School of Optometry and Vision Science, University of New South Wales Sydney, Kensington, New South Wales, Australia.
Centre for Eye Health, University of New South Wales Sydney, Kensington, New South Wales, Australia.
Ophthalmic Physiol Opt. 2024 Jan;44(1):83-95. doi: 10.1111/opo.13229. Epub 2023 Oct 6.
To compare clinical visual field outputs in glaucoma and healthy patients returned by the Humphrey Field Analyzer (HFA) and virtual reality (Virtual Field, VF) perimetry.
One eye of 54 glaucoma patients and 41 healthy subjects was prospectively tested (three times each in random order) using the HFA and VF perimeters (24-2 test grids). We extracted and compared global indices (mean deviation [MD] and pattern standard deviation [PSD]), pointwise sensitivity (and calculated 'equivalent' sensitivity after accounting for differences in background luminance) and pointwise defects. Bland-Altman (mean difference [M ] and 95% limits of agreement [LoA]) and intraclass correlation analyses were performed.
The VF test was shorter (by 76 s) and had lower fixation losses (by 0.08) and false-positive rate (by 0.01) compared to the HFA (all p < 0.0001). Intraclass correlations were 0.86, 0.82 and 0.47 for MD, PSD and pointwise sensitivity between devices, respectively. Test-retest variability was higher for VF (M 0.3 dB, LoA -7.6 to 8.2 dB) compared to the HFA (M -0.3 dB, LoA -6.4 to 5.9 dB), indicating greater test-retest variability. When using each device's underlying normative database, the HFA detected, on average, 7 more defects (at the p < 0.05 level) out of the 52 test locations compared to this iteration of VF in the glaucoma cohort.
Virtual Field returns global results that are correlated with the HFA, but pointwise sensitivities were more variable. Differences in test-retest variability and defect detection by its current normative database raise questions about the widespread adoption of VF in lieu of the HFA.
比较青光眼和健康患者的 Humphrey 视野分析仪（HFA）和虚拟现实（VF）视野计的临床视野结果。
前瞻性地对 54 例青光眼患者和 41 例健康受试者的一只眼（随机顺序各测试三次）进行测试，使用 HFA 和 VF 视野计（24-2 测试网格）。我们提取并比较了全局指标（平均偏差[MD]和模式标准偏差[PSD]）、逐点灵敏度（并在考虑背景亮度差异后计算“等效”灵敏度）和逐点缺陷。进行 Bland-Altman（平均差异[M]和 95%置信区间[LoA]）和组内相关分析。
VF 测试时间更短（缩短 76 秒），固视丢失更少（少 0.08），假阳性率更低（少 0.01），与 HFA 相比（均 p<0.0001）。MD、PSD 和逐点灵敏度在设备之间的组内相关性分别为 0.86、0.82 和 0.47。VF 的测试-重测变异性更高（M 0.3dB，LoA -7.6 至 8.2dB），与 HFA 相比（M -0.3dB，LoA -6.4 至 5.9dB），表明测试-重测变异性更大。当使用每个设备的基础标准数据库时，与该次 VF 迭代相比，HFA 在青光眼队列中的 52 个测试位置中平均检测到 7 个以上的缺陷（p<0.05 水平）。
VF 返回与 HFA 相关的全局结果，但逐点灵敏度更具变异性。测试-重测变异性和当前标准数据库检测缺陷的差异引发了对 VF 广泛替代 HFA 的广泛采用的质疑。
