Agreement between frequency-doubling technology perimetry and Heidelberg retinal tomography 3

Purpose

To compare Heidelberg retinal tomography (HRT) 3 and frequency-doubling technology (FDT) perimetry for diagnosis of glaucoma.

Methods

One eye of each of 117 patients was randomly chosen. The eyes were imaged by HRT3 and tested by FDT. The pattern standard deviation (PSD) and global glaucoma probability score (GPS) were selected as representative output, and sensitivity, specificity, positive predictive value, and negative predictive value determined for each. The agreement between the 2 diagnostic methods was analyzed.

Results

The sensitivity and specificity of HRT3 and FDT perimetry for PSD (65.4 and 62.7 %, respectively) and for GPS (69.2 and 62.7 %, respectively) were similar, as were the positive predictive values (PSD 40.5 %, GPS 41.9 %). However, the 2 methods had only slight diagnostic agreement (κ = 0.112), and this was not significant (P = 0.281).

Conclusions

FDT perimetry and HRT3 had no significant diagnostic agreement. Thus, the results from both examinations should be considered when determining diagnosis of glaucoma.     

Baseline thickness of macular ganglion cell complex predicts progression of visual field loss

Background

Previous studies reported that the thickness of the macular ganglion cell complex (mGCC) showed good diagnostic ability for detecting glaucoma. However, its impact on the progression of visual field loss in primary open angle glaucoma (POAG) is unknown. The purpose of this study was to assess whether baseline mGCC thickness is associated with the progression of visual field loss in POAG.

Methods

Fifty-six patients with POAG were included in the study. All patients were followed for more than 2 years after baseline optical coherence tomography (OCT) measurements. They had at least five reliable Humphrey visual field tests with 30–2 Swedish Interactive Threshold Algorithm standard tests during the follow-up period. The subjects were divided into two groups according to the slope of the mean deviation (MD): the fast progression group (MD slope < ?0.4 dB/y) and the slow progression group (MD slope ≥ ?0.4 dB/y). Factors compared between the groups were as follows: age, baseline intraocular pressure (IOP), mean IOP during the follow-up, refraction, baseline MD, pattern standard deviation (PSD), and baseline OCT measurements.

Results

There were no significant differences between the two groups in age, baseline IOP, mean IOP during the follow-up, refraction, baseline MD or PSD, average thickness of retinal nerve fiber layer (RNFL), or disc parameters. However, the baseline mGCC thickness (average and inferior hemifield) was significantly thinner in the fast progression group than in the slow progression group (74.0?±?7.2 μm vs. 80.3?±?8.6 μm; 68.0?±?6.6 μm vs. 78.2?±?11.6 μm, respectively). Moreover, global loss volume and focal loss volume, which are parameters of mGCC, showed significantly higher rates in the fast progression group than in the slow progression group. In multivariate analysis, only mGCC thickness of the inferior hemifield was associated with disease progression (P?=?0.007).

Conclusions

Baseline mGCC thickness can be predictive of progressive visual field loss in patients with POAG.     

Glaucoma detection with matrix and standard achromatic perimetry

BACKGROUND: Matrix perimetry is a new iteration of frequency-doubling technology (FDT) which uses a smaller target size in the standard achromatic perimetry presentation pattern. AIM: To compare the performance of matrix and Swedish interactive thresholding algorithm (SITA) perimetry in detecting glaucoma diagnosed by structural assessment. DESIGN: Prospective cross-sectional study. METHODS: 76 eyes from 15 healthy subjects and 61 consecutive glaucoma suspects and patients with glaucoma were included. All patients underwent optic nerve head (ONH) photography, SITA and matrix perimetries, and optical coherence tomography (OCT) within a 6-month period. Glaucoma diagnosis was established by either glaucomatous optic neuropathy or OCT by assessing retinal nerve fibre layer (RNFL) thickness. Mean deviation (MD), pattern standard deviation (PSD), glaucoma hemifield test and cluster of abnormal testing locations were recorded from matrix and SITA perimetries. RESULTS: Similar correlations were observed with matrix and SITA perimetry MD and PSD with either cup-to-disc ratio or OCT mean RNFL. The area under the receiver operating characteristic (AROC) curves of MD and PSD for discriminating between healthy and glaucomatous eyes ranged from 0.69 to 0.81 for matrix perimetry and from 0.75 to 0.77 for SITA perimetry. There were no significant differences among any corresponding matrix and SITA perimetry AROCs. CONCLUSIONS: Matrix and SITA perimetries had similar capabilities for distinguishing between healthy and glaucomatous eyes regardless of whether the diagnosis was established by ONH or OCT-RNFL assessment.     

