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Spatial Resolution of the Tendency-Oriented Perimetry Algorithm

From Discoveries in Sight, Devers Eye Institute, Portland Oregon.

PURPOSE. Tendency-oriented perimetry (TOP) is a new strategy designed to estimate the sensitivity of the visual field quickly, by using linear interpolation between test locations. This study determined the spatial resolution characteristics of TOP.

METHODS. A Monte-Carlo technique was used to simulate visual fields, and incorporated realistic amounts of subject response variability as well as variability in the average sensitivity of the field. Visual field defects of various depths, ranging from a single point through to 18 contiguous points, were added to the simulated fields. An estimate of the visual field was made using the TOP algorithm. Global indices (mean deviation [MD] and loss variance [LV]) were calculated for both the true visual field and the TOP estimate.

RESULTS. For small defects of one or two points, the TOP algorithm typically overestimated sensitivity. Sensitivity estimates tended to stratify into one of two possible values, with the lower value being dependent on the absolute position of the defect within the visual field. Although MD was satisfactorily predicted by TOP, LV was underestimated and reached a plateau when defects were deep, especially with smaller defects. For relatively large defects of nine contiguous points, both defect depth and LV was predicted with reasonable accuracy by TOP. The TOP sensitivity estimate for normal locations surrounding a defect was systematically reduced.

CONCLUSIONS. The TOP procedure has a number of unusual spatial characteristics that prevent it from accurately estimating the spatial extent and absolute sensitivity of visual field defects.