Automated perimetry. American Academy of Ophthalmology.

Automated perimetry is one product of the computer revolution that has had a dramatic impact on the practice of ophthalmology, affecting the quality of both the perimetric test (perimetric technique) and the interpretation of the test results. Before automation, the quality of visual field technique in many practices was poor, partly because perimetrists lacked the volume of patients requiring the test to provide training sufficient to maintain a high level of experience and expertise. At first, automated perimetry was developed simply to make available to all practitioners visual field testing that was nearly as good as the most skilled manual perimetry. The data provided by first-generation automated perimeters lacked the accuracy, sensitivity, and reproducibility obtainable from a highly skilled manual perimetrist. As automated perimeters evolved, perimetric techniques and the software that analyzes data for clinical significance were improved. The use of automated perimetry to evaluate routinely various visual disorders that require testing of the visual field has increased significantly. Statistical analysis of the test results aids interpretation, both to determine if the field is abnormal and if there is change in the field from one occasion to another, especially in the context of glaucoma. The test is excellent; it is now standardized, with better test algorithms, and in many cases it achieves better results than the best manual perimetrist. However, attention to detail and skill in administering the automated test are still essential. The future will hold further improvements. Nevertheless, as each manufacturer enhances computerized perimetry, it may become more difficult to compare the test results among instruments or even between two test algorithms on the same instrument. In addition, clinical knowledge and experience will still be necessary to reach accurate diagnostic conclusions.