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• W2028247795 abstract "Dr. Zhang et al raise an important issue regarding the utility of Humphrey field analyzer (HFA) program 10–2 in confirming threat to fixation when one of the four innermost paracentral points is significantly defective on HFA program 30–2. Their study has shown that when at least one of the four paracentral points situated 4.2° from fixation on program 30–2 is significantly disturbed and suggests threat to fixation, almost a third of such patients do not actually have disturbance within 1.4° of fixation on program 10–2. The authors have considered paracentral points on program 30–2 significantly defective when their threshold on the total deviation plot had 1% (P < 0.01) chance of being normal and was therefore marked with a solid black box on Statpac 1 of the HFA. It has been our clinical observation that the actual threshold value in decibels (dB) at the paracentral point on either 24–2 or 30–2 numeric plot is a good indicator for confirmation of fixation threat. We studied 20 eyes of 20 patients with primary open-angle glaucoma with at least one of the four innermost paracentral points reproducibly and significantly defective (threshold on the total deviation plot having <1% chance of being normal on Statpac II) on two consecutive occasions on program 24–2 or 30–2 and size III target on the HFA II. Visual fields were classified into two groups: group I with actual threshold value at the innermost paracentral point on the numerical plot ≤ 0 dB (n = 12); and group II with threshold ≥ 1 dB (n = 8). All these patients had a visual field test performed with program 10–2 with target size III on HFA II on the same day of obtaining a reproducible defect on HFA 24–2 or a 30–2 test. Standard reliability parameters were met by all the patients included in the study. All of the 12 fields (18 significantly defective paracentral points) in group I showed significantly defective paracentral point 1.4° from fixation on program 10–2. In 11 fields (17 paracentral points) the actual threshold value at this point on 10–2 was also ≤ 0 dB; at one innermost paracentral point in one field it was 4 dB with P < 0.5% on the total deviation plot. In group II the average threshold value at the involved innermost paracentral point on 24–2 or 30–2 was 11.3 dB (range, 6–16 dB; n = 10 paracentral points in eight fields). On 10–2 test, none of the eight fields in group II had involvement of the paracentral point 1.4° from fixation, while three points (two fields) 2.24° from the fixation were significantly defective. The results of our study indicate that the actual threshold value at the innermost paracentral point on the numerical plot of HFA 24–2 or 30–2 could be a reliable predictor of fixation threat. If the threshold at the paracentral point is ≤0 dB, it almost certainly indicates fixation threat, obviating the need for a confirmatory HFA 10–2. When the defective paracentral points show higher sensitivity, a 10–2 test may be essential to confirm threat to fixation. The point that we are making is in fact well illustrated by the figures provided by Zhang et al themselves, which, however, do not seem to have been considered in their analysis. In Figure 1 of their paper, the threshold value at the defective innermost paracentral point on HFA 30–2 is < 0 dB, which continues to be similar in the corresponding 10–2, confirming threat to fixation. In Figure 2 the actual threshold value of the defective paracentral point on HFA 30–2 is 12 dB, and the corresponding 10–2 field does rule out threat to fixation. Automated perimetry and threats to fixation: Author’s replyOphthalmologyVol. 105Issue 9Preview Full-Text PDF" @default.
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• W2028247795 date "1998-09-01" @default.
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• W2028247795 title "Automated perimetry and threats to fixation" @default.
• W2028247795 doi "https://doi.org/10.1016/s0161-6420(98)99003-0" @default.
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