Long- and Short-term Variability of Automated Perimetry Results in Patients With Optic Neuritis and Healthy Subjects

Abstract

To measure the short-and long-term variability of automated perimetry in patients with optic neuritis and normal subjects. Design: Prospective case-control design of patients with recovered optic neuritis with intraday and interday repetitions to obtain robust variability measurements. Entry criteria included a corrected pattern SD that was worse than the normal 5% probability level and a mean deviation worse than −3 dB but better than −20 dB. Five Humphrey 30-2 full threshold tests were administered during a 7-hour period (1 test every 2 hours) on the same day and at the same periods on 5 separate days. Subjects: Seventeen patients with recovered optic neuritis and 10 healthy subjects of similar age. Main Outcome Measures: Short-term variability and long-term variability for global visual field data. Results: Patients with optic neuritis demonstrated variations in visual field sensitivity that were outside the entire range of variability for normal controls. These variations occurred for multiple tests performed on the same day at specific times and for tests performed at specific times on different days. There were no consistent patterns of sensitivity changes that could be attributed to time of day. The most dramatic fluctuations occurred in a patient whose visual fields varied from normal to a hemianopic defect from one week to another and from a partial quadrant loss to a hemianopic defect at different times on the same day. Seven of the patients with optic neuritis also demonstrated intermittent vertical step defects. Conclusions: Patients with resolved optic neuritis can have large variations in visual field results on different days and at different times on the same day. The variations affect both the severity and the pattern of visual field loss and do not appear to be consistent across patients. These data indicate that care must be taken when automated visual field results in patients with optic neuritis are interpreted. Distinguishing systematic changes in sensitivity from variability requires more than a comparison of the current visual field with the most recent previous visual field.

Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions

“…2 Wall et al have demonstrated that when using the testing algorithm for HFA, four primary points are the first to be determined in each visual field quadrant and if a low threshold for a primary point is observed, it may cause the transient vertical steps seen in patients with optic neuritis. 3 In our study, the primary points in the quadrants with the visual field defects had low thresholds in cases 1 and 2 (Table 2). Thus, the testing algorithm for HFA may be responsible for the findings in patients with optic neuritis.…”

Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions

“…2 Wall et al have demonstrated that when using the testing algorithm for HFA, four primary points are the first to be determined in each visual field quadrant and if a low threshold for a primary point is observed, it may cause the transient vertical steps seen in patients with optic neuritis. 3 In our study, the primary points in the quadrants with the visual field defects had low thresholds in cases 1 and 2 (Table 2). Thus, the testing algorithm for HFA may be responsible for the findings in patients with optic neuritis.…”

Frequency of visual field testing when monitoring patients newly diagnosed with glaucoma: mixed methods and modelling

“…The results confirm that a reduction in VF sensitivity is accompanied by a large increase in variability. 50,54,57,[59][60][61]78,79 However, there are notable differences between this study and previous investigations of VF variability. Test-retest studies assume that VF measurements remain unchanged over the testing period and take an average of threshold values to approximate true sensitivity.…”

Longitudinal Evaluation of Visual Function in Multiple Sclerosis

“…In ON<6mo, a significant percentage (4/13, 31%) showed improvement in CS (p<0.001) (Figure 4A). For HVF MD, none of the non-ON, and only 2/14 (11%) of ON<6mo and 1/27 (4%) of ON≥6mo exceeded the limits, 31 both in the direction of improvement, but the percentages were not significantly different from 5% for either group (Figure 4B). …”

Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions

“…2 Wall et al have demonstrated that when using the testing algorithm for HFA, four primary points are the first to be determined in each visual field quadrant and if a low threshold for a primary point is observed, it may cause the transient vertical steps seen in patients with optic neuritis. 3 In our study, the primary points in the quadrants with the visual field defects had low thresholds in cases 1 and 2 (Table 2). Thus, the testing algorithm for HFA may be responsible for the findings in patients with optic neuritis.…”

Frequency of visual field testing when monitoring patients newly diagnosed with glaucoma: mixed methods and modelling

“…The results confirm that a reduction in VF sensitivity is accompanied by a large increase in variability. 50,54,57,[59][60][61]78,79 However, there are notable differences between this study and previous investigations of VF variability. Test-retest studies assume that VF measurements remain unchanged over the testing period and take an average of threshold values to approximate true sensitivity.…”

Longitudinal Evaluation of Visual Function in Multiple Sclerosis

“…In ON<6mo, a significant percentage (4/13, 31%) showed improvement in CS (p<0.001) (Figure 4A). For HVF MD, none of the non-ON, and only 2/14 (11%) of ON<6mo and 1/27 (4%) of ON≥6mo exceeded the limits, 31 both in the direction of improvement, but the percentages were not significantly different from 5% for either group (Figure 4B). …”

Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions

“…2 Wall et al have demonstrated that when using the testing algorithm for HFA, four primary points are the first to be determined in each visual field quadrant and if a low threshold for a primary point is observed, it may cause the transient vertical steps seen in patients with optic neuritis. 3 In our study, the primary points in the quadrants with the visual field defects had low thresholds in cases 1 and 2 (Table 2). Thus, the testing algorithm for HFA may be responsible for the findings in patients with optic neuritis.…”

Frequency of visual field testing when monitoring patients newly diagnosed with glaucoma: mixed methods and modelling

“…The results confirm that a reduction in VF sensitivity is accompanied by a large increase in variability. 50,54,57,[59][60][61]78,79 However, there are notable differences between this study and previous investigations of VF variability. Test-retest studies assume that VF measurements remain unchanged over the testing period and take an average of threshold values to approximate true sensitivity.…”

Longitudinal Evaluation of Visual Function in Multiple Sclerosis

“…In ON<6mo, a significant percentage (4/13, 31%) showed improvement in CS (p<0.001) (Figure 4A). For HVF MD, none of the non-ON, and only 2/14 (11%) of ON<6mo and 1/27 (4%) of ON≥6mo exceeded the limits, 31 both in the direction of improvement, but the percentages were not significantly different from 5% for either group (Figure 4B). …”