Automated static perimetry is one of the most frequently performed psychophysical tests, in that it is one of the primary diagnostic tools for glaucoma, a major blinding eye disease. Clinical perimetry adopted standardized stimuli 60 years ago: circular luminance increments presented on a uniform photopic background (Goldmann,
1999). Since then, basic vision research has moved on to more complex sinusoidal stimuli produced on computer-controlled displays. Over the past 25 years, basic spatial vision researchers have developed a wide range of models for visual thresholds, which, in general, agree on common features: detection is mediated by cortical processes that vary in spatial and orientation tuning and whose outputs are combined with a nonlinear summation process (Graham,
1989). However, the insights from the past 25 years of basic vision research have not yet been applied to perimetric studies. Models of sensitivity to perimetric stimuli to date have only considered ganglion cell responses (Gardiner, Demirel, & Johnson,
2006; Harwerth et al.,
2004). As a result, clinical researchers have expressed great uncertainty about how to compare sensitivities for traditional stimuli versus more complex spatial stimuli and have based comparisons on the dynamic ranges of different devices rather than on visual processing of the stimuli (Spry, Johnson, McKendrick, & Turpin,
2001).
Contemporary perimetric theories analyze effects of varying stimulus size in two different ways. One approach (Garway-Heath, Caprioli, Fitzke, & Hitchings,
2000; Harwerth et al.,
2004) uses an empirical equation with a “summation exponent”
k, which varies with eccentricity: Sensitivity =
cGk, where
G is the number of ganglion cell bodies in the region being tested and
c and
k are free parameters. The other approach (Inui, Mimura, & Kani,
1981; Wilson,
1970) uses Ricco's law for small stimuli (threshold is inversely related to stimulus area) and characterizes the effects of eccentricity in terms of increase in critical diameter (the largest stimulus for which Ricco's law holds). For the first approach, the empirical parameters have no straightforward theoretical interpretation and can vary dramatically depending on how the data are analyzed. For the second approach, there is no standard way of describing the effects of stimulus size for stimuli larger than the critical diameter. Both approaches assume that detection is mediated by ganglion cells, with little role for cortical processing (Gardiner et al.,
2006; Glezer,
1965).
The ganglion-cell-based perimetric theories have limited utility for design of improved perimetric stimuli. In earlier studies, we have demonstrated several advantages of using low spatial frequency sinusoids for perimetric testing, including decreased variability without loss of ability to detect glaucomatous defect (Pan, Swanson, & Dul,
2006; Sun, Dul, & Swanson,
2006). These results cannot be explained by models based on detection by retinal ganglion cells. A recent review concluded that the field of perimetry would benefit greatly from better theoretical underpinnings (Anderson,
2006). At this point, a bridge is needed to connect the gap between the ganglion-cell-based approach that perimetric researchers use and the cortical-processing approach that has been used in basic spatial vision for decades.
The purpose of this study was to provide improved theoretical underpinnings through quantitative modeling of spatial summation for conventional perimetric stimuli—circular luminance increments. Our results are consistent with the critical diameter being determined by the peak spatial frequency of the cortical processes mediating detection rather than by the ganglion cell receptive field centers. The summation exponent is interpreted as reflecting the difference between stimulus size and peak spatial frequency, rather than as a pooling exponent for ganglion cell number. The results of the model provide a good description for normative spatial summation data from a wide range of perimetric studies. A masking experiment showed an example of revealing responses to perimetric types of stimuli by mechanisms tuned to low spatial frequencies.