The influence of the learning effect on automated perimetry in patients with suspected glaucoma

Wild, J. Martin; Dengler-Harles, M.; Searle, A. E. T.; O'Neill, E C; Crews, S. J.

doi:10.1111/j.1755-3768.1989.tb04105.x

Cited by 91 publications

(39 citation statements)

References 17 publications

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“…The first VF examination in each series were then removed from further analysis to account for perimetric learning effects. [13][14][15] Precision of estimating the rate of MD loss (dB/year) using simple linear regression varies enormously by the length of follow-up. 16 We attempted to control for this by only calculating the rate within a fixed 4-year period (window) from the baseline test (see Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Boodhna

Saunders

Crabb

2015

Eye

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Purpose To examine changes in rates of visual field (VF) progression in patients attending a sample of glaucoma clinics in England between 1999 and 2012. Methods An archive of 473 252 Humphrey VFs recorded across the UK was retrospectively examined. Distribution of rates recorded in the first half of the decade was compared with the second. The relationship between age and severity of MD loss at baseline with rates of loss and frequency of testing was examined. Results VF series from 18 926 eyes were analysed. Median rate of MD loss for the period before and after 2003 was − 0.11 and − 0.06 dB/year, respectively, but the proportion of eyes with medium or fast rates of MD loss remained constant. Median rate of MD loss in older (470 years) eyes was faster than that observed in younger (o60 years) eyes (−0.21 compared with − 0.01 dB/ year). Median rate of loss did not vary with severity of MD loss at baseline. Frequency of testing, typically carried out annually, did not vary by age, rate of loss or disease severity. Conclusions VFs of eyes treated in the first half of the decade deteriorated more rapidly than those in the second half. Several factors might explain these differences but average effects were small and there was no reduction in the proportion of rapidly progressing eyes over the decade. Older age and, to a lesser extent, worse VF damage at diagnosis are indicators for faster VF loss in clinics, but frequency of VF testing was similar for all patients.

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Section: Methodsmentioning

confidence: 99%

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Boodhna

Saunders

Crabb

2015

Eye

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“…The degree of improvement in sensitivity varied both within and between eyes as a function of the number of examinations and was greater beyound 30" eccentricity. Wild et al (1989) also found evidence for intra-and inter-test fatigue effects. Indeed, the inter-test fatigue effect was found to last over successive days.…”

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confidence: 79%

“…The purpose of the present study was to determine the influence of a short-term training period (Wild et al 1989) on any long-term learning and fatigue effects obtained at follow-up approximately 9 months later.…”

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confidence: 99%

Long‐term follow‐up of baseline learning and fatigue effects in the automated perimetry of glaucoma and ocular hypertensive patients

Wild

Searle

Dengler-Harles

et al. 1991

Acta Ophthalmologica

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The detection of change in the visual field is confounded by factors associated with the patient response. Sixteen patients who had previously undergone a training regime in automated perimetry over a short time period were followed up to evaluate the longer term learning and fatigue effects. The patients, all attending a glaucoma clinic, were originally naive to automated perimetry. The training period had comprised examination of the right followed by that of the left eye with the Humphrey Field Analyser 630 on each of 3 successive days and again after an interval of 12 days. The follow-up study comprised two examinations on 2 successive days after a follow-up period of between 5 and 15 months (mean 8.7 months). The learning effects present over the initial training period were not observed at the follow-up whilst the fatigue effects in the fellow eye were still apparent.

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“…We found a lower sensitivity during the first and third tertiles of the follow-up, indicating a systematic deviation from a linear deterioration. This might be explained by prolonged learning 45,46 and/or the fact that glaucoma seems to have an accelerating character when using the MD as the outcome measure. 16 As a consequence, short series of visual fields might underestimate the rate of progression.…”

Section: Other Issuesmentioning

confidence: 99%

Factors That Influence Standard Automated Perimetry Test Results in Glaucoma: Test Reliability, Technician Experience, Time of Day, and Season

Montolio

Wesselink

Gordijn

et al. 2012

Invest. Ophthalmol. Vis. Sci.

105

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PURPOSE.To determine the influence of several factors on standard automated perimetry test results in glaucoma.METHODS. Longitudinal Humphrey field analyzer 30-2 Swedish interactive threshold algorithm data from 160 eyes of 160 glaucoma patients were used. The influence of technician experience, time of day, and season on the mean deviation (MD) was determined by performing linear regression analysis of MD against time on a series of visual fields and subsequently performing a multiple linear regression analysis with the MD residuals as dependent variable and the factors mentioned above as independent variables. Analyses were performed with and without adjustment for the test reliability (fixation losses and false-positive and false-negative answers) and with and without stratification according to disease stage (baseline MD).RESULTS. Mean follow-up was 9.4 years, with on average 10.8 tests per patient. Technician experience, time of day, and season were associated with the MD. Approximately 0.2 dB lower MD values were found for inexperienced technicians (P < 0.001), tests performed after lunch (P < 0.001), and tests performed in the summer or autumn (P < 0.001). The effects of time of day and season appeared to depend on disease stage. Independent of these effects, the percentage of false-positive answers strongly influenced the MD with a 1 dB increase in MD per 10% increase in false-positive answers. The variability of SAP test results depends on many factors. A well-known factor is disease stage. 1,2 Other factors are patient motivation and technician performance, the latter via appropriateness of refraction and patient instruction, reassurance before the test, and patient monitoring during the test. [3][4][5] Circadian rhythms and seasonal influences may also contribute to the variability. These periodicities may influence SAP test results in at least two different ways. First, patients need a good cognitive function to perform perimetry. In an extensive review, Blatter et al. 6 described a daily variation in cognitive function in humans. Cognitive function deteriorated over the day in the elderly (at the typical age of a glaucoma patient), whereas the opposite is the case in young subjects. Second, SAP measures a threshold sensitivity of the visual system. Earlier studies in humans showed a daily variation in retinal visual sensitivity, suggesting lower sensitivities in the early morning. CONCLUSIONS.7-9 Besides a daily variation, a seasonal (circannual) variation might also be present. After all, exposure to light varies per season and prior light history affects light sensitivity.10 Indeed, retinal sensitivity seems to be highest in the spring. 11,12 Variability is entangled with reliability, which is commonly assessed by reliability indices and displayed as the percentages of fixation losses (FL) and false-positive (FP) and false-negative (FN) answers. Two issues concerning reliability are relevant to this study. First, whether reliability as assessed by the reliability indices influences variability. Se...

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The influence of the learning effect on automated perimetry in patients with suspected glaucoma

Cited by 91 publications

References 17 publications

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Long‐term follow‐up of baseline learning and fatigue effects in the automated perimetry of glaucoma and ocular hypertensive patients

Factors That Influence Standard Automated Perimetry Test Results in Glaucoma: Test Reliability, Technician Experience, Time of Day, and Season

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