High- versus low-density multifocal pupillographic objective perimetry in glaucoma

Clin Exp Ophthalmol. 2013 Mar;41(2):140-7. doi: 10.1111/ceo.12016. Epub 2013 Jan 17.


Background: Multifocal pupillographic objective perimetry was compared using 24 and 44 regions per visual field.

Design: Experimental design in a university setting.

Participants: Twenty-seven normal control and 36 age-matched glaucoma patients.

Methods: The four test variants differed in the mean interval between stimuli: 4, 1 or 0.25 s; and the number of visual field regions tested within the central 60 degrees: 24 or 44. All subjects had their diagnostic status confirmed by optical coherence tomography, two forms of perimetry and slit-lamp biomicroscopy. Both eyes were measured concurrently in 2.73 ± 0.45 min/eye (mean ± standard deviation), and tests were repeated about 2 weeks apart.

Main outcome measures: The main outcome measures were: (i) mean change in light sensitivity due glaucoma; and (ii) areas under Receiver Operator Characteristic plots for detecting glaucoma.

Results: For all four variants, consensual responses, female gender and age produced small but significant sensitivity differences, and sensitivity declined with age by ≤-0.27 dB/decade (all P < 0.0003). The best diagnostic accuracy (area under curve 93.2 ± 3.89%) was produced by the one-presentation/s 44-region protocol. Across the four protocols, the effect of repeat testing was small (all methods ≤0.15 dB).

Conclusions: Presentation rate had little effect, but increasing the tested density from 24 to 44 regions/field improved diagnostic power. Given that multifocal pupillographic objective perimetry also provides information on response delay and afferent versus efferent defects at every visual field region, it may be a useful adjunct to perimetry.

Publication types

  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Cohort Studies
  • Female
  • Glaucoma / diagnosis*
  • Glaucoma / drug therapy
  • Glaucoma / physiopathology*
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Photic Stimulation / methods
  • Pupil / physiology*
  • ROC Curve
  • Severity of Illness Index
  • Tomography, Optical Coherence
  • Visual Field Tests / methods*
  • Visual Fields / physiology*


  • Antihypertensive Agents