Test time and efficiency of the dynamic strategy in glaucoma perimetry

The dynamic strategy is a perimetric measurement procedure where by the luminance-step sizes are optimized according to physiological data. In contrast to the traditional 4- to 2-dB strategy, the step sizes are not constant but vary between 2 and 10 dB depending on the sensitivity. We examined 40 eyes of 40 glaucoma patients with both the traditional and the dynamic strategy using a modified Octopus 1-2-3 perimeter. A total of 16 visual field locations were examined using both strategies 3 times each in alternation. The order of the initial strategy was randomized. The variance of the three measurements was calculated as a measure of reproducibility. The quantity of presented stimuli was recorded as a measure of test time. After the elimination of starting points, absolute scotomata, and series of fields showing a significant trend during the session, 255 measured locations of 27 series were available for evaluation. The mean number of presentations (indicating test time) was 46% (dynamic strategy versus traditional strategy). The variance of the three measurements depended on the sensitivity. In the normal sensitivity range, the dynamic strategy had a markedly lower variance (58%). For relative defects, the variance was higher (141%-156%). According to a benefit/cost calculation, the efficiency of the dynamic strategy was better in all sensitivity ranges and reached a factor of 3 for high sensitivities. The dynamic strategy is considerably more efficient than the traditional strategy using fixed step sizes.