Interpretation of the Humphrey Matrix 24-2 test in the diagnosis of preperimetric glaucoma

Purpose  To define the diagnostic precision of the Humphrey Matrix 24-2 test and to determine a clinically applicable cutoff criterion for the inclusion of preperimetric glaucoma. Methods  Eyes with preperimetric glaucoma (99 eyes) were defined as having normal standard automated perimetry (SAP) results and a glaucomatous optic nerve head, along with one or more optical coherence tomography (OCT) parameters flagged as <0.05 or a retinal nerve fiber layer (RNFL) defect on red-free fundus photographs. Normal controls (122 eyes) were defined as having a normal optic disc and RNFL with normal SAP. Receiver—operating characteristic (ROC) curves were constructed to determine the best-discriminating parameter of the frequency-doubling technology (FDT) Matrix. The sensitivity, specificity, and hit ratio of all available criteria were calculated from the FDT Matrix. Results  Pattern standard deviation (PSD) showed a larger area under the ROC curve (AUC) (0.767) than mean deviation (MD) (0.619). A pattern deviation plot (PDP) analysis by modified Anderson criteria showed the highest discriminating power, with a sensitivity of 75.76%, followed by a PSD cutoff value of 3.14 dB (sensitivity, 73.74%). Conclusions  FDT Matrix seems to be a valuable clinical tool in the detection of preperimetric glaucoma. Among the parameters of the FDT Matrix, PDP analysis by modified Anderson criteria may provide a reliable cutoff criterion.     

Standard achromatic perimetry, short wavelength automated perimetry, and frequency doubling technology for detection of glaucoma damage

OBJECTIVE: Reevaluation of the relationship between short wavelength automated perimetry (SWAP), standard achromatic perimetry (SAP), and frequency doubling technology (FDT) in glaucoma and ocular hypertensive patients and in glaucoma suspects. DESIGN: Prospective comparative observational study. PARTICIPANTS: Four age-matched groups were evaluated (42 patients with early to moderate glaucoma, 34 ocular hypertensives, 22 glaucoma suspects, and 25 normal controls) using SAP, SWAP, and FDT. INTERVENTION: All participants underwent full clinical ophthalmologic evaluation followed by SWAP, SAP, and FDT perimetry within a period of not more than 3 months. Mean defect (MD), pattern standard deviation (PSD), visual field (VF) indices, and the percentage of depressed visual field points with P value <5% and <1% in the pattern deviation plot were evaluated. MAIN OUTCOME MEASURES: For each of the four study groups, the MD, PSD, and the percentage of abnormal points significantly depressed <5% and <1% were compared for the three VF testing modalities. RESULTS: In the glaucoma group, the mean percentage of the total number of abnormal points in SWAP was significantly less than abnormal points in SAP and FDT, both for 5% (P values were 0.0001 and 0.0001, respectively) and 1% (P values were 0.0001 and 0.0001, respectively). The same applied to the ocular hypertensives group. However, in the suspects group, no significant difference was detected. In normal controls, the abnormal points in SWAP were significantly lower than those in SAP for 5% (P value was 0.01) and 1% (P value was 0.05). FDT detected significantly larger defects (percentage of points <5%) than SAP in ocular hypertensives and suspects (P values were 0.01 and 0.004, respectively). CONCLUSIONS: SWAP in its existing condition is markedly less efficient than either SAP or FDT in detecting VF defects, especially in glaucoma patients and ocular hypertensives (defects detected with SWAP are less than both SAP and FDT). Defects detected with FDT are equivalent to SAP and sometimes larger, especially in ocular hypertensives and glaucoma suspects; this makes it a useful tool for picking up early glaucomatous defects in populations at risk.     

Detecting the Progression of Normal Tension Glaucoma: A Comparison of Perimetry,Optic Coherence Tomography,and Heidelberg Retinal Tomography

Purpose

We compared the abilities of Stratus optical coherence tomography (OCT), Heidelberg retinal tomography (HRT) and standard automated perimetry (SAP) to detect the progression of normal tension glaucoma (NTG) in patients whose eyes displayed localized retinal nerve fiber layer (RNFL) defect enlargements.

