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Editors Selection IGR 9-4

Visual function

Comment by Chris Johnson on:

11706 Probing glaucoma visual damage by rarebit perimetry, Brusini P; Salvetat ML; Parisi L et al., British Journal of Ophthalmology, 2005; 89: 180-184

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A key aspect of the detection and differential diagnosis of glaucoma is perimetry and visual field testing. Unfortunately, many studies have indicated that substantial reductions in retinal ganglion cell density can occur in glaucoma before there is any noticeable visual field loss for standard (white-on-white) automated perimetry. This has prompted the development and validation of a variety of other visual field test procedures such as frequency doubling technology (FDT) perimetry and short wavelength automated perimetry (SWAP). These procedures have improved our ability to detect earlier and more extensive glaucomatous visual field losses, but there remains a need for further improvement. Rarebit perimetry (RBP) is a rationally-based technique recently developed by Frisen that uses a display of microdots on a video monitor to assess the integrity of overlapping retinal ganglion cell receptive fields. A paper by Brusini et al. (125), in conjunction with several prior studies, indicates that RBP can be readily used to evaluate the visual fields of many individuals, and can distinguish among individuals with normal vision, ocular hypertension and glaucoma. These findings are encouraging and suggest that further investigations of RBP are warranted. It will be of interest to determine many additional features of this test procedure such as test-retest reliability, dynamic range, clinical performance, robustness to artifactual influences, differential diagnostic capabilities and overall clinical value. It is my sincere hope that this paper will inspire a sufficient number of clinical investigators to pursue these and related issues.

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