measure was the number of abnormal points that were selected as test locations., Results: For 8 eyes, no method found more abnormal points than would be expected by chance (hypergeometric distribution, P < 0.05). Of the remaining 15 eyes, the defect-based method identified more abnormal locations on nine eyes, which was significantly better than the other three sampling schemes (24-2: 2 eyes, P < 0.001; polar: 2 eyes, P < 0.001; reduced polar: 2 eyes, P < 0.004; and uniform: 1 eye, P < 0.001)., Conclusions: Using structural information to choose locations to test in a VF for individual patients identifies more abnormal locations than using existing grid patterns and uniform sampling based on structure.

Purpose: To determine the normal variation in orientation of the temporal nerve fiber raphe, and the accuracy with which it may be predicted or approximated in lieu of direct measurement., Methods: We previously described an algorithm for automatic measurement of raphe orientation from optical coherence tomography, using the intensity of vertically oriented macular cubes. Here this method was applied in 49 healthy participants (age 19-81 years) and 51 participants with primary open angle glaucoma (age 51-80 years)., Results: Mean fovea-disc-raphe angle was 173.5° ± 3.2° (range = 166°-182°) and 174.2° ± 3.4° (range = 166°-184°) in healthy and glaucoma patients, respectively. Differences between groups were not significant. Fovea-disc-raphe angle was not correlated with age or axial length (P > 0.4), showed some symmetry between eyes in glaucoma (R2 = 0.31, P < 0.001), and little symmetry in the healthy group (P = 0.06). Fovea-disc angle was correlated with fovea-raphe angle (R2 = 0.27, P = 0.0001), but was not a good predictor for raphe orientation (average error = 6.8°). The horizontal axis was a better predictor (average error = 3.2°; maximum error = 9.6°), but still gave approximately twice the error previously reported for direct measurement from macular cubes., Conclusions: There is substantial natural variation in temporal nerve fiber raphe orientation, which cannot be predicted from age, axial length, relative geometry of the disc and fovea, or the contralateral eye. For applications to which the orientation of the raphe is considered important, it should be measured directly.

Purpose: To explore the potential relationship between optic disc haemorrhage, venous pulsation pressure (VPP), ocular perfusion pressures and visual field change in glaucomatous and glaucoma suspect eyes., Materials and Methods: This prospective observational study examined 155 open angle glaucoma or glaucoma suspect eyes from 78 patients over 5 years. Patients were followed with 3 monthly non-mydriatic disc photographs, 6 monthly standard automated perimetry and annual ophthalmodynamometry. The number of disc haemorrhages in each hemidisc was counted across the study period. Visual field rate of change was calculated using linear regression on the sensitivity of each location over time, then averaged for the matching hemifield. VPP and central retinal artery diastolic pressure (CRADP) were calculated from the measured ophthalmodynanometric forces (ODF). The difference between brachial artery diastolic pressure (DiastBP) and CRADP was calculated as an index of possible flow pathology along the carotid and ophthalmic arteries., Results: Mean age of the cohort was 71.9 ± 7.3 Years. 76 out of 155 eyes (49%) followed for a mean period of 64.2 months had at least 1 disc haemorrhage. 62 (81.6%) of these 76 eyes had recurrent haemorrhages, with a mean of 5.94 recurrences over 64.2 months. Using univariate analysis, rate of visual field change (P<0.0001), VPP (P = 0.0069), alternative ocular perfusion pressure (CRADP-VPP, P = 0.0036), carotid resistance index (DiastBP-CRADP, P = 0.0108) and mean brachial blood pressure (P = 0.0203) were significantly associated with the number of disc haemorrhages. Using multivariate analysis, increased baseline visual field sensitivity (P = 0.0243, coefficient = 0.0275) was significantly associated with disc haemorrhage, in conjunction with higher VPP (P = 0.0029, coefficient = 0.0631), higher mean blood pressure (P = 0.0113, coefficient = 0.0190), higher carotid resistance index (P = 0.0172, coefficient = 0.0566), and rate of visual field loss (P<0.0001, coefficient = -2.0695)., Conclusions: Higher VPP was associated with disc haemorrhage and implicates the involvement of venous pathology, but the effect size is small. Additionally, a greater carotid resistance index suggests that flow pathology in the ophthalmic or carotid arteries may be associated with disc haemorrhage.

