False Positive Responses in Standard Automated Perimetry

Anders Heijl; Vincent Michael Patella; John G. Flanagan; Aiko Iwase; Christopher K. Leung; Anja Tuulonen; Gary C. Lee; Thomas Callan; Boel Bengtsson

doi:10.1016/j.ajo.2021.06.026

False Positive Responses in Standard Automated Perimetry

Anders Heijl^*
, Vincent Michael Patella
, John G. Flanagan
, Aiko Iwase
, Christopher K. Leung
, Anja Tuulonen
, Gary C. Lee
, Thomas Callan
, Boel Bengtsson

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

46 Citations (Scopus)

38 Downloads (Pure)

Abstract

Purpose: To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results. Design: Prospective multicenter cross-sectional study. Methods: One hundred twenty-six patients with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH). Results: Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6%-1.4%). Only small parts of intervisit differences were explained by FP (r² values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r² values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP. Conclusions: Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results, except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.

Original language	English
Pages (from-to)	180-188
Number of pages	9
Journal	American Journal of Ophthalmology
Volume	233
Early online date	Jul 2021
DOIs	https://doi.org/10.1016/j.ajo.2021.06.026
Publication status	Published - Jan 2022
Publication type	A1 Journal article-refereed

Funding

Funding/Support: The clinical study was supported by the Herman Järnhardt Foundation, the Foundation for Visually Impaired in Former Malmöhus County, Sweden. These funding organizations had no role in the design or conduct of this research. Carl Zeiss Meditec Inc., Dublin, California, USA was directly involved in the development of SITA Faster and loaned perimeters to 4 of the participating clinical sites. Carl Zeiss Meditec Inc. provided research funding for this study to J.G.F. at the University of California, Berkeley. Financial Disclosures: A.H. and B.B. are consultants of and are entitled to royalties from Carl Zeiss Meditec. A.H. is a consultant for Allergan plc and has received speaker honoraria from Allergan and Zeiss. V.M.P. is a consultant for Carl Zeiss Meditec and was a Carl Zeiss Meditec employee during the development and evaluation of SITA Faster. J.G.F. is a consultant for and received research support from Carl Zeiss Meditec, Inc. A.I. is a consultant for Santen and has received speaker honoraria from Pfizer, Santen, Kowa, Alcon, Heidelberg Engineering through Japan focus Company, and Carl Zeiss Meditec, Tokyo. A.I. also holds a patent licensed to Topcon without any royalties. C.K.L. has received speaker honoraria from Carl Zeiss Meditec, Topcon, Tomey, Allergan, Novartis, Santen, Glaukos, and Global Vision; research support in the form of instruments from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, and Optovue; research grants from Carl Zeiss Meditec, Topcon, Novartis, Glaukos, Alcon, and Optovue; consultant fees from Allergan and Novartis; and has patents with Carl Zeiss Meditec. A.T. has no financial disclosures, but Carl Zeiss Meditec provided the perimeter used in the clinical evaluation. G.C.L. and T.C. are employees of Carl Zeiss Meditec. All authors attest that they meet the current ICMJE criteria for authorship. ALL AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE FORM FOR DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST and none were reported. Funding/Support: The clinical study was supported by the Herman J?rnhardt Foundation, the Foundation for Visually Impaired in Former Malm?hus County, Sweden. These funding organizations had no role in the design or conduct of this research. Carl Zeiss Meditec Inc. Dublin, California, USA was directly involved in the development of SITA Faster and loaned perimeters to 4 of the participating clinical sites. Carl Zeiss Meditec Inc. provided research funding for this study to J.G.F. at the University of California, Berkeley. Financial Disclosures: A.H. and B.B. are consultants of and are entitled to royalties from Carl Zeiss Meditec. A.H. is a consultant for Allergan plc and has received speaker honoraria from Allergan and Zeiss. V.M.P. is a consultant for Carl Zeiss Meditec and was a Carl Zeiss Meditec employee during the development and evaluation of SITA Faster. J.G.F. is a consultant for and received research support from Carl Zeiss Meditec, Inc. A.I. is a consultant for Santen and has received speaker honoraria from Pfizer, Santen, Kowa, Alcon, Heidelberg Engineering through Japan focus Company, and Carl Zeiss Meditec, Tokyo. A.I. also holds a patent licensed to Topcon without any royalties. C.K.L. has received speaker honoraria from Carl Zeiss Meditec, Topcon, Tomey, Allergan, Novartis, Santen, Glaukos, and Global Vision; research support in the form of instruments from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, and Optovue; research grants from Carl Zeiss Meditec, Topcon, Novartis, Glaukos, Alcon, and Optovue; consultant fees from Allergan and Novartis; and has patents with Carl Zeiss Meditec. A.T. has no financial disclosures, but Carl Zeiss Meditec provided the perimeter used in the clinical evaluation. G.C.L. and T.C. are employees of Carl Zeiss Meditec. All authors attest that they meet the current ICMJE criteria for authorship.

