Peripheral Visual Field Testing in Glaucoma by Automated Kinetic Perimetry With the Humphrey Field Analyzer Bruce J.
Ballon, MD; David A. Echelman, MD; M.
\s=b\ A Humphrey automated perimeter was used to measure the central 24\s=deg\of vision with static threshold targets and the peripheral field with two automatic kinetic stimuli in 100 eyes of 100 patients with glaucoma or a suspicion of glaucoma and to compare the additional information gained with the peripheral tests. The peripheral visual field supported the diagnosis made with central field testing in approximately one third of the eyes and added additional diagnostic information in another fourth of the cases. In 4% of patients a normal central field was associated with a glaucomatous peripheral defect. Virtually all peripheral defects were in the nasal quadrant, and the more sensitive isopter uncovered the vast majority of the defects.
(Arch Ophthalmol. 1992;110:1730-1732)
perimetry is a convenient, relatively reproducible method of measuring the field of vision. One dis¬ advantage, however, is the increased time required for static threshold test¬ ing with most automated perimeters. Consequently, most perimetric pro¬ grams for glaucoma limit testing to the central 24° or 30°. While the majority of early glaucomatous defects are within these limits, peripheral visual field mea¬ utomated
·**
surements with automated kinetic tar¬
gets have been shown to add
some de¬ gree of information to that obtained from the central static tests.1·2 An auto¬ matic kinetic mode was recently added to the Humphrey Field Analyzer (Mod¬ el 630, Humphrey Instruments, San Leandro, Calif). The purpose of the present study was to evaluate the addi¬ tional information gained from the mea¬ surement of two peripheral isopters with this system in comparison with in¬ formation acquired with standard cen¬ tral static testing.
PATIENTS, MATERIALS, AND METHODS A single Humphrey Field Analyzer was
used for all tests in this study. This instru¬ ment is a fully automated bowl perimeter
Bruce
Shields, MD; Anita R. Ollie, COT
that can perform kinetic as well as static pe¬ rimetry. Details of the static technique have been described previously.3·4 Program 24-2 was selected for static testing, which mea¬ sures the retinal threshold at 56 points, off¬ set to either side of the vertical and horizon¬ tal midlines and extending 24° from fixation in all quadrants and 30° in the nasal
quadrant.
For the kinetic tests, two stimuli were se¬ lected: generally a Goldmann size II stimulus for the outer isopter and a Goldmann size I for the inner isopter, with larger or more in¬ tense stimuli if the isopter created with the initial stimulus was too constricted. The need for a larger or more intense stimulus was determined and executed automatically with the Humphrey Field Analyzer. Kinetic tar¬ gets were presented from the periphery in a variable sequence at a velocity of 47s. The pattern of the target locations (Fig 1) was specified for this study, and was not a stan¬ dard pattern programmed by the manufac¬ turer. For each eye, the static test was per¬ formed first, followed by the outer and then the inner peripheral isopters. The subjects in this study were consecu¬ tive patients from the Glaucoma Service of the Duke University Eye Center, Durham, NC. All had established glaucoma or sus¬ pected glaucoma on the basis of an elevated intraocular pressure or appearance of the optic nerve head. All patients had previous experience with automated visual field test¬ ing, and all of the visual field tests were per¬ formed by one of us (A.R.O.). Only right eyes were included in the study.1·2 The times for each phase of the field test were documented. The central static and peripheral kinetic measurements were printed separately and interpreted independently by two of us (BJ.B. and D.A.E.) without knowledge of which central field went with which periph¬ eral field. The interpretations were based on
for publication June 4, 1992. From the Duke University Eye Center, Durham, NC. The authors have no proprietary interest in the perimeter or programs used in this study. Reprints not available.
defect in association with a questionable central defect. A "diagnostically additive" peripheral field was defined as a glaucoma¬ tous peripheral defect associated with a nor¬ mal or questionable central defect or a
Fig 1.—Example of normal peripheral visual field measured by automated kinetic perime¬ try with the Humphrey Field Analyzer. A indi¬ cates the inner isopter, which was typically plotted with a l-2-e Goldmann-equivalent tar¬ get; and B, the outer isopter, which was typ¬ ically plotted with a ll-4-e Goldmannequivalent target.
Table 1.—Criteria Used for Interpretation of
Peripheral Visual Fields
Interpretation Normal Questionable defect Nasal hemianopic offset Peripheral constriction, other than nasal quadrant
Glaucomatous defect Nasal step
Accepted
predetermined criteria that placed a field into one of three categories: (1) normal, (2) questionable defect, or (3) glaucomatous de¬ fect (Tables 1 and 2). A peripheral defect was defined as an abnormality if present in either or both isopters. Central defects with a P
Ballon, MD; David A. Echelman, MD; M.
