Vfi (Artes, Iovs Apr11)

Artes et al.
, Visual Field Index (IOVS 10-6905, uncorrected proof for personal use only)
Properties of the Statpac Visual Field Index
Authors Paul H Artes PhD (corresponding author)

Neil O’Leary PhD, Donna Hutchison, Lisa Heckler MD,
Glen Sharpe MSc, Marcelo T Nicolela MD, Balwantray C Chauhan PhD
Keywords  glaucoma, visual field, progression, mean deviation, index,  scaling, vision ,
visual field index
Affiliation Ophthalmology and Visual Sciences, Faculty of Medicine

 Dalhousie University, Halifax, NS, Canada
Correspondence Paul H Artes, PhD  [paul@dal.ca]
Ophthalmology and Visual Sciences, Dalhousie University 
Rm 2035, West Victoria,  1276 South Park St,
Halifax, Nova Scotia, B3H 2Y9,  Canada
Support Glaucoma Research Foundation (PHA)
 Grant # MOP-11357, Canadian Institutes for Health Research (BCC)
Précis Global visual field indices are useful for estimating the speed of visual field
progression over time. In this report, compare the properties of the Visual
Field Index (VFI) to those of Mean Deviation (MD), in patients with
glaucoma followed for 10 years.
1
Artes et al., Visual Field Index (IOVS 10-6905, uncorrected proof for personal use only)
Abstract
Purpose
To compare the properties of the Visual Field Index (VFI) to those of Mean Deviation (MD), in
patients with glaucoma.
Methods
MD and VFI were calculated in data obtained from an ongoing longitudinal study in which patients
with glaucoma (n=109, 204 eyes) were followed for 9.8 years (median, 21 tests) with static automated
perimetry. MD and VFI were compared in one test of each eye, and a subset of 30 tests was selected
to compare the VFI to the judgments of 8 experts who judged the percentage of remaining visual field.
In series of tests obtained over time, rates of change, statistical significance, evidence of non-linearity,
and variability were compared between both indices.
Results
In single tests, MD and VFI were closely related (r=0.88, p<0.001). The relationship between both
indices appeared linear, except in visual fields with MDs better than -5.0 dB where 29/129 eyes (22%)
exhibited a ceiling effect (VFI=100%). Based on this relationship, the predicted VFIs for visual fields
with MD values of -5 dB, -10 dB, and -15 dB were 91%, 76%, and 60%, respectively. The percentage
of remaining visual field suggested by the VFI exceeded the range of experts’ subjective judgments in
16 of 30 eyes (53%).
In series of tests obtained over time, rates of change with the two indices were closely related (r=0.79,
p<0.001), and statistically significant reductions over time (p<0.05) occurred in a similar number of
eyes (92 [45%] with MD, and 87 [43%] with VFI). Of the 105 eyes with statistically significant (p<0.05)
negative trend in either MD or VFI, 74 eyes (70%) showed such trends with both indices (κ = 0.69).
Variability of MD and VFI increased with damage, and there was no evidence that change over time
was more linear with VFI than with MD.
Conclusions
The VFI provides a simple and understandable metric of visual field damage, but its estimates of
remaining visual field were more optimistic than those of experts. Rates of change over time with both
indices were closely related, but the reliance of the VFI on pattern deviation probability maps causes
a ceiling effect which may reduce its sensitivity to change in eyes with early damage. In this group of
patients we did not find evidence to suggest that the VFI is either superior or inferior to the MD as a
summary measure of visual field damage.
2
Introduction
In patients with optic neuropathies such as glaucoma, the visual field is the most important functional
measure of the severity of the disease and its progression. In conjunction with other tools such as
greyscale plots, total and pattern deviation probability maps,1 ranked deviation analysis,2 global indices3
such as Mean Deviation (MD) are widely used to summarize and interpret various aspects of the visual
field.4, 5
The MD expresses the overall reduction in sensitivity, averaged across the visual field, relative to a
group of healthy age-matched observers.3 Despite minor differences in how the MD is defined in
various instruments,6, 7 this index has become ubiquitous for describing the overall status of visual
fields in individuals as well as in groups of patients enrolled in research studies.
A particular challenge in glaucoma is to estimate the speed of progression. Previous reports have
highlighted large differences between the rates of change in individuals, both in treated and untreated
patients with glaucoma.8-13 Most treated patients progress slowly, but a few show rapid changes that
pose a much greater risk of visual disability. Statistical analyses of the trend in a single summary index
of the visual field provide a simple and intuitive approach to judge whether the current management is
likely to prevent visual disability.14
