Purpose: To devise and evaluate a rapid, accurate, and cost-effective method of detecting neuro-ophthalmologic visual field defects. Methods: One hundred fifty-nine consecutive patients were evaluated with 76-point, central 30° automated static threshold perimetry on the Humphrey Visual Field Analyzer, as well as by a 76-point, central 30° suprathreshold examination with the central reference levels set at 2 or 4 dB lower than the estimated normal median central reference level adjusted for age. Six masked readers reviewed the fields. Their readings were compared with those of the other observers, as well as with the final diagnoses as determined from all available clinical information. Results: In detecting abnormality, the full- threshold 30° test had a sensitivity (percent of eyes with true field defects identified by the field test) of 93% or 99% (depending on whether borderline results were counted as a positive or negative test) and a specificity (percent of cases without true field defects appropriately identified by the field test) of 71% or 91%. In comparison, the 4-dB offset suprathreshold test had a sensitivity (averaged over all reviewers) of 79% or 87% and a specificity of 81% or 89%, whereas the 2-dB test had a sensitivity of 87% or 94% and a specificity of 73% or 85%. The mean duration of the suprathreshold tests was 3.5 ± 1.0 minute, compared with 14.8 ± 2.8 minutes for the full-threshold technique. Conclusion: The central 30°, 76-point, 2- dB offset suprathreshold automated perimetry is more rapid and nearly as effective as the full-threshold test in detecting visual field abnormalities due to neuro-ophthalmologic disease. More quantitative, full-threshold perimetric strategies should be used in all equivocal cases and to follow progression of established disease.
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