Multiple Criterion and Multiple Stimulus Signal Detection Theory Analysis of Corneal Painful and Cool Pneumatic Stimuli

Purpose: To evaluate the detectability of pneumatic corneal stimuli and response bias using multi-stimuli multi-criterion signal detection theory (MSDT). Methods: Thirty-six participants were recruited using convenience sampling. A Waterloo Belmonte esthesiometer was used to deliver cold, mechanical, and chemical stimuli to the center of the cornea at three separate study visits. The stimulus type was assigned randomly to each visit at the start of the study. The threshold (baseline for detection theory experiment) for the assigned stimulus type was obtained using the ascending method of limits. In the cold and mechanical MSDT experiments, 100 trials (80 signal (20 each for 4 intensities) and 20 catch trials) were presented in randomized order, and participants responded with a 5-point confidence rating to each trial. In the chemical MSDT experiments, 50 trials (20 signal trials each for two intensities and 10 catch trials) were presented, and responses were provided using 4-point confidence ratings. Detection theory indices were calculated individually and as groups, which were then analyzed using mixed models and paired t-tests. Results: Detectability (d(a)) and the area under the curve (A(z)) were significantly different between stimulus intensities within each stimulus type (all p < 0.001) but were not different between the stimulus types. Receiver operating characteristics (ROC) curves were separable between the scaled intensities for all stimulus types, and no overlaps were observed in the z-ROC space. The log-likelihood ratio (lnβ) depended on stimulus intensity and psychophysical criterion for all stimulus types. Conclusion: It is feasible to use MSDT for analyzing ocular surface sensory processing and the theory provides insight into the possible bias associated with the use of pneumatic stimuli. With noxious and non-noxious pneumatic stimulation, detectability and criteria vary systematically with stimulus intensity, a result that cannot be derived using classical psychophysics and this highlights the importance of signal detection theory and its approaches in studying ocular surface pain and thermal processing.