Elsevier

Ophthalmology

Volume 106, Issue 1, 1 January 1999, Pages 178-181
Ophthalmology

Continuous visual field test supervision may not always be necessary1,

Presented in part at the ARVO annual meeting, Fort Lauderdale, Florida, May 1997.
https://doi.org/10.1016/S0161-6420(99)90016-7Get rights and content

Abstract

Objective

To assess the effect of supervision on computerized visual field (VF) performance and to determine what patient characteristics predict poor unsupervised performance.

Design

Randomized, crossover, cross-sectional, clinical trial.

Participants

Two hundred unselected patients with definite or suspect glaucoma or neuro-ophthalmic VF indication participated.

Intervention

All patients completed two 30–2 tests of one eye on a Humphrey perimeter, one with continuous active technician supervision and one without supervision after the initial 2 minutes of the test.

Main outcome measures

Visual field reliability and global VF indices were measured.

Results

Supervision had a positive effect on overall reliability (P = 0.04) but not on individual reliability parameters or any of the global VF indices. There was no difference between Humphrey Field Analyzers I and II in the need for supervision. Predictors of need for supervision were low educational level and a prior test result with false-positive responses. Predictors of an unreliable test were advanced age and a prior test with a high proportion of fixation losses.

Conclusion

Supervision is necessary for those with risk factors for unsatisfactory perimetry such as advanced age, low level of formal education, and prior test results with false-positive responses or high fixation losses; in the remainder, omission of supervision can be considered.

Section snippets

Patients and methods

Two hundred consecutive patients undergoing VF testing for glaucoma, glaucoma suspect, and neuro-ophthalmic indications were examined twice using the 30–2 full-threshold strategy on a Humphrey Field Analyzer, once with continuous technician supervision and once without such supervision. The eye to be tested (right or left), the perimeter model to be used (HFA I or HFA II), and the order of testing (supervised or unsupervised first) were randomly selected for each patient using a table of random

Results

All patients completed the test protocol, 99 on the HFA I and 101 on the HFA II. With unreliability as the criterion (manufacturer’s “XX” flag) on any of the reliability parameters, we tested for a difference between the HFA I and HFA II in the proportion of patients who benefited from supervision (Table 1). A benefit from supervision was defined as a reliable result with supervision and an unreliable result without supervision. The proportion of patients benefiting from supervision was 10.1%

Discussion

Supervision was significantly associated with increased test reliability (P = 0.04). However, if a Bonferroni or other correction for multiple statistical tests had been applied, the significance of supervision would have disappeared entirely, despite the large sample size of 200 patients. The effect size of supervision was much smaller than had been anticipated during the study design. No difference in the beneficial effect of supervision on reliability was observed between the older HFA I and

References (5)

  • D.R. Anderson
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    No significant differences were found in any reliability or performance measure, so the authors concluded that both strategies were equally effective. Van Coevorden et al6 also examined the utility of continuous versus initial technician supervision in VF testing. In that study, 200 patients with glaucoma or neuro-ophthalmic disease had 1 eye undergo VF testing both with and without supervision, with testing order randomized.

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Supported in part by NIH Grant EY01730, and in part by an unrestricted award from Research to Prevent Blindness, Inc., New York, New York.

1

The authors have no proprietary interest in Humphrey-Zeiss, Inc.

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