Objective: We propose an effective automatic method for identification of four retinal layer boundaries from the spectral domain optical coherence tomography images in the presence and absence of pathologies and morphological changes due to disease., Methods: The approach first finds an approximate location of three reference layers and then uses these to bound the search space for the actual layers, which is achieved by modeling the problem as a graph and applying Dijkstra's shortest path algorithm. The edge weight between nodes is determined using pixel distance, slope similarity to a reference, and nonassociativity of the layers, which is designed to overcome the distorting effects that pathology can play in the boundary determination., Results: The accuracy of our method was evaluated on three different datasets. It outperforms the current five state-of-the-art methods. On average, the mean and standard deviation of the root-mean-square error in the form of mean ± standard deviation in pixels for our method is 1.57 ± 0.69, which is lower than compared to the existing top five methods of 16.17 ± 22.64, 6.66 ± 9.11, 5.70 ± 10.54, 3.69 ± 2.04, and 2.29 ± 1.54., Conclusion: Our method is highly accurate, robust, reliable, and consistent. This identification can enable to quantify the biomarkers of the retina in large-scale study for assessing, monitoring disease progression, as well as early detection of retinal diseases., Significance: Identification of these boundaries can help to determine the loss of neuroretinal cells or layers and the presence of retinal pathology, which can be used as features for the automatic determination of the stages of retinal diseases.

Purpose: Interindividual variance in optic nerve head (ONH) position, axial length, and location of the temporal raphe suggest that customizing mapping between visual field locations and ONH sectors for individuals may be clinically useful. Herein we quantify the proportion of the population predicted to have structure-function mappings that markedly deviate from "average," and thus would benefit from customized mapping., Design: Database study and case report., Participants: Population database of 2836 eyes from the Beijing Eye Study and a single case report of an individual with primary open-angle glaucoma., Methods: Using the morphometric fundus data of the Beijing Eye Study for 2836 eyes and applying a recently developed model based on axial length and ONH position relative to the fovea, we determined for each measurement location in the 24-2 Humphrey (Carl Zeiss Meditec, Dublin, CA) visual field the proportion of eyes for which, in the customized approach as compared with the generalized approach, the mapped ONH sector was shifted into a different sector. We determined the proportion of eyes for which the mapped ONH location was shifted by more than 15°, 30°, or 60°., Main Outcome Measures: Mapping correspondence between locations in visual field space to localized sectors on the ONH., Results: The largest interindividual differences in mapping are in the nasal step region, where the same visual field location can map to either the superior or inferior ONH, depending on other anatomic features. For these visual field locations, approximately 12% of eyes showed a mapping opposite to conventional expectations., Conclusions: Anatomically customized mapping shifts the map markedly in approximately 12% of the general population in the nasal step region, where visual field locations can map to the opposite pole of the ONH than conventionally considered. Early glaucomatous damage commonly affects this region; hence, individually matching structure to function may prove clinically useful for the diagnosis and monitoring of progression within individuals., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Motivation: Next generation sequencing machines produce vast amounts of genomic data. For the data to be useful, it is essential that it can be stored and manipulated efficiently. This work responds to the combined challenge of compressing genomic data, while providing fast access to regions of interest, without necessitating decompression of whole files., Results: We describe CSAM (Compressed SAM format), a compression approach offering lossless and lossy compression for SAM files. The structures and techniques proposed are suitable for representing SAM files, as well as supporting fast access to the compressed information. They generate more compact lossless representations than BAM, which is currently the preferred lossless compressed SAM-equivalent format; and are self-contained, that is, they do not depend on any external resources to compress or decompress SAM files., Availability and Implementation: An implementation is available at https://github.com/rcanovas/libCSAM CONTACT: canovas-ba@lirmm.frSupplementary Information: Supplementary data is available at Bioinformatics online., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Purpose: A recent proposal for why glaucomatous perimetric sensitivities of approximately 15 to 19 dB or less are unreliable involves the idea that the neural response of normal retinal ganglion cells saturates for intense perimetric stimuli. A predicted consequence of this saturation is that the neural response for two different high intensity stimuli will be the same, leading to an inability to discriminate between them. We test that prediction., Methods: We used a two-interval forced-choice method of constant stimuli (7 steps, 40 presentations/step) to measure the ability of four healthy observers to discriminate between different intensity Size III perimetric stimuli at 0°, 9°, and 21° eccentricity. The lower intensity stimulus for each discrimination was either 27, 23, 19, 15, or 11 dB (Humphrey Field Analyzer equivalents)., Results: Foveally, discrimination performance exceeded 90% for all observers provided the more intense stimulus was made sufficiently intense, even if the lower intensity stimulus in the pair was itself already intense (≤19 dB). The shapes of the curves were similar across all lower intensity stimulus values investigated. At 21°, discrimination performance exceeded 90% in three of the four observers despite the lower intensity stimulus being 19 dB., Conclusions: Observers can reliably discriminate between two different, but both very intense, perimetric stimuli, indicating that responses of the human visual system are not saturated by such stimuli. Therefore, the cause of high perimetric test-retest variability is not readily predicted from our current knowledge of how normal ganglion cells respond to high intensity stimuli.

