New Developments in Supra-threshold Perimetry

Purpose: To describe a series of recent enhancements to supra-threshold perimetry.

Methods: Computer simulations were used to develop an improved algorithm (HEART) for the setting of the supra-threshold test intensity at the beginning of a field test, and to evaluate the relationship between various pass/fail criteria and the test's performance (sensitivity and specificity) and how they compare with modern threshold perimetry. Data were collected in optometric practices to evaluate HEART and to assess how the patient's response times can be analysed to detect false positive response errors in visual field test results.

Results: The HEART algorithm shows improved performance (reduced between-eye differences) over current algorithms. A pass/fail criterion of '3 stimuli seen of 3-5 presentations' at each test location reduces test/retest variability and combines high sensitivity and specificity. A large percentage of false positive responses can be detected by comparing their latencies to the average response time of a patient.

Conclusions: Optimised supra-threshold visual field tests can perform as well as modern threshold techniques. Such tests may be easier to perform for novice patients, compared with the more demanding threshold tests.