Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS

Caitlin Campbell; Victoria Stapley; RS Anderson; David F. Garway-Heath; Tony Redmond; Padraig Mulholland

doi:10.1167/tvst.14.11.14

Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS

Caitlin Campbell, Victoria Stapley, RS Anderson, David F. Garway-Heath, Tony Redmond, Padraig Mulholland

Cardiff University

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To compare the ability of conventional luminance-modulating perimetric stimuli and an area-modulation stimulus (AMS) designed to measure changes in complete spatial summation to identify physiological retinal ganglion cell density (RGCD) gradients in healthy observers.

Methods: Contrast thresholds were measured for Goldmann III (GIII; 0.43°, 200 ms) and V (GV; 1.72°, 200 ms) stimuli at 3° and 10° eccentricity in 100 healthy observers (median age, 43 years, range, 18–85 years), with mean spherical equivalent refractive errors ranging from −10.38 to +4.63 DS. Area thresholds were measured at the same locations using a fixed luminance stimulus (ΔL: 4.4 cd/m2, 200 ms). Colocalized RGCD estimates were determined using (i) optical coherence tomography (OCT) RGC layer thickness measures, and (ii) achromatic peripheral grating resolution acuity (PGRA) thresholds. Ratios of the difference in log energy threshold (ΔE) and log RGCD (ΔRGCD) between eccentricities were calculated (ΔE/|ΔRGCD|), with a value of 1 assumed to be the optimal relationship between functional thresholds and RGCD.

Results: ΔE/|ΔRGCD|) values (median and interquartile range [IQR]) were largest for AMS (OCT, 0.54 [IQR, 0.37–0.78]; PGRA, 0.71 [IQR, 0.46–1.19]), followed by GIII (OCT, 0.29 [IQR, 0.08–0.44]; PGRA, 0.33 [IQR, 0.07–0.54]; and GV (OCT, 0.16 [IQR, 0.02–0.29]; and PGRA, 0.19 [IQR, 0.02–0.44]). Interstimulus differences between all stimulus pairs were statistically significant (AMS vs GIII, both P < 0.001; AMS vs GV, both P < 0.001; GIII vs GV, both P < 0.05).

Conclusions: ΔE/|ΔRGCD| values were closest to 1 for AMS, suggesting this stimulus relates best to underlying physiological variations in RGCD.

Translational Relevance: Thresholds measured with area modulation stimuli vary more proportionally with physiological changes in retinal ganglion cell density relative to conventional perimetric stimuli.

Original language	English
Article number	14
Pages (from-to)	1-14
Number of pages	14
Journal	Translational Vision Science & Technology
Volume	14
Issue number	11
Early online date	13 Nov 2025
DOIs	https://doi.org/10.1167/tvst.14.11.14
Publication status	Published (in print/issue) - 30 Nov 2025

Bibliographical note

Data Access Statement

Supporting data will be made available upon request from the corresponding author.

Funding

This work was supported by a PhD studentship from the Department for the Economy, Northern Ireland (CSC) and in part by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (PJM, DFG-H, RSA). DFG-H's chair at UCL is supported by funding from Glaucoma UK. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Keywords

Retinal ganglion cell
Spatial summation
Area-modulation stimuli
Perimetry
Glaucoma
spatial summation
area modulation stimuli
glaucoma
perimetry
retinal ganglion cell

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1167/tvst.14.11.14Licence: CC BY-NC-ND

i2164-2591-14-11-14_1763033736.81204.cleanedFinal published version, 1.06 MBLicence: CC BY-NC-ND

Cite this

Campbell, C., Stapley, V., Anderson, RS., Garway-Heath, D. F., Redmond, T., & Mulholland, P. (2025). Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS. Translational Vision Science & Technology, 14(11), 1-14. Article 14. https://doi.org/10.1167/tvst.14.11.14

