Pattern Deviation Plot Research Articles

Efficacy of the Amsler Grid Test in Evaluating Glaucomatous Central Visual Field Defects

To investigate the efficacy of the Amsler grid test in detecting central visual field (VF) defects in glaucoma. Prospective, cross-sectional study. Patients with glaucoma with reliable Humphrey 10-2 Swedish Interactive Threshold Algorithm standard VF on the date of enrollment or within the previous 3 months. Amsler grid tests were performed for each eye and were considered "abnormal" if there was any perceived scotoma with missing or blurry grid lines within the central 10 degrees ("Amsler grid scotoma"). An abnormal 10-2 VF was defined as ≥3 adjacent points at P < 0.01 with at least 1 point at P < 0.005 in the same hemifield on the pattern deviation plot. Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area were calculated with the 10-2 VF as the clinical reference standard. Among eyes with an abnormal 10-2 VF, regression analyses were performed between the Amsler grid scotoma area and the 10-2 VF parameters (mean deviation [MD], scotoma extent [number of test points with P < 0.01 in total deviation map] and scotoma mean depth [mean sensitivity of test points with P < 0.01 in total deviation map]). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area. A total of 106 eyes (53 patients) were included (mean ± standard deviation age, 24-2 MD and 10-2 MD = 66±12 years, -9.61±8.64 decibels [dB] and -9.75±9.00 dB, respectively). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid test were 68%, 92%, 97%, and 46%, respectively. Sensitivity was 40% in eyes with 10-2 MD better than -6 dB, 58% in eyes with 10-2 MD between -12 and -6 dB, and 92% in eyes with 10-2 MD worse than -12 dB. The area under the receiver operating characteristic curve of the Amsler grid scotoma area was 0.810 (95% confidence interval, 0.723-0.880, P < 0.001). The Amsler grid scotoma area had the strongest relationship with 10-2 MD (quadratic R(2)=0.681), followed by 10-2 scotoma extent (quadratic R(2)=0.611) and 10-2 scotoma mean depth (quadratic R(2)=0.299) (all P < 0.001). The Amsler grid can be used to screen for moderate to severe central vision loss from glaucoma.

Clinical Clues to Predict the Presence of Parafoveal Scotoma on Humphrey 10-2 Visual Field Using a Humphrey 24-2 Visual Field

To investigate characteristics related to the presence of parafoveal scotoma on Humphrey 10-2 visual field (VF) in early glaucoma patients. Prospective, cross-sectional study. participants: Ninety-one eyes from 91 patients with glaucomatous optic neuropathy were prospectively tested with a 10-2 VF test. Glaucoma patients were classified into eyes with or without parafoveal scotoma on 10-2 VF based on pattern deviation plot. The central 10 degree region of Humphrey 24-2 VF test comprised 12 points and any abnormal VF points depressed <5%, <2%, <1%, or <0.5% from the normal database on pattern deviation plot were analyzed. Various factors related to the presence of parafoveal scotoma on 10-2 VF were analyzed. Abnormal 24-2 VF points, macular ganglion cell-inner plexiform layer thickness. The presence of abnormal 24-2 VF points <0.5% was significantly different between eyes with and without parafoveal scotoma on 10-2 VF (P < .01). The minimum macular ganglion cell-inner plexiform layer thickness (P = .04), any central 12 points depressed <0.5% on 24-2 VF (P < .01), and any central 12 points depressed <5% on 24-2 VF that spatially corresponds to macular ganglion cell-inner plexiform layer thinning (P < 0.01) were related factors to the presence of parafoveal scotoma on 10-2 VF. Glaucomatous eyes with any abnormal 24-2 VF points on the central 10 degree region that are depressed <0.5% or <5% that correlates to macular ganglion cell-inner plexiform layer thinning should receive attention and be further evaluated with a 10-2 VF test.

