Macular and Wide field eighty second screening tests using multifocal pupil perimetry

Purpose: To assess the potential of 80 second multifocal pupil perimetry (mfPOP) screening test variants. Methods: In order to facilitate shorter test durations, three mfPOP tests were developed with a lesser number of test-regions and different luminance profiles to our standard 6 minute 44-region tests. Each differed in their test-region layout and stimulus luminances (figure). Maximum luminance was constrained so as to avoid response saturation and consequent loss of sensitivity to dysfunction. All tests have a total duration of 80 s; approximately 20 luminance stimuli are presented in each visual field test-region. The M18 layout is congruent with ETDRS retinal sectors having regions extending to ±10.4° from fixation. Regions in the W20 layout (20 stimuli in 3 rings) and W12 layout (12 stimuli in 2 rings) extend to ±30°. The M18 test was assessed in 13 subjects with normal vision (mean age 37 ± 15 y), W20 in 10 (32 ± 13 y), and W12 in 20 (23 ± 4 y). Of the 43 subjects tested, 36 completed 3 repeats of the test, the remaining 7 completed 2 (122 tests in total). Stimuli were presented on a prototype of the FDA-cleared objectiveFIELD Analyzer (Konan Medical Inc., Irvine CA). Results: Standardized pupillary constriction amplitudes (AmpStd) were somewhat larger in the W12 mfPOP test: the mean AmpStd across test-regions was 72 µm for W12 cf. 43 µm and 49 µm for M18 and W20 respectively. Signal to noise ratios (SNRs) however, were similar for all three tests. Mean and range of mean z-scores from each test-region were as follows: M18, 4.31 [3.01 6.15]; W20, 4.33 [2.81 6.28]; W12, 4.94 [3.60 6.51]. These values are comparable with z-score SNRs from full-length 44 test-region mfPOP tests in which the reported average across 5 studies is 4.37. Conclusions: Three viable 80 second mfPOP screening tests have been developed by changing the number and layout of test-regions and adjusting stimulus luminances. The macular test (M18) has test-regions congruent with ETDRS sectors. The wide-field tests (W20, W12) provide the choice between greater spatial resolution and slightly higher SNRs. All three tests have comparable signal quality to our three standard 44-region 6 minute tests and therefore have considerable clinical potential.