Keywords

False positive responses
Glaucoma
Perimetry
Reliability Parameters
Standard Automated Perimetry
Visual Field Testing

Publication forum classification

Publication forum level 2

ASJC Scopus subject areas

Ophthalmology

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10.1016/j.ajo.2021.06.026Licence: CC BY

1-s2.0-S000293942100355X-mainFinal published version, 1.12 MBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202112038901Licence: CC BY

Cite this

@article{f3974705a6584b70b7b21e7df7341cf9,

title = "False Positive Responses in Standard Automated Perimetry",

abstract = "Purpose: To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results. Design: Prospective multicenter cross-sectional study. Methods: One hundred twenty-six patients with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH). Results: Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6\%-1.4\%). Only small parts of intervisit differences were explained by FP (r2 values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r2 values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP. Conclusions: Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results, except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.",

keywords = "False positive responses, Glaucoma, Perimetry, Reliability Parameters, Standard Automated Perimetry, Visual Field Testing",

author = "Anders Heijl and Patella, \{Vincent Michael\} and Flanagan, \{John G.\} and Aiko Iwase and Leung, \{Christopher K.\} and Anja Tuulonen and Lee, \{Gary C.\} and Thomas Callan and Boel Bengtsson",

note = "Funding Information: Funding/Support: The clinical study was supported by the Herman J{\"a}rnhardt Foundation, the Foundation for Visually Impaired in Former Malm{\"o}hus County, Sweden. These funding organizations had no role in the design or conduct of this research. Carl Zeiss Meditec Inc., Dublin, California, USA was directly involved in the development of SITA Faster and loaned perimeters to 4 of the participating clinical sites. Carl Zeiss Meditec Inc. provided research funding for this study to J.G.F. at the University of California, Berkeley. Financial Disclosures: A.H. and B.B. are consultants of and are entitled to royalties from Carl Zeiss Meditec. A.H. is a consultant for Allergan plc and has received speaker honoraria from Allergan and Zeiss. V.M.P. is a consultant for Carl Zeiss Meditec and was a Carl Zeiss Meditec employee during the development and evaluation of SITA Faster. J.G.F. is a consultant for and received research support from Carl Zeiss Meditec, Inc. A.I. is a consultant for Santen and has received speaker honoraria from Pfizer, Santen, Kowa, Alcon, Heidelberg Engineering through Japan focus Company, and Carl Zeiss Meditec, Tokyo. A.I. also holds a patent licensed to Topcon without any royalties. C.K.L. has received speaker honoraria from Carl Zeiss Meditec, Topcon, Tomey, Allergan, Novartis, Santen, Glaukos, and Global Vision; research support in the form of instruments