Position of the central retinal vessel trunk and location of visual field and parapapillary nerve fibers damage in early to moderate glaucoma

AbstractPurpose To address the question of whether the position of the central retinal vessel trunk (CRVT) exit in the optic disc has a spatial relationship with glaucomatous damageMethods This clinical observational study included patients with early to moderate primary open‐angle glaucoma. The position of the CRVT exit on the lamina cribrosa was evaluated on optic disc photographs. Visual field tests and retinal nerve fibers layer (RNFL) thicknesses, as measured by optical coherence tomography, were evaluated.Results The study included 65 eyes with a CRVT mostly decentered into the nasal region followed by the temporal half of the optic disc. Comparing measurements between the opposite disc quadrants indicated that the RNFL thickness was significantly thinner in the inferotemporal quadrant when the CRVT was located in the superonasal quadrant compared with an exit in the inferonasal (p=0.0183) or temporal (p=0.0039) quadrant. The distance from the CRVT to the nasal disc border was significantly smaller and correlated positively with the occurrence of RNFL abnormality in the temporal region (p=0.0334). Visual field defect incidence was higher in the superonasal quadrant of the pattern deviation plot when the CRVT was located in the superonasal quadrant compared with an exit in the inferonasal quadrant (p&lt;0.0003). Temporal visual field abnormalities occurred more often when the CRVT exit was located in the temporal part of the optic disc than when the CRVT exit was located in the nasal half (p=0.008).Conclusion Local susceptibility for development of glaucomatous damage correlates with the distance to the CRVT, which may act as a stabilizing element against the deformation of the lamina cribrosa.

Disparity between Visual Fields and Optical Coherence Tomography in Hydroxychloroquine Retinopathy

American Academy of Ophthalmology recommendations for screening for hydroxychloroquine (HCQ) retinopathy advise objective measures, such as spectral-domain optical coherence tomography (SD-OCT) and multifocal electroretinography (mfERG) along with visual fields. However, the relative sensitivity and specificity of screening tests have not been fully resolved. We characterize a subset of patients with toxicity who show unusual disparity between fields and SD-OCT and thus have implications for screening practice. Review of charts and clinical data. Patients at Stanford and Kaiser Permanente who had used HCQ with greater than 1000 g cumulative exposure. There were more than 2000 such individuals, among whom 150 had clear evidence of toxicity. Patients were evaluated by visual fields (10-2 white Swedish Interactive Threshold Algorithm pattern deviation plots), SD-OCT, and sometimes mfERG or fundus autofluorescence. Relative findings on visual fields in comparison with SD-OCT. There were 11 patients among those with HCQ toxicity who had parafoveal ring scotomas but a normal-appearing SD-OCT. None had a history of macular disease or evidence for any other cause of bull's eye maculopathy. Conversely, all cases with a clear degree of parafoveal damage on SD-OCT showed at least some focal spots of parafoveal field loss. Approximately 10% of patients with early HCQ toxicity showed prominent ring scotomas on field testing without obvious SD-OCT abnormality. This should encourage the inclusion of visual fields as a key screening tool, even when SD-OCT (a more specific and objective test) also is performed. The combination of visual fields and SD-OCT gives both sensitivity and specificity while avoiding unnecessary stoppage of the drug.

Stimulus Size for Perimetry in Patients With Glaucoma

Clinical perimetry today uses a stimulus that arose from historic accident. Wall and colleagues1 show that other stimulus choices are at least as valid. Automated static perimetry typically uses the Goldmann size III stimulus, a circular luminance increment whose diameter is 0.43° of visual angle. This choice of stimulus size was not a scientific standard, but was a choice made by the engineers of the first commercial device. Kinetic perimetry had varied both stimulus contrast and stimulus size, but those engineers chose to use a fixed size and a wider range of contrasts. Later companies copied this approach, which became the conventional perimetric stimulus. This approach led to high test–retest variability in glaucomatous defects.2,3 Wall and colleagues1 tested a large number of people with size III, size V (1.72° diameter), a custom “size VI” (3.44° diameter), and with a method that varies stimulus size for a fixed contrast (size threshold perimetry [STP]). They generated their own normative values for each test, and used these to compute total deviation, pattern deviation, and probability plots for the patients. They found the same number of abnormal locations with III, V, and STP, and slightly fewer for size VI. The shapes of defects on probability plots were similar for all tests. Defects were deeper for size III, and variability was higher, consistent with effects of ganglion cell saturation.4 This study is important because it shows that there is nothing special about the use of a single stimulus size, that all of these tests are measuring the same thing. New forms of perimetry are justified that choose stimuli based on desirable properties, such as lower variability and resistance to effects of blur, reduced illumination, and forward light scatter. The perimetry of the 21st century need not be shackled to a historic accident.

