Comparison of Humphrey Field Analyzer and imo visual field test results in patients with glaucoma and pseudo-fixation loss

Autoři: Hiroyasu Goukon aff001;  Kazunori Hirasawa aff002;  Masayuki Kasahara aff002;  Kazuhiro Matsumura aff002;  Nobuyuki Shoji aff002
Působiště autorů: Graduate School of Medical Science, Kitasato University, Kanagawa, Japan aff001;  Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan aff002;  Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of ophthalmology, London, United Kingdom aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224711


The aim of this cross-sectional study was to evaluate the results of a visual field (VF) test for patients with glaucoma and pseudo-fixation loss. These patients exhibit fixation loss (FL) rates >20% with the Humphrey Field Analyzer (HFA); however, actual fixation stabilizes when a head-mounted perimeter (imo) is used. This device is able to adjust the stimulus presentation point by tracking eye movements. We subjected 54 eyes of 54 patients with glaucoma and pseudo-FL to the HFA 30–2 or 24–2 Swedish Interactive Threshold Algorithm -Standard protocol. All patients also underwent the imo 30–2 or 24–2 Ambient Interactive Zipper Estimated Sequential Testing protocol after HFA measurement. We compared HFA and imo reliability indices [including false-positive (FP) responses, false-negative (FN) responses, and FL rate], global indices [including mean deviation (MD), visual field index (VFI), and pattern standard deviation (PSD)], and retinal sensitivity for each test point. There were no significant differences in MD, VFI, and PSD between HFA and imo, and these measures were strongly correlated (r > 0.96, p < 0.01). There were no significant differences in FP and FN between both devices, while FL measured with HFA (27.5%) was significantly reduced when measured with imo (13.2%) (p < 0.01). There was no correlation in FL and FN between both devices, and a weak correlation for FP (r = 0.29, p = 0.04). At each test point, retinal sensitivity averaged 1.7 dB higher with HFA, compared with imo (p < 0.01). There was no significant variability in global indices in patients with pseudo-FL. The FP response rate might have influenced measures of FL in patients with glaucoma and pseudo-FL.

Klíčová slova:

Blindness – Eye movements – Eyes – Fatigue – Glaucoma – Measurement equipment – Research validity – Visual acuity


1. Anderson DR, Patella VM. Automated Static Perimetry. 2nd ed. St Louis: Mosby; 1999.

2. McMillan TA, Stewart WC, Hunt HH. Association of reliability with reproducibility of the glaucomatous visual field. Acta Ophthalmol (Copenh). 1992; 70:665–670. 1471493PMC14714936

3. Katz J, Sommer A. Screening for glaucomatous visual field loss. The effect of patient reliability. Ophthalmology. 1990; 97(8):1032–1037. doi: 10.1016/s0161-6420(90)32467-3 2402414

4. Katz J, Sommer A. Reliability indexes of automated perimetric tests. Arch Ophthalmol. 1988; 106:1252–1254. doi: 10.1001/archopht.1988.01060140412043 3046588

5. Ishiyama Y, Murata H, Mayama C, Asaoka R. An objective evaluation of gaze tracking in Humphrey perimetry and the relation with the reproducibility of visual fields: a pilot study in glaucoma. Invest Ophthalmol Vis Sci. 2014; 55(12):8149–8152. doi: 10.1167/iovs.14-15541 25389198

6. Ishiyama Y, Murata H, Asaoka R. The Usefulness of Gaze Tracking as an Index of Visual Field Reliability in Glaucoma Patients. Invest Ophthalmol Vis Sci. 2015; 56(11):6233–6236. doi: 10.1167/iovs.15-17661 26431476

7. Ishiyama Y, Murata H, Hirasawa H, Asaoka R. Estimating the Usefulness of Humphrey Perimetry Gaze Tracking for Evaluating Structure-Function Relationship in Glaucoma. Invest Ophthalmol Vis Sci. 2015; 56(13):7801–7805. doi: 10.1167/iovs.15-17988 26650899

8. Sanabria O, Feuer WJ, Anderson DR. Psudo-loss of fixation in Automated Perimetry. Ophthalmology. 1991; 98(1):76–78. doi: 10.1016/s0161-6420(91)32338-8 2023737

9. Nelson-Quigg JM, Twelker JD, Jonson CA. Response Properties of normal observers and patients during automated perimetry. Arch Ophthalmol. 1989; 107:1612–1615. doi: 10.1001/archopht.1989.01070020690029 2818281

10. Birt CM, Shin DH, Samudrala V, Hughes BA, Kim C, Lee D. Analysis of Reliability Indices from Humphrey Visual Field Tests in an Urban Glaucoma Population. Ophthalmology.1997; 104:1126–1130. doi: 10.1016/s0161-6420(97)30173-0 9224465

