Humphrey vs. Compass: A Comparative Study of Two Perimetry Devices

Abstract

Background Visual field testing is essential for glaucoma diagnostics; however, patient cooperation can affect the reliability of the results. The COMPASS perimeter (COM; CentreVue-iCare, Padua, Italy) offers an innovative approach to enhance test quality by compensating for fixation losses and automatically adjusting light stimuli. Additionally, it enables simultaneous fundus photography during perimetry. In this prospective study, we compare the COM perimeter with the Humphrey Field Analyzer (HFA) in glaucoma patients and healthy subjects in terms of visual field parameters, reproducibility, and patient satisfaction. The aim is to evaluate the clinical applicability and potential added value of the COM perimeter.

Materials and Methods 113 eyes (67 glaucoma, 46 healthy) were tested using both COM (24 – 2 ZEST) and HFA (24 – 2 SITA-Standard). Mean deviation (MD), pattern standard deviation (PSD), test duration (TD), and subjective patient experiences were recorded. Reproducibility was assessed by analysing repeated measurements in ten healthy subjects.

Results In the overall cohort, the COM measured a mean deviation (MD) of − 2.8 ± 5.7 dB and a pattern standard deviation (PSD) of 4.3 ± 3.5 dB. In comparison, the HFA showed an MD of − 4.4 ± 5.6 dB and a PSD of 3.2 ± 3.1 dB. The average test duration was 412 ± 94 seconds for COM and 341 ± 72 seconds for HFA. Subjective patient satisfaction was significantly higher with COM (p < 0.00 001) than with HFA. Both tests demonstrated high reproducibility with no significant differences in repeated measurements.

Conclusions The COM perimeter and the HFA Field Analyser demonstrated significant differences in the parameters MD, PSD, and test duration. Higher patient satisfaction and potentially better diagnostic specificity suggest that COM is a promising method for detecting visual field defects in glaucoma patients. The observed higher specificity of the COM perimeter may be attributed to its integrated eye-tracking system. The use and further refinement of this technology could enable greater precision in glaucoma diagnostics in clinical practice.

Conclusion Box

Already known:

• Visual field measurement continues to play a major role in glaucoma diagnostics, especially when the floor effect is reached in OCT diagnostics, from which no further progression can be detected [1].

• The high variability of visual field measurements in advanced glaucoma stages poses a challenge in the evaluability of the examination and may also mask the progression of glaucoma.

• HFA perimetry is a globally established, computer-based method for the precise measurement of the visual field.

Newly described:

• COM perimetry shows comparable diagnostic performance to HFA perimetry in the detection of visual field defects. The close correlation of the measured values (MD, PSD) underlines this comparability. At the same time, our results indicate a tendency for COM to be more sensitive or specific than HFA. This may be related to the multi-parametric GSS2 staging system, whereas the classification with HFA in our analysis was based solely on the MD values. Future studies should examine the test accuracy of COM more closely in subgroups stratified by glaucoma severity.

• Advantages of COM perimetry include eye tracking, automatic refraction correction, and simultaneous high-quality fundus photography, which provides additional diagnostic value and supports efficient clinical evaluation.

• The results of the patient survey indicate a higher satisfaction and acceptance of COM perimetry compared to HFA perimetry, which could improve compliance and adherence at regular follow-up visits and thus contribute to optimal glaucoma care.

Fazitbox

Bereits bekannt:

• Die Gesichtsfeldmessung hat weiterhin einen hohen Stellenwert in der Glaukomdiagnostik insbesondere beim Erreichen vom Floor-Effekt in der OCT-Diagnostik, ab dem keine weitere Progression mehr detektiert werden kann [1].

• Die hohe Variabilität der Gesichtsfeldmessungen in fortgeschrittenen Glaukomstadien stellt eine Herausforderung bei der Auswertbarkeit der Untersuchung und kann ggf. auch die Progression des Glaukoms maskieren.

• HFA-Perimetrie ist ein weltweit etabliertes, computergestütztes Verfahren zur präzisen Messung des Gesichtsfeldes.

Neu beschrieben:

• Die COM-Perimetrie zeigt eine vergleichbare diagnostische Leistung zur HFA-Perimetrie bei der Erkennung von Gesichtsfelddefekten. Die enge Korrelation der Messwerte (MD, PSD) unterstreicht diese Vergleichbarkeit. Gleichzeitig weisen unsere Ergebnisse auf eine tendenziell höhere Sensitivität bzw. Spezifität von COM im Vergleich zu HFA hin. Dies hängt möglicherweise mit dem multiparametrischen GSS2-Staging-System, während die Klassifikation beim HFA in unserer Auswertung allein auf den MD-Werten beruhte. Zukünftige Arbeiten sollten die Testgenauigkeit von COM von Subgruppen nach Glaukomschweregrad genauer untersuchen.

• Vorteile der COM-Perimetrie umfassen Eye-Tracking, automatische Refraktionskorrektur sowie die simultane qualitativ hochwertige Fundusfotografie, die zusätzlichen diagnostischen Mehrwert bietet und eine effiziente klinische Beurteilung unterstützt.

• Die Ergebnisse der Patientenbefragung deuten auf eine höhere Zufriedenheit und Akzeptanz der COM-Perimetrie im Vergleich zur HFA-Perimetrie hin, was die Compliance und Adhärenz bei regelmäßigen Verlaufskontrollen verbessern und somit zu einer optimalen Glaukombetreuung beitragen könnte.

Keywords

glaucoma - perimetry - Compass-perimeter - Humphrey Field Analyzer - visual field examination

Publication History

Received: 02 January 2025

Accepted: 15 October 2025

Accepted Manuscript online:
22 October 2025

Article published online:
26 January 2026

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