Recently, Bengtsson et al. introduced a Visual Field Index (VFI) for estimating rates of change in
glaucoma.15 This index is meant to address several shortcomings of the MD and is incorporated into
the Statpac software of the Humphrey Field Analyzer (HFA, Carl Zeiss Meditec, Dublin, CA). Unlike
the MD, which is scaled in the original decibel (dB) units of measurement, the VFI expresses the
amount of visual field loss as a percentage relative to the sensitivity of a reference group of healthy
observers. A completely normal visual field would be associated with a VFI of 100% while a
perimetrically blind field would have a VFI of 0%. To reduce the potentially confounding effects of
cataract, the VFI disregards reductions in sensitivity unless they are associated with pattern deviation
probability outside normal limits. Locations at which the pattern deviation values are within the 95th
percentile of healthy observers are treated as normal and assigned a value of 100%. In addition,
locations in the centre of the visual field are more heavily weighted and therefore make a greater
contribution to the VFI than those in the periphery.15
The objective to this report is to determine the properties of the VFI for characterizing global visual
field damage in glaucoma. We compare MD and VFI in single examinations (cross-sectional analysis)
and investigate how both indices compare to each other in series of visual fields measured over a
period of 10 years (longitudinal analysis).
3
Methods
Data
The data for this report were obtained from an ongoing prospective longitudinal study in which a
cohort of patients with open-angle glaucoma are being followed.16 The visual field indices MD and VFI
were calculated for the purposes of this report. Since the VFI is based on normative limits of total- and
pattern-deviation that are not in the public domain, these limits were estimated from a group of healthy
controls were followed within the same study.16
Patients were recruited consecutively from the clinics at the QEII Health Sciences Centre in Halifax,
Nova Scotia, Canada. Inclusion criteria were a clinical diagnosis of open-angle glaucoma based on optic
disc and visual field changes, an MD between -2.0 and -10.0 dB in at least one eye, and absence of
other ocular disease. Controls were recruited from patients’ relatives, church groups and a local
telephone company; they had a normal eye examination and an IOP <21 mmHg. For both groups of
participants, the inclusion criteria stipulated a best-corrected visual acuity (VA) equal to or better than
6/12 (+0.3 logMAR) and refractive error within ±5.00 D sphere and ±3.00 D astigmatism. In
accordance with the Declaration of Helsinki, the Ethics Review Board of the QEII Health Sciences
Centre approved the protocol, and all participants gave written informed consent.
Patients and controls were tested at intervals of 6 months with the full threshold strategy of the HFA.
Both eyes were examined in patients, while in the controls only a randomly selected study eye was
tested. For this report, visual fields were included if the MD of the baseline test was better than -20.0
dB and at least 5 tests were available.
Analyses
Calculation of MD and VFI
Raw sensitivity values were exported from the HFA with PeriData (www.peridata.org) and transformed
to total and pattern deviation using published data on the relationship between age, sensitivity, and
between-subject variance in a reference group of healthy observers.17 The MD was calculated as the
weighted mean of the total deviation values, and the weight assigned to each location was the inverse of
the variance in the healthy reference group.6
The VFI was calculated as described by Bengtsson.15 At each location, the measured sensitivity was
expressed as a percentage of the sensitivity expected in a healthy observer of the same age, and the VFI
was calculated as the weighted mean of all locations with pattern deviation probability outside normal
limits (<5%). The weights increased from 0.45 for the most peripheral locations to 3.49 for the four
4
most central locations closest to fixation. Since pattern deviation calculations are unreliable with highly
damaged visual fields, total rather than pattern deviation probability values were used with MDs worse
than -20.0 dB.15
Total and pattern deviation probability limits were estimated, separately for each location, from the
visual fields of our healthy control group. Because these limits are used to control for physiologic
between-subject variation in the visual field only a single test was used from each control; to minimize
potential artefacts from lack of experience with static perimetry, the third test was selected. MD and
VFI agreed closely with the values provided on the Statpac printouts (see the Appendix for a formal
comparison).
Comparison of MD and VFI in single tests (cross-sectional analysis)