\s=b\ A Humphrey automated perimeter was used to measure the central 24\s=deg\of vision with static threshold targets and the peripheral field with two automatic kinetic stimuli in 100 eyes of 100 patients with glaucoma or a suspicion of glaucoma and to compare the additional information gained with the peripheral tests. The peripheral visual field supported the diagnosis made with central field testing in approximately one third of the eyes and added additional diagnostic information in another fourth of the cases. In 4% of patients a normal central field was associated with a glaucomatous peripheral defect. Virtually all peripheral defects were in the nasal quadrant, and the more sensitive isopter uncovered the vast majority of the defects.
(Arch Ophthalmol. 1992;110:1730-1732)
perimetry is a convenient, relatively reproducible method of measuring the field of vision. One dis¬ advantage, however, is the increased time required for static threshold test¬ ing with most automated perimeters. Consequently, most perimetric pro¬ grams for glaucoma limit testing to the central 24° or 30°. While the majority of early glaucomatous defects are within these limits, peripheral visual field mea¬ utomated
·**
surements with automated kinetic tar¬
gets have been shown to add
some de¬ gree of information to that obtained from the central static tests.1·2 An auto¬ matic kinetic mode was recently added to the Humphrey Field Analyzer (Mod¬ el 630, Humphrey Instruments, San Leandro, Calif). The purpose of the present study was to evaluate the addi¬ tional information gained from the mea¬ surement of two peripheral isopters with this system in comparison with in¬ formation acquired with standard cen¬ tral static testing.
PATIENTS, MATERIALS, AND METHODS A single Humphrey Field Analyzer was
used for all tests in this study. This instru¬ ment is a fully automated bowl perimeter
Bruce
Shields, MD; Anita R. Ollie, COT
that can perform kinetic as well as static pe¬ rimetry. Details of the static technique have been described previously.3·4 Program 24-2 was selected for static testing, which mea¬ sures the retinal threshold at 56 points, off¬ set to either side of the vertical and horizon¬ tal midlines and extending 24° from fixation in all quadrants and 30° in the nasal
quadrant.
For the kinetic tests, two stimuli were se¬ lected: generally a Goldmann size II stimulus for the outer isopter and a Goldmann size I for the inner isopter, with larger or more in¬ tense stimuli if the isopter created with the initial stimulus was too constricted. The need for a larger or more intense stimulus was determined and executed automatically with the Humphrey Field Analyzer. Kinetic tar¬ gets were presented from the periphery in a variable sequence at a velocity of 47s. The pattern of the target locations (Fig 1) was specified for this study, and was not a stan¬ dard pattern programmed by the manufac¬ turer. For each eye, the static test was per¬ formed first, followed by the outer and then the inner peripheral isopters. The subjects in this study were consecu¬ tive patients from the Glaucoma Service of the Duke University Eye Center, Durham, NC. All had established glaucoma or sus¬ pected glaucoma on the basis of an elevated intraocular pressure or appearance of the optic nerve head. All patients had previous experience with automated visual field test¬ ing, and all of the visual field tests were per¬ formed by one of us (A.R.O.). Only right eyes were included in the study.1·2 The times for each phase of the field test were documented. The central static and peripheral kinetic measurements were printed separately and interpreted independently by two of us (BJ.B. and D.A.E.) without knowledge of which central field went with which periph¬ eral field. The interpretations were based on
for publication June 4, 1992. From the Duke University Eye Center, Durham, NC. The authors have no proprietary interest in the perimeter or programs used in this study. Reprints not available.
defect in association with a questionable central defect. A "diagnostically additive" peripheral field was defined as a glaucoma¬ tous peripheral defect associated with a nor¬ mal or questionable central defect or a
Fig 1.—Example of normal peripheral visual field measured by automated kinetic perime¬ try with the Humphrey Field Analyzer. A indi¬ cates the inner isopter, which was typically plotted with a l-2-e Goldmann-equivalent tar¬ get; and B, the outer isopter, which was typ¬ ically plotted with a ll-4-e Goldmannequivalent target.
Table 1.—Criteria Used for Interpretation of
Peripheral Visual Fields
Interpretation Normal Questionable defect Nasal hemianopic offset Peripheral constriction, other than nasal quadrant
Glaucomatous defect Nasal step
Accepted
predetermined criteria that placed a field into one of three categories: (1) normal, (2) questionable defect, or (3) glaucomatous de¬ fect (Tables 1 and 2). A peripheral defect was defined as an abnormality if present in either or both isopters. Central defects with a P
