Advancements in Visual Field Testing: A Systematic Review of the 24-2C Test Grid

Area of Science:

• Ophthalmology
• Visual Science
• Medical Technology

Background:

• Visual field (VF) testing is crucial for diagnosing and monitoring glaucoma and other optic nerve disorders.
• Conventional VF indices and structure-function (S-F) concordance are key metrics for assessing visual impairment.
• Central visual field defects (CVFDs) can significantly impact daily function and require sensitive detection methods.

Purpose of the Study:

• To systematically review and compare the performance of the Humphrey Field Analyzer (HVF) 24-2C SITA-Faster test against the 24-2 SITA-Standard/Faster and 10-2 SITA-Standard/Fast tests.
• To evaluate differences in conventional VF indices, CVFD detection, S-F concordance, and test characteristics.
• To determine the clinical utility of the HVF 24-2C SITA-Faster for screening central visual field defects.

Main Methods:

• A systematic review of studies published up to August 30, 2024, was conducted.
• Eight studies involving 1239 subjects were analyzed, comparing HVF 24-2C SITA-Faster, 24-2 SITA-Standard/Faster, and 10-2 SITA-Standard/Fast tests.
• Key outcomes included VF indices, CVFD detection rates, S-F concordance, and test characteristics (speed, false positives/negatives, fixation losses).

Main Results:

• The 24-2C SITA-Faster demonstrated similar global VF indices to the 10-2 and 24-2 tests (ICC = 0.95 and 0.80, p < 0.001).
• It detected more VF defects and CVFD clusters with greater S-F concordance than the 24-2 SITA-Standard/Faster.
• While the 10-2 SITA-Standard/Fast detected more CVFDs, the 24-2C showed substantial agreement (ĸ = 0.488 to 0.708) and was faster with fewer fixation losses than the 24-2 Standard.

Conclusions:

• The HVF 24-2C SITA-Faster is a quicker and more effective test for identifying CVFDs compared to the 24-2 grid.
• It exhibits high agreement with the 10-2 grid, making it a valuable tool for screening central visual field defects.
• The test offers a balance of speed, detection capability, and diagnostic accuracy for clinical use.