Flicker defined form and RareBit measurements lack in specificity of visual pathways

AIM:To evaluate the different visual pathways represented by the Heidelberg Engineering Perimeter flicker defined form and RareBit(magnocellular and parvocellular respectively)in different age-groups and according to the fatigue.METHODS:Totally 64 eyes of 32 healthy subjects were included in the prospective study.Each participant underwent screening—ophthalmic examination including best-corrected visual acuity,anterior and posterior segment assessment,and visual field examination with Heidelberg Edge Perimetry(HEP)-standard automated perimeter(SAP)24-2.They were observed for 2 y previously to the enrollment.This helped to define that the enrolled patients did not bear the glaucoma-developing potential.During the screening and after two years the HEP had been conducted in the standard protocol 24-2 and RareBit perimetry(RBP)in accordance with the manufacturer’s description.Participants were randomly assigned to the groups:flicker defined form(FDF)-first or RBP-first.This defined from which additional visual field test the participant started.Participants were additionally subdivided to younger and older study groups.The effect of subject variables was explored with Mann-Whitney U-test.Testing for the presence of correlations between parameters was performed using the Spearman Rank Order Correlations and confirmed by the parametric tests.For the influence of additional factors,the Kruskal-Wallis test was performed.RESULTS:The positive correlation between meandeviation(MD)and mean hit rate(MHR)and pattern standard deviation(PSD)and standard deviation of MHR(±MHR)were found in younger study group(P=0.005,r=0.481 and P=0.0074,r=0.465),whereas in the older subgroup no correlation was observed.Additionally,the randomization protocol helped in defining the role of fatigue on the HEP-FDF results.Participant for whom the HEPFDF was performed after RareBit had significantly worse results than those for whom the HEP-FDF was first.In the younger group,the MHR and±MHR depend from age in that group(P<0.05,r=0.43 and r=-0.57 respectively)while no age-dependent differences were found in HEPrelated parameters.On the contrary in the older group the MD and PSD varies with age(P<0.05,r=0.47 and r=-0.44 respectively)while the RBP parameters remained unchanged.The questionnaire showed that participants preferred RareBit over HEP-FDF in terms of a duration time,comfort,understanding of the test procedures,and ocular pain(P<0.05).CONCLUSION:The influence of patient’s fatigue should be considered during HEP-FDF examination.An overlap hypothesis should be reevaluated after determining of other factors that affect HEP-FDF and RareBit results.