Value of Red Targets and Pattern Deviation Plots in Visual Field Screening for Hydroxychloroquine Retinopathy

To compare the value of red vs white 10-2 visual field testing in patients with different levels of hydroxychloroquine exposure and retinopathy in reference to recent American Academy of Ophthalmology recommendations on screening for hydroxychloroquine retinopathy that advised the use of 10-2 visual field testing with a white test object. We studied retrospectively 13 patients using hydroxychloroquine who had undergone both red (FASTPAC) and white (SITA) 10-2 automated visual field testing in the course of their management. On clinical grounds, they were judged to have no retinopathy, early retinopathy, or moderate or severe hydroxychloroquine retinopathy. White visual field diagrams were difficult to interpret, but pattern deviation plots consistently showed parafoveal sensitivity losses in early retinopathy. Red fields often showed more prominent scotomas in early retinopathy but sometimes showed irregular losses that were hard to evaluate. Either modality showed clear losses in moderate retinopathy. On repeated testing, the pattern deviation plots were somewhat more consistent than red fields in showing parafoveal damage. With white 10-2 visual field hydroxychloroquine screening, the use of pattern deviation plots should be standard practice. Red testing appears to be more sensitive for early retinopathy but may be slightly less specific or consistent. We believe the main application for red testing is in screening for the earliest signs of retinopathy. Either red or white fields should be acceptable for hydroxychloroquine screening, as long as the clinician is sensitive to the characteristic patterns of early parafoveal damage and is prepared to retest fields and add objective tests.

Effect of artificial tears on automated visual field testing in patients with glaucoma and dry eye

ObjectiveTo evaluate the effects of artificial tears on automated visual field (VF) testing in patients with glaucoma with dry eye syndrome. DesignProspective study. ParticipantsFifty eyes of 50 patients with medically treated primary open-angle glaucoma (POAG) were recruited for this study. The patients were subdivided into 2 subgroups: those with dry eye syndrome (group I) and those without dry eye syndrome (group II). MethodsTear break-up time, Lissamine green staining, and Schirmer I test with topical anesthesia were performed in the same order in all patients. Ocular Surface Disease Index questionnaire was completed by the patients. All participants underwent automated perimetry using the 24-2 SITA (Swedish interactive threshold algorithm) standard strategy before and after 1-week treatment with a lubricating eye drop 4 times daily. VF results were compared before and after the treatment using Wilcoxon signed rank test, and Mann–Whitney test was performed to compare the results of patients in groups I and II. ResultsOf the 50 patients, 25 (50%) were diagnosed with dry eye syndrome. No significant differences between both groups were found with respect to age (P = 0.779) and glaucoma duration (P = 0.722). In patients with glaucoma with dry eye syndrome, there was a significant improvement in test duration, mean deviation, and the number of depressed points at probability level less than 0.5% and less than 1% in pattern deviation plots after the treatment (P< 0.05). ConclusionsThe use of artificial tears in patients with glaucoma with dry eye syndrome decreased VF testing time and improved test results.

Comparison of SWAP and SAP on the point of glaucoma conversion

BackgroundThe purpose of this study was to compare the two perimetric modalities, SWAP (short wavelength automated perimetry) and SAP (standard automated perimetry), on the point of conversion to glaucoma.MethodsIn this prospective, longitudinal, follow-up study, 282 patients with ocular hypertension were recruited consecutively and tested with both SAP and SWAP annually for 5 years or until the onset of conversion to glaucoma. SAP and SWAP perimetry was performed with the Humphrey Field Analyzer II using the 24-2 full-threshold test. Abnormality for both SAP and SWAP fields was determined on the pattern deviation plot and defined as either a) one point below the 0.5% probability level or b) a cluster of 2 or more points below 1% or c) a cluster of 3 or more points below 2% or d) a cluster of 4 or more points below 5%. Abnormal tests had to be confirmed on a subsequent test within one year to be classified as conversion.ResultsOf the 282 patients initially recruited, 32 were excluded. Of the 250 remaining patients, a total of 38 converted during the follow-up period; 36.8% of conversions were detected earlier with SWAP, 29% simultaneously, and 34.2% were not detected with SWAP during the follow-up period; 2.4% of patients showed SWAP visual field loss that did not result in conversion during the follow-up period.ConclusionThe results in our study are inconclusive. There were patients with earlier, simultaneous, or no SWAP conversion, with SAP conversion as the golden standard criterion. One should consider both SAP and SWAP with confirmation when visual field loss is evident to maximize early detection of glaucoma, because it appears that each method identifies early glaucoma in a subset of patients and these subsets overlap only partially.

