Reducing Variability of Perimetric Global Indices from Eyes with Progressive Glaucoma by Censoring Unreliable Sensitivity Data

Pathak, Manoj Kumar; Demirel, Shaban; Gardiner, Stuart K.

doi:10.1167/tvst.6.4.11

Cited by 17 publications

(18 citation statements)

References 16 publications

(29 reference statements)

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“…It could be argued that improvements in testeretest variability in the upper range of sensitivity values could be more clinically relevant for progression detection. [24][25][26][27][28][29] However, this is speculation because only analysis of long-term follow-up of glaucoma subjects with the CMP will allow the assessment of the real effect of such reduction in variability on earlier diagnosis of progression. Additionally, Wyatt et al 30 identified gaze instability as a possible source of variability at the edges of scotomata, and tracking might help reduce this effect.…”

Section: Discussionmentioning

confidence: 99%

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer

et al. 2019

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Section: Discussionmentioning

confidence: 99%

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer

et al. 2019

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“…Higher variance at locations with greater defect depth has been demonstrated by a number of other studies, 54,55 and there have also been suggestions for the censoring of perimetric data below certain sensitivity levels (15-19 dB). 31,56 When we censored our data below 19 dB, there was no difference in the slope values or goodness of fit, suggesting that moderate strength of correlation was not related to high variance at low sensitivities but rather was likely driven by algorithm differences.…”

Section: Are the Sita Algorithms Interchangeable?mentioning

confidence: 97%

“…26,27 However, the implementation of recommendations for increased frequency of testing has been challenging, with issues of timing and availability of resources being cited as barriers, despite long-term cost savings. 28 Alternative approaches, such as the use of previous sensitivity information, 29 adaptation to regions of interest, such as scotomata, 30 censoring of unreliable test points to reduce the number of stimulus presentations, 31 and the use of structural information for targeting specific regions of the visual field 32,33 remain theoretical at present and have not yet been widely implemented in practice.…”

mentioning

confidence: 99%

Clinical Evaluation of Swedish Interactive Thresholding Algorithm–Faster Compared With Swedish Interactive Thresholding Algorithm–Standard in Normal Subjects, Glaucoma Suspects, and Patients With Glaucoma

Phu

Khuu

Agar

et al. 2019

American Journal of Ophthalmology

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To compare the visual fields results obtained using the Swedish interactive thresholding algorithm-Standard (SS) and the Swedish interactive thresholding algorithm-Faster (SFR) in normal subjects, glaucoma suspects, and patients with glaucoma and to quantify potential time-saving benefits of the SFR algorithm. DESIGN: Prospective, cross-sectional study. METHODS: One randomly selected eye from 364 patients (77 normal subjects, 178 glaucoma suspects, and 109 patients with glaucoma) seen in a single institution underwent testing using both SS and SFR on the Humphrey Field Analyzer. Cumulative test time using each algorithm was compared after accounting for different rates of test reliability. Pointwise and cluster analysis was performed to determine whether there were systematic differences between algorithms. RESULTS: Using SFR had a greater rate of unreliable results (29.3%) compared with SS (7.7%, P < .0001). This was mainly because of high false positive rates and seeding point errors. However, modeled test times showed that using SFR could obtain a greater number of reliable results within a shorter period of time. SFR resulted in higher sensitivity values (on average 0.5 dB for patients with glaucoma) that was greater under conditions of field loss (<19 dB). Cluster analysis showed no systematic patterns of sensitivity differences between algorithms. CONCLUSIONS: After accounting for different rates of test reliability, SFR can result in significant time savings compared with SS. Clinicians should be cognizant of false positive rates and seeding point errors as common sources of error for SFR. Results between algorithms are not directly interchangeable, especially if there is a visual field deficit <19 dB.

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“…We do not fully threshold these locations, consistent with recent evidence that censoring data in this range does not alter the ability to detect progression in existing visual field datasets, determined using either global indices or on a pointwise basis. 21 , 22 We demonstrate that this new approach allows more complete visualization of the spatial nature of progressing visual field loss in glaucoma, without sacrificing specificity, and with an improvement in test time.…”

Section: Introductionmentioning

confidence: 86%

“…Note that the cutoff value of 16 dB is somewhat arbitrary, and perhaps even conservative as there is some evidence that using any values up to 19 dB might be appropriate. 18 , 21 , 22 …”

Section: Methodsmentioning

confidence: 99%

Improving Spatial Resolution and Test Times of Visual Field Testing Using ARREST

Turpin

Morgan

McKendrick

2018

Trans. Vis. Sci. Tech.

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PurposeCorrectly classifying progression in moderate to advanced glaucoma is difficult. Pointwise visual field test–retest variability is high for sensitivities below approximately 20 dB; hence, reliably detecting progression requires many test repeats. We developed a testing approach that does not attempt to threshold accurately in areas with high variability, but instead expends presentations increasing spatial fidelity.MethodsOur visual field procedure Australian Reduced Range Extended Spatial Test (ARREST; a variant of the Bayesian procedure Zippy Estimation by Sequential Testing [ZEST]) applies the following approach: once a location has an estimated sensitivity of <17 dB (a “defect”), it is checked that it is not an absolute defect (<0 dB, “blind”). Saved presentations are used to test extra locations that are located near the defect. Visual field deterioration events are either: (1) decreasing in the range of 40 to 17 dB, (2) decreasing from >17 dB to “defect”, or (3) “defect” to blind. To test this approach we used an empirical database of progressing moderate-advanced 24-2 visual fields (121 eyes) that we “reverse engineered” to create visual field series that progressed from normal to the end observed field. ARREST and ZEST were run on these fields with test accuracy, presentation time, and ability to detect progression compared.ResultsWith specificity for detecting progression matched at 95%, ZEST and ARREST showed similar sensitivity for detecting progression. However, ARREST used approximately 25% to 40% fewer test presentations to achieve this result in advanced visual field damage. ARREST spatially defined the visual field deficit with greater precision than ZEST due to the addition of non–24-2 locations.ConclusionsSpending time trying to accurately measure visual field locations that have high variability is not productive. Our simulations indicate that giving up attempting to quantify size III white-on-white sensitivities below 17 dB and using the presentations saved to test extra locations should better describe progression in moderate-to-advanced glaucoma in shorter time.Translational RelevanceARREST is a new visual field test algorithm that provides better spatial definition of visual field defects in faster test time than current procedures. This outcome is achieved by substituting inaccurate quantification of sensitivities <17 dB with new spatial locations.

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Reducing Variability of Perimetric Global Indices from Eyes with Progressive Glaucoma by Censoring Unreliable Sensitivity Data

Cited by 17 publications

References 16 publications

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer

Clinical Evaluation of Swedish Interactive Thresholding Algorithm–Faster Compared With Swedish Interactive Thresholding Algorithm–Standard in Normal Subjects, Glaucoma Suspects, and Patients With Glaucoma

Improving Spatial Resolution and Test Times of Visual Field Testing Using ARREST

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