(Investigative Ophthalmology and Visual Science. 2000;41:2558-2560.)
© 2000
by The Association for Research in Vision and Ophthalmology, Inc.
Frequency Doubling Perimetry in Resolved Optic Neuritis
Naoya Fujimoto and
Emiko Adachi-Usami
From the Department of Ophthalmology, Chiba University School of Medicine, Chiba, Japan.
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Abstract
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PURPOSE. To study the visual field with frequency doubling technology (FDT) in
patients with recovered optic neuritis and to detect loss of
magnocellular projecting cells (M cells) in the extrafovea.
METHODS. Fourteen patients who had undergone one attack of optic neuritis and
recovered normal vision (1.0 or better) and critical fusion frequency
were examined with conventional Humphrey automated perimetry central
30-2 and FDT c-20 threshold tests. After 1 year, 12 patients were
reexamined with central 30-2 and FDT c-20 tests. The visual fields
examined by both perimeters were divided into three zones. The mean
sensitivity in each zone in involved eyes, uninvolved eyes, and
involved eyes after 1 year was compared with that in healthy eyes.
RESULTS. Conventional automated perimetry showed depression toward the fovea.
However, FDT demonstrated general depression, especially midperipheral
deficits. After 1 year, the midperipheral deficits with frequency
doubling perimetry (FDP) improved, as did central depression,
as observed with central 30-2 tests.
CONCLUSIONS. FDT was developed to detect early glaucomatous damage, which was
thought to be caused by a loss of M cells. Our study suggested that
patients with resolved optic neuritis also had a loss of M-cell
function in the extrafoveal area, as observed by field damage and its
recovery.
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Introduction
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Patients with optic neuritis have shown abnormalities of critical
flicker frequency,1
contrast sensitivity, color vision,
and central visual field2
3
after their visual acuity
improved. Except visual field, these tests reflected foveal function.
Wall reported that parvocellular projecting retinal ganglion cell (P
cell) function was more affected in the foveal area than the
magnocellular projecting cell (M cell) function in resolved optic
neuritis.2
P-cell function reflected color vision and
contrast sensitivity at high spatial frequency and low temporal
frequency. However, Jacobson and Olson1
showed impaired
critical flicker frequency, which reflected M-cell function, in the
fovea in recovered optic neuritis. In the extrafoveal region,
sensitivity at some temporal frequency was checked at maximal
eccentricity of 10° in optic neuritis.4
Recently,
frequency doubling technology (FDT) has been developed to detect
glaucomatous damage.5
6
This perimetry, using frequency
doubling illusion, reflected a subclass of M-cell
(MY) function even at an eccentricity of
20°. To our knowledge, no reports have described M-cell function in
optic neuritis at the extrafoveal area. We studied M-cell function at a
range of 20° in patients with recovered optic neuritis with the use
of FDT and compared the results with conventional automated perimetry.
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Materials and Methods
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Fourteen patients (6 men and 8 women) who had one attack of
decreased vision (range, 0–0.5) and recovered their vision and
critical fusion frequency to normal ranges were studied. Their ages
ranged from 15 to 55 years old (mean, 35.4 years). Ten patients had an
attack of decreased vision in one eye, and 4 patients had binocular
loss of vision. Only one eye in these 4 patients was randomly selected.
Fourteen healthy volunteers (7 men and 7 women) were included in this
study. They ranged in age from 24 to 50 years (mean, 36.7 years). All
had 1.0 or better visual acuity and 35 Hz or more of critical fusion
frequency, as measured by CFF Test Apparatus II (Matsumoto Medical
Instruments, Osaka, Japan). The stimulation subtended 2° of arc.
