Perimetry Testing in the 10th Decade of Life

Abstract

Purpose

The prevalence of glaucoma increases with age and as life expectancy rises, the number of glaucoma patients in their 10th decade of life will increase. Here we aimed to assess the usefulness of glaucoma diagnostic testing in the very old and identify ways to improve testing reliability.

Design

Cohort study.

Subjects

Patients aged 90-99 years who were seen in our university-based glaucoma division between February 1, 2020, and May 10, 2023.

Methods

All Swedish Interactive Testing Algorithm-Standard 24-2 visual fields (VFs) performed by subjects were collected. Reliability indices and summary metrics were recorded.

Main Outcome Measures

Rate of reliable VF tests among individuals aged 90 years or older at the time of the test. The main criterion for a reliable field was a false-positive (FP) rate <15%. The effect of age, gender, and time of testing on FP, false-negative (FN), fixation losses (FLs), and test duration were also evaluated.

Results

A total of 3951 VF tests were collected from 289 patients (530 eyes) who met the inclusion criteria. The mean age at the time of the most recent VF was 92.8 ± 2.3 years. One hundred six (7.5%) of the VFs were unreliable based on the FP<15% criteria. Testing after age 90 increased the rate of FP, FN, and FL (all P < 0.001) compared to tests performed at a younger age. In addition, among VF performed by nonagenarians, tests performed in the afternoon were associated with statistically significant higher rates of FP (P < 0.01). A higher FP was also found among the eyes tested first. Testing in the afternoon was also associated with significantly increased FN rates (P < 0.05).

Conclusions

In the very old, reliable perimetry can be obtained. Reliability deteriorates with age and testing should be performed in the morning to maximize performance.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.