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Corinne Carle, Andrew James, Maria Kolic, Rohan Essex, Ted Maddess; Getting the timing right: Clustered volley stimulus presentation for multifocal pupil perimetry in glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3963. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Multifocal pupillographic perimetry (mfPOP) is being developed as an objective method of assessing patients’ visual fields in various disorders. The purpose of this study is to assess a new mfPOP stimulus presentation method in glaucoma, and to compare luminance stimuli presented using this method with those also utilising red/green color-exchange.
20 subjects with open-angle glaucoma and 24 age-matched subjects with normal vision were tested twice using three 6-minute mfPOP stimulus protocols. Stimuli of 33 ms duration were presented in each of 44 test-regions per eye within a 60° field. Presentations occurred at mean intervals of 4 s in each of these regions, either in a continuous series across all regions as in previous studies, or in spatially clustered volleys. One protocol (OldLum) used the older continuous presentation method and comprised yellow luminance stimuli on a 10 cd/m2 yellow background. The remaining two protocols used the new Clustered Volley (CV) method and either the same yellow luminance stimuli (CVLum), or green stimuli of the same luminance as the other two protocols on a 10 cd/m2 red background (CVLum+Col). We report the mean of ROC outputs (AUC) for the single- and two-worst performing regions in each eye.
In Severe eyes (n=7) and using pupillary constriction amplitudes, CVLum produced the best diagnostic accuracy (AUC=1.00±0.00), somewhat better than OldLum (AUC=0.93±0.04) and CVLum+Col (AUC=0.92±0.04). In Moderate (n=13) and Mild (n=13) eyes CVLum+Col produced the best AUCs of 0.85±0.05 and 0.67±0.07 respectively. (7 fellow eyes showed no signs of disease.) Use of pattern deviations produced a small improvement in Mild eyes (AUC=0.69±0.07), the best result for this group however was obtained using constriction latencies and CVLum (AUC=0.79±0.05).
Higher diagnostic accuracy was achieved using the new Clustered Volley method. Luminance stimuli in this format were more accurate in Severe eyes, color-exchange stimuli performing better in less damaged eyes.
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