Methods

One hundred four NTG patients were selected who met the selection criteria: a localized RNFL defect visible on red-free fundus photography, a minimum of five years of follow-up, and a minimum of five reliable SAP, Stratus OCT and HRT tests. Tests which detected progression at any visit during the 5-year follow-up were identified, and patients were further classified according to the state of the glaucoma using the mean deviation (MD) of SAP. For each test, the overall rates of change were calculated for parameters that differed significantly between patients with and without NTG progression.

Results

Forty-seven (45%) out of 104 eyes displayed progression that could be detected by red-free fundus photography. Progression was detected in 27 (57%) eyes using SAP, 19 (40%) eyes using OCT, and 17 (36%) eyes using HRT. In early NTG, SAP detected progression in 44% of eyes, and this increased to 70% in advanced NTG. In contrast, OCT and HRT detected progression in 50 and 7% of eyes during early NTG, but only 30 and 0% of eyes in advanced NTG, respectively. Among several parameters, the rates of change that differed significantly between patients with and without progression were the MD of SAP (p = 0.013), and the inferior RNFL thickness (p = 0.041) and average RNFL thickness (p = 0.032) determined by OCT.

Conclusions

SAP had a higher detection rate of NTG progression than other tests, especially in patients with advanced glaucoma, when we defined progression as the enlargement of a localized RNFL defect. The rates of change of the MD of SAP, inferior RNFL thickness, and average RNFL thickness differed between NTG patients with and without progression.     

Diagnostic approaches for early detection of glaucoma progression

BACKGROUND: To monitor the efficiency of glaucoma therapy it is necessary to detect progression of the disease as soon as possible. This survey presents the results on functional and morphological approaches to detect glaucoma progression. MATERIAL AND METHODS: Risk factors identified in the therapeutic intervention studies should be used to evaluate the possible risk for progression. The functional test approaches of standard achromatic perimetry (SAP), short wavelength automated perimetry (SWAP) and frequency doubling technology (FDT) are described. Furthermore, morphologic changes are described by means of optic nerve head and nerve fiber photography, optic nerve head tomography, optic coherence tomography and nerve fiber polarimetry. RESULTS: The risk factors identified in the interventional studies were as follows: 1. higher intraocular pressure, 2. worse mean deviation (MD), 3. older age, and 4. frequent disc hemorrhages. Additionally, in patients with normal pressure glaucoma, migraine headaches were identified. Patients with ocular hypertension showed a higher risk of conversion into open angle glaucoma in case of higher pattern standard deviation (PSD), thinner central corneal thickness and larger vertical cup-to-disc ratio. The optic nerve head photography was the standard procedure of morphological monitoring in the interventional studies. A direct comparison of the available techniques on nerve fiber thickness and optic nerve head morphology is not yet available. SAP represents the functional methodology with the most validated results. SWAP and FDT showed that progression in early glaucoma can be detected before SAP damage occurs. CONCLUSION: Glaucoma patients should be regularly tested with SAP and optic nerve head photography. Automated nerve fiber or optic nerve head morphology measuring techniques might be favourable to complete the diagnostic monitoring. In patients without glaucomatous damage SWAP and FDT may be able to detect changes earlier than SAP. The results of a review of the literature are presented and discussed for each technology.     

Threshold and variability properties of matrix frequency-doubling technology and standard automated perimetry in glaucoma

