Comparison of head-mounted perimeter (imo®) and Humphrey Field Analyzer

Tairo Kimura, Chota Matsumoto, Hiroki Nomoto, Tairo Kimura, Chota Matsumoto, Hiroki Nomoto

Abstract

Purpose: The head-mounted automated perimeter imo® is a new portable perimeter that does not require a dark room and can be used to examine patients in any setting. In this study, imo 24plus (1-2) AIZE examinations were compared with previous Humphrey Field Analyzer (HFA) 30-2 (SITA standard) examinations within the same patient.

Patients and methods: imo examinations (either head-mounted [i-H] or fixed [i-F] type) were performed in patients with glaucoma or suspected glaucoma who had already experienced HFA five or more times. Measurement time and correlations of mean deviation (MD) and visual field index (VFI) values were compared between groups for HFA, i-H, i-F, and imo total (i-T). Fixation loss (FL), false-positive (FP), and false-negative (FN) detection rates were compared. The percentage of binocular random single-eye tests under possible non-occlusion conditions using imo was determined. Mann-Whitney U test was performed, and Spearman's rank-order correlation coefficient was calculated.

Results: The inclusion period was July to December 2016. Among 273 subjects (543 eyes), 147 (292 eyes) were tested with i-H type and 126 (251 eyes) with i-F type. Mean MD values for HFA and i-T were -6.1±7.8 and -6.2±7.1 dB, respectively. Mean measurement times for HFA, i-H, i-F, and i-T were 15.23±2.07, 10.47±2.11, 11.04±2.31, and 10.54±2.19 minutes, respectively (P<0.01 for HFA vs i-H/i-F). Total mean measurement time was shorter by 30.8% for i-T vs HFA. Correlation coefficients of MD and VFI were R 2>0.81 for HFA vs i-H and i-F. FP and FN detection rates were significantly higher with i-T than HFA; there was no significant difference in FL. Binocular random single-eye tests were possible in 85% of cases.

Conclusion: imo reduced measurement time by 30.8%. imo VFI and MD values were highly correlated with HFA. As i-F and i-H types produced similar results, imo can be used in accordance with the patient's situation.

