A comparison of tangent screen, Goldmann, and Humphrey perimetry in the detection and localization of occipital lesions

doi:10.1016/S0161-6420(99)00092-5

Ophthalmology

Volume 107, Issue 3, March 2000, Pages 527-544

https://doi.org/10.1016/S0161-6420(99)00092-5 Get rights and content

Abstract

Objective

To compare manual kinetic perimetry with tangent screen and Goldmann techniques and automated static perimetry with the Humphrey Field Analyzer in the detection and localization of occipital lobe lesions.

Design

Prospective consecutive comparative case series.

Participants

Twelve patients with well-defined occipital lobe infarcts on magnetic resonance (MR) imaging were studied.

Main outcome measures

The patients were tested by tangent screen, Goldmann, and Humphrey perimetry (central 30-2 threshold program). The three visual fields were compared and correlated with MR images.

Results

All three perimetric techniques detected the presence of postchiasmal lesions. However, localization of lesions differed with perimetric technique. Visual fields obtained from tangent screen and Goldmann perimetry were similar and corresponded well with the location of lesions on MR images in all 12 patients. Humphrey perimetry inaccurately localized the lesion to the proximal part of the postchiasmal pathway by revealing incongruous fields in two patients, failed to detect sparing of the posterior occipital cortex or occipital pole in four patients, and estimated a larger extent of damage in one patient when compared with MR images and manual perimetry.

Conclusions

All three perimetric techniques are satisfactory screening tests to detect occipital lesions. However, tangent screen and Goldmann perimetry provide information about the location and extent of lesions that is more consistent with prevailing knowledge of the effects of the lesion in the postgeniculate visual pathway.

Section snippets

Materials and methods

Consecutive patients with homonymous hemianopia on screening with Humphrey perimetry were recruited into the study from the Neuro-ophthalmology Unit at The Toronto Hospital. Serial axial and sagittal T1-weighted (TR, 516–517 msec; TE, 8–11 msec) and T2-weighted (TR, 2200–4383 msec; TE, 80–95 msec, two separate acquisitions) MR images were obtained (slice thickness, 5 mm), with the Signa 1.5 Tesla system (version 5.4.2/General Electric Medical Systems, Milwaukee, WI). Patients with well-defined

Results

Twelve patients had reliable fields in all three perimetric examinations and well-defined occipital infarcts on MRI and were included in the analysis. There were nine men and three women, with a mean age of 57.5 years (range, 29–80 years). The mean duration of patients’ symptoms of impaired vision was 8 months (range, 4–20 months). The results of visual field examinations using tangent screen, Goldmann, and Humphrey perimetry are shown in Figure 1.

Table 1 summarizes our interpretation of the

Discussion

With the advent of newer generations of automated perimeters and the availability of more sophisticated software programs, such as STATPAC of the Humphrey Field Analyzer, automated perimetry is increasingly relied on for detection and localization of visual pathway damage in clinical practice. Establishing its ability to detect abnormal fields and its accuracy to localize lesions is important for the diagnosis and management of neurologic diseases. Prior studies have shown that automated

Conclusion

The results of this investigation indicate that both manual kinetic perimetry (tangent screen and the Goldmann perimeter) and automated static perimetry (Humphrey Field Analyzer) are satisfactory as screening tests to detect occipital lesions. However, tangent screen and Goldmann perimetry provide information about the location and extent of lesions as identified by MRI that is most consistent with prevailing knowledge12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22of the perimetric effects of

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Kinetic perimetry is the traditional method used to measure the extent of the visual field via an examiner controlling a moving stimulus (Goldmann, 1945a, 1945b, 1946). This technique is useful when examining patients without visual field defects within the central 30° (Hicks & Anderson, 1983; Keltner et al., 1999; Stewart, 1992) or patients with intracranial disease (Keltner & Johnson, 1984; Wong & Sharpe, 2000). Manual kinetic perimetry has the advantage of obtaining measurements while keeping pace with the patient’s response time for stimulus exposure.
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^☆: Supported by Medical Research Council of Canada Grant MA15362 and by the E. A. Baker Foundation, Canadian National Institute for the Blind.

¹: The authors have no commercial interests in any products described in the manuscript.

View full text

Original ArticlesA comparison of tangent screen, Goldmann, and Humphrey perimetry in the detection and localization of occipital lesions1☆,

Abstract

Objective

Design

Participants

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Conclusion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Curr Opin Neurobiol

Ophthalmology

A comparison of Goldmann and Humphrey automated perimetry in patients with glaucoma

Br J Ophthalmol

Automated (Octopus) and manual (Goldmann) perimetry in glaucoma

Albrecht von Graefes Arch Exp Ophthalmol

Automated and manual perimetry—a six-year overview. Special emphasis on neuro-ophthalmic problems

Ophthalmology

The Visual FieldsText and Atlas of Clinical Perimetry

Wounds of the visual pathway.Part II: The striate cortex

J Neurol Neurosurg Psychiatry

Visual field changes after temporal lobectomy in man

Neurology

The architecture of the optic radiation in the temporal lobe of man

Brain

Visual field changes following anterior temporal lobectomytheir significance in relation to “Meyer’s loop” of the optic radiation

Brain

Original Articles
A comparison of tangent screen, Goldmann, and Humphrey perimetry in the detection and localization of occipital lesions¹☆,