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Editors Selection IGR 17-4

Examination methods: To SWAP or SAP; that's the question

Comment by Chris Johnson on:

14106 Diagnostic sensitivity of fast blue-yellow and standard automated perimetry in early glaucoma: a comparison between different test programs, Bengtsson B; Heijl A, Ophthalmology, 2006; 113: 1092-1097

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The availability of an adaptive forecasting test strategy for SWAP that reduces test time is indeed encouraging, and this investigation (724) appears to have been very carefully performed. However,there are also some questions that are raised by this evaluation. First of all, the results are quite different from the publications of many other laboratories that have extensively studied SWAP (the degree of evaluation for SWAP may be greater than for any other visual field test procedure). It is not clear why these findings are at variance with the results of many other laboratories. Secondly, it is unfortunate that this procedure has not been available until recently, particularly when the data were collected by several other clinical centers more than 10 years ago. Thirdly, the rationale underlying some of the analysis and interpretation of results is not clear. Why were 101 patients evaluated (there is no indication of sample size calculations)? Why were Bonferroni corrections applied, when a comparison of different procedures should be somewhat independent? Why were only early disease cases employed? It is also not clear why SITA-Fast was employed rather than SITA-Standard.Finally, it is well known that confirmation of visual field results is important for all investigations, and it would have been helpful if this had been employed for the present study. In view of the fact that the SITA-SWAP results demonstrated a strong trend for characterizing greater damage in this study, these factors are important. This investigation is an important step in characterizing the clinical performance of visual field test procedures, although consideration of the above-mentioned concerns is also critical.

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