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      Comparison of the Humphrey Field Analyser and Humphrey Matrix Perimeter for the Evaluation of Glaucoma Patients

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          Abstract

          Aims: To compare the Humphrey Matrix Perimeter (HMP) with the Humphrey Field Analyser (HFA) in visual-field examinations of patients with glaucoma or suspected glaucoma. Methods: One hundred and forty-nine patients with suspected glaucoma or glaucoma were recruited. All patients underwent visual-field examinations with the Swedish Interactive Threshold Algorithm standard, the central 30-2 threshold test with the HFA, and the frequency doubling technique 30-2 threshold test with the HMP. The examination times, mean deviations (MDs) and pattern standard deviations (PSDs) of both perimeters were compared in all patients and according to the patient’s diagnosis or the severity of their visual-field defects (VFDs). The paired 2-tailed t test and Pearson’s correlation coefficients were used for statistical analyses. Results: Overall, the examination times were significantly shorter with the HMP than with the HFA. There was a positive correlation between the HFA and HMP measurements of MD and PSD. In patients with suspected glaucoma, the PSDs measured with the HMP were significantly higher than those measured with the HFA. In patients with mild VFDs (MD >–4.0 dB), PSDs measured with the HMP were significantly higher than those measured with the HFA. In patients with severe VFDs (MD <–12.0 dB), MDs measured with the HMP were significantly higher than those measured with the HFA, whereas PSDs measured with the HMP were significantly lower than those measured with the HFA. Conclusions: The HMP is more time efficient than the HFA in visual-field examinations. The HMP tends to overestimate mild VFDs and underestimate severe VFDs.

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          Most cited references 20

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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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            Classification of visual field abnormalities in the ocular hypertension treatment study.

            (1) To develop a classification system for visual field (VF) abnormalities, (2) to determine interreader and test-retest agreement, and (3) to determine the frequency of various VF defects in the Ocular Hypertension Treatment Study. Follow-up VFs are performed every 6 months and are monitored for abnormality, indicated by a glaucoma hemifield test result or a corrected pattern SD outside the normal limits. As of January 1, 2002, 1636 patients had 2509 abnormal VFs. Three readers independently classified each hemifield using a classification system developed at the VF reading center. A subset (50%) of the abnormal VFs was reread to evaluate test-retest reader agreement. A mean deviation was calculated separately for the hemifields as an index to the severity of VF loss. A 97% interreader hemifield agreement. The average hemifield classification agreement (between any 2 of 3 readers) for 5018 hemifields was 97% and 88% for the 1266 abnormal VFs that were reread (agreement between the first and second classifications). Glaucomatous patterns of loss (partial arcuate, paracentral, and nasal step defects) composed the majority of VF defects. The Ocular Hypertension Treatment Study classification system has high reproducibility and provides a possible nomenclature for characterizing VF defects.
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              Frequency doubling technology perimetry abnormalities as predictors of glaucomatous visual field loss.

              To determine whether frequency doubling technology (FDT) perimetry results predict glaucomatous visual field defects, as assessed by standard automated perimetry (SAP), in a glaucoma suspect population. Longitudinal observational study. The study included 105 eyes of 105 glaucoma suspect patients, with a mean follow-up time of 41 +/- 17 months. Glaucoma suspects had either intraocular pressure (IOP) higher than or equal to 23 mm Hg or glaucomatous optic neuropathy by stereophotograph assessment. All patients had normal SAP visual fields at baseline. A baseline FDT test was performed within 3 months of the normal SAP examination. Several baseline FDT parameters and other variables (age, gender, IOP, central corneal thickness, SAP visual field indices, and stereophotograph assessment) were investigated by univariate and multivariate Cox proportional hazards models to obtain hazard ratios (HR) and identify factors that predicted which patients had SAP glaucomatous visual field loss during follow-up. Seventeen patients (16%) developed repeatable SAP visual field abnormality during follow-up. An abnormal FDT examination at baseline predicted the development of SAP visual field conversion in both univariate (HR = 3.17; 95% confidence interval [CI] = 1.22-8.25; P =.018) and multivariate models (Adjusted HR = 3.68; 95% CI = 1.06-12.8; P =.04). The analysis of FDT examinations during follow-up revealed that in 59% of converters the FDT abnormalities preceded SAP visual field loss by as much as 4 years. Also, the initial development of glaucomatous visual field loss as measured by SAP occurred in regions that had previously demonstrated abnormalities on FDT testing. Functional abnormalities detected by FDT perimetry were predictive of the future onset and location of SAP visual field loss among glaucoma suspect patients.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2008
                December 2008
                10 September 2008
                : 222
                : 6
                : 400-407
                Affiliations
                Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
                Article
                154203 Ophthalmologica 2008;222:400–407
                10.1159/000154203
                18781091
                © 2008 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
                Tables: 5, References: 35, Pages: 8
                Categories
                Original Paper

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