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Editors Selection IGR 15-2
Clinical Examination Methods: New developments: Landolt C acuity perimetry
Comment by Shaban Demirel on:
24953 Central field perimetry of discriminated targets: I. Results for normal individuals using high-contrast targets, Yavuz GA; Unver YB; Bekiroglu N et al., Eye, 2009; 23: 2082-2089
Yavuz et al. (1477) describe a prototype Landolt C acuity perimeter. Although others have explored resolution and discrimination perimetry, generally these attempts have been performed in the laboratory. None have advanced to routine clinical use. Similarly, the current study was performed as a proof of concept for this type of testing ‐ acuity perimetry inside 10 degrees eccentricity ‐ but with a few novel enhancements. For example, fixation was continuously monitored during testing and any responses made during malfixation were rejected. Landolt C acuity perimetry was performed on a cohort of normal healthy individuals (70 normals tested once with 24 returning for a repeat test). The manuscript reports results for high contrast, white optotypes presented on a dim background. However, the authors' report that they can produce virtually any combination of color or contrast between the stimulus and background. The results fit well within the acuity ranges reported in the literature for similar procedures performed in the central visual field. There was little evidence of learning effects, even though the subjects were naïve, and the test-retest reliability was decent.
The authors' longer-term aim is to produce a form of perimetry that will generate clinical results that are better correlated with a patient's ability to perform activities of daily living. Although their primary interest seems to be macular disease, the technique described could be applied to glaucoma. Most types of perimetry involve contrast detection (SAP, Matrix, SWAP) and although acuity perimetry has been suggested for some time and can generate data that perhaps better reflects the neural condition of the retina, it has not made inroads to clinical care. Given the inertia around clinical procedures and testing and resistance to changing established paradigms, it remains to be seen whether acuity perimetry as described by Yavuz et al. will manage to make its way to clinical reality.
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