We evaluated several approaches for automatic location of the temporal nerve fiber raphe from standard macular cubes acquired on a Heidelberg Spectralis OCT. Macular cubes with B-scan separation of 96-122 µm were acquired from 15 healthy participants, and "high density" cubes with scan separation of 11 µm were acquired from the same eyes. These latter scans were assigned to experienced graders for subjective location of the raphe, providing the ground truth by which to compare methods operating on the lower density data. A variety of OCT scan parameters and image processing strategies were trialed. Vertically oriented scans, purposeful misalignment of the pupil to avoid reflective artifacts, and the use of intensity as opposed to thickness of the nerve fiber layer were all critical to minimize error. The best performing approach "cFan" involved projection of a fan of lines from each of several locations across the foveal pit; in each fan the line of least average intensity was identified. The centroid of the crossing points of these lines provided the raphe orientation with an average error of 1.5° (max = 4.1°) relative to the human graders. The disc-fovea-raphe angle was 172.4 ± 2.3° (range = 168.5-176.2°), which agrees well with other published estimates.

Purpose: To validate the performance of a new perimetric algorithm (Gradient-Oriented Automated Natural Neighbor Approach; GOANNA) in humans using a novel combination of computer simulation and human testing, which we call Artificial Scotoma Generation (ASG)., Methods: Fifteen healthy observers were recruited. Baseline conventional automated perimetry was performed on the Octopus 900. Visual field sensitivity was measured using two different procedures: GOANNA and Zippy Estimation by Sequential Testing (ZEST). Four different scotoma types were induced in each observer by implementing a novel technique that inserts a step between the algorithm and the perimeter, which in turn alters presentation levels to simulate scotomata in human observers. Accuracy, precision, and unique number of locations tested were measured, with the maximum difference between a location and its neighbors (Max&#95;d) used to stratify results., Results: GOANNA sampled significantly more locations than ZEST (paired t -test, P < 0.001), while maintaining comparable test times. Difference plots showed that GOANNA displayed greater accuracy than ZEST when Max&#95;d was in the 10 to 30 dB range (with the exception of Max&#95;d = 20 dB; Wilcoxon, P < 0.001). Similarly, GOANNA demonstrated greater precision than ZEST when Max&#95;d was in the 20 to 30 dB range (Wilcoxon, P < 0.001)., Conclusions: We have introduced a novel method for assessing accuracy of perimetric algorithms in human observers. Results observed in the current study agreed with the results seen in earlier simulation studies, and thus provide support for performing larger scale clinical trials with GOANNA in the future., Translational Relevance: The GOANNA perimetric testing algorithm offers a new paradigm for visual field testing where locations for testing are chosen that target scotoma borders. Further, the ASG methodology used in this paper to assess GOANNA shows promise as a hybrid between computer simulation and patient testing, which may allow more rapid development of new perimetric approaches.

Purpose: Recently in glaucoma, different mapping schemes to combine structural and functional information within the macula have been proposed. This paper aims to investigate whether the changes in foveal shape parameters are important in the mapping between structure and function within the macular region., Methods: Twenty younger adults (aged 24- to 33-years old) and 10 older adults (aged 62- to 76-years old) participated. On each subject, four foveally-centered radial spectral-domain optical coherence tomography (SD-OCT) scans with 45° of separation between each scan were acquired. After scan acquisition, foveal shape was extracted by fitting a previously proposed model that has been used to customize structure-function mapping in the macular region. Three parameters were obtained from the scans and then compared: the central thickness, the maximum thickness, and the radius., Results: There were significant differences in the foveal shape parameters between subjects. There was no main effect of the scan axis for the central thickness; however, there was an interaction between the scan axis and maximum thickness and between the scan axis and radius. With respect to the effect of age, we did not find a main effect for the central thickness, the maximum thickness or the radius, although this parameter approached statistical significance., Conclusions: In our study, we demonstrated that the foveal shape is different for different subjects, but predictable superiorly and inferiorly within an individual. Our study highlights features important for the development of individually customized structure-function maps for the investigation of glaucomatous damage in the macular region.

