Comparison of Saccadic Vector Optokinetic Perimetry and Standard Automated Perimetry in Glaucoma. Part I: Threshold Values and Repeatability.

Ian C Murray,Alice D Mctrusty,Harry M Brash,Brian W Fleck,Andrew J Tatham,Lorraine A Cameron,Robert A Minns,Pankaj K Agarwal,Antonios Perperidis

doi:10.1167/tvst.6.5.3

Abstract

PurposeWe evaluated threshold saccadic vector optokinetic perimetry (SVOP) and compared results to standard automated perimetry (SAP).MethodsA cross-sectional study was done including 162 subjects (103 with glaucoma and 59 healthy subjects) recruited at a university hospital. All subjects underwent SAP and threshold SVOP. SVOP uses an eye tracker to monitor eye movement responses to stimuli and determines if stimuli have been perceived based on the vector of the gaze response. The test pattern used was equivalent to SAP 24-2 and stimuli were presented at Goldmann III. Average and pointwise sensitivity values obtained from both tests were compared using Pearson's correlation coefficient. Two versions of SVOP were evaluated.ResultsA total of 124 tests were performed with SAP and SVOP version 2. There was excellent agreement between mean threshold values obtained using SVOP and SAP (r = 0.95, P < 0.001). Excluding the blind spot, correlation between SVOP and SAP individual test point sensitivity ranged from 0.61 to 0.90, with 48 of 54 (89%) test points > 0.70. Overall SVOP showed good repeatability with a Pearson correlation of 0.88. The repeatability on a point-by-point basis ranged from 0.66 to 0.98, with 45 of 54 points (83%) > 0.80. Repeatability of SAP was 0.87, ranging from 0.69 to 0.96, with 47 of 54 (87%) points > 0.80.ConclusionEye-tracking perimetry is repeatable and compares well with the current gold standard of SAP. The technique has advantages over conventional perimetry and could be useful for evaluating glaucomatous visual field loss, particularly in patients who may struggle with conventional perimetry.Translational RelevanceSuprathreshold SVOP already is in the field. To our knowledge, this is the first report of threshold SVOP and provides a benchmark for future iterations.

Highlights

The use of a static white stimulus on a white background has become the accepted standard for investigation of visual function in patients with glaucoma
Translational Relevance: Suprathreshold Saccadic vector optokinetic perimetry (SVOP) already is in the field
This is the first report of threshold SVOP and provides a benchmark for future iterations

Summary

Introduction

The use of a static white stimulus on a white background (white-on-white) has become the accepted standard for investigation of visual function in patients with glaucoma. White-on-white automated suprathreshold tests often are used for screening purposes,[1] with threshold tests (standard automated perimetry, SAP) used to aid glaucoma diagnosis and quantify disease progression.[2] Evaluating differential light sensitivity using threshold testing is an essential part of glaucoma management; full threshold testing is time-consuming, which can have an adverse effect on reliability. Patients are required to maintain a fixed head position, which may be problematic. All of these factors can lead to longer test times and contribute to test–retest variability and low test reliability.[7,8]

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