Citation: Wall M, Doyle CK, Eden T, Zamba KD, Johnson CA. Size threshold perimetry performs as well as conventional automated perimetry with stimulus sizes III, V, and VI for glaucomatous loss. Invest Ophthalmol Vis Sci. 2013;54:3975-3983. DOI:10. 1167/iovs.12-11300 PURPOSE. It is thought that large perimetric stimuli are insensitive for demonstrating visual field defects. To test the hypothesis that there is no difference in the total number of abnormal test locations with total deviation empiric probability plots in glaucoma patients, we compared results of glaucoma patients tested with sizes III (0.438 diameter), V (1.728), and VI (3.448), and size threshold perimetry (STP), a method that finds threshold by changing stimulus size. METHODS. We derived normative limits for total deviation probability plots using the second test from 60 age-matched normals. We analyzed the probability plots of 120 glaucoma patients (mean deviation was À9.3 6 6.1 dB with a range of À0.2 to À31.6) at the 42 nonblind spot locations common to the tests. We compared the number of abnormal test locations at the 5% level among the tests using one-way repeated measures ANOVA on ranks. We stratified the results by mean deviation. RESULTS. There was a statistically significant difference in the number of abnormal test locations among the tests: III, 28.5; V, 29.7; VI, 27.0; and STP, 28.8, P ¼ 0.001; Tukey pairwise comparisons were statistically significant for the assessments between sizes V and VI and between STP and size VI. When stratifying by mean deviation, with mild visual loss, size V was most sensitive, followed by STP; size VI appeared slightly less sensitive. CONCLUSIONS. Size V and STP provide favorable stimulus methodology for detection of mild to moderate glaucoma. Size VI appears slightly less sensitive for glaucoma with mild loss. Keywords: perimetry, visual testing, visual field, vision testing, stimulus size C onventional automated perimetry, since its introduction in the late 1970s, has almost exclusively used the Goldmann size III stimulus. However, it has been shown that detection of defects from glaucoma and other optic neuropathies can be done at least as well with larger stimuli. 1,2 In addition, these large stimuli have been shown to give better retest variability and extend the dynamic range of the test. 5 However, the original 108 frequency doubling technology stimulus is over 40 times the size of the 1.78 size V stimulus in area and Frequency Doubling Technology (FDT) testing is similar in sensitivity to conventional automated perimetry using a size III stimulus (0.438) for glaucoma and other optic neuropathies
