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

Abstract

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.

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Central 10-2 Tests

“…On the other hand, the steep elevation of FNs in 70 s indicated the aging effect. Interestingly, the same steep elevation of FNs in 70 s was found in our previous study of the 30-2 test [ 20 ]. There have been several reports of anatomical and functional aging changes in the macula and perifoveal area [ 24 , 25 ].…”

“…Regarding the association among the parameters for all ages ( Table 2 ), aging correlated significantly with FNs, with no significant correlation between age and FL or between age and FPs; our previous reports on the 30-2 test showed that all three reliability indices correlated significantly with aging [ 20 ]. To exclude the effects derived from the small number of extreme cases, only the subjects aged 40 years or older were included in the multivariate analyses.…”

“…We have previously investigated the relationships between age and the VF reliability indices in a 30-2 dataset [ 20 ]. In subjects who are 40 years old or older, the mean ages of the two datasets (the 10-2 test from this study and the 30-2 test from our previous study) were virtually equivalent (68.8 years for the 10-2 and 68.4 years for the 30-2), while the MDs were distinctly different (−16.1 dB for the 10-2 and −7.3 dB for the 30-2) ( Table 7 ).…”

“…The evaluation of these indices is critical in monitoring glaucoma progression [ 2 , 9 , 16 , 17 , 18 , 19 ]. We previously reported the influence of aging on the reliability of VF testing by using a large dataset of a central 30-2 program by the Humphrey Visual Field Analyzer [ 20 ]. However, the influence of aging on the reliability indices of VFs tested by the central 10-2 program, a program suitable to test both advanced cases and glaucoma with paracentral scotoma, is not well documented.…”

Spotlight on iPad Visual Field Tests Efficacy

“… 5 Fixation Losses are consistently elevated after the third decade of life, and False Negatives elevated after the seventh decade. 6 Therefore, portable, tablet (iPad) based tests and virtual reality (VR) headset based perimetry are gaining popularity as an alternative form of VF testing. Tablet perimetry has the potential to be used as a low-cost method for glaucoma screening.…”