Comparison between Fundus Automated Perimetry and Humphrey Field Analyzer: Performance and usability of the Fundus Automated Perimetry and Humphrey Field Analyzer in healthy, ocular hypertensive, and glaucomatous patients.

Abstract

We compared the performance and usability of the Fundus Automated Perimetry (FAP) and Humphrey Field Analyzer (HFA) in patients with glaucoma, ocular hypertension, and healthy subjects. A total of 60 participants, divided in three groups of 20, glaucoma (POAG), ocular hypertension (OHT), and controls group, underwent a HFA test 24-2 SITA standard and a FAP test 24-2 ZEST sequence, in randomized order. The mean differences between perimeters of mean deviation (MD), pattern standard deviation (PSD) were correlated using the t-test and the Bland-Altman plot while execution time, Glaucoma Staging System 2 (GSS2), Hodapp-Parrish-Anderson staging system, localization of the defect, false positives (FP), and false negatives (FN) were compared with t-test analysis. Usability was measured through answers of a dedicated questionnaire. MD's difference was higher for FAP than HFA: OHT -2.20 ± 1.33 dB (p < 0.001), POAG -2.00 ± 1.66 dB (p < 0.001), and controls -1.08 ± 1.43 dB (p < 0.001). PSD's difference was higher for FAP than HFA: OHT 0.85 ± 1.16 dB (p < 0.001), POAG 0.78 ± 2.32 dB (p = 0.043), and controls 0.49 ± 1.15 dB (p < 0.001). GSS2's difference showed that FAP found more severe defects than HFA. Exams duration was longer for FAP versus HFA: in OHT 363 s versus 301 s, in POAG 494 s versus 362 s, and in controls 360 s versus 277 s. For FN and FP, there were no statistically significant differences. The 77% of all subjects preferred FAP to HFA test. Considering MD and GSS2 classification, FAP finds more severe defects. Moreover, although FAP duration is longer, this method is preferred by most of the patients.