Purpose: We develop a methodology for designing perimetric screening procedures, using Octopus perimeters as a case study., Methods: The process has three stages: analytically determining specificity and number of presentations required for different multisampling suprathreshold schemes at a single location of the visual field, ranking visual field locations by their positive predictive value (PPV) for glaucoma, and determining a pass/fail criteria for the test. For the case study the Octopus G-program visual field test pattern is used, and a dataset of 385 glaucoma and 86 normal patients., Results: Using a 1-of-3 sampling strategy at a level equal to the 95 percentile of normal observers gave the most robust specificity under the influences of false-negative responses using an average of 1.5 presentations per location. The PPV analysis gave 19 locations that completely classified our glaucomatous data. A further 9 points were added to screen for nonglaucomatous loss. The final stage found that insisting that 3 locations are missed for the screening to fail gave a simulated specificity and sensitivity of approximately 95% for unreliable responders., Conclusions: Our method gives a principled approach to choosing between the many parameters of a visual field screening procedure. We have developed a procedure for the Octopus that should terminate in less than 1 minute for normal observers with high specificity and sensitivity to glaucoma., Translational Relevance: Visual field screening is used in community settings and eye care practice. This study provides a principled approach to the development of such screening procedures and details a new procedure.

Purpose: To introduce a perimetric algorithm (Spatially Weighted Likelihoods in Zippy Estimation by Sequential Testing [ZEST] [SWeLZ]) that uses spatial information on every presentation to alter visual field (VF) estimates, to reduce test times without affecting output precision and accuracy., Methods: SWeLZ is a maximum likelihood Bayesian procedure, which updates probability mass functions at VF locations using a spatial model. Spatial models were created from empirical data, computational models, nearest neighbor, random relationships, and interconnecting all locations. SWeLZ was compared to an implementation of the ZEST algorithm for perimetry using computer simulations on 163 glaucomatous and 233 normal VFs (Humphrey Field Analyzer 24-2). Output measures included number of presentations and visual sensitivity estimates., Results: There was no significant difference in accuracy or precision of SWeLZ for the different spatial models relative to ZEST, either when collated across whole fields or when split by input sensitivity. Inspection of VF maps showed that SWeLZ was able to detect localized VF loss. SWeLZ was faster than ZEST for normal VFs: median number of presentations reduced by 20% to 38%. The number of presentations was equivalent for SWeLZ and ZEST when simulated on glaucomatous VFs., Conclusions: SWeLZ has the potential to reduce VF test times in people with normal VFs, without detriment to output precision and accuracy in glaucomatous VFs., Translational Relevance: SWeLZ is a novel perimetric algorithm. Simulations show that SWeLZ can reduce the number of test presentations for people with normal VFs. Since many patients have normal fields, this has the potential for significant time savings in clinical settings.

Background/aims: A recent study has shown that the paracentral upper visual field in the macular region is often affected in glaucoma and suggested that two test locations within the central 10° should be added to the Humphrey 24-2 visual field test pattern to detect such damage. This study employed data collected using a different visual field test pattern to determine whether the same two-test locations are supported as the most informative regarding visual field loss., Methods: A data set of 62 patients with glaucoma and 48 controls had visual field assessments on the Medmont perimeter M700 (Central Threshold or Glaucoma test). Twelve 24-2 locations within central 10° of visual field were derived by interpolation of the nearest neighbours of the Medmont data. The remaining 24 Medmont locations in the central 10° of the glaucomatous set were labelled as abnormal if their thresholds fell outside the lower 5th centile of the age-corrected values for the same location from the control group. All possible pairs of the 24 locations were then assessed for diagnostic power by counting the number of patients that had 0, 1 or 2 abnormal locations in a pair., Results: Overwhelmingly, pairs of locations in the superior macular region were more often abnormal than pairs in the inferior. About 50 pairs of locations had equivalent ability to detect damage, with the best pair having 74% of patients with at least one of the locations as abnormal, and 52% both., Conclusions: Adding a pair of locations to the superior macular region of the Humphrey Visual Field 24-2 pattern increases the number of abnormal locations identified in individuals with glaucoma., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: In the macula, retinal ganglion cells (RGCs) are displaced from their receptive fields. We used optical coherence tomography (OCT) to customize displacements for individual eyes by taking into account macular shape parameters, and determined the likely effect of individual anatomical differences on structure-function mapping in the central visual field., Methods: Using the population average model of Drasdo et al. as a starting point, we altered the RGC count in that model based on the ratio of an individual's RGC layer plus inner plexiform layer thickness to the population average on a pointwise basis as a function of eccentricity from the fovea. For 20 adults (age, 24-33; median age, 28) with normal vision, we computed displacements with the original model and our customized approach. We report the variance in displacements among individuals and compare the effects of such displacements on structure-function mapping of the commonly used the 10-2 visual field pattern., Results: As expected, customizing the displacement using individual OCT data made only a small difference on average from the population-based values predicted by the Drasdo et al. model. However, the range between individuals was over 1° at many locations, and closer to 2° at some locations in the superior visual field., Conclusions: Individualizing macular displacement measurements based on OCT data for an individual can result in large spatial shifts in the retinal area corresponding to 10-2 locations, which may be important for clinical structure-function analysis when performed on a local, spatial scale.

