Repeatability of Automated Perimetry: A Comparison between Standard Automated Perimetry with Stimulus Size III and V, Matrix, and Motion Perimetry

PURPOSE: Standard automated perimetry (SAP) shows a marked increase in variability in damaged areas of the visual field. This study was conducted to test the hypothesis that larger stimuli are associated with more uniform variability, by investigating the retest variability of four perimetry tests: standard automated perimetry size III (SAP III), with the SITA standard strategy; SAP size V (SAP V), with the full-threshold strategy; Matrix (FDT II), and Motion perimetry. METHODS: One eye each of 120 patients with glaucoma was examined on the same day with these four perimetric tests and retested 1 to 8 weeks later. The decibel scales were adjusted to make the test's scales numerically similar. Retest variability was examined by establishing the distributions of retest threshold estimates, for each threshold level observed at the first test. The 5th and 95th percentiles of the retest distribution were used as point-wise limits of retest variability. Regression analyses were performed to quantify the relationship between visual field sensitivity and variability. RESULTS: With SAP III, the retest variability increased substantially with reducing sensitivity. Corresponding increases with SAP V, Matrix, and Motion perimetry were considerably smaller or absent. With SAP III, sensitivity explained 22% of the retest variability (r(2)), whereas corresponding data for SAP V, Matrix, and Motion perimetry were 12%, 2%, and 2%, respectively. CONCLUSIONS: Variability of Matrix and Motion perimetry does not increase as substantially as that of SAP III in damaged areas of the visual field. Increased sampling with the larger stimuli of these techniques is the likely explanation for this finding. These properties may make these stimuli excellent candidates for early detection of visual field progression.