Standard Reliability and Gaze Tracking Metrics in Glaucoma and Glaucoma Suspects

Area of Science:

• Ophthalmology
• Visual field testing
• Medical device technology

Background:

• Standard reliability metrics like fixation loss, false-positive, and false-negative rates are crucial for interpreting visual field test results.
• Gaze tracking (GT) metrics offer a novel approach to assess patient fixation and reliability during visual field testing.
• The Humphrey Field Analyzer (HFA) is a widely used device for perimetric assessment in glaucoma diagnosis and management.

Purpose of the Study:

• To compare the efficacy of standard reliability metrics with novel gaze tracking (GT) metrics on the Humphrey Field Analyzer (HFA).
• To determine the clinical significance and correlation between established reliability measures and GT-derived metrics in glaucoma patients.

Main Methods:

• A retrospective cross-sectional study involving 494 glaucoma and glaucoma suspect patients who underwent HFA 24-2 SITA Fast visual field (VF) testing.
• Comparison of standard reliability metrics (fixation loss, false-positive, false-negative) against GT metrics (M1, M3, M6, TFF).
• Statistical analysis included Spearman correlation and area under the receiver operating characteristic (AUROC) curves to assess associations.

Main Results:

• Statistically significant correlations were found between standard and GT reliability metrics, but with low correlation values and AUROC, indicating limited clinical significance.
• False-negative rates (FN) and M6 (deviations >6°) were found to be influenced by visual field severity.
• Aggregate GT metrics did not demonstrate an improvement in reliability assessment compared to standard metrics.

Conclusions:

• Gaze tracking (GT) metrics do not currently show a clinically significant association with standard reliability metrics in visual field testing.
• While GT metrics may offer potential as alternative or complementary measures, they do not enhance the reliability assessment of the Humphrey Field Analyzer.
• Both false-negative rates and specific GT metrics (M6) are influenced by the severity of visual field loss, highlighting the need for context-specific interpretation.