Critical fusion frequency was determined when the subjects perceived
the beginning of flicker. Three descending trials were averaged. The
conventional visual field was performed with Humphrey field analyzer
750 (Zeiss-Humphrey, Dublin, CA). The central visual field was measured
by threshold central 30-2 (76 test points in central 30° field)
program. Frequency doubling perimetry was measured by FDT
(Humphrey-Welch Allyn, Dublin, CA). The program was threshold c-20 (17
test areas in 20° field). One test area was 10° of square or arc
(the very center). Each area had black and white 0.25 cycle per degree
sinusoidal grating at 25 Hz flickering. The contrast between black and
white varied automatically with the response of the subjects. Contrast
sensitivity was calculated from log contrast and expressed as dB. Both
visual fields were measured twice after recovery, and the second result
was adopted. Twelve patients were reexamined with both perimeters after
1 year. Results with more than 30% of false positive, false negative,
or fixation loss were excluded. The visual field was divided into three
zones, which were composed of 1 test area (R1; the very center), 4 test
areas (R2; inside 10° field), and 12 test areas (R3; inside 20°
field) of FDT (Fig. 1A
). The Humphrey 30-2 visual field was also divided into three zones
corresponding to the three respective FDT zones (Fig. 1B)
. Age,
critical fusion frequency, and mean sensitivity in each zone in
involved eyes, uninvolved eyes, and involved eyes after 1 year was
compared with those in healthy eyes using one-way ANOVA and post hoc
tests (Bonferroni-Dunn method). Statistical significance level was
0.0167 for critical fusion frequency and 0.0083 for age and mean
sensitivity.
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Figure 1. (A) Three zones (R1, R2, and R3) in FDT threshold c-20 are
shown as right eye. R1 is the central circle at central 5°. R2 is 4
areas between 5 and 10°. R3 is 12 squares between 10 and 20°.
(B) Three zones in Humphrey threshold central 30-2
corresponding with those in FDT c-20 are shown.
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The research was conducted in accordance with institutional guidelines
and with the tenets of the World Medical Association Declaration of
Helsinki. We obtained written informed consent from each subject.
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Results
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All data are shown in Table 1
.
Critical fusion frequency was 44.1 ± 1.1 (mean ± SE) Hz in
eyes that had a previous attack of optic neuritis, 46.3 ± 0.85 Hz
in unaffected eyes, and 48.9 ± 1.2 Hz in healthy eyes. Critical
fusion frequency in involved eyes was significantly (P = 0.0021) decreased, compared with that in healthy eyes.
Fourteen visual fields by Humphrey 30-2 were estimated as 8 with normal
findings and 6 with localized defects (2 peripheral rim, 1 paracentral,
1 central scotoma, and 2 enlarged blind spots), according to criteria
of the Optic Neuritis Treatment Trials.7
None had dense central scotomas.
Mean sensitivity in R1 and R2 with Humphrey 30-2 in involved eyes was
significantly lower than that in each respective zone in healthy eyes
(Fig. 2A
). Mean sensitivity in R3 in involved eyes was not significantly
decreased. After 1 year, mean sensitivity in R1 and R2 with Humphrey
30-2 in 12 involved eyes was also significantly lower than that in
healthy eyes. Statistical P level (0.0002) in mean
sensitivity in R1 decreased to 0.0025 after 1 year.
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Figure 2. (A) The mean sensitivity in three zones by Humphrey 30-2
corresponding to three respective zones by FDT c-20. The mean
sensitivity in R1 and R2 in involved eyes was significantly lower than
that in R1 (P = 0.0002) and R2 (P =
0.0065), respectively, in healthy eyes. The mean sensitivity in R1 and
R2 zones in involved eyes after 1 year was also significantly
decreased. *Statistically significant decreased mean
sensitivity. Bars, SEs. (B) The mean sensitivity in three
zones by FDT c-20. The mean sensitivity in R2 and R3 in involved eyes
was significantly lower than that in R2 (P = 0.0077)
and R3 (P = 0.0013), respectively, in healthy eyes. The
mean sensitivity in three zones after 1 year was not significantly
decreased. *Statistically significant decreased mean
sensitivity. Bars, SEs.
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Mean sensitivity in R2 and R3 with FDT in involved eyes was
significantly lower than that in each respective zone in healthy eyes
(Fig. 2B) . After 1 year, mean sensitivity in each zone with FDT in 12
involved eyes was not significantly lower than that in healthy
eyes.
No significant abnormalities in mean sensitivity of each zone examined
with both perimeters in uninvolved eyes were found, compared with that
in healthy eyes.