The relationship between MD and VFI in single tests was estimated using the 3rd test in each series.
Because both indices are derived from the same measured threshold data, orthogonal regression18 was
used to derive an equation describing the relationship, irrespective of which index is selected to be the
dependent or independent variable.
A subset of 30 tests that covered a wide range of MD and VFI values were selected to assess how the
VFI compared with the judgment of experts. Statpac printouts of these visual fields, with the VFI
masked, were then distributed to 8 experts (see Acknowledgment section) who were asked to provide a
subjective judgment of the percentage of remaining visual field. Experts were at liberty to consider any
information on the printout they might regard as relevant, including greyscale plots, total and pattern
deviation maps, and global indices (except the VFI, which had been masked). They were also instructed
that their judgment should reflect their beliefs of relative importance of central and peripheral, as well
as superior and inferior, visual field damage. The median and range of the expert judgments were then
compared with the VFI.
Comparison of MD and VFI in series of examinations (longitudinal analysis)

To compare rates of change with the two indices, separate linear regressions were performed on the
entire series of visual fields available for each eye. Rates of change were estimated from the slope of the
regression line of MD (dB) and VFI (%) as dependent and age (years) as independent variable. The
slope of the regression line (in dB/y with MD, and %/y with VFI) gave an estimate of the average
speed of change over the entire follow-up.
5
To determine if either MD or VFI were more sensitive to visual field deterioration, we compared the
number of eyes with statistically significant negative slopes at p-values of <0.05, <0.01, and <0.001.
Area-proportional Venn diagrams19 were constructed to visualize the proportions of eyes with
significant negative slopes with either MD or VFI, or both indices.
To assess if either MD or VFI provided a more linear fit to the series of tests over time, we compared
the number of eyes with statistically significant deviations from linearity. Nonlinearity was tested by
comparing the variance explained by a linear regression to that of a more complex model containing
second and third-order polynomials (F-test).20 Evidence of nonlinearity was established if the more
complex model explained a significantly greater proportion of variance than linear regression.
To estimate the variability of both indices, we first derived a “best available estimate” (BAE) of MD
and VFI for each test in the series. Considering that each test is affected by random variability, an
estimate for the “true” value at each time point can be obtained by forming a moving average from the
observed value and the values obtained before and after it, such that a large proportion of random
measurement error is smoothed out. The differences between the observed values and the BAEs can
then be regarded as residual random error. BAEs were calculated using Lowess regression, a robust
non-parametric and non-linear technique21 that derives a weighted average over a moving window of
tests (illustrated in the examples in Figs. 7-10).
Because the spread of the error distributions increased with visual field damage, quantile regression22
was then performed to estimate marginal quantiles (2.5%, 5%, 10%, 90%, 95%, and 97.5%) of the error
distributions (dependent variable), with BAE as the independent variable.
All analyses were performed in the free open-source environment R (http://cran.r-project.org, version
2.11.1).23 The quantreg package24 was used for quantile regression.
6
Results
Demographic details of patients and controls
Table 1 provides demographic details of the patients. In 95 of 109 patients (87%), both eyes met the
inclusion criteria (baseline MD better than -20.0 dB, at least 5 tests available for analysis) and were
entered in the analysis. In the remaining 14 patients one eye had advanced damage at baseline (MD
worse than -20.0 dB) such that only the better eye qualified for inclusion.
Table 1. Demographic details (median and interquartile range) for patients with glaucoma.
N 109 patients (204 eyes)
Age 61.8 (52.4, 71.8) years
baseline MD -4.5 dB (-6.9, -2.7) dB
follow-up 9.9 (5.4, 11.9) years
number of tests 21 (12, 24)
The total and pattern deviation limits used in the VFI calculation were derived from 100 healthy
controls (median age 46.5 years, interquartile range [IQR] 38.1, 59.2 years).
VFI and MD in single visual fields (cross-sectional analysis)

In single visual fields, there was a close relationship between MD and VFI (Fig 1, Spearman’s r=0.88,
p<0.001). However, a ceiling effect was apparent with the VFI; of 129 eyes with MD better than
-5.0 dB, 29 (22%) had a VFI at its upper limit of 100%. For eyes with MD worse than approximately
-5.0 dB, the relationship between both indices appeared linear and was best described by the equation
VFI = 106% + 3.1 * MD, predicting VFIs of 91%, 76%, and 60% for visual fields with MDs of
-5.0 dB, -10 dB, and -15 dB, with prediction intervals of approximately ±9%.
7
Figure 1
Relationship between MD and VFI in single
examinations. For eyes with MD worse than
-5.0 dB, the relationship appeared linear
(red line). The 95% prediction interval is
shaded in grey. Histograms on the x- and y-
axes show the distribution of MD and VFI.
Except for 3 visual fields with MD > 0 dB, the VFI estimates of the percentage remaining visual field
were higher than the median judgment of the experts, on average by 12%. In 16 of the 30 fields (53%),
the VFI was higher than the largest individual judgment of the 8 experts (Fig. 2). Of note was the large
spread in the experts’ estimates. In all visual fields with MD <5 dB, the ranges were larger than 20%.
Figure 2
The percentage of remaining visual field
estimated by the VFI (large points), in
comparison to judgments of 8 experts (median,
dot; range, vertical bars). MDs are given by
numbers inside the VFI points.
8
VFI and MD in visual field series (longitudinal analysis)

