Developing a Screening Tool for Areas of Abnormal Central Vision Using Visual Stimuli With Natural Scene Statistics

Purpose: Previous studies show that some visual field (VF) defects are detectable from visual search behavior; for example, when watching video. Here, we developed and tested a VF testing approach that measures the number of fixations to find targets on a background with spatial frequency content similar to natural scenes. Methods: Twenty-one older controls and 20 people with glaucoma participated. Partic-ipants searched for a Gabor (6 c/degrees) that appeared in one of 25 possible locations within a 15 degrees (visual angle) 1/f noise background (RMS contrast: 0.20). Procedure performance was assessed by calculating sensitivity and specificity for different combinations of control performance limits (p = 95%, 98%, 99%), number of target locations with fixations outside control performance limits (k = 0 to 25) and number of repeated target presen-tations (n = 1 to 20). Results: Controls made a median of two to three fixations (twenty-fifth to seventy-fifth percentile: two to four) to locate the target depending on location. A VF was flagged "abnormal" when the number of fixations was greater than the p = 99% for k = 3 or more locations with n = 2 repeated presentations, giving 85% sensitivity and 95.2% specificity. The median test time for controls was 85.71 (twenty-fifth to seventy-fifth percentile: 66.49-113.53) seconds. Conclusion: Our prototype test demonstrated effective and efficient screening of abnormal areas in central vision. Translational Relevance: Visual search behavior can be used to detect central vision loss and may produce results that relate well to performance in natural visual environ-ments.