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Discussion
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Conventional Humphrey automated perimetry showed general
depression in patients with resolved optic neuritis, especially within
central depression in a 5° field. The findings corresponded with
those reported by Wall.2
FDT demonstrated general
depression in resolved optic neuritis, especially depression in the
extrafoveal area. The area outside 10° of eccentricity showed an
abnormality with the Humphrey field analyzer.2
This
perimeter could not separate the function of P and M cells. M-cell
function was related to high temporal frequency. Sensitivity up to
10° field at temporal frequency was abnormal at up to 2.5° at 23 Hz
in optic neuritis.4
The area outside 10° at high
temporal frequency had not previously been examined in optic neuritis;
however, FDT could cover up to 20° at high temporal frequency.
Glaucomatous visual field defects were specifically detected by
FDT.5
6
Early glaucomatous damage was correlated with a
loss of large retinal ganglion cells (M cells)8
and
nonlinear units (MY cells).9
Patients in the present study had normal intraocular pressure
throughout the course and no glaucomatous cupping after resolution.
Visual field defects in optic neuritis were thought to include losses
of both P and M cells. Both P and M cells were found in the extrafoveal
area and in the fovea.10
Central depression detected by
conventional automated perimetry led to a loss of P
cells,1
and deficits in the midperiphery detected by FDT
led to a loss of MY cells, because of
dissociation of field damage pattern and its long-term recovery
observed between both perimeters. Central (R1) depression was detected
by conventional automated perimetry, but mean sensitivity in R3 was not
significantly decreased. On the other hand, midperipheral deficits (R2
and R3) were found by FDT, but the central area (R1) was near normal.
Midperipheral deficits by FDT tended to recover after 1 year, whereas
the field in R3 observed by conventional automated perimetry remained
unchanged. FDT takes approximately 5 minutes per eye to perform and
could be useful as a follow-up study of the midperipheral visual field
of patients with optic neuritis after recovery.
One third of the uninvolved eyes showed abnormal visual fields in the
recovery stage.7
The visual field in uninvolved eyes by
conventional automated perimetry and FDT showed slight general
depression but was not significantly different in any zone.
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Footnotes
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Supported in part by a grant from the Ministry of Education, Japan, Grant 10357015.
Submitted for publication November 29, 1999; revised February 23, 2000; accepted March 22, 2000.
Commercial relationships policy: N.
Corresponding author: Naoya Fujimoto, Department of Ophthalmology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260, Japan. fujimoto{at}ophthalm.m.chiba-u.ac.jp
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References
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Wall, M. (1990) Loss of P retinal ganglion cell function in resolved optic neuritis Neurology 40,649-653[Abstract/Free Full Text]
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. The Optic Neuritis Study Group (1997) Visual function 5 years after optic neuritis. Experience of the Optic Neuritis Treatment Trial Arch Ophthalmol 115,1545-1552[Abstract/Free Full Text]
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Edgar, GK, Foster, DH, Honan, WP, Heron, JR, Snelgar, RS (1990) Optic neuritis: variations in temporal modulation sensitivity with retinal eccentricity Brain 113,487-496[Abstract/Free Full Text]
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Johnson, CA, Samuels, SJ (1997) Screening for glaucomatous visual field loss with frequency-doubling perimetry Invest Ophthalmol Vis Sci 38,413-425[Abstract/Free Full Text]
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Quigley, HA (1998) Identification of glaucoma-related visual field abnormality with the screening protocol of frequency doubling technology Am J Ophthalmol 125,819-829[Medline][Order article via Infotrieve]
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Keltner, JL, Johnson, CA, Spurr, JO, Beck, RW, . Optic Neuritis Study Group (1994) Visual field profile of optic neuritis. One-year follow-up in the Optic Neuritis Treatment Trial Arch Ophthalmol 112,946-953[Abstract/Free Full Text]
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Quigley, HA, Dunkelberger, GR, Green, WR (1988) Chronic human glaucoma causing selectively greater loss of large optic nerve fibers Ophthalmology 95,357-363[Medline][Order article via Infotrieve]
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Maddess, T, Henry, GH (1992) Performance of nonlinear visual units in ocular hypertension and glaucoma Clin Vis Sci 7,371-383
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Livingstone, MS, Hubel, DH (1988) Do the relative mapping densities of the magno- and parvocellular systems vary with eccentricity? J Neurosci 8,4334-4339[Abstract]
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Abstract
Introduction