Measuring Visual Function in Age-Related Macular Degeneration with Frequency-Doubling (Matrix) Perimetry

To determine the agreement between the Humphrey Matrix perimeter 10-2 test and the 10-2 Humphrey Field Analyzer (HFA) test when assessing visual function in patients with age-related macular degeneration (AMD). Forty-two eyes of 42 subjects with AMD (average 75.0 years, SD=6.2: median visual acuity in logarithm of the minimum angle of resolution of 0.26, range, -0.12 to 1.04) were evaluated with the Matrix and HFA 10-2 visual field tests. Mean deviation (MD), pattern standard deviation, and test time were recorded. We calculated spatial concordance of individual test locations, being the proportion of spatially agreeing locations with identical classification (normal vs. abnormal, p < 5%) on the pattern deviation plot. As multiple HFA stimuli overlapped with some Matrix locations, several criteria for grouping HFA data into locations were investigated. Both MD and pattern standard deviation were significantly correlated for the two devices (r(2)=0.79 and r(2)=0.80, respectively, p<0.0001). Using our standard criterion for abnormal HFA locations (≥50% stimuli abnormal), the median spatial concordance was 0.76, with 95% of tests giving a concordance of ≥0.59. A small, but significant, increase in concordance occurred when a stricter criterion (all stimuli abnormal at a location) was applied. Median fixation loss percentages were 7 and 0% for the HFA and Matrix, respectively. Visual acuity in logarithm of the minimum angle of resolution showed modest correlations with both defect depth (HFA MD: r(2)=0.39, p<0.0001) and size of defect (number of abnormal points on the HFA: r(2)=0.24, p<0.0001). Using a simple metric to calculate spatial concordance, the Matrix 10-2 test quantifies the spatial extent of significant depression of the central visual fields in AMD in a manner similar to the HFA 10-2. The spatial extent and depth of central visual field loss in AMD are only modestly predicted by visual acuity measurements.

Evaluation of the optic nerve in early glaucoma diagnosis: standard automated perimetry, short‐wavelength automated perimetry, frequency doubling technology, pattern electroretinogram and visual evoked potential in glaucoma suspects

Abstract Purpose To compare the ability of different functional tests in detecting early glaucomatous damage Methods 68 randomly selected patients screened by the glaucoma unit of the University Eye Clinic of Pavia were considered glaucoma suspects on the basis of the IOP and the morphometric analysis of the optic nerve with GDx‐VCC and HRT‐III. They were submitted to SAP and divided into two age‐matched groups according to Glaucoma Staging System II: group A (45 subjects, mean age 62±8 y) with GSSII 0 (MD≤‐2dB, PSD&lt;2.7dB) and group B (23 subjects , mean age 64±6 y) with GSSII ≤ 2 (MD≤‐10dB, PSD≤9dB). The two groups were then submitted to a complete evaluation of the optic nerve function based on SWAP, FDT, PERG, VEP. Number of points significantly depressed &lt;5% and &lt;1% in the pattern deviation plot,MD,PSD, and test duration for all perimetric tests, amplitude and latency of P50 and N95 for PERG and P100 for VEP were compared using the Wilcoxon signed rank test Results All parameters of SAP and SWAP pointed out a good correlation to glaucomatous damage.Only PSD and the number of points &lt;1% were correlated to GSSII in FDT. PERG and VEP outcomes were not correlated to glaucatous damage. Conclusion SITA‐SWAP can point out glaucomatous functional damage at least as well as SAP while FDT seems to be less efficient. In perimetric testing the global index PSD seems to be effective in pointing out glaucomatous damage. PERG and VEP are less sensitive but this could be due to the criteria based on VF outcomes to divide examined subjects.

