Repeatability of Automated Perimetry: A Comparison between Standard Automated Perimetry with Stimulus Size III and V, Matrix, and Motion Perimetry

Wall, Michael; Woodward, K. R.; Doyle, Carrie K.; Artes, Paul H.

doi:10.1167/iovs.08-1789

Cited by 133 publications

(156 citation statements)

References 31 publications

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“…[18][19][20][21] A larger stimulus could be used for all testing, or the stimulus size could be increased when testing is being conducted at damaged visual FIGURE 3. The contrasts (dB) that would give 50% (left) or 25% (right) response probability for each stimulus size, based on the fitted frequency-of-seeing curves, at each location tested.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] Previously it has been suggested that use of a size V (1.728 diameter) stimulus could also reduce variability, allowing reliable visual field testing to be performed later into the disease process. [18][19][20][21] This study examines whether the reduction in variability observed when using size V stimuli can be explained solely by the increase in sensitivity, or whether the reliable stimulus range is also extended to higher contrasts than when using size III stimuli. The results from this study will help clinicians, researchers and manufacturers understand the most reliable testing strategies for glaucoma patients with moderate to severe visual field loss, who have the most variable results and also the highest risk of permanent visual impairment.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Stimulus Size on the Reliable Stimulus Range of Perimetry

Gardiner¹,

Demirel²,

Goren³

et al. 2015

Trans. Vis. Sci. Tech.

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Purpose: Automated perimetry uses a 3.5 log unit (35dB) range of stimulus contrasts to assess function within the visual field. Using 'Size III' stimuli (0.438), presenting stimuli within the highest 15dB of available contrast may not increase the response probability at locations damaged by glaucoma, due to retinal ganglion cell response saturation. This experiment examines the effect of instead using 'Size V' (1.728) stimuli.Methods: Luminance increment thresholds for circular spot stimuli of each stimulus size were measured in 35 participants (mean deviation À20.9 to À3.4 dB, ages 52-87) using the method of constant stimuli, at four locations per participant. Frequency-ofseeing curves were fit at each size and location, with three free parameters: mean, standard deviation, and asymptotic maximum response probability. These were used to estimate the contrasts to which each participant would respond on 25% of presentations (c25).Results: Using segmented orthogonal regression, the maximum observed response probabilities for size III stimuli began to decline at c25 ¼ 25.2 dB (95% confidence interval 23.3-29.0 dB from bootstrap resampling). This decline started at similar contrast for the size V stimulus: c25 ¼ 25.0dB (22.0-26.8 dB). Among locations at which the sensitivity was above these split-points for both stimulus sizes, c25 averaged 5.6 dB higher for size V than size III stimuli. Conclusions:The lower limit of the reliable stimulus range did not differ significantly between stimulus sizes. However, more locations remained within the reliable stimulus range when using the size V stimulus.Translational Relevance: Size V stimuli enable reliable clinical testing later into the glaucomatous disease process.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Stimulus Size on the Reliable Stimulus Range of Perimetry

Gardiner¹,

Demirel²,

Goren³

et al. 2015

Trans. Vis. Sci. Tech.

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“…Thus, it may be presumed that increased RT may be a predictor of increased variability and fatigue. In static perimetry, RT in glaucomatous visual field loss increases when the stimulus is closer to threshold [38] and it depends primarily on the slope of the frequency of the seeing curve for that test location and on the frequency of false-positive and false-negative responses [6] . RT, as determined by SKP, increases with increasing eccentricity of the origin of the vector in healthy individuals [24] and in patients with advanced visual field loss [23] .…”

Section: Discussionmentioning

confidence: 99%

Variability in Isopter Position and Fatigue during Semi-Automated Kinetic Perimetry

et al. 2011

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repeated examination was 656 square degrees (deg 2 ) in the glaucoma group, 104 deg 2 in the retinitis pigmentosa group and 227 deg 2 in the group of patients with postchiasmal lesions. Post-hoc regression analysis revealed that the variability of isopter position increased as the RT increased. Conclusion: The variability of III4e-isopter position and fatigue were most pronounced among glaucoma patients. RT is the most important factor influencing the variability of responses and fatigue during SKP, thus we propose that it can be used as a reliability indicator of SKP.

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“…[8][9][10] Increased test-retest variability is not present for frequency-doubling perimetry, which uses large, sinusoidal stimuli. [11][12][13][14][15] Knowledge about why frequency-doubling stimuli have this property could help identify a wider range of potential new stimuli for perimetry with improved test-retest variability near and within glaucomatous defects.…”

Section: Introductionmentioning

confidence: 99%

“…12,13,26 It is possible that the size of sinusoidal stimuli, rather than their property of being sinusoidal, is the source of reduced variability. For instance, variability in glaucomatous defects can also be reduced 15 by using the size V stimulus, which is has a width of 1.78. However, size alone may not be sufficient to reduce variability because even size V and frequency-doubling stimuli have been found to have an effective dynamic range that is smaller than the range of possible stimulus contrasts provided by the instrument.…”

Section: Introductionmentioning

confidence: 99%

Choice of Stimulus Range and Size Can Reduce Test-Retest Variability in Glaucomatous Visual Field Defects

Swanson

Horner

Dul

et al. 2014

Trans. Vis. Sci. Tech.

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Purpose: To develop guidelines for engineering perimetric stimuli to reduce testretest variability in glaucomatous defects.Methods: Perimetric testing was performed on one eye for 62 patients with glaucoma and 41 age-similar controls on size III and frequency-doubling perimetry and three custom tests with Gaussian blob and Gabor sinusoid stimuli. Stimulus range was controlled by values for ceiling (maximum sensitivity) and floor (minimum sensitivity). Bland-Altman analysis was used to derive 95% limits of agreement on test and retest, and bootstrap analysis was used to test the hypotheses about peak variability.Results: Limits of agreement for the three custom stimuli were similar in width (0.72 to 0.79 log units) and peak variability (0.22 to 0.29 log units) for a stimulus range of 1.7 log units. The width of the limits of agreement for size III decreased from 1.78 to 1.37 to 0.99 log units for stimulus ranges of 3.9, 2.7, and 1.7 log units, respectively (F ¼ 3.23, P , 0.001); peak variability was 0.99, 0.54, and 0.34 log units, respectively (P , 0.01). For a stimulus range of 1.3 log units, limits of agreement were narrowest with Gabor and widest with size III stimuli, and peak variability was lower (P , 0.01) with Gabor (0.18 log units) and frequency-doubling perimetry (0.24 log units) than with size III stimuli (0.38 log units).Conclusions: Test-retest variability in glaucomatous visual field defects was substantially reduced by engineering the stimuli.Translational Relevance: The guidelines should allow developers to choose from a wide range of stimuli.

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Repeatability of Automated Perimetry: A Comparison between Standard Automated Perimetry with Stimulus Size III and V, Matrix, and Motion Perimetry

Cited by 133 publications

References 31 publications

The Effect of Stimulus Size on the Reliable Stimulus Range of Perimetry

The Effect of Stimulus Size on the Reliable Stimulus Range of Perimetry

Variability in Isopter Position and Fatigue during Semi-Automated Kinetic Perimetry

Choice of Stimulus Range and Size Can Reduce Test-Retest Variability in Glaucomatous Visual Field Defects

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