The mean and median rates of global visual field change in the patients with glaucoma were -0.27 and
-0.18 dB/y with MD, and -0.84 and -0.26 %/year with VFI, respectively (Fig. 3). Rates of change
estimated from both indices were closely related (Spearman’s ρ = 0.79, p<0.001). Of the 204 visual
field series, 85 (42%) contained at least one test in which the VFI was 100%. When such series were
excluded, the relationship between the rates of change estimated with both indices was RateVFI = 0.1 +
3.7 * RateMD. Thus, for eyes with MD slopes of -0.5 dB/y, -1.0 dB/y, -1.5 dB/y and -2.0 dB/y, the
corresponding VFI slopes were, approximately, -1.8%/y, -3.6%/y, -5.4%/y, and -7.3%/y.
Figure 3
Rates of change in MD and VFI.
Series with evidence of a ceiling effect
(VFI=100%) are marked with a
white dot - these points were not
included in the regression (red line).
Histograms on the x- and y-axes show
the rate-of-change distributions, means
are indicated by arrows.
9
The number of eyes with statistically significant negative trends in MD and VFI were similar (Fig 4).
For example, 92 eyes (45%) showed a negative MD slope significant at the 5% level, while 87 eyes
(43%) had a negative VFI slope at the same significance (Fig 4a; κ=0.65). The close agreement on the
presence of a negative trend with MD and VFI remained similar when p-values of <0.01 and <0.002
were chosen as criteria for statistical significance (κ, 0.67-0.73; Fig 4b, c).
Figure 4
 Number of eyes with and without statistically significant rates of change in MD (red section) and VFI (blue
section) according to 3 different criteria (p<0.05, p<0.01, p<0.002). Areas are proportional to the numbers in
each group.
With both MD and VFI, variability increased with the level of visual field damage (Fig. 5). For a visual
field whose MDBAE was near 0 dB, for example, the MD of a single test was likely to fall within ±1 dB
95% of the time. In contrast, with MDBAE near -10 dB, this interval was more than twice as wide,
ranging from approximately -8 to -12.5 dB. Because the VFI never exceeds 100%, the variability of this
index was artificially reduced at the top of the scale, but the increased spread with more damaged visual
fields was similar to that noted with the MD.
10
Figure 5 
Probability limits for the differences between the level of MD and VFI at single tests and their “best available
estimates” (BAEs). For a specific level of BAE, the interval enclosed by the 2.5th and 97.5th percentiles (dark
grey shading) encompasses the range within which estimates from single tests are likely to fall 95% of the time.
Intervals for 90% and 80% are shown in medium and light grey, respectively.
To investigate if either MD or VFI would provide a more linear fit of visual field change over time,
statistical tests for non-linearity were performed by testing whether a quadratic or cubic polynomial
explained a significantly larger variance than a linear model. The proportions of eyes in which this was
the case were similar with the MD and the VFI (Fig. 6); thus, there was no evidence that the temporal
pattern of change was more linear with one index than the other.
Figure 6
Proportion of eyes in which the series of MD and VFI
appeared significantly non-linear, at p-values of 0.05,
0.01, and <0.001.
11
Case examples.
In Example 1 (Fig. 7), the visual field series showed a slow rate of global visual field change that was
statistically significant with both indices. Over a period of nearly 13 years, the MD changed from
-3.8 dB (first test) to -6.7 dB (last test), with a linear rate of change of -0.15 dB/y. The VFI changed
from 95% to 88%, at a linear rate of -0.3%/y. With the MD, the temporal pattern of visual field change
appeared non-linear (p=0.04), with a faster speed initially, but no evidence of non-linearity was detected
with the VFI (p=0.44).
Example 2 (Fig. 8) illustrates a case with a rapid rate of change (-0.8 dB/y with MD, and -3%/y with
VFI). During the early follow-up, the rate appeared relatively more rapid with MD than with the VFI,
most likely due to a ceiling effect with the latter index. Over the entire follow-up, the trend in both
indices was non-linear (p=0.005 with MD, p<0.001 with VFI).
Example 3 (Fig. 9) shows a case of localized progression in the central visual field which was poorly
reflected in MD. The linear rates of change were +0.1 dB/y with MD (p=0.24) and -0.8%/y (p<0.001)
with the VFI. The positive slope of the MD was likely related to the a sustained learning effect - the
general height of this visual field improved, gradually, by approximately 3 dB during the course of the
follow-up (not shown). Non-linearity was evident with MD as well as VFI (p=0.02 and <0.001,
respectively).
Example 4 (Fig. 10) shows a slow rate of change in a visual field developing an early nasal step
superiorly. The rates of change were -0.3 dB/y with the MD and -0.26%/y with the VFI; statistically
this was highly significant with the MD (p<0.001) but only borderline with the VFI (p=-0.06).
Legend, Fig. 7 (Figure overleaf)

