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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay- per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 26, 2021 by guest. Protected copyright. BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from BMJ Open Functional visual fields: A cross-sectional study to determine which visual field paradigms best reflect difficulty with mobility function For peer review only Journal: BMJ Open Manuscript ID bmjopen-2017-018831 Article Type: Research Date Submitted by the Author: 25-Jul-2017 Complete List of Authors: Subhi, Hikmat; Anglia Ruskin University, Vision and Hearing Sciences Latham, Keziah; Anglia Ruskin University, Vision and Hearing Sciences Myint, Joy; University of Hertfordshire School of Life and Medical Sciences Crossland, Michael; Moorfields Eye Hospital NHS Foundation Trust, Optometry <b>Primary Subject Ophthalmology Heading</b>: Secondary Subject Heading: Ophthalmology Low vision, Visual fields, Perimetry, Mobility function, Visual impairment, http://bmjopen.bmj.com/ Keywords: Self-reported function on September 26, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from Page 1 of 39 BMJ Open 1 2 3 Title Functional visual fields: A cross-sectional study to determine which 4 visual field paradigms best reflect difficulty with mobility function 5 Running head Functional visual fields 6 Authors *Subhi, Hikmat; Anglia Ruskin University, Department of Vision and 7 Hearing Sciences and Vision and Eye Research Unit 8 9 Latham, Keziah; Anglia Ruskin University, Department of Vision and 10 Hearing Sciences and Vision and Eye Research Unit 11 12 Myint, Joy; University of Hertfordshire, Life and Medical Sciences, 13 Postgraduate Medicine 14 15 For peer review only 16 Crossland, Michael D.; Moorfields Eye Hospital, London 17 18 *Corresponding author: [email protected] 19 Word count 3746 20 Key words Visual fields, self-reported function, mobility function, functional vision, 21 visual impairment 22 23 24 25 26 27 28 29 30 31 32 http://bmjopen.bmj.com/ 33 34 35 36 37 38 39 40 on September 26, 2021 by guest. Protected copyright. 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from BMJ Open Page 2 of 39 1 2 3 Abstract 4 5 6 Objectives 7 8 9 To develop an appropriate method of assessing visual field (VF) loss which reflects its 10 11 functional consequences, this study aims to determine which method(s) of assessing visual 12 13 fields best reflect mobility difficulty. 14 15 For peer review only 16 Setting 17 18 19 20 This cross-sectional observational study took place within a single primary care setting. 21 22 Participants attended a single session at a University Eye Clinic, with data collected by a 23 24 single researcher (HS), a qualified optometrist. 25 26 27 Participants 28 29 30 50 adult participants with peripheral field impairment were recruited for this study. Individuals 31 32 with conditions not primarily affecting peripheral visual function, such as macular http://bmjopen.bmj.com/ 33 34 degeneration, were excluded from the study. 35 36 37 Primary and secondary outcome measures 38 39 40 on September 26, 2021 by guest. Protected copyright. Participants undertook three custom and one standard binocular VF tests assessing visual 41 42 43 field to 60 degrees, and also integrated monocular threshold 24-2 visual fields (IVF). Primary 44 45 VF outcomes were average mean threshold, percentage of stimuli seen, and VF area. VF 46 47 outcomes were compared to self-reported mobility function assessed with the Independent 48 49 Mobility Questionnaire, and time taken and patient acceptability were also considered. 50 51 Receiver Operating Characteristic (ROC) curves determined which tests best predicted 52 53 difficulty with mobility tasks. 54 55 56 Results 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from Page 3 of 39 BMJ Open 1 2 3 Greater VF loss was associated with greater self-reported mobility difficulty with all field 4 5 paradigms (R2 0.38-0.48, all p<0.001). All four binocular tests were better than the IVF at 6 7 predicting difficulty with at least three mobility tasks in ROC analysis. Mean duration of the 8 9 tests ranged from 1min 26sec (±9sec) for kinetic assessment to 9min 23sec (±24 sec) for 10 11 IVF. 12 13 14 Conclusions 15 For peer review only 16 17 The binocular VF tests extending to 60 deg eccentricity all relate similarly to self-reported 18 19 mobility function, and slightly better than integrated monocular VFs. A kinetic assessment of 20 21 VF area is quicker than and as effective at predicting mobility function as static threshold 22 23 24 assessment. 25 26 27 28 29 30 Strengths and limitations of this study 31 32 http://bmjopen.bmj.com/ 33 Strengths of this study include: 34 35 36 o Rigorous and novel visual field testing on a relative large cohort of people 37 38 with visual field loss 39 40 o Consideration of the patient’s perspective of visual field assessment on September 26, 2021 by guest. Protected copyright. 41 42 o Use of Rasch analysed data from a validated questionnaire to reflect a broad 43 44 range of mobility function 45 46 o Different visual field paradigms compared to functional vision, which has not 47 48 previously been reported 49 50 51 52 Potential limitations include: 53 54 55 o Single, rather than repeated, measures of visual field function are used 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from BMJ Open Page 4 of 39 1 2 3 Copyright 4 5 6 The Corresponding Author has the right to grant on behalf of all authors and does grant on 7 8 behalf of all authors, an exclusive licence (or non exclusive for government employees) on a 9 10 worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be 11 12 published in BMJ editions and any other BMJPGL products and sublicences such use and 13 14 exploit all subsidiary rights, as set out in our licence. 15 For peer review only 16 17 Funding statement 18 19 20 21 This work was supported by a College of Optometrists’ Postgraduate Research Scholarship. 22 23 24 Competing interests 25 26 27 The authors report no conflicts of interest and have no proprietary interest in any of the 28 29 materials mentioned in this article. 30 31 32 Results included in this manuscript were presented in part at Vision 2017, The Hague, The http://bmjopen.bmj.com/ 33 34 Netherlands (June 2017). 35 36 37 Author contribution 38 39 40 on September 26, 2021 by guest. Protected copyright. All authors (HS, KL, JM and MC) made substantial contributions to the design of the work. 41 42 43 HS acquired the data for the study. All authors contributed to the analysis and interpretation 44 45 of the data, drafting the manuscript, and critical revision of the article. All authors give final 46 47 approval for the manuscript to be published and agree to be accountable for all aspects of 48 49 the work. 50 51 52 Transparency declaration 53 54 55 56 57 58 4 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-018831 on 20 November 2017. Downloaded from Page 5 of 39 BMJ Open 1 2 3 I affirm that the manuscript is an honest, accurate, and transparent account of the study 4 5 being reported; that no important aspects of the study have been omitted; and that any 6 7 discrepancies from the study as planned (and, if relevant, registered) have been explained. 8 9 10 Data sharing statement 11 12 13 Data are available from FigShare, doi to be confirmed. 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 http://bmjopen.bmj.com/ 33 34 35 36 37 38 39 40 on September 26, 2021 by guest.
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