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A Comparison Between Fundus-Oriented Perimetry and Conventional Visual Field Examination

Ulrich Schiefer, MD; Mark Flad, PJ; Florian Stumpp, AiP; Alexander Malsam, AiP; Jens Paetzold, Dr rer nat; Reinhard Vonthein, Dr rer pol; P. Oliver Denk, MD; Pamela A. Sample, PhD

Arch Ophthalmol. 2003;121:458-465.

Objective  To compare detection rates of glaucomatous visual field defects (VFDs) between the conventional 6° x 6° stimulus grid and locally condensed target arrangements in morphologically suspicious regions.

Methods  A total of 66 eyes of 66 patients with glaucoma or patients suspected of having glaucoma (34 females and 32 males; age range, 14-85 years) were enrolled in this study. Individual, local target condensation was realized by fundus-oriented perimetry (FOP) using a campimeter and compared with the results of conventional automated perimetry (CAP), obtained with the Humphrey Field Analyzer (30-2 grid).

Results  Twenty-three of the 66 patients showed normal findings with both methods; 27 had concordantly pathological results. In 15 patients we obtained normal findings with CAP, whereas FOP revealed early glaucomatous VFDs. Only one patient showed VFDs with CAP, whereas FOP results were normal. Scotoma detection rates significantly differed between the 2 methods (P<.001, sign test). Test duration with FOP was more than doubled compared with CAP. When considering only FOP points coinciding with the 6° spacing of the 30-2 grid, there was no longer a significant difference between FOP and CAP (P>.25, sign test). This indicated that the target pattern, rather than the perimetric device, was most relevant for detecting glaucomatous VFDs. Follow-up throughout a series of 3 subsequent sessions at 6-month intervals revealed repeatable results in more than two thirds of all eyes for both FOP and CAP.

Conclusions  Fundus-oriented perimetry that uses individually condensed test grids significantly increases the detection rate of glaucomatous VFDs in morphologically conspicuous areas compared with CAP using equidistant (6° x 6°) target arrangements. Repeatability is comparable between both methods.

From the Departments of Pathophysiology of Vision and Neuro-Ophthalmology (Drs Schiefer and Paetzold and Mssrs Flad, Malsam, and Stumpp) and Ophthalmology, Anterior and Posterior Segment Eye Disease (Dr Denk), University Eye Hospital Tuebingen, and Department of Medical Biometry, University of Tuebingen (Dr Vonthein), Tuebingen, Germany; and Department of Ophthalmology, University of California, San Diego (Dr Sample). The authors have no relevant financial interest in this article.

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