African Descent and Glaucoma Evaluation Study (ADAGES)

To investigate differences in visual function between the healthy eyes of people of African (AD) and European descent (ED). Visual function was assessed in 393 AD and 367 ED participants selected from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study. Participants had normal appearance of the optic disc and intraocular pressure of less than 22 mm Hg. Each participant had 2 reliable 24-2 standard automated perimetry tests, and most had short-wavelength automated perimetry and frequency-doubling technology tests. The generalized estimating equation was used to adjust for intereye correlations. Results were adjusted for age, vertical cup-disc ratio, disc size, central corneal thickness, and presence of high blood pressure. The AD participants were younger (mean [SD] age, 46.2 [13.2] years) than the ED participants (age, 49.5 [16.6] years) (P = .003). The AD participants had worse mean deviation and pattern standard deviation and more points triggered as abnormal on the total and pattern deviation plots compared with ED participants on all tests (P < .05). A larger percentage of AD participants had confirmed abnormal glaucoma hemifield test results on standard automated perimetry only. People of AD have significantly worse performance than people of ED on all tests of visual function. Additional research using longitudinal data is needed to determine the cause of these small but significant ancestry differences in visual function.

The Effect of Myopic Optical Defocus on the Humphrey Matrix 30-2 Threshold Test

To examine the effect of the myopic optical defocus on the Humphrey Matrix 30-2 test. Prospective, nonrandomized, comparative case series. Forty eyes from 40 patients with and without glaucoma underwent 2 consecutive tests using the Humphrey Matrix 30-2 threshold program. The first and second tests were performed with and without a correction of myopia. All the eyes studied were divided into low-myopic [spherical equivalent (SE) < or = -3.0 diopter] and moderate-myopic groups. The difference in the mean deviation (DeltaMD) was calculated. The correlation between the SE and DeltaMD was examined. The influence of optical defocus on the total deviation and pattern deviation plot change according to the severity of glaucomatous visual field damage was also evaluated. The DeltaMD between the 2 tests was statistically significant in both the low-myopic (P<0.01) and moderate-myopic (P<0.01) groups. The correlation between SE and DeltaMD was significant in the moderate-myopic group (P=0.03). The correlation was less significant, however, in the low-myopic group (P=0.07). In the moderate-myopic group, a less damaged visual field was more susceptible to the myopic optical defocus (P<0.01). Myopic optical defocus has a significant effect on the Humphrey Matrix 30-2 test results, even in the low-myopic eyes.

The Effect of Lubricating Eye Drop Containing Hydroxypropyl Guar on Perimetry Results of Patients with Glaucoma and Trachomatous Dry Eye

Purpose: To evaluate the effects of a mid-viscosity mucomimetic lubricant eye drop containing hydroxypropyl guar (HPG) as a gelling agent on computerized perimetry FASTPAC test results of primary open-angle glaucoma (POAG) patients with trachomatous dry eye. Methods: Both eyes of 33 patients with bilateral POAG and trachomatous dry eye were included in the study. They were treated with the same antiglaucomatous eye drop and underwent computerized perimetry. Before and after the treatment with lubricant eye drop (Systane™) for 8 weeks, tear function tests (Schirmer test with topical anesthesia, fluorescein staining and tear film break-up time) and FASTPAC test with computerized perimetry were performed. Pre- and posttreatment tear functions, visual field test global indices, reliability indices, test duration and numbers of depressed points in pattern deviation plots were compared. Results: We found significant improvements in tear function tests results, in computerized perimetry FASTPAC test indices, test duration and the number of depressed points in pattern deviation plots in the posttreatment evaluations. Conclusion: This study indicates that there was a benefit of mid-viscosity lubricant eye drop containing HPG treatment on computerized perimetry FASTPAC test performance in POAG subjects with trachomatous dry eye. We assume that the positive effect of this therapy is probably due to a better tear film stability, resulting in a higher optical quality of the repaired anterior corneal surface.

