Periphery kinetic perimetry: clinically feasible to complement central static perimetry

Xiaoxiao Ma,Li Tang,Liuzhi Zeng,Xiaoming Chen

doi:10.1186/s12886-021-02056-5

Abstract

BackgroundExisting evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals. The following study compared the central visual field defects with the peripheral visual field defects in patients with suspect glaucoma and primary open-angle glaucoma (POAG) and investigated whether using the central visual field test alone could result in loss of clinically valuable information.MethodsIn this prospective observational study, 167 eyes from 89 patients with suspect glaucoma or POAG were first examined with static automated perimetry (SAP), followed by a peripheral visual field test on Octopus 900 perimeter (Haag-Streit, Koeniz, Switzerland). The peripheral visual field test was performed by “Auto Kinetic Perimetry” program, in which Goldmann III4e stimuli randomly moved along 16 vectors at a constant angular velocity of 5 deg/s.ResultsGlaucomatous peripheral visual field defects were seen in 18% of the eyes with a normal central visual field. In addition, 86% of glaucoma patients with moderate-to-severe central visual field defects had corresponding peripheral visual field defects in the form of localized or diffuse depression of the isopters. Furthermore, a moderate correlation was found between the central and peripheral visual fields. The median test duration was 71 s for the peripheral test and 803 s for the central test (p < 0.001).ConclusionsOur study demonstrated the diversity of glaucomatous visual field defects, as well as the possibility of losing the clinically valuable information due to focusing on the central visual field test alone. The peripheral kinetic perimetry is clinically feasible to complement the central static perimetry for a comprehensive assessment of visual function in glaucoma patients.

Highlights

Existing evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals
Diagnosis of primary open-angle glaucoma (POAG) was based on the presence of glaucomatous optic nerve head (ONH), open anterior chamber angle, and visual field defects corresponding to ONH appearance, regardless of the level of intraocular pressure (IOP)
Reliability of visual field testing We considered that the results of the central static visual field test were unreliable if the reliability factor (RF) was > 15 [23, 24]; the results of the peripheral kinetic visual field test were unreliable if the patients’ fixation was assessed as poor by the examiner or the isopter radius difference on the same vector between the two tests was > 5 degrees [17]

Summary

Introduction

Existing evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals. Glaucoma is the second leading cause of global blindness. It is a group of eye conditions characterized by irreversible optic nerve damage and progressive visual field defect [1,2,3]. The kinetic perimetry is sensitive to detect peripheral visual field defects and is correlated with daily living activities [13,14,15,16]. Goldmann kinetic perimetry, which is a high-quality assessment of the peripheral visual field, can be obtained within a short test time by a welltrained and experienced perimetrist. The “Auto kinetic perimetry” program using Octopus 900 perimeter provides greater standardization and shorter test time of the peripheral visual field test

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