False Positive Responses in Standard Automated Perimetry

Anders Heijl,Vincent Michael Patella,John G Flanagan,Aiko Iwase,Christopher K Leung,Anja Tuulonen,Gary C Lee,Thomas Callan,Boel Bengtsson

doi:10.1016/j.ajo.2021.06.026

Abstract

To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results. Prospective multicenter cross-sectional study. One hundred twenty-six patients with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH). Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6%-1.4%). Only small parts of intervisit differences were explained by FP (r2 values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r2values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP. Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results,except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.

Highlights

W z 970’ “ b ”helping users judge whether test results were reliable and useful
Increasing false positive (FP) values were associated with higher mean deviation (MD) values for all three algorithms, but the effects were small, 0.3-0.6 dB, for an increase of 10 percentage points of FP rate, and for visual field index (VFI) even smaller, 0.6-1.4%
The effects of FP were larger in severe glaucoma, with MD increases of 1.1-2.0 dB per 10 percentage points of FP, and r2 values ranging from 0.04 to 0.33

Summary

Introduction

Helping users judge whether test results were reliable and useful. These parameters were fixation losses (FL), false negative (FN). Fixation loss responses are obtained using a method described in 1974 in which test stimuli are presented at the expected location of the physiological blind spot of the tested eye 1. The method was originally designed to give a qualitative idea about fixation in a very early computerized perimeter, where the operator could not see the tested eye. The method has been widely used in many or most automated perimeters, but has well-known shortcomings, especially in eyes where the blind spot is not situated in the assumed location. Today various methods for gaze tracking can be considered superior to the blind spot technique, and at least one new testing algorithm relies by default upon gaze tracking and not FL estimates based on the blind spot method[4]

Methods

Results

Conclusion