Validation of the Reaction Time-Based False-Positive Rate as a Reliability Index for Standard Automated Perimetry.

Purpose: To validate a reaction time (RT)-based false-positive rate (RT-FP) for standard automated perimetry (SAP) and to determine the optimal RT listening window. Design: Retrospective cross-sectional study. Participants: A total of 1201 eyes from 607 glaucoma patients tested with the AIZE algorithm (imo perimeter, 24plus[1-2] pattern). Methods: Reaction time-based FP rate was defined as the proportion of stimulus responses below a defined RT listening window, excluding catch trials. Listening windows of 100, 200, and 300 ms were compared using receiver operating characteristic (ROC) analysis against conventional catch-trial FP rate ≥15%. The effect of excluding responses at locations with estimated threshold ≤0, ≤5, ≤10, and ≤15 dB on the association between RT-FP and disease severity was evaluated using Spearman correlation with mean deviation (MD). Relative variability of each FP index was assessed using the coefficient of variation (CV). Main Outcome Measures: Area under the ROC curve (AUC) for discriminating conventional FP ≥15%, Spearman correlation with MD and CV. Results: A 300-ms listening window achieved the highest discriminative accuracy (AUC = 0.783), outperforming 200-ms (AUC = 0.733) and 100-ms (AUC = 0.718) listening windows (both Conclusion: Reaction time-based FP rate with a 300-ms listening window restricted to locations with estimated threshold >10 dB substantially reduced metric dependence on disease severity to levels comparable to conventional FP, with greater measurement stability and no requirement for dedicated catch trials. This optimized RT-FP represents a promising reliability index for SAP warranting prospective validation. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.