Determining Spatial Summation and Its Effect on Contrast Sensitivity across the Central 20 Degrees of Visual Field

PURPOSE Recent studies propose that the use of target stimuli within or close to complete spatial summation reveal larger threshold elevation in ocular disease. The Humphrey Visual Field Analyzer (HFA) is used to assess visual function yet the spatial summation characteristics are unexplored for the central macular region. We therefore wanted to establish the relationship between contrast sensitivity and stimulus size (spatial summation) within the central 20° visual field using the high sampling density of the 10-2 test grid. METHODS Thresholds were measured for one eye from 37 normal subjects using the HFA 10-2 test grid with all five Goldmann (G) targets (GI to GV). Subject data were converted to 50-year-old equivalent using published and calculated location-specific decade correction factors. Spatial summation curves were fitted for all data at all locations. The size of Ricco's critical area (Ac) within which complete spatial summation operates (k = 1), and the slope of partial summation (k < 1: to characterize partial summation), was established. RESULTS The 50-year-old age normative data were determined for all Goldmann stimulus sizes for the 10-2 HFA test grid and showed a marked change in contrast sensitivity for small test stimuli (e.g. GI) and little change in larger test stimuli (e.g. GV). Both the Ac and k values did not vary with age allowing for the application of the age correction factors. Ac and k values increased with eccentricity with GI remaining within complete spatial summation and GII was close or within complete spatial summation. GIII or larger test sizes were always outside complete spatial summation operating within various levels of partial summation. CONCLUSIONS The developed normative data now allows comparisons of data sets with high sampling density using the 10-2 grid irrespective of subject age. Test size is important when assessing ocular disease yet only GI or GII stimuli operate close to or within complete spatial summation in the macula. Current visual field testing protocols employ GIII which is always outside complete spatial summation and operates under various values of partial summation: GIII may not be the most suitable test size to assess ocular disease affecting the macula.