SITA‐SWAP and SITA‐SAP in glaucoma suspects

Abstract Purpose To compare the ability of Standard and Short‐Wavelength Automated Perimetry to point out early functional defects in glaucoma suspects picked up using imaging tests such as GDx‐VCC and HRT‐III Methods Randomly selected 90 eyes of 90 patients screened on the basis of clinical suspicion of having early glaucoma, were submitted to a complete ophthalmic examination including GDx and HRT. Moorfields regression analysis(MRA), cup shape measure (CSM), rim area (RA) for HRT‐III and nerve fiber indicator (NFI), superior and inferior TSNIT average for GDx‐VCC were taken into account. If at least one of the parameters was found out of the normal limits, a 24‐2 SITA‐SAP and SITA‐SWAP tests. Mean defect (MD), pattern standard deviation (PSD), number of points significantly depressed &lt;5% and &lt;1% in the pattern deviation plot and test duration for SAP and SWAP were compared using the Wilcoxon signed rank test and Bland and Altman plot. Media opacities &gt;1 according to LOCS‐III were excluded Results According to the results of the Wilcoxon test SWAP gave a significantly larger MD and PSD defect than SAP (p&lt;0.01) and a larger number of depressed points with p&lt;1%(p&lt;0.01). SWAP test duration was shorter than SAP(p&lt;0.01). These results were not confirmed by Bland and Altman plot that could not point out significant differences between the parameters provided by SWAP and SAP Conclusion In patients with suspicion of early glaucomatous damage given by imaging techniques (GDx‐VCC and HRT‐III), SITA‐SWAP is not able to identify a functional loss in all cases. The SITA applied to SWAP can improve the ability of the perimetric test to pick up early defects involving short‐wavelength sensitive ganglion cells at least in some patients and in a shorter test time than SITA‐SAP

Interpretation of the Humphrey Matrix 24-2 test in the diagnosis of preperimetric glaucoma

To define the diagnostic precision of the Humphrey Matrix 24-2 test and to determine a clinically applicable cutoff criterion for the inclusion of preperimetric glaucoma. Eyes with preperimetric glaucoma (99 eyes) were defined as having normal standard automated perimetry (SAP) results and a glaucomatous optic nerve head, along with one or more optical coherence tomography (OCT) parameters flagged as <0.05 or a retinal nerve fiber layer (RNFL) defect on red-free fundus photographs. Normal controls (122 eyes) were defined as having a normal optic disc and RNFL with normal SAP. Receiver-operating characteristic (ROC) curves were constructed to determine the best-discriminating parameter of the frequency-doubling technology (FDT) Matrix. The sensitivity, specificity, and hit ratio of all available criteria were calculated from the FDT Matrix. Pattern standard deviation (PSD) showed a larger area under the ROC curve (AUC) (0.767) than mean deviation (MD) (0.619). A pattern deviation plot (PDP) analysis by modified Anderson criteria showed the highest discriminating power, with a sensitivity of 75.76%, followed by a PSD cutoff value of 3.14 dB (sensitivity, 73.74%). FDT Matrix seems to be a valuable clinical tool in the detection of preperimetric glaucoma. Among the parameters of the FDT Matrix, PDP analysis by modified Anderson criteria may provide a reliable cutoff criterion.

Comparing the Full-Threshold and Swedish Interactive Thresholding Algorithms for Short-Wavelength Automated Perimetry

To compare the Swedish interactive thresholding algorithm (SITA) with the full-threshold (FT) strategy for short-wavelength automated perimetry (SWAP). One eye of 286 patients with glaucomatous optic neuropathy (GON) and 289 age-matched participants without GON from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES) were classified with optic disc stereophotographs taken within 6 months of visual field testing, conducted within a 3-month period. Six parameters were derived per test, including pattern standard deviation (PSD) and the number of pattern deviation plot (PDP) points triggered at <1%. Receiver-operating characteristic (ROC) analysis equated the tests for specificity (80%, 90%, and 95%). Sensitivities of parameters with the highest area under the curve (AUC) and STATPAC (Carl Zeiss Meditec, Inc., Dublin, CA) PSD were compared. Agreement, severity, and test duration between algorithms were assessed. Sensitivities were not different between algorithms using PSD. With PDP <1%, SWAP-FT was more sensitive (35%) than SWAP-SITA (29%) at 95% specificity (P<0.05). Sensitivity and specificity using the STATPAC PSD at 95% (P<5%) and 99.5% (P<0.05%) was similar between algorithms. Severity correlated significantly between algorithms (P<0.001), although there was bias for SWAP-SITA to suggest more severe loss. SWAP-SITA required significantly less test time than did SWAP-FT (P<0.001). Mean differences in PSD, PDP <1%, and MD between algorithms were not clinically significant. Both algorithms performed similarly when equated for specificity. The reduced test duration makes SWAP-SITA the better choice. Testing with both algorithms within a short period is recommended for confirmation of results when switching from FT to SITA.

Lower threshold estimates at the onset of automated perimetry causing artefacts in perimetrically naive subjects

Reduction in the threshold value of the primary points resulting in depressed points on the pattern deviation plot of Humphrey visual fields was observed in a series of four perimetrically naive subjects. The defect disappeared on repeated testing. This primary point defect could be attributed to the patient's poor understanding of the test, response bias or poor instruction by the perimetrist.