The left panel shows the series of MD values over time, the middle panel the VFI. Open circles correspond to the first,
middle, and last visual field in the series for which greyscale, total- and pattern-deviation maps are shown on the right. The
corresponding dates are indicated on the y-axes of the MD and VFI plots. The coefficients of the least-squares linear
regression (dashed grey line) are given as slope, standard error (in brackets), and p-value. A robust non-parametric
Lowess regression fit is shown for comparison (solid red line).
21
12
Figure 7) Example 1.
Figure 8) Example 2. See legend to Fig. 7 (page 13).
13
14
Discussion
The aim of this report was to compare the MD and VFI indices for estimating rates of change in
glaucoma. Our results indicate that, in the large majority of patients, both indices provide equivalent
information on the speed of visual field progression (Fig. 3). In addition, there were no substantial
differences between the number of eyes in which MD and VFI showed statistically significant negative
rates of change (Fig. 4), suggesting that both indices have similar capability to detect the presence of
global visual field progression.
The increase in the variability of MD observed in damaged visual fields is consistent with previous
reports.5, 25-27 Our analysis suggests that in visual fields with a “true” MD near 0 dB, MDs from single
tests are likely to fall into a 95% tolerance interval of ±1 dB, suggesting that a deterioration by more
than 2 dB, from one test to the next, is unlikely to occur due to chance. When the true MD is near
-5 dB, the tolerance interval is much broader (-3 dB, -7 dB), suggesting that differences of up to 4 dB
from one test to the next may be explained by variability. A similar picture emerged with the VFI.
When the true value of the index was near 90%, the tolerance interval of single tests ranged from 85%
to 95%, but this expanded with VFIs near 70% to cover a range from 60% to 77%.
Because the VFI disregards loss of sensitivity at locations at which the pattern deviation is within
normal limits, this index may be more resistant than the MD to diffuse visual field changes caused by
cataract. This is an advantage for estimating the speed of glaucomatous change in patients who develop
significant lens opacity during follow-up. In our material, however, there were only very few patients in
whom surgery was delayed sufficiently long for cataract to lead to a substantial reduction in MD.
A previous report from this study population showed that, despite a 2-line post-operative improvement
in visual acuity, the mean improvement in MD after cataract surgery was <0.1 dB.28 Similar findings
have been reported by others.29 In a population that is older, or more likely to delay cataract surgery
until more advanced lens opacity has developed, the differences between rates of change with MD and
VFI might well be larger.
The resistance of the VFI to diffuse visual field change caused by cataract comes at the cost of lesser
sensitivity to diffuse visual field changes that may be an integral part of glaucoma-related visual field
damage and its progression.16, 30-33 In patients with firmly established focal visual field damage at the
start of follow-up this is unlikely to be a practically important drawback, but it is likely to reduce the
capability of the VFI to reflect glaucomatous progression in the early stages of the disease when focal
losses may not yet be well established. In a substantial proportion of eyes with MDs better than -5 dB,
the VFI was close to its maximum value of 100% (ceiling effect). This suggests that the VFI may
underestimate the rate of change in eyes with initially normal visual fields that are developing
glaucomatous damage. Because the vast majority of eyes in our sample already had focal visual field
damage at the beginning of the study, we are unable to test this hypothesis in our material. Studies that
15
investigated the development of glaucoma in patients with initially normal visual function would
provide an ideal opportunity to do this.
Compared to the MD, the VFI places a greater weight on locations in the paracentral visual field (see
Fig. 9, Example 3), and arguably gives a more appropriate reflection of small but clinically important
losses in this area. This weighting, however, does not make the VFI an index of functional vision. Both
MD and VFI are indices of visual function, but not of functional vision. The VFI was designed to
measure rates of change in glaucoma, but, as with MD, solid empirical evidence is needed to underpin
how changes in this index affect real-world performance of visual tasks,34-37 behavior,38-41 self-perceived
quality of vision42,43 and life,44 and, ultimately, health-related outcomes.45,46 The intuitive percentage
scale of the VFI may make it prone to be interpreted as a “percentage of remaining visual field”, but