Keywords: automatic perimetry; glaucoma; mean deviation; reliability index; visual field; visual field index.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Components of imo®. Notes: (A) Perimeter unit. (B) Patient response button. (C) Control tablet. If the pupil is detected at three points of the iris margin, pupil monitoring is automatically performed. If the pupil edge is not detected due to drowsiness, blepharoptosis, etc, pupil monitoring is not performed.
Figure 2
Figure 2
Types of imo®. Notes: (A) The head-mounted type allows patients to sit back in a chair and be tested in a comfortable position. (B) The fixed position type can be moved up and down and allows the position to be determined according to a patient’s body type. No dark room is required for either type.
Figure 3
Figure 3
Test points of the HFA 30-2 and the imo® 24plus (1-2) and 24plus (1) programs. Notes: imo 24plus (1-2) has 28 points at 2° intervals within the central 10°. imo 24plus (1) has 36 points along the retinal nerve fiber layer. Abbreviation: HFA, Humphrey Field Analyzer.
Figure 4
Figure 4
Three representative cases. Notes: (A) Case 1: 55-year-old female, normal tension glaucoma. (B) Case 2: 64-year-old male, primary open-angle glaucoma. (C) Case 3: 70-year-old male, normal tension glaucoma. Pattern deviation plots are shown below the HFA 30-2 and imo® 24plus (1-2) test results. For each case, MD and PSD values are found. The red circle indicates the central 10°. Abbreviations: HFA, Humphrey Field Analyzer; MD, mean deviation; PSD, pattern SD.
Figure 5
Figure 5
Target presentation and examinee’s view during the binocular random single-eye test. Notes: The test target is presented randomly to either eye under non-occlusion conditions without the patient being aware of which eye is being tested. Copyright ©2016 Matsumoto et al. Reproduced from Matsumoto C, Yamao S, Nomoto H, et al. Visual Field Testing with Head-Mounted Perimeter ‘imo’. PLoS One. 2016;11(8):e0161974.
Figure 6
Figure 6
During the examination, each pupil may be individually and continuously monitored and the images are used for an eye tracking system. Notes: The distance between the pupil center and the LED center is the tracking amount. If a fixation disparity occurs, the tracking function ensures test accuracy by following fixation and automatically correcting the target location (within a range of ±5°). Abbreviation: LED, light-emitting diode.
Figure 7
Figure 7
Comparison of mean measurement time (SITA standard vs AIZE). Notes: (A) HFA vs i-T. (B) HFA vs i-H and i-F. Total mean measurement time for imo® was 10:54±2:19 minutes, which was shorter by 30.8% compared to the mean of 15:23±2:07 minutes for HFA. There was no significant difference between i-H type and i-F type. Abbreviations: HFA, Humphrey Field Analyzer; i-F, imo fixed type; i-H, imo head-mounted type; i-T, imo total.
Figure 8
Figure 8
Age vs measurement time. Notes: (A) HFA: red dotted regression line (r=0.04, P<0.001), slope 95% CI (−0:01 to +0:05). (B) imo®: red dotted regression line (r=0.04, P<0.001), slope 95% CI (−0:01 to +0:05). Abbreviation: HFA, Humphrey Field Analyzer.
Figure 9
Figure 9
MD correlation between HFA and imo®. Notes: (A) Correlation between HFA 30-2 and imo 24plus (1-2). Blue dotted regression line (r=0.82, P<0.001): right eye slope, 95% CI (0.96–1.02); orange dotted regression line (r=0.83, P<0.001): left eye slope, 95% CI (1.00–1.06). (B) Bland–Altman plots: right eye mean value, 95% CI (−0.65, −6.49 to 5.19); left eye mean value, 95% CI (0.56, −4.70 to 5.81). Abbreviations: HFA, Humphrey Field Analyzer; MD, mean deviation.
Figure 10
Figure 10
VFI correlation between HFA and imo®. Notes: (A) Correlation between HFA 30-2 vs imo 24plus (1-2). Blue dotted regression line (r=0.81, P<0.001): right eye slope, 95% CI (0.90–0.94); orange dotted regression line (r=0.84, P<0.001): left eye slope, 95% CI (0.95–0.99). (B) Bland–Altman plots: right eye mean value, 95% CI (−1.1, −18.4 to 16.2); left eye mean value, 95% CI (0.50, −15.6 to 16.7). Abbreviations: HFA, Humphrey Field Analyzer; VFI, visual field index.
Figure 11
Figure 11
MD correlation by imo® type. Notes: (A) HFA vs i-H. Blue dotted regression line (r=0.83, P<0.001): right eye slope, 95% CI (0.92–1.00); orange dotted regression line (r=0.86, P<0.001): left eye slope, 95% CI (0.94–1.02). (B) HFA vs i-F. Blue dotted regression line (r=0.81, P<0.001): right eye slope, 95% CI (0.98–1.08); orange dotted regression line (r=0.78, P<0.001): left eye slope, 95% CI (1.04–1.12). Abbreviations: HFA, Humphrey Field Analyzer; i-F, imo fixed type; i-H, imo head-mounted type; MD, mean deviation.
Figure 12
Figure 12
VFI correlation between HFA and imo® type. Notes: (A) HFA vs i-H. Blue dotted regression line (r=0.81, P<0.001): right eye slope, 95% CI (0.92–0.96); orange dotted regression line (r=0.86, P<0.001): left eye slope, 95% CI (0.92–0.96). (B) HFA vs i-F. Blue dotted regression line (r=0.81, P<0.001): right eye slope, 95% CI (0.89–0.93); orange dotted regression line (r=0.81, P<0.001): left eye slope, 95% CI (0.97–1.01). Abbreviations: HFA, Humphrey Field Analyzer; i-F, imo fixed type; i-H, imo head-mounted type; VFI, visual field index.
Figure 13
Figure 13
Reliability index: comparison of false positive, false negative, and fixation loss test results between HFA 30-2 and imo® 24plus (1-2) (total). Abbreviations: FL, fixation loss; FN, false negative; FP, false positive; HFA, Humphrey Field Analyzer.

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