June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Visual Crowding in Glaucoma: Structural and Functional Relationships
Author Affiliations & Notes
  • James Stringham
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Alessandro A Jammal
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Eduardo Bicalho Mariottoni
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Tais Estrela
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Carla Urata
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Leonardo Shigueoka
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Nara Ogata
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Henry Tseng
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Felipe Medeiros
    ophthalmology, Duke Eye Center, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   James Stringham, None; Alessandro Jammal, None; Eduardo Mariottoni, None; Tais Estrela, None; Carla Urata, None; Leonardo Shigueoka, None; Nara Ogata, None; Henry Tseng, None; Felipe Medeiros, Aeri Pharmaceuticals (C), Allergan (C), Annexon (C), Biogen (C), Biozeus (C), Carl-Zeiss Meditec (F), Carl-Zeiss Meditec (C), Galimedix (C), Google (F), Heidelberg Engineering (F), IDx (C), NGoggle, Inc (P), Novartis (C), Reichert (F), Reichert (C), Stealth Biotherapeutics (C)
  • Footnotes
    Support  NEI EY029885 (FAM)
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3214. doi:
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      James Stringham, Alessandro A Jammal, Eduardo Bicalho Mariottoni, Tais Estrela, Carla Urata, Leonardo Shigueoka, Nara Ogata, Henry Tseng, Felipe Medeiros; Visual Crowding in Glaucoma: Structural and Functional Relationships. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3214.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In the peripheral visual field, objects that are identifiable in isolation become impossible to recognize when surrounded in close proximity by other objects. This phenomenon is known as visual crowding, and the threshold spacing of objects required for correct identification of a target is referred to as critical spacing (Scritical). Visual crowding influences the performance of a wide array of daily visual tasks, notably visual search. Due to the effects of glaucoma on peripheral vision, we hypothesized that neural loss in the disease would lead to stronger effects of visual crowding.

Methods : The study included 44 eyes of 28 patients with glaucoma and 24 eyes of 12 healthy subjects. Scritical thresholds were determined for all four quadrants of the visual field for each eye, at 10 degrees eccentricity; 218 total quadrants were tested. A quadrant was excluded from analysis if the standard automated perimetry (SAP) mean sensitivity (MS) value for that quadrant fell below the 5thpercentile of normal, as determined from an independent population of healthy eyes. Participants were presented with a target letter, flanked radially by two other letters. The QUEST threshold-seeking algorithm was used to determine Scritical. Each quadrant threshold test required 30 stimulus presentations and took roughly two minutes to complete. We investigated the relationship between Scriticaland measures of structural damage on the macula and retinal nerve fiber layer (RNFL), obtained with spectral-domain optical coherence tomography (SDOCT), as well as SAP MS.

Results : In glaucoma patients, the mean Scriticalwas found to be substantially greater than that of visually normal individuals (4.97±2.41 deg vs. 4.05±1.91 deg; p=0.034). Multivariable regression analysis revealed that Scritical thresholds were a significant predictor of RNFL thickness (p=0.009), ganglion cell-inner plexiform layer thickness (GC+IPL; p=0.045), and SAP 24-2 and 10-2 MS (p=0.016; p=0.043 respectively).

Conclusions : These results suggest that a test of visual crowding may differentiate visually normal individuals from those with glaucoma. Given the significant relationships found between Scritical and GC+IPL / RNFL thickness, the larger Scritical thresholds required for glaucoma patients may be explained by anatomical reorganization of remaining ganglion cells (i.e. larger receptive fields in response to neural damage caused by the disease).

This is a 2020 ARVO Annual Meeting abstract.

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