PURPOSE: To compare test results from second-generation Frequency-Doubling Technology perimetry (FDT2, Humphrey Matrix; Carl-Zeiss Meditec, Dublin, CA) and standard automated perimetry (SAP) in patients with glaucoma. Specifically, to examine the relationship between visual field sensitivity and test-retest variability and to compare total and pattern deviation probability maps between both techniques. METHODS: Fifteen patients with glaucoma who had early to moderately advanced visual field loss with SAP (mean MD, -4.0 dB; range, +0.2 to -16.1) were enrolled in the study. Patients attended three sessions. During each session, one eye was examined twice with FDT2 (24-2 threshold test) and twice with SAP (Swedish Interactive Threshold Algorithm [SITA] Standard 24-2 test), in random order. We compared threshold values between FDT2 and SAP at test locations with similar visual field coordinates. Test-retest variability, established in terms of test-retest intervals and standard deviations (SDs), was investigated as a function of visual field sensitivity (estimated by baseline threshold and mean threshold, respectively). The magnitude of visual field defects apparent in total and pattern deviation probability maps were compared between both techniques by ordinal scoring. RESULTS: The global visual field indices mean deviation (MD) and pattern standard deviation (PSD) of FDT2 and SAP correlated highly (r > 0.8; P < 0.001). At test locations with high sensitivity (>25 dB with SAP), threshold estimates from FDT2 and SAP exhibited a close, linear relationship, with a slope of approximately 2.0. However, at test locations with lower sensitivity, the relationship was much weaker and ceased to be linear. In comparison with FDT2, SAP showed a slightly larger proportion of test locations with absolute defects (3.0% vs. 2.2% with SAP and FDT2, respectively, P < 0.001). Whereas SAP showed a significant increase in test-retest variability at test locations with lower sensitivity (P < 0.001), there was no relationship between variability and sensitivity with FDT2 (P = 0.46). In comparison with SAP, FDT2 exhibited narrower test-retest intervals at test locations with lower sensitivity (SAP thresholds <25 dB). A comparison of the total and pattern deviation maps between both techniques showed that the total deviation analyses of FDT2 may slightly underestimate the visual field loss apparent with SAP. However, the pattern-deviation maps of both instruments agreed well with each other. CONCLUSIONS: The test-retest variability of FDT2 is uniform over the measurement range of the instrument. These properties may provide advantages for the monitoring of patients with glaucoma that should be investigated in longitudinal studies.     

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Purpose

To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

Methods

In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp–Anderson–Parish classification. Pearson’s correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

Results

Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70?±?46.28 mm³; 167.40?±?45.36 mm³) than in the mild glaucoma group (264.03?±?78.53 mm³; 264.76?±?78.88 mm³) and the control group (297.80?±?71.45 mm³; 296.56?±?71.02 mm³). Moderate correlation was observed between: RNFL thickness and ON volume (r?=?0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r?=?0.60, p?<?0.001). ON volume below 236 mm³ was 96 % sensitive and 80 % specific for the detection of severe glaucoma.

Conclusions

MRI measured optic nerve volume is a reliable method of assessing glaucomatous damage beyond the optic nerve head. A value of 236 mm³ and below can be used to define severe glaucoma.     

Pattern ERG and RNFL thickness in hypertensive eyes with normal blue-yellow visual field

Purpose

To evaluate the transient pattern electroretinogram (t-PERG) and the retinal nerve fiber layer (RNFL) thickness in eyes with ocular hypertension (OH) and normal short-wavelength automated perimetry (SWAP).

Methods

In 26 patients with bilateral OH with normal SWAP, and in 26 age and sex matched healthy controls, t-PERG recording and RNFL thickness measurement were performed. Mean deviation (MD) and pattern standard deviation (PSD) of a reliable full threshold 24-2 SWAP were considered. RNFL thickness was determined by OCT3. Monocular PERG were recorded by using a black and white checkerboard pattern (check size 0.9°, contrast 100 %, mean luminance 80 cd/m2) generated on a monitor and reversed in contrast (four reversals per second, 2 Hz) at a distance of 70 cm. Patients had optimal correction at viewing distance; no mydriatic or miotic eye drops were used. Silver/silver chloride skin electrodes were placed over the lower eyelids in the stimulated eye (active electrode) and in the patched eye (reference electrode); ground electrode was in the Fpz scalp. Peak-to peak amplitude of P50 (N35-P50) and N95 (P50-N95) waves, and implicit time of P50, were considered.

Results

Compared to controls, in OH eyes, a reduction of N35-P50 amplitude (2.86?±?1.49 vs. 3.77?±?1.08 microvolts, ?24.1 %, t-test p?=?0.015), of average RNFL thickness (88?±?11 vs. 96?±?10 μm, ?9.5 %, t-test p?=?0.002), and of RNFL thickness in superior (p?=?0.015) and inferior quadrant (p?<?0.001), were found. Multivariate analysis showed that in OH eyes, N35-P50 amplitude was inversely related to intraocular pressure (IOP) (p?=?0.001); no correlation was found between N35-P50 amplitude and MD, PSD, CCT or RNFL thickness.

Conclusions

In OH eyes, both PERG and RNFL thickness changes occur in hypertensive eyes with undamaged SWAP; the correlation of PERG amplitude with IOP, but not with RNFL thickness, suggests that such PERG changes are an effect of the IOP on retinal ganglion cells, rather than a sign of their loss.     

