Division of Optometry and Visual Science, School of Health Science, City, University of London, London, UK.
Acta Ophthalmol. 2019 Sep;97(6):e833-e838. doi: 10.1111/aos.14069. Epub 2019 Feb 22.
In spite of faster examination procedures, visual field (VF) results are potentially influenced by fatigue. We use large-scale VF data collected from clinics to test the hypothesis that perimetric fatigue effects are greater in the eye examined second.
Series of six Humphrey Swedish Interactive Testing Algorithm (SITA) VFs from 6901 patients were retrospectively extracted from a VF database from four different glaucoma clinics. Mean deviation (MD) was compared between first and second tested eyes. A surrogate measure of longitudinal MD variability over time was estimated from errors using linear regression of MD against time then compared between first and second tested eye.
Right eye VF was tested consistently first throughout in 6320 (91.6%) patients. Median (interquartile range; IQR) MD in the first tested (right) eye and second tested (left) eye was -2.57 (-6.15, -0.58) dB and -2.70 (-6.34, -0.80) dB respectively (median reduction VF sensitivity of 0.13 dB; p < 0.001). Median (IQR) increase in our surrogate measure of longitudinal MD variability in the second eye tested was 3% (-43%, 50%); this effect was not associated with patient age or rest time between examinations.
Statistically significant perimetric fatigue effects manifest on average in the second eye tested in routine clinics using Humphrey Field Analyzer SITA examinations. However, the average effects were very small and there was enormous variation among patients. We recommend starting with a right eye examination so that any perimetric fatigue effects, if they exist in an individual, will be as constant as possible from visit to visit.
尽管检查程序加快，视野（VF）结果仍可能受到疲劳的影响。我们使用从诊所收集的大规模 VF 数据来检验以下假设，即第二个接受检查的眼睛的周边疲劳效应更大。
从四个不同的青光眼诊所的 VF 数据库中回顾性提取了 6901 例患者的 6 个 Humphrey 瑞典交互式测试算法（SITA）VF 系列。比较了第一只和第二只受检眼的平均偏差（MD）。使用 MD 随时间的线性回归来估计时间上 MD 变化的纵向替代测量值，然后比较第一只和第二只受检眼之间的差异。
在 6320 例（91.6%）患者中，右眼 VF 始终首先进行测试。第一只受检眼（右眼）和第二只受检眼（左眼）的中位数（四分位距[IQR]）MD 分别为-2.57（-6.15，-0.58）dB 和-2.70（-6.34，-0.80）dB（VF 敏感性中位数降低 0.13 dB；p < 0.001）。第二只受检眼的纵向 MD 变化的替代测量值中位数（IQR）增加了 3%（-43%，50%）；该效果与患者年龄或两次检查之间的休息时间无关。
在常规诊所使用 Humphrey 视野分析仪 SITA 检查，平均而言，在第二只接受检查的眼睛中会出现明显的周边疲劳效应。但是，平均效果非常小，并且患者之间存在巨大差异。我们建议从右眼检查开始，以便在个体中存在任何周边疲劳效应时，每次就诊时的效果尽可能保持一致。
