Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static

Abstract

Visual field assessment is an important clinical evaluation for eye disease and neurological injury. We evaluated Octopus semi-automated kinetic peripheral perimetry (SKP) and Humphrey static automated central perimetry for detection of neurological visual field loss in patients with pituitary disease. We carried out a prospective cross-sectional diagnostic accuracy study comparing Humphrey central 30-2 SITA threshold programme with a screening protocol for SKP on Octopus perimetry. Humphrey 24-2 data were extracted from 30-2 results. Results were independently graded for presence/absence of field defect plus severity of defect. Fifty patients (100 eyes) were recruited (25 males and 25 females), with mean age of 52.4 years (SD = 15.7). Order of perimeter assessment (Humphrey/Octopus first) and order of eye tested (right/left first) were randomised. The 30-2 programme detected visual field loss in 85%, the 24-2 programme in 80%, and the Octopus combined kinetic/static strategy in 100% of eyes. Peripheral visual field loss was missed by central threshold assessment. Qualitative comparison of type of visual field defect demonstrated a match between Humphrey and Octopus results in 58%, with a match for severity of defect in 50%. Tests duration was 9.34 minutes (SD = 2.02) for Humphrey 30-2 versus 10.79 minutes (SD = 4.06) for Octopus perimetry. Octopus semi-automated kinetic perimetry was found to be superior to central static testing for detection of pituitary disease-related visual field loss. Where reliant on Humphrey central static perimetry, the 30-2 programme is recommended over the 24-2 programme. Where kinetic perimetry is available, this is preferable to central static programmes for increased detection of peripheral visual field loss.

• Humphrey
• kinetic
• octopus
• perimetry
• pituitary
• static

Acknowledgements

We should like to thank the patients who took part in this study, and Nicola Beere, Royal Bolton Hospital, for permission to use their perimeter.

Declaration of interest: The authors do not have any commercial or proprietary interest in the Octopus 900 perimeter and Humphrey automated perimeter or Haag Streit International and Carl Zeiss UK. Haag Streit has provided the loan of the Octopus 900 perimeter for the conduct of this research study. Haag Streit and Carl Zeiss UK had no role in the design or conduct of this research.

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.