A visual field test is a measurement of the area where objects can be seen in the peripheral vision when someone focuses on a central point. Visual field testing is one way to measure how much vision a person has in either eye, and how much vision loss may have occurred over time. Because of this a series of visual field tests can identify patterns and the process of change one's vision has undergone. In this way, visual fields can be essential for clinicians in identifying vision problems early on or for helping researchers understand the effect a certain therapy has on one's vision.  

While the staff at the Iowa Visual Field Reading Center (IVFRC) might not work directly with patients, they're having a huge impact on new and developing therapies for patients across the country. At its core, the IVFRC specializes in the meticulous assessment of visual fields—an essential component in diagnosing and managing a spectrum of ocular conditions, from glaucoma to neurological disorders affecting vision. Michael Wall, MD, director of the IVFRC, emphasized that their commitment to accuracy is paramount to the reputation the center has developed across the country. "We first use a digital checking method to evaluate a visual field in order to make sure the right test was given, the pupil size is appropriate, among many other things. A score out of 100 is provided by this digital tool based on how clean the results of the visual field test file are” Wall said. “But then we have two independent readers analyze the results to look for errors called perimetric artifacts that interfere with analysis. If those readers independently agree, we go with that result. If they don't agree, a third independent reader is brought in until a consensus is achieved." While it might seem tedious at points, it's a process that produces the most accurate results—and accuracy is what has helped build the international reputation of the IVFRC. Wall said “Our job is to give the research sponsor the cleanest data possible.” Wall stressed that the iVFRC assists sponsors in clinical trials all the way from developing the study protocol to obtaining clean results, to performing visual field analysis and aiding in the study’s statistical analysis. 

Before the IVFRC opened their doors in 2008, there was only one other visual field reading center in the country, which was at UC Davis. The IVFRC was the brainchild of Chris A. Johnson, PhD, DSc and Michael Wall, MD, who had a history of collaboration and a passion for creating accurate visual fields readings that could be used by researchers and clinicians alike. As the IVFRC ramped up, Trina Eden, COA was hired to manage many of the day to day logistics and help train research sites to accurately produce visual field results. When asked about Trina's role at the IVFRC, Dr. Wall said, "she's a vital part of our reading center. She takes care of all the nuts and bolts of the daily activities. When we start a study, Trina helps us develop the study protocol and then certifies all the perimetrists in the study and makes sure those collecting the visual field results know how to give the test properly. So she spends a lot of time teaching and making sure these people understand the proper technique to doing a visual field.”   

While most of the IVFRC's work is for researchers, Dr. Wall thinks it is also a valuable tool for clinicians to use directly. "We could, in addition to helping with clinical trials, we can also help clinical practices. Ophthalmologists really depend on this sort of data to make informed decisions, and analyzing visual fields gets pretty complicated, because there's so many different statistics. Part of our job is training, and I think we could really help offices by training their technicians in the same way we train them for a clinical trial."  

As the IVFRC continued to grow, around 2018 they retained the services of Bio::Neos, an informatics and software development group, to design, implement and maintain a secure web site and database management system. This partnership allows the IVFRC to provide a paperless means of allowing clinicians and researchers to transmit data securely over the internet and to communicate and transmit information to Data Coordinating Centers.   

With nearly all of the visual field data being processed digitally, this work seems like it would fit well with some of the pattern recognition A.I. is able to do. While Dr. Wall sees this as a direction they are headed, there is still plenty of work to be done in order to create A.I. that can produce results with the same level of accuracy. "You know, AI is great, but, you know, it's not the gold standard, and for what we do, the gold standard is an  experienced visual field reader analyzing the visual field patterns. But since we have so much clean data, we're using some of that to train A.I. to help recognize these patterns."   

As one of the most notable visual field reading centers in the nation, the IVFRC continues to develop new services and abilities in reading visual fields. In addition to analyzing visual field results, the IVFRC also works to train, certify and monitor technicians and other clinical personnel for clinical trials, develop new analysis and interpretation tools for visual field assessment and validate new visual function test procedures.