AUTOMATED SUPRATHRESHOLD STATIC PERIMETRY SCREENING FOR DETECTING NEUROOPHTHALMOLOGICAL DISEASE

Purpose: To devise and evaluate a rapid, accurate, and cost-effective, method of detecting neuro-ophthalmologic visual field defects. Methods : One hundred fifty-nine consecutive patients were evaluated with 76-p oint, central 30 degrees automated static threshold perimetry on the H umphrey Visual Field Analyzer, as well as by a 76-point, central 30 de grees suprathreshold examination with the central reference levels set at 2 or 4 dB lower than the estimated normal median central reference level adjusted for age. Six masked readers reviewed the fields. Their readings were compared with those of the other observers, as well as with the final diagnoses as determined from all available clinical inf ormation. Results: In detecting abnormality, the full-threshold 30 deg rees test had a sensitivity (percent of eyes with true field defects i dentified by the field test) of 93% or 99% (depending on whether borde rline results were counted as a positive or negative test) and a speci ficity (percent of cases without true field defects appropriately iden tified by the field test) of 71% or 91%. In comparison, the 4-dB offse t suprathreshold test had a sensitivity (averaged over all reviewers) of 79% or 87% and a specificity of 81% or 89%, whereas the 2-dB test h ad a sensitivity of 87% or 94% and a specificity of 73% or 85%. The me an duration of the suprathreshold tests was 3.5 +/- 1.0 minute, compar ed with 14.8 +/- 2.8 minutes for the full-threshold technique. Conclus ion: The central 30 degrees, 76-point, 2-dB offset suprathreshold auto mated perimetry is more rapid and nearly as effective as the full-thre shold test in detecting visual field abnormalities due to neuro-ophtha lmologic disease. More quantitative, full-threshold perimetric strateg ies should be used in all equivocal cases and to follow progression of established disease.