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Published on: May 25, 2020
Validation of the Reaction Time-Based False-Positive Rate as a Reliability Index for Standard Automated Perimetry
Hiroki Nomoto1, Sachiko Okuyama1, Chota Matsumoto1
1Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan.
Purpose:
To validate a reaction time (RT)-based false-positive rate (RT-FP) for standard automated perimetry (SAP) and to determine the optimal RT listening window.
Design:
Retrospective cross-sectional study.
Participants:
A total of 1201 eyes from 607 glaucoma patients tested with the AIZE algorithm (imo perimeter, 24plus[1-2] pattern).
Methods:
Reaction time-based FP rate was defined as the proportion of stimulus responses below a defined RT listening window, excluding catch trials. Listening windows of 100, 200, and 300 ms were compared using receiver operating characteristic (ROC) analysis against conventional catch-trial FP rate ≥15%. The effect of excluding responses at locations with estimated threshold ≤0, ≤5, ≤10, and ≤15 dB on the association between RT-FP and disease severity was evaluated using Spearman correlation with mean deviation (MD). Relative variability of each FP index was assessed using the coefficient of variation (CV).
Main Outcome Measures:
Area under the ROC curve (AUC) for discriminating conventional FP ≥15%, Spearman correlation with MD and CV.
Results:
A 300-ms listening window achieved the highest discriminative accuracy (AUC = 0.783), outperforming 200-ms (AUC = 0.733) and 100-ms (AUC = 0.718) listening windows (both P < 0.001). Without location exclusion, RT-FP showed association between RT-FP and disease severity (rs = -0.185, P < 0.001). Among the exclusion thresholds evaluated, excluding responses at locations with estimated threshold ≤10 dB most effectively reduced this bias to rs = -0.081 (P < 0.01), equivalent to conventional FP (rs = -0.081, P < 0.01). The optimized RT-FP showed lower relative variability than the conventional FP rate (CV, 1.27 vs. 1.52). Among eyes with conventional FP ≥15%, 37.9% had normal RT-FP and mild disease.
Conclusion:
Reaction time-based FP rate with a 300-ms listening window restricted to locations with estimated threshold >10 dB substantially reduced metric dependence on disease severity to levels comparable to conventional FP, with greater measurement stability and no requirement for dedicated catch trials. This optimized RT-FP represents a promising reliability index for SAP warranting prospective validation.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
