Selective perimetry in glaucoma diagnosis

Abstract

Selective perimetry evaluates visual function by using visual stimuli that attempt to target specific subpopulations of retinal ganglion cells, which is designed to improve sensitivity to detect glaucomatous functional loss. This paper reviews recent studies that have assessed the characteristics of new strategies/programs of selective perimetry. Selective perimetry is usually compared against an existing standard technique--standard automated perimetry. Recent studies did not consider standard automated perimetry results as part of inclusion/exclusion criteria, avoiding selection bias and permitting fair comparisons between perimetry techniques. Furthermore, the Swedish Interactive Threshold Algorithm is replacing Full-Threshold as the standard automated perimetry gold-standard strategy, and comparisons of the diagnostic performance of function-specific perimetry may be influenced by which standard automated perimetry technique is used as the reference. These factors may impact our perception about the role of selective perimetry in glaucoma management. The lack of a perfect gold-standard diagnostic test for glaucoma limits the interpretation of results from cross-sectional studies evaluating visual field tests. Nevertheless, evidence suggests that visual dysfunction in eyes with early glaucoma varies significantly between individuals and no single technique is superior to the others in all patients. A multimodal functional assessment may be more effective in detecting/quantifying visual impairment associated with early glaucoma.