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Subhi 2017.Pdf ANGLIA RUSKIN UNIVERSITY FACULTY OF SCIENCE AND TECHNOLOGY TOWARDS A FUNCTIONAL VISUAL FIELD ASSESSMENT FOR LOW VISION HIKMAT SUBHI A thesis in partial fulfilment of the requirements of Anglia Ruskin University for the degree of Doctor of Philosophy (PhD) Submitted: June 2017 Acknowledgments I would like to express my special appreciation and thanks to my first supervisor Dr Keziah Latham for her unwavering support and guidance during my PhD. Thanks also to my second and third supervisors, Dr Joy Myint and Dr Michael Crossland for their invaluable guidance and advice. Thank you to CamSight, the International Glaucoma Association, Huntingdonshire Society for the Blind, and RP Fighting Blindness for their help in the recruitment of participants. I am grateful also to Anglia Ruskin University Eye Clinic for providing facilities for my data collection. I would like to acknowledge the financial support from the College of Optometrists who funded this research over the last 3 years, and the Visual Function and Physiology Research Group at Anglia Ruskin University who provided funding to attend numerous national and international conferences. Thanks to my family and friends for their patience and encouragement, in particular my parents, Aisha Elmuntasser and Ahmed Subhi, and siblings, Emnani, Kalid, and Mohammed who offered much support and humour. Finally, I would like to express my deep and sincere gratitude to the individuals who gave up their time and travelled from far and wide to participate in this research. The completion of this research and thesis would not have been possible without you. i Abstract Visual field assessment is not only important to monitor disease progression, but also to reflect and predict functional difficulty in the real world. Despite this, no test currently available is optimised for determining functional consequences of visual field loss. The aim of this study is to determine the locations within the visual field that best reflect functional difficulty, and to use this information to develop an appropriate method of assessing field loss which reflects its functional consequences. For the first experiment, fifty two participants with peripheral field loss undertook binocular assessment of visual fields using the 30-2 and 60-4 SITA Fast programs on the Humphrey Field Analyser. The mean threshold within different areas of the visual field was used as the main outcome measure. Self-reported difficulties with activities of daily living were assessed using the Dutch ICF Activity Inventory. Greater visual field loss was associated with greater perceived difficulty, and both central (0-30 deg) and peripheral (30-60 deg) visual field areas were similarly related to self-reported function. The results of this experiment suggested that in order to accurately determine the functional consequences of visual field loss, it is necessary to consider the visual field beyond 30 degrees. These findings informed the development of custom visual field assessments in Experiment 2. Fifty participants with peripheral field impairment undertook three custom binocular visual field tests on the Octopus 900 that assessed the field out to 60 degrees from fixation: a threshold, 10dB supra-threshold, and a 10dB kinetic assessment. The mean threshold, percentage of stimuli seen, and visual field area were used as the main outcome measures for analysis. Visual field scores were compared to overall self-reported function assessed during the Dutch ICF Activity Inventory, and mobility function assessed using the Independent Mobility Questionnaire. Results were also compared to currently available methods of assessing functional visual field including integrated visual fields, and Esterman tests. Perceived function related similarly to binocular threshold, suprathreshold, kinetic, and Esterman visual field scores suggesting that as long as a functional visual field test is performed binocularly and includes assessment of eccentricities to 60 degrees, the paradigm used to assess the visual field makes little difference to the test’s ability to predict function. Quick tests using a kinetic or suprathreshold paradigm are more favoured by patients however. A binocular visual field assessment that utilises a suprathreshold or kinetic paradigm, and that assesses the visual field past 30 degrees is effective at reflecting the functional abilities of patients with peripheral visual impairment. Keywords: visual impairment, visual field, visual function, self-report, mobility function ii Table of Contents Acknowledgments .................................................................................................................................. i Abstract .................................................................................................................................................. ii Table of Contents ................................................................................................................................. iii List of Figures ....................................................................................................................................... ix List of Tables ...................................................................................................................................... xiii Abbreviations .................................................................................................................................... xviii List of Appendices ............................................................................................................................... xix Copyright Declaration .........................................................................................................................xx Chapter 1 Visual Fields in Low Vision .................................................................................................................. 1 1.1 Visual impairment ......................................................................................................................... 1 1.2 Peripheral visual field loss ............................................................................................................ 1 1.3 Sight loss registration .................................................................................................................... 4 1.4 Strategies of visual field assessment ............................................................................................. 6 1.5 Effect of binocular visual field loss on visual activities ............................................................... 8 1.5.1 Mobility .................................................................................................................................. 9 1.5.2 Increased risk of falling........................................................................................................ 11 1.5.3 Reading ................................................................................................................................ 13 1.5.4 Quality of life ....................................................................................................................... 14 1.6 Ideal functional visual field assessment ...................................................................................... 14 1.7 Current methods of functional visual field assessment ............................................................... 16 1.7.1 Integrated visual fields (IVF) ............................................................................................... 23 1.7.2 Esterman .............................................................................................................................. 27 1.7.3 Binocular threshold visual field ........................................................................................... 30 1.7.4 Kinetic .................................................................................................................................. 32 1.7.5 Automated combined kinetic and static perimetry ............................................................... 33 1.8 Visual field paradigms ................................................................................................................ 34 1.9 Relevant areas of the functional visual field ............................................................................... 36 1.9.1 Central and peripheral field .................................................................................................. 36 1.9.2 Superior and inferior field .................................................................................................... 37 1.10 Quantification of visual field loss ............................................................................................. 39 iii 1.11 Patients’ opinions ...................................................................................................................... 42 1.12 Clinical uses of a functional visual field test ............................................................................ 43 Chapter 2 Assessing functional ability ................................................................................................................ 44 2.1 Introduction ................................................................................................................................. 44 2.2 Self-reported function ................................................................................................................. 44 2.3 Scoring
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