June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Clinically practical measurement of standard error in bundled visual field tests
Author Affiliations & Notes
  • Benjamin T Backus
    Vivid Vision Inc, San Francisco, California, United States
  • Michael Deiner
    Ophthalmology, University of California San Francisco, San Francisco, California, United States
  • Zer Keen Chia
    Ophthalmology, University of California San Francisco, San Francisco, California, United States
  • Marcus Lawrence Turner
    Ophthalmology, University of California San Francisco, San Francisco, California, United States
  • Bertil Damato
    Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom
  • James Blaha
    Vivid Vision Inc, San Francisco, California, United States
  • Yvonne Ou
    Ophthalmology, University of California San Francisco, San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Benjamin Backus Vivid Vision Inc., Code E (Employment), Vivid Vision Inc., Code I (Personal Financial Interest), Vivid Vision Inc., Code P (Patent); Michael Deiner Vivid Vision Inc., Code E (Employment), Vivid Vision Inc., Code I (Personal Financial Interest), Vivid Vision Inc., Code O (Owner), Vivid Vision Inc., Code P (Patent); Zer Keen Chia None; Marcus Turner None; Bertil Damato None; James Blaha Vivid Vision Inc., Code E (Employment), Vivid Vision Inc., Code I (Personal Financial Interest), Vivid Vision Inc., Code P (Patent); Yvonne Ou None
  • Footnotes
    Support  UCSF Resource Allocation Program
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1283 – A0423. doi:
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    • Get Citation

      Benjamin T Backus, Michael Deiner, Zer Keen Chia, Marcus Lawrence Turner, Bertil Damato, James Blaha, Yvonne Ou; Clinically practical measurement of standard error in bundled visual field tests. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1283 – A0423.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The reliability of a scientific measurement is usually estimated from variability across repeated measurements, with standard error (SE) estimating variability in the mean. However, conventional visual field tests are labor intensive, so it is not practical to collect repeated measurements. New at-home tests with redesigned psychophysical procedures have recently made it practical for patients to undertake a “bundle” of 10 tests at home within a period of 5-14 days (Deiner, Damato, & Ou, 2020. Ophthalmology 127:1258) for which a mean and SE can be computed.

Methods : Patients from the UCSF Glaucoma Clinic were provided a mobile VR headset (Oculus Go, Facebook Inc) running Vivid Vision Perimetry (VVP) software (Vivid Vision Inc, San Francisco, CA). Patients received virtual training while at home and were then asked to perform VVP 10 times within a two-week period at intervals of approximately four months. Tested field locations were arrayed in the Humphrey 24-2 layout. Each location was tested four times per test with a fixed-contrast stimulus chosen to be close to threshold at locations having a sensitivity of 15 dB in conventional HVFA. Percent seen was the dependent variable.

Results : Between April 2020 and October 2021, 24 patients took 1472 tests in 142 bundles, each containing 5 to 15 tests apiece (mean 10.3, SD 1.9). Percent seen varied from 0% to 100% depending on sensitivity at the location, corresponding to a dynamic range of approximately 5 to 25 dB (HVFA). Mean sensitivity (MS) for each of the 1472 tests was percent seen across 52 locations, not including near the blind spot. Bundle SE was 1.2% on average (std dev 0.9%), corresponding to a test-retest variability of 0.24 dB in HVFA units for the bundle, which compares favorably with the test-retest variability of HVFA in glaucomatous eyes, usually estimated between 0.5 and 1.0 dB. 21 of the bundles contained an outlier (interquartile test); it was generally worse, not better, than the bundle mean. Data review suggested that a change in MS of > 2 SE be used to detect changes in vision.

Conclusions : The SE for a bundle of visual field tests provides a clinically practical objective measure of test reliability. It quantifies the statistical difference between test epochs when monitoring progressive field loss in diseases like glaucoma.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Test dates and example results

Test dates and example results

 

Left: Bundle SE vs MS. Colors plot 24 patients: o OS, * OD. Right: histogram of SE.

Left: Bundle SE vs MS. Colors plot 24 patients: o OS, * OD. Right: histogram of SE.

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