High-resolution multifocal pupillographic objective perimetry in glaucoma.
OBJECTIVE
The recent development of an objective and noninvasive perimetric technique using pupillary responses to sparse multifocal visual stimuli shows promise for the assessment of visual function in glaucoma. This study assesses the sensitivity and specificity of four variants of dichoptic multifocal pupillographic objective perimetry (mfPOP) with a high-resolution, 40-region/field stimulus.


METHODS
Nineteen normal subjects and 17 with open-angle glaucoma were tested with four 4-minute stimulus protocols, presented in eight segments of 30 seconds each. Achromatic multifocal stimuli comprised 40 test regions per eye arranged in a four-ring dartboard layout subtending 60° of visual field. Background luminance was 10 cd/m² with active stimulus regions displaying steady or flickered stimuli at 290 cd/m². Stimulus durations were between 33 and 150 ms, mean intervals between presentations to each test region ranged from 1 to 16 seconds. Fixation was monitored in real time.


RESULTS
Longer mean intervals and durations resulted in better diagnostic performance. Best results were obtained with 150-ms flickered stimuli and a discriminant function that incorporated both amplitude and width of responses: ROC area under the curve 0.86 ± 0.05 (mean ± SE) across all visual field severities, (n = 34) and 1.00 ± 0.00 for moderate and severe fields (n = 10).


CONCLUSIONS
mfPOP produces separate information on response delay and afferent and efferent defects at every point in the field. The diagnostic accuracy of the 40-region, 150-ms stimulus is comparable to that of commonly used subjective perimeters and encourages further investigation of this technique.
Carle
Corinne F
CF
ARC (Australian Research Council) Centre of Excellence in Vision Science, Research School of Biology, The Australian National University, Canberra, Australia.
James
Andrew C
AC
Kolic
Maria
M
Loh
Yik-Wen
YW
Maddess
Ted
T
D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011680:Pupil / Q000502:physiology*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014065:Tonometry, Ocular; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields