Optimising the glaucoma signal/noise ratio by mapping changes in spatial summation with area-modulated perimetric stimuli

Lindsay Rountree, Pádraig J. Mulholland, Roger S. Anderson, David F. Garway-Heath, James E. Morgan, Tony Redmond

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)
48 Downloads (Pure)


Identification of glaucomatous damage and progression by perimetry are limited by measurementand response variability. This study tested the hypothesis that the glaucoma damage signal/noiseratio is greater with stimuli varying in area, either solely, or simultaneously with contrast, than with conventional stimuli varying in contrast only (Goldmann III, GIII). Thirty glaucoma patients and 20 age-similar healthy controls were tested with the Method of Constant Stimuli (MOCS). One stimulus modulated in area (A), one modulated in contrast within Ricco’s area (CR), one modulated in both area and contrast simultaneously (AC), and the reference stimulus was a GIII, modulating in contrast. Stimuli were presented on a common platform with a common scale (energy). A three-stage protocol minimised artefactual MOCS slope bias that can occur due to differences in psychometric function sampling between conditions. Threshold difference from age-matched normal (total deviation), response variability, and signal/noise ratio were compared between stimuli. Total deviation was greater with, and response variability less dependent on defect depth with A, AC, and CR stimuli, compared with GIII. Both A and AC stimuli showed a significantly greater signal/noise ratio than the GIII, indicating that area-modulated stimuli offer benefits over the GIII for identifying early glaucoma and measuring progression.
Original languageEnglish
Article number2172 (2028)
Number of pages13
JournalScientific Reports
Issue number1
Early online date1 Feb 2018
Publication statusPublished online - 1 Feb 2018


  • Glaucoma
  • Perimetry
  • Spatial summation


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