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Does eye examination order for standard automated perimetry matter?

Kelly, S. R., Bryan, S. R. & Crabb, D. P. ORCID: 0000-0001-8754-3902 (2019). Does eye examination order for standard automated perimetry matter?. Acta Ophthalmologica, doi: 10.1111/aos.14069


PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Publication Type: Article
Additional Information: ª 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Publisher Keywords: fatigue – glaucoma – perimetry – visual fields
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
Text - Published Version
Available under License Creative Commons Attribution Non-commercial.

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