Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static

Abstract

Visual field assessment is an important clinical evaluation for eye disease and neurological injury. We evaluated Octopus semi-automated kinetic peripheral perimetry (SKP) and Humphrey static automated central perimetry for detection of neurological visual field loss in patients with pituitary disease. We carried out a prospective cross-sectional diagnostic accuracy study comparing Humphrey central 30-2 SITA threshold programme with a screening protocol for SKP on Octopus perimetry. Humphrey 24-2 data were extracted from 30-2 results. Results were independently graded for presence/absence of field defect plus severity of defect. Fifty patients (100 eyes) were recruited (25 males and 25 females), with mean age of 52.4 years (SD = 15.7). Order of perimeter assessment (Humphrey/Octopus first) and order of eye tested (right/left first) were randomised. The 30-2 programme detected visual field loss in 85%, the 24-2 programme in 80%, and the Octopus combined kinetic/ static strategy in 100% of eyes. Peripheral visual field loss was missed by central threshold assessment. Qualitative comparison of type of visual field defect demonstrated a match between Humphrey and Octopus results in 58%, with a match for severity of defect in 50%. Tests duration was 9.34 minutes (SD = 2.02) for Humphrey 30-2 versus 10.79 minutes (SD = 4.06) for Octopus perimetry. Octopus semi-automated kinetic perimetry was found to be superior to central static testing for detection of pituitary disease-related visual field loss. Where reliant on Humphrey central static perimetry, the 30-2 programme is recommended over the 24-2 programme. Where kinetic perimetry is available, this is preferable to central static programmes for increased detection of peripheral visual field loss.

Programme choice for perimetry in neurological conditions (PoPiN): a systematic review of perimetry options and patterns of visual field loss

“…The 24–2 program has limitations in that its assessment of visual field is restricted on superior, inferior and temporal sides to 24° with an extension to 27° nasally, assessing a total grid of 54 points [ 1 ]. As a result, it can miss visual field loss outside these extremities leading to poor diagnostic accuracy in certain conditions [ 10 , 15 ]. Although static automated perimetry has been shown to be adequate in neuro-ophthalmology practice, kinetic perimetry is useful for patients with severe visual and neurological deficits and patients with peripheral visual field defects [ 16 , 17 ].…”

“…The authors concluded in the majority of cases optic neuritis could be monitored using a central program, but in more severe cases peripheral perimetry would be required [ 19 ]. Rowe et al compared the Humphrey 30–2 and 24–2 programs and Octopus semi-automated kinetic perimetry in a population with pituitary disease, they reported kinetic perimetry to be the favoured option when available and recommends the 30–2 over the 24–2 program in this population [ 10 ]. Wong and colleagues compared the Goldmann perimeter (manual kinetic), Humphrey perimeter (30–2 program) and tangent screen (manual kinetic) for the detection and localisation of occipital lesions [ 20 ].…”

“…Visual field loss is a common mode of presentation for chiasmal compression. There is clinical significance to the detection of visual field loss in chiasmal compression and capturing peripheral loss is important to early diagnosis, which is essential to allow prompt neurosurgical intervention [ 10 ].…”

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

“…Humphrey using either the 24-2 or 30-2 strategy) and kinetic perimetry (such as Goldmann) are commonly used in patients with pituitary tumours. It should be pointed out though that standardised perimetry is susceptible to variability influenced by patient attention and reporting during testing, as well as by physician interpretation (25). Comparison of Humphrey and Goldmann perimetry found no significant difference in the results within the central 30 degrees of the visual field in patients with adenomas (26).…”

“…Comparison of Humphrey and Goldmann perimetry found no significant difference in the results within the central 30 degrees of the visual field in patients with adenomas (26). Rowe et al, however, reported that kinetic peripheral visual field assessment is superior to static central visual field assessment for detection of peripheral visual field loss, which is typically the area first compromised by chiasmal compression in pituitary lesions (25).…”