Adaptation Mechanisms, Eccentricity Profiles, and Clinical Implementation of Red-on-White Perimetry

Purpose. To determine the visual adaptation and retinal eccentricity profiles for red flickering and static test stimuli and report a clinical implementation of these stimuli in visual perimetry. Methods. The adaptation profile for red-on-white perimetry stimuli was measured using a threshold vs. intensity (TvI) paradigm at 0 degree and 12 degrees eccentricity and by comparing the eccentricity-related sensitivity change for red and white, static, and flickering targets in young normal trichromats (n = 5) and a group of dichromats (n = 5). A group of older normal control observers (n = 30) were tested and retinal disease was evaluated in persons having age-related maculopathy (n = 35) and diabetes (n = 12). Results. Adaptation and eccentricity profiles indicate red static and flickering targets are detected by two mechanisms in the paramacular region, and a single mechanism for >5 degrees eccentricity. The group data for the older normal observers has a high level of inter-observer variability with a generalized reduction in sensitivity across the entire visual field. Group data for the participants with age-related maculopathy show reduced sensitivities that were pronounced in the central retina. The group data for the diabetic observers showed sensitivities that were reduced at all eccentricities. The disease-related sensitivity decline was more apparent with red than white stimuli. Conclusions. The adaptation profile and change in sensitivity with retinal eccentricity for the red-on-white perimetric stimuli are consistent with two detection processes. In the macula, the putative detection mechanism is color-opponent with static targets and non-opponent with flickering targets. At peripheral field locations, the putative detection mechanism is non-opponent for both static and flicker targets. The long-wavelength stimuli are less affected by the preretinal absorption common to aging. Red-on-white static and flicker perimetry may be useful for monitoring retinal disease, revealing greater abnormalities compared with conventional white-on-white perimetry, especially in the macula where two detection mechanisms are found.