Continuous visual field test supervision may not always be necessary

Abstract

Objective To assess the effect of supervision on computerized visual field (VF) performance and to determine what patient characteristics predict poor unsupervised performance. Design Randomized, crossover, cross-sectional, clinical trial. Participants Two hundred unselected patients with definite or suspect glaucoma or neuro-ophthalmic VF indication participated. Intervention All patients completed two 30–2 tests of one eye on a Humphrey perimeter, one with continuous active technician supervision and one without supervision after the initial 2 minutes of the test. Main outcome measures Visual field reliability and global VF indices were measured. Results Supervision had a positive effect on overall reliability ( P = 0.04) but not on individual reliability parameters or any of the global VF indices. There was no difference between Humphrey Field Analyzers I and II in the need for supervision. Predictors of need for supervision were low educational level and a prior test result with false-positive responses. Predictors of an unreliable test were advanced age and a prior test with a high proportion of fixation losses. Conclusion Supervision is necessary for those with risk factors for unsatisfactory perimetry such as advanced age, low level of formal education, and prior test results with false-positive responses or high fixation losses; in the remainder, omission of supervision can be considered.