this, in our view, is an over-simplification. Caveats include that the VFI is scaled in reference to
normative values which depend on the arbitrarily selected maximum stimulus intensity of the HFA
(3200 cd/m2) and are valid only for this instrument.
It is neither unambiguous nor straightforward to translate between clinical and functional scales,47 and
the discrepancy between the experts’ intuitive judgment and the VFI further cautions against a too-
literal interpretation of the VFI’s percentage scale. Notwithstanding the substantial spread between
experts’ judgments (which was larger than 20% in almost all cases), the VFI exceeded even the most
optimistic estimate of 8 experts in more than 50% of visual fields in our sample. These findings support
the need for a more in-depth investigation of expert judgments on visual field loss, and how they
accord with objective evidence from performance-based measures.
Rates of change with MD and VFI were closely related, and there was no evidence that the time course
of change was more linear with one index or the other. The finding that statistically significant non-
linearity was observed in many series does not suggest, however, that a simple linear model is inferior
to other, more complex, models for estimating the average global speed of change over a given period
of time.48, 49 The time course of visual field progression, and how best to distinguish sudden and
gradual patterns of change, are outside the scope of this report but remain topics of ongoing research.
While the VFI has advantages and disadvantages compared to the MD, both are global indices that aim
to summarize the entire visual field. Such indices are useful for estimating the average speed of global
change in glaucoma, but they are not well suited to detect early evidence of visual field progression.4, 50,
51 Because visual field progression usually entails localized components, point-by-point analyses such as
the Glaucoma Change Probability or Pointwise Linear Regression techniques may be more appropriate
to detect the earliest signs of visual field progression in glaucoma.51-55 Clinicians and researchers in
glaucoma are universally familiar with the MD, and its strengths and limitations are well understood.
Given the lack of distinct advantages of the VFI, at least in patients who do not develop visually
relevant opacity during follow-up, we suggest that the MD should be used in preference to the VFI
when summary measures of global visual field damage and rates of change are reported in scientific
publications.
16
Appendix
The visual field indices provided on the Statpac printouts are based on proprietary normative values
whereas the MD and VFI values in this report were calculated using data from healthy subjects that
have either been previously reported in the literature17 or have been derived from a group of healthy
controls followed in our center.16 To compare the calculations of MD and VFI performed in this
report to the Statpac analyses, we selected a subset of 100 visual fields covering a large spectrum of
visual field damage. MD and VFI were manually extracted from the Statpac printouts and compared
with the values derived from our analyses (Fig. A1).
Although the MD according to our calculations was systematically higher than that of Statpac, the
mean difference (-0.21 dB, 95% CI -0.27, -0.15 dB, p<0.001) was small and unlikely to be of practical
importance. On average, the differences between the VFIs were small (<0.1%, 95% CI,
-0.36%, 0.34%, p=0.89), and although we appeared to overestimate the VFI at the top of its range, the
differences were <5% in all cases.
Figure A1
Comparison of the MD and
VFI calculations against values
from the proprietary Statpac
software.
Acknowledgements
The authors thank Drs Douglas Anderson, David Garway-Heath, Chris Johnson, John Keltner, Allison
McKendrick, and Lesya Shuba for providing subjective judgments of visual field damage. Two of the
authors (BCC and MTN) participated also. Dr Jörg Weber (Köln, Germany) provided us with licenses
for the PeriData software.
17
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Artes et al.

Properties of the Statpac Visual Field Index

Authors Paul H Artes PhD (corresponding author)

Affiliation Ophthalmology and Visual Sciences, Faculty of Medicine

Comparison of MD and VFI in single tests (cross-sectional analysis)

Comparison of MD and VFI in series of examinations (longitudinal analysis)

VFI and MD in single visual fields (cross-sectional analysis)

VFI and MD in visual field series (longitudinal analysis)

Legend, Fig. 7 (Figure overleaf)

Figure 8) Example 2. See legend to Fig. 7 (page 13).

Figure 9) Example 3. See legend to Fig. 7 (page 13).

Figure 10) Example 4. See legend to Fig. 7 (page 13).

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