from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, and Optovue; research grants from Carl Zeiss Meditec, Topcon, Novartis, Glaukos, Alcon, and Optovue; consultant fees from Allergan and Novartis; and has patents with Carl Zeiss Meditec. A.T. has no financial disclosures, but Carl Zeiss Meditec provided the perimeter used in the clinical evaluation. G.C.L. and T.C. are employees of Carl Zeiss Meditec. All authors attest that they meet the current ICMJE criteria for authorship. Funding Information: ALL AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE FORM FOR DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST and none were reported. Funding/Support: The clinical study was supported by the Herman J?rnhardt Foundation, the Foundation for Visually Impaired in Former Malm?hus County, Sweden. These funding organizations had no role in the design or conduct of this research. Carl Zeiss Meditec Inc. Dublin, California, USA was directly involved in the development of SITA Faster and loaned perimeters to 4 of the participating clinical sites. Carl Zeiss Meditec Inc. provided research funding for this study to J.G.F. at the University of California, Berkeley. Financial Disclosures: A.H. and B.B. are consultants of and are entitled to royalties from Carl Zeiss Meditec. A.H. is a consultant for Allergan plc and has received speaker honoraria from Allergan and Zeiss. V.M.P. is a consultant for Carl Zeiss Meditec and was a Carl Zeiss Meditec employee during the development and evaluation of SITA Faster. J.G.F. is a consultant for and received research support from Carl Zeiss Meditec, Inc. A.I. is a consultant for Santen and has received speaker honoraria from Pfizer, Santen, Kowa, Alcon, Heidelberg Engineering through Japan focus Company, and Carl Zeiss Meditec, Tokyo. A.I. also holds a patent licensed to Topcon without any royalties. C.K.L. has received speaker honoraria from Carl Zeiss Meditec, Topcon, Tomey, Allergan, Novartis, Santen, Glaukos, and Global Vision; research support in the form of instruments from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, and Optovue; research grants from Carl Zeiss Meditec, Topcon, Novartis, Glaukos, Alcon, and Optovue; consultant fees from Allergan and Novartis; and has patents with Carl Zeiss Meditec. A.T. has no financial disclosures, but Carl Zeiss Meditec provided the perimeter used in the clinical evaluation. G.C.L. and T.C. are employees of Carl Zeiss Meditec. All authors attest that they meet the current ICMJE criteria for authorship. ",

year = "2022",

month = jan,

doi = "10.1016/j.ajo.2021.06.026",

language = "English",

volume = "233",

pages = "180--188",

journal = "American Journal of Ophthalmology",

issn = "0002-9394",

publisher = "Elsevier",

}

TY - JOUR

T1 - False Positive Responses in Standard Automated Perimetry

AU - Heijl, Anders

AU - Patella, Vincent Michael

AU - Flanagan, John G.

AU - Iwase, Aiko

AU - Leung, Christopher K.

AU - Tuulonen, Anja

AU - Lee, Gary C.

