Psychophysical Testing

Psychophysical Testing

Douglas J. Rhee

Tara A. Uhler

L. Jay Katz


The goal of this chapter is to show representative visual field patterns for glaucoma rather than provide a comprehensive discussion of perimetry. There are several texts dedicated solely to the extended description of perimetry and atlases dedicated to just perimetric findings.

The broad term psychophysical testing refers to the subjective testing of vision of an eye. In clinical terms for the glaucoma patient, this involves perimetry to assess the peripheral vision of an eye. Because the pathophysiology of glaucoma affects the paracentral and peripheral vision before affecting central acuity, there are both diagnostic and therapeutic benefits to assessing the patient’s visual field. It is important to note that usage of the term peripheral vision does not necessarily mean far periphery. In fact, most glaucomatous visual field defects occur paracentrally (within 24 degrees of fixation). Our use of the term peripheral refers to anything beyond central fixation (i.e., greater than the central 5 to 10 degrees).

Contrast sensitivity is not routinely tested in glaucoma patients. Contrast sensitivity is affected in even early glaucoma (but not ocular hypertension, that is, an elevated intraocular pressure [IOP] without the presence of optic nerve damage), and progressively worsens with continued optic nerve damage. Contrast sensitivity highly correlates to the perceived visual problems in patients with glaucoma (Fig. 8-1A). The Pelli Robson chart is the most commonly used (Fig. 8-1B and C), but other charts have been developed. When testing, it is important to use standard illumination.

Ishihara color plates are not generally affected in glaucoma until very advanced stages of disease. Even patients with very small central islands have minimal defects on color plate testing. Using techniques with more refined color discrimination, patients with even early glaucoma can have decreases primarily in the blue-yellow axis which is exploited by the short-wave automated perimetry (SWAP) test.


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FIGURE 8-1. Contrast sensitivity. A. Photoshop simulation of the effect of worsening levels of contrast. The original image without manipulation is the top left. Down the left-hand column is decreasing contrast by 50% (middle left) and 75% (bottom left). The right-hand column increasing contrast by 25% (top right), 50% (middle right), and 75% (bottom right). (Figure from: Pelli Robson Contrast Sensitivity Chart (B) letters in triplet with decreasing contrast as one moves from left to right and down each row. The testing distance is 1 m using an illumination of 85 cd/mm2. The score of the test is recorded by the faintest triplet, out of which at least two letters are correctly identified. The log CS value for this triplet is given by the number on the scoring pad.

FIGURE 8-1 (continued) C. Shows sample letters (different from A) without fading and the log values next to the triplet. Grossly, normal contrast perception is being able to see 6 to 7 lines (12-14 triplets), moderate loss is seeing 4 to 5 lines, severe loss is being able to see 2 to 3 lines, and profound loss would be to only see 1 line.


May 4, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Psychophysical Testing

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