Clinical Application of Photopic Negative Response of the Flash Electroretinogram in Primary Open-angle Glaucoma

 PURPOSE: To evaluate the diagnostic performance of the photopic negative response (PhNR) for the detection of primary open-angle glaucoma (POAG). METHODS: Fifty-two normal subjects (52 eyes) and 173 POAG patients (173 eyes) were studied. The PhNR was elicited using a white stimuli on a white background. The mean deviation (MD) and pattern standard deviation (PSD) of the visual field were measured using standard automated perimetry (SAP). Spectral domain optical coherence tomography (SD-OCT) was used to measure the mean thickness of the retinal nerve fiber layer (RNFL). RESULTS: In the glaucoma group, as compared to the normal group, the amplitudes of a-waves, b-waves and PhNR were significantly smaller (P<0.001), and the PhNR implicit time was significantly longer (P=0.004). The MD, PSD and mean thickness of the RNFL were significantly correlated with the amplitude of the PhNR (P<0.001). The area under the receiver operating characteristic curve (AUCs) for the amplitudes of a-waves, b-waves and PhNR were 0.853, 0.830 and 0.918, respectively. When the specificity was ≥95%, the sensitivities were 60.4%, 54.2% and 85.4% respectively. CONCLUSION：The PhNR amplitude was reduced even when the loss in visual field sensitivity was mild, which suggests that PhNR might be a useful indicator of early glaucoma disease.       

The association of office intraocular pressure fluctuation in ocular hypertension with frequency doubling technology perimetry abnormality

Purpose To characterize intraocular pressure (IOP) and central corneal thickness (CCT) measurements of ocular hypertension (OHT) patients with and without frequency doubling technology (FDT) perimetry test abnormalities. Patients and methods In this prospective, observational, cross-sectional, comparative case series, one eye of 33 OHT patients was randomly chosen. All OHT patients had IOP ≥23 mmHg in 2 out of 3 measurements on the test day, normal appearing discs and nerve fiber layer, and normal white on white standard automated perimetry (SAP). Several IOP calculations (outpatient IOP, highest office IOP, mean office IOP, office IOP fluctuation, and office IOP peak), CCT, SAP and FDT parameters were compared between OHT patients with repeatable FDT perimetry abnormality and normal FDT perimetry. Results Eight (24%) of 33 OHT patients had an abnormal FDT perimetry test. The median office IOP fluctuation (5.0 vs 2.0, P = 0.007), office IOP peak (3.2 vs 1.0, P = 0.004), and FDT pattern standard deviation (PSD) (5.03 v 3.32, P = 0.000) were significantly higher in OHT patients with repeatable FDT perimetry test abnormalities compared to OHT patients with normal FDT perimetry test. Office IOP fluctuation and office IOP peak were significantly correlated with both number of significantly depressed FDT points and FDT PSD index. CCT measurements and SAP global indices did not differ significantly in OHT patients with and without FDT perimetry test abnormality. Conclusion Our results suggest that currently diagnosed OHT patients who have large office IOP fluctuations and office IOP peaks are more likely to have repeatable FDT perimetry test abnormalities. These results suggest that OHT patients with large IOP fluctuations and IOP peaks are more likely to have early glaucomatous damage, and this should be taken into account when assessing the risk of conversion to primary open angle glaucoma.     

Assessment of peripapillary choroidal thickness in primary open-angle glaucoma patients with choroidal vascular prominence

Purpose

To investigate the relationship between peripapillary choroidal thickness (PCT) and choroidal vascular prominence (CVP) colocalized with retinal nerve fiber layer (RNFL) defect in primary open-angle glaucoma (POAG) eyes and to evaluate the relationship between PCT and POAG severity.

Methods

In this cross-sectional comparative study, 29 POAG patients with CVP on RNFL imaging (Group A), 70 POAG patients without CVP (Group B) and 63 healthy controls (Group C) were examined. Various factors including age, intraocular pressure (IOP), spherical equivalent (SE), axial length (AXL), central corneal thickness (CCT), peripapillary RNFL thickness, visual-field mean deviation (MD) and pattern standard deviation (PSD) were investigated. Also, PCT (average, clock-hour) was measured by swept-source optical coherence tomography. The differences in each of the factors were analyzed among the groups.

