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Can Swedish Interactive Thresholding Algorithm Fast Perimetry Be Used as an Alternative to Goldmann Perimetry in Neuro-ophthalmic Practice?
Gabriella Szatmáry, MD;
Valérie Biousse, MD;
Nancy J. Newman, MD
Arch Ophthalmol. 2002;120:1162-1173.
Objective To assess the potential role of Swedish Interactive Thresholding Algorithm
(SITA) Fast computerized static perimetry, compared with that of Goldmann
manual kinetic perimetry (GVF), for reliably detecting visual field defects
in neuro-ophthalmic practice.
Background Automated visual field testing is challenging in patients with poor
visual acuity or severe neurological disease. In these patients, GVF is often
the preferred visual field technique, but performance of this test requires
a skilled technician, and this option may not be readily available. The recent
development of the SITA family of perimetry has allowed for shorter automated
perimetry testing time in normal subjects and in glaucoma patients. However,
its usefulness for detecting visual field defects in patients with poor vision
or neurological disease has not been evaluated.
Design and Methods We prospectively studied 64 consecutive, neuro-ophthalmologically impaired
patients with neurologic disability of 3 or more on the Modified Rankin Scale,
or with visual acuity of 20/200 or worse in at least one eye. Goldmann manual
kinetic perimetry and SITA Fast results were compared for each eye, with special
attention to reliability, test duration, and detection and quantification
of neuro-ophthalmic visual field defects. We categorized the results into
1 of 9 groups based on similarities and reliabilities. Patient test preference
was also assessed.
Results Patients were separated into 2 groups, those with severe neurologic
deficits (n = 50 eyes) and those with severe vision loss but mild neurologic
dysfunction or none at all (n = 50 eyes). Overall, GVF and SITA Fast were
equally reliable in 77% of eyes. Goldmann manual kinetic perimetry and SITA
Fast showed similar visual field results in 75% of all eyes (70% of eyes of
patients with severe neurologic deficits and 80% of eyes with poor vision).
The mean ± SD duration per eye was 7.97 ± 3.2 minutes for GVF
and 5.43 ± 1.41 minutes for SITA Fast (P<.001).
Ninety-one percent of patients preferred GVF to SITA Fast.
Conclusions We found the SITA Fast strategy of automated perimetry to be useful
in the detection, and accurate in the quantification of central visual field
defects associated with neuro-ophthalmic disorders. Our results suggest that
for the general ophthalmologist or neurologist, visual field testing with
SITA Fast perimetry might even be preferable to GVF, especially if performed
by a marginally trained technician, even in patients with severely decreased
vision or who are neurologically disabled.
From the Departments of Ophthalmology (Drs Szatmáry, Biousse,
and Newman), Neurology (Drs Biousse and Newman), and Neurological Surgery
(Dr Newman), Emory University School of Medicine, Atlanta, Ga.
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