Is There Evidence for Continued Learning Over Multiple Years in Perimetry?

Abstract

The existence of learning effects in perimetry, whereby a subject's first test is more variable and has lower mean sensitivity (MS) than subsequent tests, is well established. However, studies have typically examined this issue by testing subjects at a frequency that would be unusual in a clinical setting. This study seeks to determine the validity of these conclusions for less frequent, yet more clinically realistic, testing rates. One hundred sixty eyes of 80 subjects with suspected or early glaucoma were included. Subjects were tested annually for 8 years using white-on-white standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). All subjects had undergone at least one test with both paradigms before entering the study. For SAP, MS increased by 0.5 dB over the first year, and then showed no significant change until after year 5 (despite expected effects of aging and disease progression), after which it started to decline. For SWAP, MS of the average eye continued to improve until year 6 of the study. Our findings seem to indicate a prolonged learning effect for SWAP, with MS increasing for several years. A smaller prolonged learning effect may also be present for SAP, counteracting the effects of aging and disease progression. Deterioration of the subject's visual field may be underestimated within this period.