Results

There was no significant difference in age, IOP, SE, AXL or CCT among the three groups (P > 0.05). MD, PSD and RNFL thickness (RNFLT) in Groups A and B were lower than in Group C, but there was no difference between Groups A and B. There was a significant difference in adjusted PCT between Groups A and B (79.39 ± 6.56 vs. 115.87 ± 4.25, P < 0.001). Every adjusted clock-hour PCT in Group A was significantly thinner than in Group B.

Conclusions

CVP in red-free RNFL images indicated severe thinning of PCT. Although PCT thinning was not related to glaucoma severity, CVP in red-free RNFL images should be observed as an indicator of PCT thinning, associated with POAG.

     

Relationship between corneal hysteresis and optic nerve parameters measured with spectral domain optical coherence tomography

Background

Corneal hysteresis (CH) has been associated with visual field damage in glaucoma and is related to the velocity of perimetric glaucoma progression. We undertook this investigation to determine whether CH is associated with structural markers of glaucoma damage on spectral domain optical coherence tomography (SD-OCT).

Methods

In this retrospective study, 131 patients under glaucoma evaluation were evaluated with SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) and had CH measurements with the ocular response analyzer (Reichert, Inc., Buffalo, NY). Pearson and partial correlation adjusting for age were preformed to examine the association between CH and variables of interest. Generalized estimating equations were used to construct simple and multiple linear models.

Results

While Pearson correlations were modest overall, CH best correlated with mean deviation (MD; r?=?0.19) followed by average retinal nerve fiber layer (RNFL) thickness (r?=?0.18) and vertical cup to disc ratio (r?=??0.11) in the open angle glaucoma group. In univariable models, CH varied as a function of MD (ß?=?0.1, 95 % CI 0.03, 0.1; p?<?0.001) and of average RNFL thickness (ß?=?0.2, 95 % CI 0.1, 0.4; p?=?0.001). In a multivariable analysis including MD, age, average RNFL thickness, and glaucoma status, MD (p?=?0.001) and age (p?<?0.001) retained significant associations with CH.

Conclusions

In patients under evaluation and treatment for glaucoma, CH was more closely related to visual field MD than to structural markers of glaucoma damage as measured by SD-OCT.     

Paracentral scotoma in glaucoma detected by 10-2 but not by 24-2 perimetry

Purpose

To describe, in glaucomatous patients, spectral-domain optical coherence tomography (SD-OCT) results predictive of paracentral visual field (VF) defects present on standard automated perimetry (SAP) 10-2, but not on SAP 24-2.

Methods

The SAP 10-2 test was repeated 3 times to determine whether paracentral VF defects were present. Spectralis? HRA + OCT was used to obtain speckle-noise-reduced macular B-scans. The macular scan protocol consisted of 19 vertical cross-sectional scan lines centered on the fovea (30° × 15° volume scan), each of which was the average of 50 scans. A 3D OCT-2000 was also used to determine macular layer thicknesses and to detect abnormally thin regions (below the 1 % confidence interval of the normative data).

Results

We identified 3 cases in which paracentral VF defects were detected on SAP 10-2, but not on SAP 24-2. Paracentral VF defects were detected on all of the SAP 10-2 tests repeated 3 times, and included absolute scotoma in 2 of the 3 SAP 10-2 results. Retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) damage was diminished on SD-OCT macular images; 2 patients had RNFL and GCL thinning within and central to the parafoveal region, where the GCL is generally thickest in healthy eyes, and 1 patient had evident RNFL and GCL thinning in the papillomacular bundle.

Conclusions

Macular SD-OCT scans may be useful in deciding whether SAP 10-2 should be performed.     

Correlation between polarimetric retinal nerve fiber layer thickness and retinal sensitivity determined with frequency-doubling technology.

BACKGROUND AND OBJECTIVE: Correlation between polarimetric retinal nerve fiber layer thickness measured with variable corneal compensation and retinal sensitivity measured with frequency-doubling technology (FDT) and standard automated perimetry (SAP) was investigated. PATIENTS AND METHODS: Twenty-four consecutive patients with chronic open-angle glaucoma and 17 healthy control subjects (1 randomly selected eye for each subject) were evaluated. RESULTS: For all subjects, quadrant scanning laser polarimetry parameters correlated positively with both FDT and SAP mean sensitivity of the opposite hemifield (P< .001). Global scanning laser polarimetry parameters correlated positively with FDT-mean sensitivity, SAP-mean sensitivity, and FDT-mean deviation, and negatively with SAP-mean deviation (in SAP, mean deviation is positive in case of sensitivity loss) (P < or = .02). The nerve fiber indicator also correlated with FDT-pattern standard deviation and SAP-corrected loss variance (P < or = .01). Using un-logged sensitivity values, no further correlations were found. CONCLUSION: Our results show that a similar structure-function relationship exists between polarimetric retinal nerve fiber layer thickness determined with variable corneal compensation and retinal sensitivity measured with SAP and FDT.     

