Department of Glaucoma, Anand Eye Institute, Habsiguda, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2023 Oct;71(10):3424. doi: 10.4103/IJO.IJO_601_23.
In Humphrey visual field analyzer, the false-positive (FP) responses imply that the patient has pressed the response button despite no stimulus being seen at the time of response and FP rates >15% are flagged. The classical "Trigger happy" visual field has increased fixation loss, very high threshold retinal sensitivity with the values in supernormal range, "white scotoma" on grayscale map, high positive mean deviation (MD), glaucoma hemifield test (GHT) gives classification of "abnormally high sensitivity, 'Excessive high false positive' message is displayed," and pattern deviation probability plot has more defects than total deviation probability plot known as "reverse cataract pattern." However, these classical findings are not seen in all the cases of FP as the same thumb rule cannot be applied to all the visual fields with high FP.
This video emphasizes the significance of careful examination of all the parameters in a visual field printout of high FP to interpret the test results and the caution needed when an FP response is seen in a patient with advanced glaucoma.
The video presents some interesting visual fields in normal and glaucoma patients and the effect of high FP responses on MD, the different classification messages displayed for GHT, patterns of total deviation probability plot and pattern deviation probability plot, and how to identify the hidden FP.
This video highlights the importance of careful examination of all the parameters in a visual field printout to interpret the test results. One should be especially cautious when an FP response is noted in a patient with advanced glaucoma, as the retinal sensitivity values may not be in supernormal range but are significantly affected by the increased FP. Clinician should be able to identify this and repeat the test as high FP reponses can lead to underestimation of visual field loss.
在 Humphrey 视野分析仪中，假阳性（FP）反应意味着患者在没有看到刺激的情况下按下了反应按钮，而 FP 率>15%则会被标记。经典的“Trigger happy”视野会导致固视损失增加，阈值视网膜敏感度非常高，处于超正常值范围，灰度图上出现“white scotoma”，平均偏差（MD）值为正，青光眼半视野测试（GHT）给出“异常高敏感度，‘过度高假阳性’信息显示”的分类，以及模式偏差概率图的缺陷比总偏差概率图多，被称为“反转白内障模式”。然而，并非所有 FP 病例都具有这些经典表现，因为同样的拇指规则不能应用于所有 FP 较高的视野。
本视频强调了在 FP 较高的视野打印输出中仔细检查所有参数的重要性，以解释测试结果，并在高级青光眼患者中出现 FP 反应时需要谨慎。
本视频介绍了正常和青光眼患者的一些有趣视野，以及 FP 高反应对 MD 的影响、GHT 显示的不同分类信息、总偏差概率图和模式偏差概率图的模式、以及如何识别隐藏的 FP。
本视频强调了仔细检查视野打印输出中所有参数以解释测试结果的重要性。当在高级青光眼患者中注意到 FP 反应时，应特别小心，因为视网膜敏感度值可能不在超正常值范围内，但会受到增加的 FP 的显著影响。临床医生应该能够识别出这一点并重复测试，因为 FP 高反应可能导致低估视野损失。
