The digital Cullen chart: a red colour perimetry aid for visual field examination

• Published in: British Journal of Neurosurgery Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 5
• Main Authors: Hughes, Mark Antony, Ho, Jen Wae, Keenlyside, Andrew, Sieradzki, Jake, Statham, Patrick F. X.
• Format: Report
• Language: English
• Published: Taylor & Francis 24.01.2022
• Subjects: pituitary surgery; smartphone; suprasellar; Visual field
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2021.2014782

30 years ago, a paper chart was developed in Edinburgh by Cullen et al. and validated as a swift, supplementary method for perimetric evaluation of visual fields. We have re-developed this concept in digital form (on smartphone screen) and assessed its sensitivity and specificity in detecting visual field loss, by comparison with formal machine-based perimetry. Patients with sellar and parasellar tumours, being managed in a single neurosurgical centre, underwent formal visual field perimetry as part of standard care. They also underwent assessment using the smartphone-based Cullen chart. 37 eye testing episodes were assessed, incorporating pre- and post-treatment assessments for a range of potentially compressive pathologies (non-secretory and secretory pituitary adenoma, craniopharyngioma, and parasellar meningioma). The smartphone-based Cullen chart was compared with formal machine-based perimetry for concordance in detecting visual field loss. The digital Cullen chart had a sensitivity of 75% and specificity of 98% compared with machine-based perimeters. The positive predictive value was 93% and the negative predictive value was 92%. For the visual field assessment of patients with sellar/parasellar tumours, this simple and swift smartphone-based chart shows good concordance with machine-based perimeters. With amendments to the user interface, there may be potential for telemetric patient-led visual field monitoring.