Long-term Survival of Central Visual Field in End-Stage Glaucoma

To evaluate the long-term survival of visual field and visual acuity in treated glaucoma patients with end-stage glaucomatous visual field loss defined by a field constricted to a 10-degree radius or less. Retrospective chart review. Sixty-four patients with end-stage glaucoma. Serial 10-2 Humphrey visual fields with size III stimulus were analyzed. The following data were recorded for each visual field: mean deviation (MD), pattern standard deviation, the largest horizontal and vertical diameters measured in degrees including only locations with thresholds of 10 decibels or more, and the number of points on the pattern deviation plot with a probability value of more than 5%. Change in visual acuity and visual field. Eighty-four eyes of 64 patients satisfied inclusion criteria with an average follow-up of 8.34+/-3.1 years. Seventy-eight percent of patients were black. During the study period, 14 eyes lost more than 3 lines of visual acuity. Of these 14, 8 eyes progressed to a visual acuity of 20/200 or worse. Seven eyes lost 3 decibels or more from the MD that could be reproduced over 2 visual fields. In this predominantly black population, most treated patients with end-stage glaucoma did not demonstrate a decline in visual acuity or progressive loss of the central visual field during long-term follow-up.

Relationship between second‐generation frequency doubling technology and standard automated perimetry in patients with glaucoma

The aim of the study was to establish the correlation between visual filed loss as shown by second-generation Frequency Doubling Technology (Humphrey Matrix) and Standard Automated Perimetry (Humphrey Field Analyser) in patients with glaucoma. Also, compared were the test duration and reliability. Forty right eyes from glaucoma patients from a private ophthalmology practice were included in this prospective study. All participants had tests within an 8-month period. Pattern deviation plots and mean deviation were compared to establish the correlation between the two perimetry tests. Overall correlation and correlation between hemifields, quadrants and individual test locations were assessed. Humphrey Field Analyser tests were slightly more reliable (37/40 vs. 34/40 for Matrix)) but overall of longer duration. There was good correlation (0.69) between mean deviations. Superior hemifields and superonasal quadrants had the highest correlation (0.88 [95% CI 0.79, 0.94]). Correlation between individual points was independent of distance from the macula. Generally, the Matrix and Humphrey Field Analyser perimetry correlate well; however, each machine utilizes a different method of analysing data and thus the direct comparison should be made with caution.

Reproducibility of Visual Field End Point Criteria for Standard Automated Perimetry, Full-Threshold, and Swedish Interactive Thresholding Algorithm Strategies: Diagnostic Innovations in Glaucoma Study

To compare the interthreshold and intrathreshold strategy agreement of visual field end point criteria for standard automated perimetry (SAP) with the full-threshold (FT) algorithm and the Swedish interactive threshold algorithm (SITA). Prospective, longitudinal cohort study. The interstrategy group included a randomly selected eye of 173 participants in the Diagnostic Innovations in Glaucoma Study who had undergone FT algorithm and SITA analysis within three months (sequence 1, FT + SITA). Intrastrategy agreement for the FT algorithm (sequence 2, FT + FT) was tested for 44 (25.4%) participants who had undergone FT analysis within one year of the FT used in the interstrategy pairing, and for 89 patients (51.4%) who had undergone SITA analysis within one year before (sequence 3, SITA + SITA). Four different end point criteria using Statpac II indices were tested. Interstrategy agreement was compared with intrastrategy agreement using kappa statistics. FT + SITA agreement (kappa) for pattern standard deviation (PSD) < 1% was 0.82; for PSD < 5%, the kappa value was 0.64; and for four or more pattern deviation plot points, the kappa value was 0.43. Agreement with glaucoma hemifield test (GHT) results was significantly higher (P < .01) for FT + FT (kappa = 0.94) than FT + SITA (kappa = 0.67), and approached significance (P = .07) when comparing FT + FT with SITA + SITA (kappa = 0.77). GHT results were more likely to be abnormal on the SITA analysis than on the FT analysis. No other significant differences were found. To minimize misinterpreting abnormal GHT results on SITA as evidence of change when switching strategies, both SITA and FT should be performed and compared within a short period. Other indices are comparable between the two strategies.