AU - Callan, Thomas

AU - Bengtsson, Boel

N1 - Funding Information: Funding/Support: The clinical study was supported by the Herman Järnhardt Foundation, the Foundation for Visually Impaired in Former Malmöhus County, Sweden. These funding organizations had no role in the design or conduct of this research. Carl Zeiss Meditec Inc., Dublin, California, USA was directly involved in the development of SITA Faster and loaned perimeters to 4 of the participating clinical sites. Carl Zeiss Meditec Inc. provided research funding for this study to J.G.F. at the University of California, Berkeley. Financial Disclosures: A.H. and B.B. are consultants of and are entitled to royalties from Carl Zeiss Meditec. A.H. is a consultant for Allergan plc and has received speaker honoraria from Allergan and Zeiss. V.M.P. is a consultant for Carl Zeiss Meditec and was a Carl Zeiss Meditec employee during the development and evaluation of SITA Faster. J.G.F. is a consultant for and received research support from Carl Zeiss Meditec, Inc. A.I. is a consultant for Santen and has received speaker honoraria from Pfizer, Santen, Kowa, Alcon, Heidelberg Engineering through Japan focus Company, and Carl Zeiss Meditec, Tokyo. A.I. also holds a patent licensed to Topcon without any royalties. C.K.L. has received speaker honoraria from Carl Zeiss Meditec, Topcon, Tomey, Allergan, Novartis, Santen, Glaukos, and Global Vision; research support in the form of instruments from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, and Optovue; research grants from Carl Zeiss Meditec, Topcon, Novartis, Glaukos, Alcon, and Optovue; consultant fees from Allergan and Novartis; and has patents with Carl Zeiss Meditec. A.T. has no financial disclosures, but Carl Zeiss Meditec provided the perimeter used in the clinical evaluation. G.C.L. and T.C. are employees of Carl Zeiss Meditec. All authors attest that they meet the current ICMJE criteria for authorship. Funding Information: ALL AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE FORM FOR DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST and none were reported. Funding/Support: The clinical study was supported by the Herman J?rnhardt Foundation, the Foundation for Visually Impaired in Former Malm?hus County, Sweden. These funding organizations had no role in the design or conduct of this research. Carl Zeiss Meditec Inc. Dublin, California, USA was directly involved in the development of SITA Faster and loaned perimeters to 4 of the participating clinical sites. Carl Zeiss Meditec Inc. provided research funding for this study to J.G.F. at the University of California, Berkeley. Financial Disclosures: A.H. and B.B. are consultants of and are entitled to royalties from Carl Zeiss Meditec. A.H. is a consultant for Allergan plc and has received speaker honoraria from Allergan and Zeiss. V.M.P. is a consultant for Carl Zeiss Meditec and was a Carl Zeiss Meditec employee during the development and evaluation of SITA Faster. J.G.F. is a consultant for and received research support from Carl Zeiss Meditec, Inc. A.I. is a consultant for Santen and has received speaker honoraria from Pfizer, Santen, Kowa, Alcon, Heidelberg Engineering through Japan focus Company, and Carl Zeiss Meditec, Tokyo. A.I. also holds a patent licensed to Topcon without any royalties. C.K.L. has received speaker honoraria from Carl Zeiss Meditec, Topcon, Tomey, Allergan, Novartis, Santen, Glaukos, and Global Vision; research support in the form of instruments from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, Tomey, and Optovue; research grants from Carl Zeiss Meditec, Topcon, Novartis, Glaukos, Alcon, and Optovue; consultant fees from Allergan and Novartis; and has patents with Carl Zeiss Meditec. A.T. has no financial disclosures, but Carl Zeiss Meditec provided the perimeter used in the clinical evaluation. G.C.L. and T.C. are employees of Carl Zeiss Meditec. All authors attest that they meet the current ICMJE criteria for authorship.

PY - 2022/1

Y1 - 2022/1

N2 - Purpose: To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results. Design: Prospective multicenter cross-sectional study. Methods: One hundred twenty-six patients with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH). Results: Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6%-1.4%). Only small parts of intervisit differences were explained by FP (r2 values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r2 values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP. Conclusions: Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results, except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.

AB - Purpose: To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results. Design: Prospective multicenter cross-sectional study. Methods: One hundred twenty-six patients with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH). Results: Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6%-1.4%). Only small parts of intervisit differences were explained by FP (r2 values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r2 values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP. Conclusions: Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results, except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.

KW - False positive responses

KW - Glaucoma

KW - Perimetry

KW - Reliability Parameters

KW - Standard Automated Perimetry

KW - Visual Field Testing

U2 - 10.1016/j.ajo.2021.06.026

DO - 10.1016/j.ajo.2021.06.026

M3 - Article

C2 - 34283973

AN - SCOPUS:85118803594

SN - 0002-9394

VL - 233

SP - 180

EP - 188

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

ER -

False Positive Responses in Standard Automated Perimetry

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