Kinetic and static fixation methods in automated threshold perimetry

Purpose: Static fixation is the standard method for stabilizing the eye during automated perimetry. Kinetic fixation is an alternative for fixation control in which the eye follows a moving target. This study was conducted to evaluate the fixation accuracy of static and kinetic fixation perimetry and to determine their ability to detect the absolute scotoma of the physiologic blind spot. Methods: The 71 patients with early glaucomatous field loss (mean age 65 years) and 45 control subjects (mean age 57 years) recruited from five clinical sites underwent threshold testing on the Dicon perimeter (kinetic fixation; Vismed, San Diego, CA) and Humphrey Field Analyzer (static fixation). The frequency of Heijl-Krakau fixation catch-trial errors was used as an indicator of fixation accuracy, and the measured sensitivity at the physiologic blind spot was used as an indicator of perimetric accuracy. Results: In patients with glaucoma, the frequency of fixation errors was significantly greater for kinetic fixation (17.2%) than for static fixation (10.2%). In the control group, the frequency of fixation errors also was significantly greater for kinetic fixation (27.5%) than for static fixation (12.6%). The threshold at the presumed location of the blind spot (15° temporal, 3° inferior from fixation) was 14.8 dB using kinetic fixation versus 4.0 dB with static fixation in patients with glaucoma, and 18.5 dB using kinetic fixation versus 2.5 dB using static fixation in the control group. Conclusion: Relative to static fixation, kinetic fixation was associated with fixation inaccuracy and underestimation of the absolute scotoma at the physiologic blind spot.