Moving Stimulus Perimetry: A New Functional Test for Glaucoma

PURPOSE: Static pointwise perimetric sensitivities of less than approximately 19 dB are unreliable in glaucoma owing to excessive variability. We propose using moving stimuli to increase detectability, decrease variability, and hence increase this dynamic range. METHODS: A moving stimulus was designed to travel parallel to the average nerve fiber bundle orientation at each location, and compared against an otherwise identical static stimulus. To assess dynamic range, psychometric functions were measured at 4 locations of each of 10 subjects. To assess clinically realistic test–retest variability, 34 locations of 94 subjects with glaucoma and glaucoma suspects were tested twice, 6 months apart. Pointwise sensitivity estimates were compared using generalized estimating equation regression models. The test–retest limits of agreement for each stimulus were assessed, adjusted for within-eye clustering. RESULTS: Using static stimuli, 9 of the 40 psychometric functions had less than a 90% maximum response probability, suggesting being beyond the dynamic range. Eight of those locations had asymptotic maximum of more than 90% with moving stimuli. Sensitivities were higher for moving stimuli (P < 0.001); the difference increased as sensitivity decreased (P < 0.001). Test-retest limits of agreement were narrower for moving stimuli (−6.35 to +6.48 dB) than static stimuli (−12.7 to +7.81 dB). Sixty-two percent of subjects preferred using moving stimuli versus 19% who preferred static stimuli. CONCLUSIONS: Using a moving stimulus increases perimetric sensitivities in regions of glaucomatous loss. This extends the effective dynamic range, allowing reliable testing later into the disease. Results are more repeatable, and the test is preferred by most subjects. TRANSLATIONAL RELEVANCE: Moving stimuli allow reliable testing in patients with more severe glaucoma than currently possible.