Does eye examination order for standard automated perimetry matter?

Kelly, Stephen R.; Bryan, Susan R; Crabb, David P.

doi:10.1111/aos.14069

Cited by 14 publications

(11 citation statements)

References 40 publications

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“…The limitation of this study was the absence of the consideration of some physical factors such as fatigue and loss of concentration, which may affect the results of reliability indices in that the eye tested second has a greater amount of variability [31][32][33]. However, these studies were based on older, prolonged examination protocols that are no longer used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Humans

Shirakami

Omura

Fukuda

et al. 2021

JCM

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Relationships between age and visual field (VF) reliability indices were investigated using a large real-world dataset (42,421 VF data points from 11,525 eyes of 5930 subjects). All VFs tested and stored at Shimane University Hospital between 1988 and 2019 were exported. Correlations between age, mean deviation (MD), pattern standard deviation (PSD), and reliability indices including fixation losses (FLs), false negatives (FNs), and false positives (FPs) were analyzed. The mean ± standard deviation age was 65.0 ± 15.1 years; MD—−6.9 ± 8.1 decibels (dB); PSD—6.3 ± 4.6 dB; FL—8.6 ± 11.7%; FN—5.3 ± 8.3%; and FP—2.6 ± 5.0%. Univariate analyses showed strong associations between age and FNs (correlation coefficient, ρ = 0.20, p < 0.0001) and MD (ρ = −0.21, p < 0.0001). All FLs, FNs, and FPs were lowest during the third decade (20–29 years) of life. FLs were elevated consistently after that decade, and FNs were elevated sharply after the seventh decade. FPs were relatively stable after the fourth decade (30–39 years). Mixed-effect regression analyses in subjects 40 years and older showed that older age was associated with worse FLs (p < 0.0001) and FNs (p < 0.0001) but not FPs (p = 0.4126). Aging affects FLs and FNs with different modes but had minimal effects on FPs. Decreased VF sensitivity, deteriorated macular function, and technical difficulties with testing may be mechanisms of age-related changes in FLs and FNs.

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Section: Discussionmentioning

confidence: 99%

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Humans

Shirakami

Omura

Fukuda

et al. 2021

JCM

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“…Also, the 24-2C was tested after the 24-2 test, which may introduce a bias in the form of a fatigue effect. Kelly et al 45 found statistically significant reductions in mean deviation for the second eye tested resulting from fatigue, but this was unlikely to be clinically significant in magnitude. A prediction in this study would be that visual field indices would be systematically worse in the 24-2C.…”

Section: Clinical Impact Of 24-2c Exclusive Test Loca-tionsmentioning

confidence: 92%

Ability of 24-2C and 24-2 Grids to Identify Central Visual Field Defects and Structure-Function Concordance in Glaucoma and Suspects

Phu¹,

Kalloniatis²

2020

American Journal of Ophthalmology

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The purpose of this study was to compare the ability of the 24-2 test grid with that of the 24-2C test grid to measure visual field global indices, identify central visual field defects, and facilitate macular structure-function analysis with optical coherence tomography (OCT) scans in glaucoma suspects and glaucoma patients.DESIGN: Prospective, cross-sectional study. METHODS: One eye from each of 100 glaucoma suspects and glaucoma patients (60 undergoing SITA-Faster [Zeiss Meditec] testing on 24-2 and 24-2C; 40 undergoing SITA-Standard [Zeiss Meditec] testing on 24-2 and SITA-Faster on 24-2C) were included in the study. Global visual field indices, test duration, and pattern deviation results were extracted. The deviation map from the Cirrus OCT (Carl Zeiss Meditec) Ganglion Cell Analysis (GCA) was extracted, and structure-function relationships were compared after correction of the visual field test stimulus location that stimulated the corresponding retinal ganglion cell.RESULTS: Global index results of the 24-2 grid were similar to those of the 24-2C grid, and both identified a comparable number of clusters of visual field defects. Centrally, the 24-2C grid identified more clusters of defects than the 24-2 grid, but this was not statistically significant. Although the 24-2C test locations resulted in more instances of structure-function concordance than the 24-2 locations, half the locations in the 24-2C grid fell close to or outside the GCA grid when corrected for ganglion cell displacement.CONCLUSIONS: The 24-2C returned global visual field indices similar to the 24-2 grid but tended to identify more clusters of central functional defects. Central structure-function concordance was better achieved using the 24-2C grid, but half of the visual field test loca-Supplemental Material available at AJO.com.

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“…Common considerations are the learning effect and between-eye fatigue effects. [42][43][44] Learning effects may manifest as greater rates of low test reliability in the eye that was tested first, with improvements seen for the second eye. The effect of fatigue in producing unreliable results have been widely reported in the second eye tested.…”

Section: Spes Can Be Detected Early In the Test Processmentioning

confidence: 99%

A Strategy for Seeding Point Error Assessment for Retesting (SPEAR) in Perimetry Applied to Normal Subjects, Glaucoma Suspects, and Patients With Glaucoma

Phu

Kalloniatis

2021

American Journal of Ophthalmology

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We sought to determine the impact of seeding point errors (SPEs) as a source of low test reliability in perimetry and to develop a strategy to mitigate this error early in the test.DESIGN: Cross-sectional study. METHODS: Visual field test results from 1 eye of 364 patients (77 normal eyes, 178 glaucoma suspect eyes, and 109 glaucoma eyes) were used to develop models for identifying SPE. Two test cohorts (326 undertaking Swedish interactive thresholding algorithm [SITA]-Faster and 327 glaucoma eyes undertaking SITA-Standard) were used to prospectively evaluate the models for identifying SPEs. Global visual field metrics were compared among reliable and unreliable results. Regression models were used to identify factors distinguishing SPEs from non-SPEs. Models were evaluated using receiver operating characteristic (ROC) curves.RESULTS: In the test cohorts, SITA-Faster produced a higher rate of unreliable visual field results (30%-49.7%) compared with SITA-Standard (10.8%-16.6%). SPEs contributed to most of the unreliable results in SITA-Faster (57.5%-64.9%) compared with gaze tracker deviations accounting for most of the unreliable results in SITA-Standard (40%-77.8%). In SITA-Faster, results with SPEs had worse global indices and more clusters of sensitivity reduction than reliable results. Our best model (using 9 test locations) can identify SPEs with an area under the ROC curve of 0.89.CONCLUSION: SPEs contribute to a large proportion of unreliable visual field test results, particularly when using SITA-Faster. We propose a useful model for identifying SPEs early in the test that can then guide retesting using both SITA algorithms. We provide a simplified framework for the perimetrist to improve the overall fidelity of the test result.

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Does eye examination order for standard automated perimetry matter?

Cited by 14 publications

References 40 publications

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Humans

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Humans

Ability of 24-2C and 24-2 Grids to Identify Central Visual Field Defects and Structure-Function Concordance in Glaucoma and Suspects

A Strategy for Seeding Point Error Assessment for Retesting (SPEAR) in Perimetry Applied to Normal Subjects, Glaucoma Suspects, and Patients With Glaucoma

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