Comparison of Peristat Online Perimetry with the Humphrey Perimetry in a Clinic-Based Setting

Eugene A Lowry, Jing Hou, Lauren Hennein, Robert T Chang, Shan Lin, Jeremy Keenan, Sean K Wang, Sean Ianchulev, Louis R Pasquale, Ying Han, Eugene A Lowry, Jing Hou, Lauren Hennein, Robert T Chang, Shan Lin, Jeremy Keenan, Sean K Wang, Sean Ianchulev, Louis R Pasquale, Ying Han

Abstract

Purpose: We determined the receiver operating characteristic (ROC) curves for Peristat online perimetry at detecting varying degrees of glaucoma and the correlation between Peristat online perimetry and Humphrey visual field.

Methods: A prospective, comparative study of Peristat online perimetry (an achromatic static computer threshold testing program) and Humphrey visual field (HVF) 24-2 SITA standard testing was performed by 63 glaucoma patients and 30 healthy controls in random order. The number of total adjacent abnormal test points were identified for each test, and compared with Spearman correlation. Receive operating characteristic curves were generated for Peristat online perimetry detection of mild and moderate-severe glaucoma patients using contrast sensitivity thresholds of -16.7, -21.7, and -26.7 dB.

Results: The area under the ROC curve for glaucoma detection ranged from 0.77 to 0.81 for mild disease (mean deviation [MD], >-6 dB on HVF) and 0.85 to 0.87 for moderate to severe disease (MD, <-6 dB on HVF) depending on contrast threshold. Peristat online perimetry and Humphrey visual field abnormal points were highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all P < 0.001).

Conclusions: Peristat online perimetry exhibits a reasonable ROC curve without specialized equipment and exhibited significant correlation with the conventional 24° Humphrey visual field test.

Translational relevance: Low cost widely available internet-based visual fields may complement traditional office-based visual field testing.

Keywords: glaucoma; online; perimetry; visual field.

Conflict of interest statement

Dr. Pasquale is author of a patent on the blue arc test for glaucoma owned by Mass Eye and Ear Infirmary (US patent 6,758,823.B2. 2004 Jul 6). The blue arc test is a computer-based test to detect glaucoma that leverages the blue arc entoptic phenomenon. There are no conflicting relationships for the other authors.

Figures

Figure 1
Figure 1
(A, B) Peristat online perimetry. Patients were instructed to fix their vision on a central white circle at such a distance that the blinking green circles would disappear in their blind spot. High contrast stimuli were initially presented in the central visual area to establish a baseline response pattern followed by peripheral stimuli of varying intensity (left). Patients were instructed to respond to each stimulus by pressing the computer space bar. The errors were recorded to create a plot of visual field defects at −16.7, −21.7, and −26.7 dB contrast sensitivities (right).
Figure 2
Figure 2
(A, B) Scatterplots showing the number of missed adjacent Peristat points against missed adjacent Humphrey visual field points for total deviation (left) and pattern deviation (right). Peristat missed points are shown at −26.7, −21.7, and −16.7 dB while HVF points are shown at 5%, 2%, 1%, and 0.5%. Spearman correlation coefficients (ρ) are shown in right lower corner for each scatterplot; all were significant at the P < 0.001 level after Bonferroni adjustment.
Figure 3
Figure 3
(A, B) Receiver operating characteristic (ROC) curves for Peristat detection of patients with glaucoma severity equal or greater than mild glaucoma (0.81, 0.77, 0.77) or moderate glaucoma (0.87, 0.85, 0.85) at low (−16.7 dB), medium (−21.7 dB), and high (−26.7 dB) contrast sensitivity, respectively.

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