Abstract
PurposeTo propose a new tablet-enabled test for evaluation of visual performance in glaucoma, the PERformance CEntered Portable Test (PERCEPT), and to evaluate its ability to predict history of falls and motor vehicle crashes.DesignCross-sectional study.MethodsThe study involved 71 patients with glaucomatous visual field defects on standard automated perimetry (SAP) and 59 control subjects. The PERCEPT was based on the concept of increasing visual task difficulty to improve detection of central visual field losses in glaucoma patients. Subjects had to perform a foveal 8-alternative-forced-choice orientation discrimination task, while detecting a simultaneously presented peripheral stimulus within a limited presentation time. Subjects also underwent testing with the Useful Field of View (UFOV) divided attention test. The ability to predict history of motor vehicle crashes and falls was investigated by odds ratios and incident-rate ratios, respectively.ResultsWhen adjusted for age, only the PERCEPT processing speed parameter showed significantly larger values in glaucoma compared to controls (difference: 243ms; P<0.001). PERCEPT results had a stronger association with history of motor vehicle crashes and falls than UFOV. Each 1 standard deviation increase in PERCEPT processing speed was associated with an odds ratio of 2.69 (P = 0.003) for predicting history of motor vehicle crashes and with an incident-rate ratio of 1.95 (P = 0.003) for predicting history of falls.ConclusionA portable platform for testing visual function was able to detect functional deficits in glaucoma, and its results were significantly associated with history of involvement in motor vehicle crashes and history of falls.
Highlights
Glaucoma is a neurodegenerative disease associated with progressive loss of retinal ganglion cells, characteristic optic nerve changes, and loss of visual function.[1]
When adjusted for age, only the PERformance CEntered Portable Test (PERCEPT) processing speed parameter showed significantly larger values in glaucoma compared to controls
PERCEPT results had a stronger association with history of motor vehicle crashes and falls than Useful Field of View (UFOV)
Summary
Glaucoma is a neurodegenerative disease associated with progressive loss of retinal ganglion cells, characteristic optic nerve changes, and loss of visual function.[1]. The requirements for highly trained technicians, cost, complexity, and lack of portability of SAP testing preclude its general use for screening or evaluation of visual function loss in primary care settings or in underserved populations. SAP has a relatively weak ability to assess parameters that may be related to functional impairment from the disease, such as risk for motor vehicle collisions or falls, for example. In SAP, the ability to detect a static white-on-white peripheral visual stimulus at threshold is evaluated under optimal conditions of adaptation and testing. These artificial test conditions minimize potential distractions and may give unrealistic estimates of the amount of useful vision that is available to perform real work tasks.[13,14]
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