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      Comparison of Diagnostic Ability between a Fast Strategy, Tendency-Oriented Perimetry, and the Standard Bracketing Strategy

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          Abstract

          Purpose: To compare the diagnostic abilities of the standard bracketing strategy (BR) and a fast strategy, the tendency-oriented perimetry (TOP). Methods: Seventy-seven controls and 91 eyes from patients with glaucoma were analyzed with the strategies TOP and BR. Sensitivity (Se), specificity (Sp), the area under the receiver operating characteristic (ROC) curve (AC) and the optimum cutoff value (CO) were calculated for the visual field indices mean defect (MD), the square root of the loss variance (sLV) and the number of pathological points (NPP). Results: In the glaucoma group, the mean MD value using TOP and BR was 7.5 and 8.3 dB, respectively. The mean sLV value using TOP and BR was 5.0 and 5.3 dB, respectively. Indices provided by TOP had higher ROC values than the ones provided by BR. Using TOP, the index with the best diagnostic ability was sLV (Sp = 94.8, Se = 90.1, AC = 0.966, CO = 2.5 dB), followed by NPP and MD. Using BR, the best results were obtained for MD (Sp = 92.2, Se = 81.3, AC = 0.900, CO = 2.5 dB) followed by sLV and NPP. Conclusions: A fast strategy, TOP, had superior diagnostic ability than the standard BR. Although TOP provided lower LV values than BR, the diagnostic ability of this index was higher than that of the conventional strategy.

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          Most cited references 10

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          Comparison between Tendency-Oriented Perimetry (TOP) and octopus threshold perimetry.

          To compare the results obtained by a new ultra-short automated perimetry test known as Tendency-Oriented Perimetry (TOP), which is an algorithm based on estimation of thresholds from information gathered from adjacent points with those obtained by a standard bracketing approach. TOP is designed to save up to 1/5 of the time taken by standard strategy by presenting each stimulus once on each location (instead of 4 to 6 times per location with the standard technique) and reaching a final threshold estimate by gathering information from responses to adjacent locations.
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            Discrimination between normal and glaucomatous eyes with visual field and scanning laser polarimetry measurements.

            To evaluate the ability of structural parameters (as determined by retinal nerve fibre layer (RNFL) measurements obtained with the scanning laser polarimeter (SLP-NFA/GDx)) and functional parameters (as determined by automated perimetry) to discriminate between normal and glaucomatous eyes. In a case-control study, a total of 91 normal subjects and 94 patients with glaucoma underwent automated perimetry and RNFL measurements obtained with the SLP. Three independent scans of each eye were obtained and a mean image was created and used for further analysis. Only one eye per individual was randomly included in the study. The sensitivity (Se) and specificity (Sp) of 12 RNFL parameters were calculated according to the SLP internal normative database. The Se and Sp of the visual field (VF) global indices and the glaucoma hemifield test (GHT) were also calculated according to the instrument's normative database. Receiver operator characteristic (ROC) curves were built for each SLP parameter and VF index. Fisher's linear discriminant formulas (LDFs) were developed for VF indices (VF LDF), SLP measurements (SLP LDF), and both examinations (combined LDF). According to the SLP internal database, the parameters with better Se and Sp were: superior/nasal ratio (Se = 58.5%; Sp = 86.8%), and GDx the number (Se = 43.3%; Sp = 96.7%). The construction of an ROC curve for the number resulted in Se = 84% and Sp = 79%. The creation of LDFs improved both the sensitivities and specificities when compared with isolated parameters SLP LDF (Se = 90.4%; Sp = 82.4%), VF LDF (Se = 89.4%; Sp = 89.0%), and combined LDF (Se = 93.0%; Sp = 90.1%). The sensitivity to diagnose early and moderate glaucomatous damage observed with the GHT was lower than that obtained with the number (p < 0.01). Creation of LDFs enhanced the Se and Sp for both VF and SLP. Integration of SLP and VF in a combined LDF reached the highest Se/Sp relation, suggesting that these examinations may be additive concerning the diagnosis of glaucoma. The SLP parameter the number may be more sensitive than the GHT in diagnosing early and moderate glaucomatous damage.
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              Fatigue effects in automated perimetry.

              The influence of fatigue and related factors on automated perimetric testing was evaluated in both eyes of sixteen normal observers and sixteen patients with early-to-moderate visual field loss using a Digilab 750 automated perimeter and a customized test procedure. False positive rate, false negative rate, and detection sensitivity at 5,10,15, and 20 degrees eccentricity were measured in 1.5-rain intervals throughout a 21-min visual field examination. Half of the normal observers and patients with visual field loss were given a briefrest(1.5-min) midway through each visual field exam to determine whether this would reduce fatigue effects. Our findings revealed that patients displayed considerably higher average false positive and false negative rates than normal observers. However, neither the patients nor normal observers demonstrated any consistent changes in false positive rate or false negative rate as a function of testing duration. In contrast, both normal observers and patients showed an average decrease in sensitivity as a function of increasing test duration with the magnitude of the time-dependent sensitivity loss becoming greater with increasing stimulus eccentricity. Patients demonstrated a larger time-dependent sensitivity loss than normal observers, averaging ~4dB at 20 degrees eccentricity. The introduction of a brief pause midway through the test procedure appeared to reduce the time-dependent sensitivity loss for the second half of the test procedure, especially for greater eccentricities.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2005
                November 2005
                16 November 2005
                : 219
                : 6
                : 373-378
                Affiliations
                aHospital Universitario de Canarias, Universidad de La Laguna, La Laguna, and bDepartment of Ophthalmology, Instituto Castroviejo, Universidad Complutense, Madrid, Spain; cGlaucoma Service, Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Tex., USA; dAberdeen Royal Infirmary, University of Aberdeen, Aberdeen, UK
                Article
                88381 Ophthalmologica 2005;219:373–378
                10.1159/000088381
                16286798
                © 2005 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 3, References: 27, Pages: 6
                Categories
                Original Paper

                Vision sciences, Ophthalmology & Optometry, Pathology

                Visual field, Perimetry, Glaucoma

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