@article{1b4a7043c06c402d8d837513f1feebc9,

title = "Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS",

abstract = "Purpose: To compare the ability of conventional luminance-modulating perimetric stimuli and an area-modulation stimulus (AMS) designed to measure changes in complete spatial summation to identify physiological retinal ganglion cell density (RGCD) gradients in healthy observers.Methods: Contrast thresholds were measured for Goldmann III (GIII; 0.43°, 200 ms) and V (GV; 1.72°, 200 ms) stimuli at 3° and 10° eccentricity in 100 healthy observers (median age, 43 years, range, 18–85 years), with mean spherical equivalent refractive errors ranging from −10.38 to +4.63 DS. Area thresholds were measured at the same locations using a fixed luminance stimulus (ΔL: 4.4 cd/m2, 200 ms). Colocalized RGCD estimates were determined using (i) optical coherence tomography (OCT) RGC layer thickness measures, and (ii) achromatic peripheral grating resolution acuity (PGRA) thresholds. Ratios of the difference in log energy threshold (ΔE) and log RGCD (ΔRGCD) between eccentricities were calculated (ΔE/|ΔRGCD|), with a value of 1 assumed to be the optimal relationship between functional thresholds and RGCD.Results: ΔE/|ΔRGCD|) values (median and interquartile range [IQR]) were largest for AMS (OCT, 0.54 [IQR, 0.37–0.78]; PGRA, 0.71 [IQR, 0.46–1.19]), followed by GIII (OCT, 0.29 [IQR, 0.08–0.44]; PGRA, 0.33 [IQR, 0.07–0.54]; and GV (OCT, 0.16 [IQR, 0.02–0.29]; and PGRA, 0.19 [IQR, 0.02–0.44]). Interstimulus differences between all stimulus pairs were statistically significant (AMS vs GIII, both P < 0.001; AMS vs GV, both P < 0.001; GIII vs GV, both P < 0.05).Conclusions: ΔE/|ΔRGCD| values were closest to 1 for AMS, suggesting this stimulus relates best to underlying physiological variations in RGCD.Translational Relevance: Thresholds measured with area modulation stimuli vary more proportionally with physiological changes in retinal ganglion cell density relative to conventional perimetric stimuli.",

keywords = "Retinal ganglion cell, Spatial summation, Area-modulation stimuli, Perimetry, Glaucoma, spatial summation, area modulation stimuli, glaucoma, perimetry, retinal ganglion cell",

author = "Caitlin Campbell and Victoria Stapley and RS Anderson and Garway-Heath, \{David F.\} and Tony Redmond and Padraig Mulholland",

year = "2025",

month = nov,

day = "30",

doi = "10.1167/tvst.14.11.14",

language = "English",

volume = "14",

pages = "1--14",

journal = "Translational Vision Science \& Technology",

issn = "2164-2591",

publisher = "Association for Research in Vision and Ophthalmology",

number = "11",

}

Campbell, C , Stapley, V , Anderson, RS, Garway-Heath, DF, Redmond, T & Mulholland, P 2025, 'Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS', Translational Vision Science & Technology, vol. 14, no. 11, 14, pp. 1-14. https://doi.org/10.1167/tvst.14.11.14

Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS. / Campbell, Caitlin ; Stapley, Victoria ; Anderson, RS et al.
In: Translational Vision Science & Technology, Vol. 14, No. 11, 14, 30.11.2025, p. 1-14.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers

T2 - Optimizing Detection of RGC Gradients with AMS

AU - Campbell, Caitlin

AU - Stapley, Victoria

AU - Anderson, RS

AU - Garway-Heath, David F.

AU - Redmond, Tony

AU - Mulholland, Padraig

PY - 2025/11/30

Y1 - 2025/11/30

N2 - Purpose: To compare the ability of conventional luminance-modulating perimetric stimuli and an area-modulation stimulus (AMS) designed to measure changes in complete spatial summation to identify physiological retinal ganglion cell density (RGCD) gradients in healthy observers.Methods: Contrast thresholds were measured for Goldmann III (GIII; 0.43°, 200 ms) and V (GV; 1.72°, 200 ms) stimuli at 3° and 10° eccentricity in 100 healthy observers (median age, 43 years, range, 18–85 years), with mean spherical equivalent refractive errors ranging from −10.38 to +4.63 DS. Area thresholds were measured at the same locations using a fixed luminance stimulus (ΔL: 4.4 cd/m2, 200 ms). Colocalized RGCD estimates were determined using (i) optical coherence tomography (OCT) RGC layer thickness measures, and (ii) achromatic peripheral grating resolution acuity (PGRA) thresholds. Ratios of the difference in log energy threshold (ΔE) and log RGCD (ΔRGCD) between eccentricities were calculated (ΔE/|ΔRGCD|), with a value of 1 assumed to be the optimal relationship between functional thresholds and RGCD.Results: ΔE/|ΔRGCD|) values (median and interquartile range [IQR]) were largest for AMS (OCT, 0.54 [IQR, 0.37–0.78]; PGRA, 0.71 [IQR, 0.46–1.19]), followed by GIII (OCT, 0.29 [IQR, 0.08–0.44]; PGRA, 0.33 [IQR, 0.07–0.54]; and GV (OCT, 0.16 [IQR, 0.02–0.29]; and PGRA, 0.19 [IQR, 0.02–0.44]). Interstimulus differences between all stimulus pairs were statistically significant (AMS vs GIII, both P < 0.001; AMS vs GV, both P < 0.001; GIII vs GV, both P < 0.05).Conclusions: ΔE/|ΔRGCD| values were closest to 1 for AMS, suggesting this stimulus relates best to underlying physiological variations in RGCD.Translational Relevance: Thresholds measured with area modulation stimuli vary more proportionally with physiological changes in retinal ganglion cell density relative to conventional perimetric stimuli.

