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      Validation of a new static perimetric thresholding strategy (GATE).

      The British Journal of Ophthalmology
      BMJ
      Diagnostic tests/Investigation, Field of vision, Glaucoma, Visual pathway

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          Abstract

          To validate the EyeSuite version of German Adaptive Threshold Estimation (GATE), a new thresholding algorithm for automated static perimetry.

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          Most cited references13

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          Collaborative normal tension glaucoma study.

          Before this study was done, there was a difference of opinion concerning whether intraocular pressure (IOP) was involved in producing optic nerve damage when there was glaucomatous damage to the optic nerve and characteristic visual field loss, even though the IOP was in the statistically normal range. This article reviews the findings of a collaborative study aimed at finding the answer to this question. The level of pressure influences the course of normal tension glaucoma, as evidenced by a slower rate of incident visual field loss in cases with 30% or more lowering of intraocular pressure. The rate of progression without treatment is highly variable, but often slow enough that half of the patients have no progression in 5 years. A faster rate occurs in women, in patients with migraine headaches, and in the presence of disc hemorrhages. Some patients may experience greater benefit from lowering of IOP than others, but further research is needed to be able to identify those most likely to benefit. As a group, patients with normal tension glaucoma benefit from lowering of IOP. Variable rate of deterioration, as well as lack of progression in a substantial number in 5 years, suggest that treatment should be individualized according to the stage of disease and rate of progression. Traits that help predict risk and rate of progression and response to treatment are beginning to become known and, when fully known, will help guide management decisions.
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            SITA Fast, a new rapid perimetric threshold test. Description of methods and evaluation in patients with manifest and suspect glaucoma.

            To describe and evaluate the new rapid SITA Fast computerized perimetric threshold strategy. Computer simulations of visual fields were used to develop a new rapid threshold strategy, SITA Fast. In a clinical evaluation 30 patients were examined twice with each of the Full Threshold, Fastpac and SITA Fast strategies. SITA Fast had significantly shorter test time using on average 34% of the test time when compared to the Full Threshold strategy (p<0.0001) and 53% compared to Fastpac (p<0.0001). Reproducibility, calculated as the average Root Mean Square Error, was 1.84 dB in SITA tests, and 1.99 dB and 2.02 dB with Full Threshold and Fastpac, respectively. Both SITA Fast and Fastpac showed slightly higher sensitivities on average than theoretically expected. Sensitivity differences were larger in eyes with large differences in test time. Defects detected by SITA Fast were often deep and more localised than those detected by the Full Threshold and the Fastpac strategies. SITA Fast tests were considerably shorter than Fastpac tests. The low test-retest variability found in the SITA Fast tests implies that it may be a sensitive test for detection of field progression.
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              Comparison of the new perimetric GATE strategy with conventional full-threshold and SITA standard strategies.

              A new, fast-threshold strategy, German Adaptive Thresholding Estimation (GATE/GATE-i), is compared to the full-threshold (FT) staircase and the Swedish Interactive Thresholding Algorithm (SITA) Standard strategies. GATE-i is performed in the initial examination and GATE refers to the results in subsequent examinations. Sixty subjects were recruited for participation in the study: 40 with manifest glaucoma, 10 with suspected glaucoma, and 10 with ocular hypertension. The subjects were evaluated by each threshold strategy on two separate sessions within 14 days in a randomized block design. SITA standard, GATE-i, and GATE thresholds were 1.2, 0.6, and 0.0 dB higher than FT. The SITA standard tended to have lower thresholds than those of FT, GATE-i, and GATE for the more positive thresholds, and also in the five seed locations. For FT, GATE-i, GATE, and SITA Standard, the standard deviations of thresholds between sessions were, respectively, 3.9, 4.5, 4.2, and 3.1 dB, test-retest reliabilities (Spearman's rank correlations) were 0.84, 0.76, 0.79, and 0.71, test-retest agreements as measured by the 95% reference interval of differences were -7.69 to 7.69, -8.76 to 9.00, -8.40 to 8.56, and -7.01 to 7.44 dB, and examination durations were 9.0, 5.7, 4.7, and 5.6 minutes. The test duration for SITA Standard increased with increasing glaucomatous loss. The GATE algorithm achieves thresholds that are similar to those of FT and SITA Standard, with comparable accuracy, test-retest reliability, but with a shorter test duration than FT.
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                Author and article information

                Journal
                25053761
                10.1136/bjophthalmol-2013-304535

                Diagnostic tests/Investigation,Field of vision,Glaucoma,Visual pathway

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