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Gary C Lee, Anders Heijl, Patricia Sha, Thomas Callan, Mary K Durbin, Todd Severin, Sunita Radhakrishnan, Andrew G Iwach, Boel Bengtsson; Performance of an Accelerated Threshold Visual Field Test Strategy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3925.
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© ARVO (1962-2015); The Authors (2016-present)
It is well known that the frequency of visual field testing in glaucoma management does not meet the recommendations of professional organizations. Test strategies with shorter test times than are available today may make clinical glaucoma care more in line with current recommendations. In this clinical study, we explored the performance of a faster test strategy based on SITA Fast (SF) in a preliminary cohort of glaucomatous eyes.
The reference (REF) SF strategy was modified on HFA II-i perimeters (ZEISS, Dublin, CA) to create a faster, experimental (EXP) strategy by: i) optimizing starting values of test points, ii) performing single staircases in primary and perimetrically blind points, iii) disabling false negative catch trials, iv) removing built-in delays following unseen stimuli, and v) turning off default blind-spot monitoring (i.e., “Gaze Only”) for EXP. Both REF and EXP visual fields (VFs) of 63 eyes of 63 glaucoma patients (median REF Mean Deviation: -4.9 dB, range: -28.0 to 1.2 dB, interquartile range: 12.2 dB) were acquired at two repeat visits within 1 month. Test order was randomized at Visit 1 and reversed at Visit 2. Summary statistics and significance testing (paired t-test) at the 5% level were calculated from Visit 2 data. Test-retest standard deviation for both visits of the thresholds from matched test locations from all REF fields across both visits pooled together were calculated as a measure of variability and plotted versus thresholds of the Visit 1 REF test. A similar calculation was also performed for the pooled EXP thresholds.
Mean, SD, and P values of various summary parameters at Visit 2 are shown in Table 1. Test time was 31% shorter for EXP, compared to REF (P < 0.001). Average Mean Sensitivity (MS) was 0.5 dB higher for EXP and correlated with REF MS with Pearson’s r = 0.97. Figure 1 shows the test-retest standard deviations of REF versus EXP were similar.
By reducing test time by an average of 31%, while maintaining similar test-retest variability, EXP may provide a reasonable clinical alternative to current clinical threshold strategies.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Table 1. Mean (standard deviation) values of parameters for REF vs EXP at Visit 2.
Figure 1. Test-retest standard deviation of thresholds.
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