AB - Purpose: To compare the ability of conventional luminance-modulating perimetric stimuli and an area-modulation stimulus (AMS) designed to measure changes in complete spatial summation to identify physiological retinal ganglion cell density (RGCD) gradients in healthy observers.Methods: Contrast thresholds were measured for Goldmann III (GIII; 0.43°, 200 ms) and V (GV; 1.72°, 200 ms) stimuli at 3° and 10° eccentricity in 100 healthy observers (median age, 43 years, range, 18–85 years), with mean spherical equivalent refractive errors ranging from −10.38 to +4.63 DS. Area thresholds were measured at the same locations using a fixed luminance stimulus (ΔL: 4.4 cd/m2, 200 ms). Colocalized RGCD estimates were determined using (i) optical coherence tomography (OCT) RGC layer thickness measures, and (ii) achromatic peripheral grating resolution acuity (PGRA) thresholds. Ratios of the difference in log energy threshold (ΔE) and log RGCD (ΔRGCD) between eccentricities were calculated (ΔE/|ΔRGCD|), with a value of 1 assumed to be the optimal relationship between functional thresholds and RGCD.Results: ΔE/|ΔRGCD|) values (median and interquartile range [IQR]) were largest for AMS (OCT, 0.54 [IQR, 0.37–0.78]; PGRA, 0.71 [IQR, 0.46–1.19]), followed by GIII (OCT, 0.29 [IQR, 0.08–0.44]; PGRA, 0.33 [IQR, 0.07–0.54]; and GV (OCT, 0.16 [IQR, 0.02–0.29]; and PGRA, 0.19 [IQR, 0.02–0.44]). Interstimulus differences between all stimulus pairs were statistically significant (AMS vs GIII, both P < 0.001; AMS vs GV, both P < 0.001; GIII vs GV, both P < 0.05).Conclusions: ΔE/|ΔRGCD| values were closest to 1 for AMS, suggesting this stimulus relates best to underlying physiological variations in RGCD.Translational Relevance: Thresholds measured with area modulation stimuli vary more proportionally with physiological changes in retinal ganglion cell density relative to conventional perimetric stimuli.

KW - Retinal ganglion cell

KW - Spatial summation

KW - Area-modulation stimuli

KW - Perimetry

KW - Glaucoma

KW - spatial summation

KW - area modulation stimuli

KW - glaucoma

KW - perimetry

KW - retinal ganglion cell

UR - https://pure.ulster.ac.uk/en/publications/1b4a7043-c06c-402d-8d83-7513f1feebc9

UR - https://www.scopus.com/pages/publications/105021845760

U2 - 10.1167/tvst.14.11.14

DO - 10.1167/tvst.14.11.14

M3 - Article

C2 - 41230898

SN - 2164-2591

VL - 14

SP - 1

EP - 14

JO - Translational Vision Science & Technology

JF - Translational Vision Science & Technology

IS - 11

M1 - 14

ER -

Campbell C , Stapley V , Anderson RS, Garway-Heath DF, Redmond T, Mulholland P. Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS. Translational Vision Science & Technology. 2025 Nov 30;14(11):1-14. 14. Epub 2025 Nov 13. doi: 10.1167/tvst.14.11.14

Perimetric Stimuli Undergoing Complete Spatial Summation Optimize the Detection of Retinal Ganglion Cell Density Gradients in Healthy Observers: Optimizing Detection of RGC Gradients with AMS

Abstract

Bibliographical note

Data Access Statement

Funding

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this