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      Comparison of Advanced Threshold and SITA Fast Perimetric Strategies

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      1 , 2 , , 1 , 2
      Journal of Ophthalmology
      Hindawi

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          Abstract

          Purpose

          To compare the results obtained with two threshold strategies of visual field assessment: Humphrey SITA Fast (SFA) (Carl Zeiss Meditec) and PTS 2000 Advanced Threshold (ADV) (Optopol Technology) in healthy subjects and patients with glaucoma.

          Methods

          The study sample comprised of 53 healthy volunteers and 69 patients with glaucoma. One eye of each patient was examined with the SFA and ADV strategies. The quantitative comparisons of test duration and global indices were made using correlation coefficients. The sensitivity and specificity of the algorithms were evaluated based on the GHT results and the adjusted Anderson–Patella (A&P) criteria.

          Results

          The ADV test duration was shorter both in healthy subjects (by 5%) and patients with glaucoma (by 18%). The mean differences in MS values between the SFA and the ADV strategies were 1.06 ± 1.13 dB (MS SFA-MS ADV) in healthy subjects and 1.00 ± 1.92 dB (MS SFA-MS ADV) in patients with glaucoma. The MD index of ADV tests was lower than the SFA in the healthy (−0.74 ± 1.09 dB) (MS SFA-MS ADV) and glaucoma group (−0.85 ± 2.19 dB) (MS SFA-MS ADV). The mean differences in PSD values determined using both methods were −0.86 ± 0.67 dB (PSD SFA-PSD ADV) and −0.53 ± 1.48 dB (PSD SFA-PSD ADV) in healthy subjects and patients with glaucoma, respectively. Analysis of receiver operating characteristic curves built from MD and PSD indices show bigger area under curve in SFA than in ADV (0.983 vs.0.968 and 0.986 vs. 0.938, respectively). The GHT-based sensitivity and specificity for the ADV strategy were 92.75% and 77.36%, respectively, as compared to 92.75% and 90.57%, respectively, for the SFA strategy.

          Conclusions

          Both SFA and ADV enable effective identification of glaucomatous defects within 5 minutes. The ADV strategy, however, is significantly faster. The correlation between the global indices of SFA and ADV is very high. Both strategies offer very high sensitivity when using both GHT and A&P criteria.

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          Most cited references42

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          STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT

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            A new generation of algorithms for computerized threshold perimetry, SITA.

            The purpose of this work was to develop a new family of test algorithms for computerized static threshold perimetry which significantly reduces test time without any reduction of data quality. A comprehensive visual field model constructed from available knowledge of normal and glaucomatous visual fields is continuously updated during testing. The model produces threshold estimates and also estimates of the certainty to which the threshold is known at each point. Testing is interrupted at each test location at predetermined levels of threshold certainty. New time-saving methods are employed for estimation of false answers, and test pacing is optimized. After completion of the test, all threshold estimates are re-computed, taking into account the complete body of patient responses. Computer simulations were used to optimize the different parameters of the new algorithms, to evaluate the relative importance of those parameters, and to evaluate the performance of the algorithm as a whole in comparison with a standard algorithm. Simulated test results obtained with this algorithm were slightly more accurate than those of the Humphrey Full Threshold test algorithm. The number of simulated stimuli presented was reduced by an average of 29% in normal fields and 26% in glaucomatous fields. Actual clinical test time should be further reduced, since the influence of the improved timing algorithm was not included in the simulations. We applied new methods which take available knowledge of visual field physiology and pathophysiology into account, and employ modern computer-intensive mathematical methods for real time estimates of threshold values and threshold error estimates. In this way it was possible to design a family of testing algorithms which significantly reduced perimetric test time without any loss of quality in results.
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              Properties of perimetric threshold estimates from Full Threshold, SITA Standard, and SITA Fast strategies.

              To investigate the distributions of threshold estimates with the Swedish Interactive Threshold Algorithms (SITA) Standard, SITA Fast, and the Full Threshold algorithm (Humphrey Field Analyzer; Zeiss-Humphrey Instruments, Dublin, CA) and to compare the pointwise test-retest variability of these strategies. One eye of 49 patients (mean age, 61.6 years; range, 22-81) with glaucoma (Mean Deviation mean, -7.13 dB; range, +1.8 to -23.9 dB) was examined four times with each of the three strategies. The mean and median SITA Standard and SITA Fast threshold estimates were compared with a "best available" estimate of sensitivity (mean results of three Full Threshold tests). Pointwise 90% retest limits (5th and 95th percentiles of retest thresholds) were derived to assess the reproducibility of individual threshold estimates. The differences between the threshold estimates of the SITA and Full Threshold strategies were largest ( approximately 3 dB) for midrange sensitivities ( approximately 15 dB). The threshold distributions of SITA were considerably different from those of the Full Threshold strategy. The differences remained of similar magnitude when the analysis was repeated on a subset of 20 locations that are examined early during the course of a Full Threshold examination. With sensitivities above 25 dB, both SITA strategies exhibited lower test-retest variability than the Full Threshold strategy. Below 25 dB, the retest intervals of SITA Standard were slightly smaller than those of the Full Threshold strategy, whereas those of SITA Fast were larger. SITA Standard may be superior to the Full Threshold strategy for monitoring patients with visual field loss. The greater test-retest variability of SITA Fast in areas of low sensitivity is likely to offset the benefit of even shorter test durations with this strategy. The sensitivity differences between the SITA and Full Threshold strategies may relate to factors other than reduced fatigue. They are, however, small in comparison to the test-retest variability.
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                Author and article information

                Contributors
                Journal
                J Ophthalmol
                J Ophthalmol
                joph
                Journal of Ophthalmology
                Hindawi
                2090-004X
                2090-0058
                2020
                23 December 2020
                : 2020
                : 7139649
                Affiliations
                1Department of Ophthalmology, Nicolaus Copernicus University, 9 M. Sklodowskiej-Curie St., Bydgoszcz 85-309, Poland
                2Oculomedica Eye Research & Development Center, 9 Broniewskiego St., Bydgoszcz 85-090, Poland
                Author notes

                Academic Editor: Luca Agnifili

                Author information
                https://orcid.org/0000-0001-5357-9560
                https://orcid.org/0000-0003-0967-4856
                Article
                10.1155/2020/7139649
                7803127
                6b068634-e716-4c42-825d-6ecee3c7b3df
                Copyright © 2020 Bartosz L. Sikorski and Adriana Laudencka.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 May 2020
                : 10 November 2020
                : 30 November 2020
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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