Deepmala Mazumdar, M.Phil. (Optometry)

Doctoral Research Student, Vestibular and Ocular Motor Research group, Dept. of Neuroscience, Erasmus MC, The Netherlands

As professionals, we often tend to become contemporaneous, which is why we skip the idea to understand the evolution of our area of interest. Though the historical events might not interest you, yet not knowing the process might lead to an insufficient frame of reference necessary to understand the development of the technique.

Be it a clinician, scientist, and even most of the patients understand the importance of testing the ‘Island of vision’ or what we call as the visual field testing/Perimetry. Many blinding diseases such as glaucoma can be better managed if detected at an early stage. It is through the evaluation of the visual field which helps clinicians to detect and monitor the progression of the blinding disease. It is one of the most sort after technique which intrigues eye care practitioners and researchers. Each discovery and practice towards the modernisation of visual field test is a new learning which leads us to where we are today. I would walk you through the notable evolutionary observations in visual field testing (Fig 1).

Figure 1: The notable pioneers in the evolution of perimetry arranged in a chronological sequence. (Reproduced from Johnson et al., 2011 and modified as a flow-chart to illustrate the evolution with time by the author)

Talking about the ‘Visual field test’, the importance of evaluating it was understood a long time ago. The first measurement of the peripheral visual field was reported almost ~2000 years ago. During the 5^th century Before Common Era (BCE), we see the first recorded mention of hemianopsia and qualitative observations of visual field from Hippocrates. The shape was predicted by the legendary Ptolemy (~150 BCE) as roughly circular. Between the 5^th century BCE till ~1600 AD there have been numerous works done to understand the visual field and its link to ocular diseases. This is when during 1668, Mariotte had the breakthrough discovery about the concept of physiological blind-spot and its location with respect to optic disc. Until Thomas Young, the visual field research was solely dependent on qualitative interpretation. In the early 1800s, Young quantified the extent of the visual field. However, it was during 1856 when the first quantitative evaluation of the visual field was reported by Albrecht von Graefe. Interestingly, Graefe’s associated the visual field loss with amblyopia as there was a lack of understanding about the disease glaucoma.

Between mid-1800 to late 1900, many pioneering works have been reported in the field of evaluating visual field (Peter L.C., 1920). Few notable mentions are Bjerrum’s Campimetry, modified Tangent Screen by Harry Traquair and Goldmann Perimeter by Hans Goldmann. The perimetry technique has been continually refined over the decades by many investigators. During early 1970s the first automated perimeter was by the Frankhauser and co-workers known as ‘Octopus’. The next major shift in the era of automated perimetry was by Anders Heijl and his team. Their work behind the development of Humphrey Visual field-testing Algorithm has been the breakthrough in the field of Ophthalmology. This piece of retrieving the ground-breaking works in the world of perimetry is incomplete without mentioning the contribution of Douglas Anderson. He has penned the systematic approach in understanding and interpreting the information derived from automated perimeters (Anderson & Patella, 1992).

To conclude, there have been many attempts made by researchers to develop an alternative to the existing perimetry technique. However, the conventional method of testing the visual field has remained unchanged for more than a century. Few noteworthy advanced perimetry methods amongst others are Eye Movement Perimetry(Mazumdar et al., 2020; Meethal et al., 2019), Pupil Perimetry (Kardon, 1992), Rarebit Perimetry (Brusini et al., 2005) etc. have been successful method in evaluating the visual fields. Since none of the new techniques have made their way to the clinical practice thus researchers around the world are working on developing easier and efficient perimetry techniques addressing limitations the conventional one possesses.

Brownie point:

In the Humphrey Field Analyser, the “2” in 24-2 and 30-2 signifies the presentation of stimuli away from x and y axis in both positive and negative direction. This is different from the first pattern i.e., 30-1 where stimuli presented directly on the x and y axes and then extending from there.

References:

Brusini, P., Salvetat, M. L., Parisi, L., & Zeppieri, M. (2005). Probing glaucoma visual damage by rarebit perimetry. British Journal of Ophthalmology, 89(2), 180–184. https://doi.org/10.1136/bjo.2003.041178

Johnson, C. A., Wall, M., & Thompson, H. S. (2011). A History of Perimetry and Visual Field Testing. 88(1), 8–15.

Kardon, R. H. (1992). Pupil perimetry. Current Opinion in Ophthalmology, 3(5), 565–570. https://doi.org/10.1097/00055735-199210000-00002

Mazumdar, D., Pel, J. J. M., Kadavath Meethal, N. S., Asokan, R., Panday, M., Steen, J. Van Der, & George, R. (2020). Visual Field Plots: A Comparison Study between Standard Automated Perimetry and Eye Movement Perimetry. Journal of Glaucoma, 29(5), 351–361. https://doi.org/10.1097/IJG.0000000000001477

Meethal, N. S. K., Pel, J. J. M., Mazumdar, D., Asokan, R., Panday, M., van der Steen, J., & George, R. (2019). Eye Movement Perimetry and Frequency Doubling Perimetry: clinical performance and patient preference during glaucoma screening. Graefe’s Archive for Clinical and Experimental Ophthalmology. https://doi.org/10.1007/s00417-019-04311-4

Patella, A. and. (1992). Automated Static Perimetry. American Journal of Ophthalmology, 114(1), 110–111.

Peter, L. C. (1920). Newer methods in perimetry and the character of studies for which they are especially adapted. The British journal of ophthalmology, 4(10), 441.

Author :-

Deepmala Mazumdar is currently pursuing her doctoral research from Dept. of Neuroscience, Erasmus MC, Rotterdam, The Netherlands. She is actively involved in providing academic guidance and supervision in the research activities of undergraduate and post graduate optometry students at the Elite School of Optometry (ESO), Chennai. She has played integral roles in various collaborative research activities and was successful in projecting the fundamental findings as scientific publications and presentations at several national/international platforms. Her area of interest is Glaucoma, Eye movements and Visual Acuity charts. Her PhD research involves analysis of eye movement behaviour in patients with neuro-degenerative diseases. She was awarded the IJO platinum award for best publication, the Ruby Banik award for best researcher by the Vision Research Foundation, Chennai, and the young clinical mentor award for the contribution towards optometric education and teaching in Elite School of Optometry in 2019.