Devers Eye Institute, Legacy Health, Portland, OR, USA.
Transl Vis Sci Technol. 2023 Aug 1;12(8):12. doi: 10.1167/tvst.12.8.12.
We have previously shown that using moving, instead of static, stimuli extends the effective dynamic range of automated perimetry in glaucoma. In this study, we further investigate the effect of using moving stimuli on the detectability of functional loss.
We used two experimental perimetry paradigms to test 155 subjects with a diagnosis of glaucoma or glaucoma suspect, and 34 healthy control subjects. One test used stimuli moving parallel to the average nerve fiber bundle orientation at each location; the other used static stimuli. Algorithms were otherwise identical. Sensitivities to moving stimuli were transformed to the equivalent values for static stimuli based on a Bland-Altman plot. The proportions of locations outside age-corrected normative limits were compared, and test-retest variability was compared against defect depth for each stimulus type.
More tested locations were below the fifth percentile of the normative range for that location using static stimuli. However, among locations abnormal according to standard clinical perimetry on the same day, 19.2% were abnormal using static stimuli, versus 20.5% using moving stimuli (P = 0.372). Test-retest variability was 44% lower for moving stimuli across the range of defect depths.
When compared with static automated perimetry and expressed on a common scale, moving stimuli extend the effective dynamic range and decrease variability, without decreasing the detectability of known functional defects.
Moving stimuli provide a method to improve known problems of current clinical perimetry.
我们之前已经表明，使用移动刺激而不是静态刺激可以扩展青光眼自动化视野检查的有效动态范围。在这项研究中，我们进一步研究了使用移动刺激对功能丧失检测的影响。
我们使用两种实验性视野检查范式来测试 155 名被诊断为青光眼或疑似青光眼的患者和 34 名健康对照者。一种测试使用与每个位置的平均神经纤维束方向平行移动的刺激；另一种使用静态刺激。算法是相同的。根据 Bland-Altman 图，将移动刺激的灵敏度转换为静态刺激的等效值。比较了超出年龄校正正常范围的位置比例，并比较了每种刺激类型的测试-重测变异性与缺陷深度。
使用静态刺激时，更多的测试位置低于该位置正常范围的第五百分位数。然而，在同一天根据标准临床视野检查异常的位置中，使用静态刺激的位置有 19.2%异常，而使用移动刺激的位置有 20.5%异常（P = 0.372）。在整个缺陷深度范围内，移动刺激的测试-重测变异性降低了 44%。
与静态自动化视野检查相比，并在共同的尺度上表示，移动刺激扩展了有效动态范围并降低了变异性，而不会降低已知功能缺陷的检测能力。
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