Introduction
White-on-white standard automated perimetry (AP) uses a white round stimulus with 0.43° diameter and 4.0 mm
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area (Goldmann size III). Patients with low vision have difficulty seeing such a small stimulus and are often tested with perimetry using the size V stimulus with 1.72° diameter and 64 mm
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area. We undertook an observational case-control study to compare the performance of patients on AP using two differently sized stimuli.
Methods
Patients with glaucoma and visual acuity worse than 20/100 underwent AP using the standard size III stimulus Swedish Interactive Threshold Algorithm (SITA) standard test and size V stimulus full threshold test. All patients were familiar with the procedure, having done the test at least twice previously. Another group of glaucoma patients with visual acuity better than 20/40 served as controls. The main outcome measures included test time, mean retinal sensitivity (MRS), foveal sensitivity (FS), fixation loss (FL), false positive (FP), false negative (FN), and the patient's subjective preference.
Results
Fifty patients were included in the study. Most preferred the size V stimulus target size test. For glaucoma patients, test time was shorter with size III; MRS and FS were higher with size V; FL, FP, and FN did not differ between the tests.
Conclusion
AP with stimulus size V may be a good alternative to standard size III in selected visually debilitated patients who report difficulty undergoing a standard SITA 24-2 test.
Electronic supplementary material
The online version of this article (10.1007/s40123-019-0175-9) contains supplementary material, which is available to authorized users.
PurposeFalls are very prevalent in the older population. Visually impaired elderly patients are prone to falls as the result of visual loss and ageing. The purpose of the study was to compare the fear of falling (FoF) between primary open angle glaucoma (POAG) and age-related macular degeneration (ARMD) patients who live in a developing country.MethodsThis was a cross-sectional observational study. After a complete eye examination including measurement of best-corrected visual acuity, ophthalmoscopy, and automated visual field, all subjects completed the Fall Efficacy Scale International Brazil (FES-I-Brazil) questionnaire.ResultsThe sample comprised 64 patients with POAG, 48 with ARMD, and 52 controls. All groups were matched for age, sex, comorbidity, and ethnic distribution. The FES-I score was 24.6 ± 8.7, 25.3 ± 6.3, and 24.2 ± 7.7 for glaucoma, ARMD, and controls, respectively (P = 0.894). A post hoc analysis comparing all subjects with advanced visual field defect (mean deviation [MD] < −12 dB) revealed a higher FES-I score in ARMD patients as compared to POAG ones (46.2 ± 16.8 and 24.0 ± 7.7 for ARMD and POAG, respectively, P < 0.001).ConclusionIn this cohort of elderly subjects with eye diseases, the FoF was similar among groups; however, ARMD patients with more compromised visual field had higher FoF as compared to POAG patients and controls.Translational RelevanceA high rate of fear of falling exists in ARMD patients with compromised visual field. This finding may be useful in developing multidimensional strategies to decrease fear of falling and improve quality of life in older persons living in a developing country.
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