Tracking failure frequency increases with dry eye symptom severity and in the left eye.
Symptoms of dry eye disease are commonly encountered in glaucoma patients and can be exacerbated by topical glaucoma medications. Dry eye disease may influence the reliability of visual field (VF) tests and impact accurate interpretation of the results.
Patients at the Veterans Administration Medical Center San Diego completed the five-item dry eye questionnaire (DEQ. 5) prior to VF testing between December 2018 and February 2019. VF reliability metrics were recorded for each patient. Standard reliability metrics included fixation losses, false positive, and false negative rates. Gate tracking (GT) metrics included percent of stimuli with gaze deviations between 1 and 2 degrees, 3-5 degrees, 6 degrees or greater, and percent of stimuli with tracking failure (TFF or Tracking Failure Frequency). The use of glaucoma medications and artificial tears was also recorded.
494 patients completed the DEQ. 5 and VF testing. There was no association between dry eye symptom severity and standard reliability metrics or most GT metrics. However, TFF increased as dry eye symptom severity increased (P=0.015). TFF was also greater in the left eye, which was tested second (P=0.012); no other reliability metrics were related to laterality. Patients were more likely to use artificial tears with increased dry eye symptom severity (P<0.001), but there was no relationship between symptom severity and glaucoma medication use.
Dry eye symptom severity may influence the acceptable range or threshold of TFF when using GT metrics to determine VF reliability. Likewise, the acceptable range or threshold for TFF may be different between eyes.

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