Purpose: To determine whether the structure-function relationship in glaucoma can be strengthened by using more precise structural and functional measurements combined with individualized structure-function maps and custom sector selection on the optic nerve head (ONH)., Design: Cross-sectional study., Participants: One eye of each of 23 participants with glaucoma., Methods: Participants were tested twice. Visual fields were collected on a high-resolution 3° × 3° grid (164 locations) using a Zippy Estimation by Sequential Testing test procedure with uniform prior probability to improve the accuracy and precision of scotoma characterization relative to standard methods. Retinal nerve fiber layer (RNFL) thickness was measured using spectral-domain optical coherence tomography (OCT; 4 scans, 2 per visit) with manual removal of blood vessels. Individualized maps, based on biometric data, were used. To customize the areas of the ONH and visual field to correlate, we chose a 30° sector centered on the largest defect shown by OCT and chose visual field locations using the individualized maps. Baseline structure-function correlations were calculated between 24-2 locations (n = 52) of the first tested visual field and RNFL thickness from 1 OCT scan, using the sectors of the Garway-Heath map. We added additional data (averaged visual field and OCT, additional 106 visual field locations and OCT without blood vessels, individualized map, and customized sector) and recomputed the correlations., Main Outcome Measures: Spearman correlation between structure and function., Results: The highest baseline correlation was 0.52 (95% confidence interval [CI], 0.13-0.78) in the superior temporal ONH sector. Improved measurements increased the correlation marginally to 0.58 (95% CI, 0.21-0.81). Applying the individualized map to the large, predefined ONH sectors did not improve the correlation; however, using the individualized map with the single 30° ONH sector resulted in a large increase in correlation to 0.77 (95% CI, 0.47-0.92)., Conclusions: Using more precise visual field and OCT measurements did not improve structure-function correlation in our cohort, but customizing the ONH sector and its associated visual field points substantially improved correlation. We suggest using customized ONH sectors mapped to individually relevant visual field locations to unmask localized structural and functional loss., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: We compared measurements of central retinal sensitivity on a portable, low-cost tablet device to the established method of microperimetry in age-related macular degeneration (AMD)., Methods: A customized test designed to measure central retinal sensitivity (within the central 1° radius) on a tablet device was developed using an open-source platform called PsyPad. A total of 30 participants with AMD were included in this study, and all participants performed a practice test on PsyPad, followed by four tests of one eye and one test of the other eye. Participants then underwent standardized microperimetry examinations in both eyes., Results: The average test duration on PsyPad was 53.9 ± 7.5 seconds, and no significant learning effect was observed over the examinations performed ( P = 1.000). The coefficient of repeatability of central retinal sensitivity between the first two examinations on PsyPad was ±1.76 dB. The mean central retinal sensitivity was not significantly different between PsyPad (25.7 ± 0.4 dB) and microperimetry (26.1 ± 0.4 dB, P = 0.094), and the 95% limits of agreement between the two measures were between -4.12 and 4.92 dB., Conclusions: The measurements of central retinal sensitivity can be performed effectively using a tablet device, displaying reasonably good agreement with those obtained using the established method of microperimetry., Translational Relevance: These findings highlight the potential of tablet devices as low-cost and portable tools for developing and performing visual function measures that can be easily and widely implemented.