11. Bickler-Bluth M, Trick GL, Kolker AE, Cooper DG. Assessing the utility of reliability indices for automated visual fields; Testing ocular hypertensives. Ophthalmology. 1989; 96:616–619. doi: 10.1016/s0161-6420(89)32840-5 2748118

12. Hardage L, Stamper RL. Reliability indices for automated visual fields [Letter]. Ophthalmology. 1989; 96:1810. doi: 10.1016/S0161-6420(89)32650-9 2622625

13. Johnson CA, Nelson-Quigg JM. A prospective three-year study of response properties of normal subjects and patients during automated perimetry. Ophthalmology. 1993; 100:269–274. doi: 10.1016/s0161-6420(93)31660-x 8437837

14. Demirel S, Vingrys AJ. Eye movements during perimetry and the effect that fixational instability has on perimetric outcomes. J Glaucoma. 1994; 3:28–35. 19920549

15. Demirel S, Vingrys AJ. Fixational instability during perimetry and the blindspot monitor. In: Mills RP, ed. Perimetry Update, 1992/1993. Amsterdam: Kugler Publications. 1992:515–520. PMID: 19920549

16. Demirel S, Vingrys AJ. The effect of fixational loss on perimetric thresholds and reliability. In: Mills RP, ed. Perimetry Update, 1992/1993. Amsterdam: Kugler Publications; 1992:521–526.

17. Henson DB, Evans J, Chauhan BC, Lane C. Influence of fixation accuracy on threshold variability in patients with open angle glaucoma. Invest Ophthalmol Vis Sci. 1996; 37:444–450. 8603850

18. Kramer BC, Musch DC, Niziol LM, Weizer JS. Reliability of simultaneous visual field testing. Ophthalmology. 2012; 119(2):304–307. doi: 10.1016/j.ophtha.2011.08.021 22115714

19. Katz J, Sommer A. Reliability of visual field results over repeated testing. Arch Ophthalmol. 1991; 98:70–75. doi: 10.1016/S0161-6420(91)32339-X 2023736

20. Henson DB, Evans J, Chauhan BC, Lane C. Influence of fixation accuracy on threshold variability in patients with open angle glaucoma. Invest Ophthalmol Vis Sci. 1996; 37(2):444–450. 8603850

21. Asman P, Fingeret M, Robin A, Wild J, Pacey I, Greenfield D, et al. Kinetic and static fixation methods in automated threshold perimetry. J Glaucoma. 1999; 8(5):290–296. 10529927

22. Hirasawa K, Kobayashi K, Shibamoto A, et al. Variability in monocular and binocular fixation during standard automated perimetry. PLoS One 2018;13(11):e0207517. doi: 10.1371/journal.pone.0207517 30462706

23. Matsumoto C, Yamao S, Nomoto H, Takada S, Okuyama S, Kimura S, et al. Visual Field testing with head-mounted perimeter ‘imo’. PLoS One. 2016; 11(8):e0161974. doi: 10.1371/journal.pone.0161974 27564382 PMCID:PMC5001626

24. Bengtsson B, Olsson J, Heijl A, Rootzén H. A new generation of algorithms for computerized threshold perimetry, SITA. Acta Ophthalmol Scand. 1997; 75(4):368–375. doi: 10.1111/j.1600-0420.1997.tb00392.x 9374242

25. de Boer RW, van den Berg TJ, Greve EL, de Waal BJ. Concepts for automatic perimetry, as applied to the Scoperimeter, an experimental automatic perimeter. Int Ophthalmol. 1982; 5(3):181–91. doi: 10.1007/bf00149152 7152801

26. Newkirk MR, Gardiner SK, Demirel S, Johnson CA. Assessment of false positives with the Humphrey Field Analyzer II perimeter with the SITA Algorithm. Invest Ophthalmol Vis Sci. 2006; 47(10):4632–4637. doi: 10.1167/iovs.05-1598 17003461

27. Kelly SR, Bryan SR, Crabb DP. Does eye examination order for standard automated perimetry matter? Acta Ophthalmol. 2019; 22. doi: 10.1111/aos.14069 30801992

28. Heijl A, Bengtsson B. The effect of perimetric experience in patients with glaucoma. Arch Ophthalmol. 1996; 114(1):19–22. doi: 10.1001/archopht.1996.01100130017003 8540846

29. Heijl A, Lindgren G, Olsson J. The effect of perimetric experience in normal subjects. Arch Ophthalmol. 1989; 107(1):81–6. doi: 10.1001/archopht.1989.01070010083032 2642703

Článek vyšel v časopise


2019 Číslo 11