Frontloading SITA-Faster

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Performing two visual field (VF) tests using SITA-Faster during one appointment can yield more valuable VF data than standard testing, report re­searchers at the University of New South Wales, in Sydney, Australia.¹

Tracking glaucoma progression is challenging but critical to identifying and following patients with glau­coma. “Because VF testing is time-consuming, most patients only receive one VF test per year, even though more tests are required to detect progression,” said study author Jeremy C.K. Tan, MD, FRANZCO.

Approach. To examine the feasibility of obtaining more VF data during a single visit, the researchers used SITA-Faster to analyze 902 eyes in 463 individuals who had either normal vision or suspected glaucoma, or who had manifest glaucoma. The mean age was 63.6 years, and the majority of participants were male. Each eye underwent two VF tests at an initial appointment and then two more tests at a follow-up visit, where the mean interval was 265 days between the two sets of tests.

High speed and reliability. Performing two VF tests per eye on the same visit—referred to as “frontloading”—produced sets of repeatable perimetric data with significant improvement of reliability indices from the first to second test, the authors reported.

Using SITA-Faster also saved time. The mean du­ration of each SITA-Faster test was 132.6 seconds, which is approximately half of the duration of a single SITA-standard test, and about two-thirds the time of a SITA-Fast test.²

“Our findings suggest that performing two VF tests on the same eye at the same visit is a feasible way to obtain more VF data,” said Dr. Tan, explaining that the shorter test duration of SITA-Faster may help increase testing frequency at minimal time cost to meet recommended guidelines.³

A surprising finding. Frontloading also led to fewer false positives in the second test. This indicated im­proved performance from the first to the second test, said the authors. “This is contrary to concerns that the second test result will be of lower quality due to patient fatigue,” said Dr. Tan.

Generalizability. The study population comprised mostly patients who were healthy or had early glauco­ma, which may not be representative of patients visit­ing eye clinics. However, Dr. Tan noted that his team is pursuing additional studies involving participants with more advanced glaucoma.

Practical tips. Jithin Yohannan, MD, MPH, at the Wilmer Eye Institute at Johns Hopkins University School of Medicine, who was not involved in the study, said that although test duration is shorter with SITA-Faster, the testing conditions may remain demanding on the patient. “Some patients just don’t do well with SITA-Faster. Although shorter in duration [than other VF tests], it may be too difficult for some,” Dr. Yohannan said.

According to Dr. Tan, providing a few minutes of rest between tests may help decrease the potential for fatigue. He also encourages clinicians to explain the rationale of frontloading to clinical staff and patients before implementation. “Frontloading does not have to be performed on all patients at all visits,” he said, because frontloading may be more beneficial for base­line evaluation of new patients inexperienced with VF testing and with the assessment of patients prone to test variability.

—Christos Evangelou, PhD

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1 Tan JCK et al. Ophthalmol Glaucoma. Published online March 21, 2023.

2 aao.org/sita. Accessed Sept. 14, 2023.

3 Gedde SJ et al. Ophthalmology. 2021;128:71-150.

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Relevant financial disclosures: Dr. Tan—None. Dr. Yohannan—None.

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