Retest Variability and Between-Subject Variability of Automated

Kinetic Perimetry in Normal Observers and Patients with Migraine

H Eshtayah, C E Maxner, L Shuba, A R Purdy, P H Artes. Ophthalmology and Visual Sciences, Neurology, Dalhousie University, Halifax, Canada
Purpose Effect of age and migraine Examples
left eye right eye left eye right eye
To determine retest variability and between-subject variation of left eye
mean radius of isopter (degrees)
right eye ●
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14020

6460
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Session 1
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6733
14080
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11170
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12010
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I4e 70
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Automated Kinetic Perimetry in normal observers and patients

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4224
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2653
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4610
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2412
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1648
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1736
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I4e
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with migraine.
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I2e
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50
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Methods
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I2e
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40
I1e Example 1 Example 2
Normal observers (n=26; mean age 41y, range 15-67y) and 30
I1e left eye
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right eye left eye

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right eye
patients with migraine (n=13, mean age 46y, range 21-55y) 20
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6639
14380

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Session 2
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6872
14270

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4172
10710
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Session 2
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10380
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2694

were examined with a custom-designed fully automated kinetic

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4027
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perimetry program (Octopus 900, Haag-Streit, Switzerland) on

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two separate study visits within two weeks. The program

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age (yrs) age (yrs)

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Fig 1) Relationship between isopter areas, age, and migraine. Patients with migraine are shown by
examined 3 isopters (I4e, I2e, I1e) at stimulus velocities of 50, filled circles. Vertical lines indicate the range of values obtained during the 2 sessions. Age effects
were determined using robust regression. left eye right eye left eye right eye
40, and 3o/s respectively. For every isopter, 12 stimulus vectors 10610

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were presented at meridians spaced 30o apart, in random order,

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Test-retest variability
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and each isopter was measured 3 times. Patients with migraine

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absolute test-retest difference, mean radius (degrees)

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had been diagnosed by a neuro-ophthalmologist according to

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left eye right eye

criteria of the International Headache Society. 0

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5 left eye right eye left eye right eye

Results ●

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1263
4331
9812

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Session 2 ●
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1365
4473
9895

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4256
11200

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Session 2
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1551
4828
11550

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No statistically significant differences in mean isopter area were

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observed between migraine patients and normal observers

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(P=0.65, ANOVA). Except from a decrease in the area of the I1e

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isopter on the second session with the right eye only, no significant -10 Fig 3) Examples illustrating within and between-subject variability with Automated Kinetic Perimetry. In each of
the 2 sessions, right eyes were examined first. Each isopter was measured 3 times, and the points shown are the
practice effect was observed. The effect of age, though statistically 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 means of the 3 responses. All participants were initially inexperienced with kinetic perimetry. Numbers give the
area enclosed by the isopter (deg2).
significant, was small compared to the variability within and between mean (mean radius, degrees) mean (mean radius, degrees)

patients (Fig 1, Table 1). Retest variability, in absolute terms (eg relative test-retest difference, mean radius (degrees)
Conclusions
mean radius of isopter in degrees) was relatively constant across left eye 40% right eye
We did not identify visual field losses to kinetic stimuli in patients
the 3 isopters (Fig 2, top). In relative terms, variability was largest 20%
with a history of migraine. Given the good retest characteristics
with the most central 14e isopter, where the 95% retest interval 0% of the peripheral isopters, Automated Kinetic Perimetry should be
spanned ±18% (Fig 2, bottom). -20% further developed as an alternative to manual Goldmann or static
Isopter I4e I2e I1e -40% suprathreshold perimetry for the surveillance of the peripheral
mean radius of isopter (40y), deg visual field, for example in drug safety studies. The data obtained
59 39 23 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70
in this research will enable power- and sample size calculations for
age effect (deg/y) -0.09 -0.13 -0.13 mean (mean radius, degrees) mean (mean radius, degrees)
future studies.
within / betw-patient variability (SD, deg) 1.66 / 2.81 2.66 / 3.19 1.91 / 2.40 Fig 2) Bland-Altman plots of test-retest variability in absolute (top) and relative (bottom)
terms. The relative test-retest variability is significantly larger for the inner isopters (I2e
test-retest variability (SD, %) 2.6% 5.6% 9.0% and I1e) compared to that seen with the I4e stimulus. Hadil Eshtayah: heshtaya@dal.ca