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      Long-Term Fluctuation of Standard Automatic Perimetry, Pulsar Perimetry and Frequency-Doubling Technology in Early Glaucoma Diagnosis

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          Purpose: Analyze the stability and accuracy of 3 perimetric techniques. Methods: A total of 104 stable eyes (65 subjects) with ocular hypertension and early glaucoma [group G, mean defect = 1.08 dB, SD = 2.0, in standard TOP automatic perimetry (SAP)] were examined 5 times during 18 months using: (a) SAP; (b) Pulsar temporal modulation perimetry (T30W), and (c) frequency-doubling technology (FDT N30). Ninety eyes from 90 normal controls were compared with the first set of examinations of group G. Results: The learning effect was minimal in the 3 techniques but higher in Pulsar (1.0 src, p < 0.05) than in SAP and FDT (0.4 dB). Long-term fluctuation (F) was significantly higher in FDT (3.1 dB, SD = 1.4, p < 0.0001) than in SAP (2.3 dB, SD = 1.1) and in Pulsar (1.9 src, SD = 0.7). Pulsar and FDT reduce F when increasing the number of examinations. F seems equivalent in SAP and FDT and lower in Pulsar, considering small-scale differences of the 3 perimeters. Conclusions: A slight learning effect would be expected on FDT and SAP in patients with previous experience with SAP. The stability and sensitivity of Pulsar is greater than on the other 2 systems. For early diagnosis of glaucoma it is essential to prove the reproducibility and coincidence of perimetric results.

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          Most cited references 13

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          Contrast sensitivity and visual disability in chronic simple glaucoma.

          A battery of vision tests was used to quantify visual defect in a group of 50 patients with chronic simple glaucoma. The vision tests were near and distance visual acuity, visual fields, and contrast sensitivity to static and temporally modulated sinusoidal grating patterns. Of these, static contrast sensitivity function appears to be the most sensitive method of measuring visual defect in glaucoma patients. The visual disability experienced by the glaucoma patients was quantified by means of a questionnaire, and the relationship between perceived visual disability and visual defect was examined. It was found that results from a group of tests, near visual acuity, visual field, and contrast sensitivity measures, are the best predictors of the difficulty experienced by patients in performing visually dependent daily activities.
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            Test-retest variability of blue-on-yellow perimetry is greater than white-on-white perimetry in normal subjects.

            To compare long-term fluctuation of blue-on-yellow automated perimetry with white-on-white automated perimetry in normal subjects. White-on-white and blue-on-yellow automated perimetry were performed on a Humphrey Visual Field Analyzer and an Octopus perimeter, both modified for blue-on-yellow perimetry. The study sample consisted of 31 eyes of 31 normal subjects for the Humphrey perimeter and 33 eyes of 33 normal subjects for the Octopus perimeter. After one practice session, each subject completed four testing sessions over a period of 2 to 8 weeks, each separated by at least 1 day. Each testing session consisted of both white-on-white and blue-on-yellow perimetry performed on one eye; the order of the tests was alternated for successive sessions. Long-term fluctuation (expressed as statistical variance) was calculated for each test location. Intersubject variability (expressed as statistical variance) across all subjects was determined for each test location. On the Humphrey perimeter, the long term fluctuation for blue-on-yellow perimetry (4.07 +/- 3.07 dB2) was significantly greater than that for white-on-white perimetry (1.97 +/- 0.99 dB2; P < .001). Long-term fluctuation increased as a function of eccentricity for both blue-on-yellow and white-on-white perimetry. Short-term fluctuation was significantly greater for blue-on-yellow (0.46 +/- 0.25 dB) than that for white-on-white perimetry (0.29 +/- 0.19 dB; P < .02). Finally, the intersubject variability was significantly greater in blue-on-yellow (13.2 +/- 2.8 dB2) than it was in white-on-white perimetry (4.25 +/- 1.13 dB2; P < .001). Similar results were found with the Octopus perimeter. Long-term fluctuation and short-term fluctuation of blue-on-yellow perimetry are greater than those of white-on-white perimetry in normal subjects. The increased long-term fluctuation requires appropriate statistical approaches when evaluating serial change of blue-on-yellow perimetry.
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              Learning effect, short-term fluctuation, and long-term fluctuation in frequency doubling technique.

              To evaluate short-term and long-term fluctuations and learning effects in healthy subjects tested with the frequency doubling technique, which is based on a low spatial frequency and a high temporal frequency stimulus. Twenty-three healthy adult subjects were consecutively recruited from volunteers, and 20 subjects finished the study. All the visual fields were assessed by the frequency doubling technique, program C-20, full threshold. The frequency doubling technique presents stimuli on a black-and-white video monitor with specialized control circuitry interfaced to a microprocessor. During program C-20, full threshold, 17 points are tested, one round point centrally and 16 square ones in the periphery up to 20 degrees of eccentricity. Each stimulus consists of a 0.25-cycle/degree sinusoidal grating undergoing a 25-Hz counterphase flicker. One eye of each patient was chosen at random. Each subject was tested once in the first session, three times in the second session, and once in the third and fourth sessions. Both short-term and long-term fluctuation were studied either as the average fluctuation value of all the points tested or as a point-to-point fluctuation. To study the learning effect, the results of the first session were compared with those of the second, the third, and the fourth sessions. The average mean sensitivity of the three examinations of the second session was 30.4 +/- 1.24 dB, and the average short-term fluctuation of all the subjects was 2.16 +/- 0.5 dB. The short-term fluctuation of each point tested ranged from 1.4 to 3.4 dB. The average mean sensitivity for all the sessions was 32.4 +/- 1.14 dB, with an average long-term fluctuation of 3.23 +/- 0.5 dB, and the long-term fluctuation of each tested point ranged from 2.5 to 4.4 dB. A mild learning effect was found between the first section and the others. Short-term and long-term fluctuations were similar to those known to occur with the conventional threshold perimetry when they were compared with the literature data. A learning effect was also observed and should be taken into account for the clinical use of this test.

                Author and article information

                Ophthalmic Res
                Ophthalmic Research
                S. Karger AG
                November 2007
                19 October 2007
                : 39
                : 6
                : 338-343
                aHospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, and bInstituto Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
                109997 Ophthalmic Res 2007;39:338–343
                © 2007 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 1, References: 37, Pages: 6
                Original Paper


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