Retinal nerve fiber layer thickness measurements with scanning laser polarimetry predict glaucomatous visual field loss

PURPOSE: To assess whether baseline retinal nerve fiber layer (RNFL) measurements obtained with a scanning laser polarimeter, the GDx Nerve Fiber Analyzer, (Laser Diagnostic Technologies Inc., San Diego, California) are predictive of development of repeatable glaucomatous visual field damage in glaucoma suspect eyes. DESIGN: Cohort study. METHODS: Participants were recruited from the UCSD longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). One eye from each of 160 glaucoma suspects with normal standard automated perimetry (SAP) visual fields at baseline was studied. Study eyes were divided into convert and nonconvert groups based on the development of three consecutive glaucomatous visual fields during follow-up. SLP parameters, IOP, vertical cup disk ratio, stereophotograph assessment as glaucoma or normal, corneal thickness, and visual field indices were included in univariate and multivariate Cox proportional hazards models to determine which SLP RNFL and ocular parameters were predictive of visual field conversion. RESULTS: Sixteen (10%) eyes developed repeatable visual field damage (converts) and 144 (90%) did not (nonconverts). Mean (95%CI) follow-up time until visual field conversion for convert eyes was 2.7 (1.7, 3.6) years. Mean total follow-up of nonconvert eyes was 3.8 (3.5, 4.1) years. Four out of thirteen examined baseline SLP parameters and baseline SAP Mean Deviation (MD), SAP Pattern Standard Deviation (PSD), and glaucomatous stereophotograph assessment were significant univariate predictors of visual field conversion. In multivariate models adjusted for age, IOP and CCT, SLP parameters inferior ratio, ellipse modulation, and UCSD linear discriminant function (LDF) were significant predictors of visual field conversion. When SAP PSD and stereophotograph assessment were also included in the multivariate model inferior ratio and UCSD LDF remained independently predictive of visual field loss. CONCLUSIONS: Thinner baseline SLP RNFL measurements were independent predictors of visual field damage. In addition to thinner SLP RNFL measurements, higher baseline SAP PSD, and baseline glaucomatous stereophotograph assessment each contributed to an increased risk of the development of abnormal visual fields in glaucoma suspect patients. SLP RNFL measurements were independently predictive of future visual loss even when age, IOP, CCT, vertical cup disk ratio, and SAP PSD were included in the model.     

Nerve fiber layer thickness in glaucoma patients with asymmetric hemifield visual field loss

PURPOSE: To investigate the presence of retinal nerve fiber layer (RNFL) thinning and determine the relationship between RNFL thickness and visual field sensitivity loss in glaucoma patients with asymmetric hemifield visual field loss. PATIENTS AND METHODS: Thirty glaucoma patients with asymmetric hemifield visual field loss and 30 normal control subjects were included in the study. RNFL thickness was measured by optical coherence tomography and visual field sensitivity was measured by automated perimetry. Glaucoma patients with advanced visual field loss restricted to 1 hemifield and early or absent glaucomatous field loss in the other hemifield on the basis of the visual field data were included. Visual field sensitivity and mean deviation (MD) were averaged separately in each of the 2 hemifields. The hemifields in each eye were categorized as early (MD>or=-6 dB) and advanced (MD<-6 dB) glaucomatous hemifields. RESULTS: RNFL thickness measurements in corresponding (eg, superior peripapillary quadrant with inferior hemifield) advanced glaucomatous hemifields (59+/-16 microm) were significantly (P<0.001) lower than in corresponding early glaucomatous hemifields (90+/-25 microm). The mean RNFL thickness in corresponding advanced and early glaucomatous hemifields were significantly lower than in normal control subjects (P<0.0001). On the basis of the normative database supplied by optical coherence tomography software, 100% and 43% of eyes had abnormal RNFL thickness in corresponding advanced and early glaucomatous hemifields, respectively. A linear correlation was found between RNFL thickness and MD in the early (r=0.6; P<0.001) and advanced (r=0.5; P=0.007) glaucomatous hemifields. CONCLUSIONS: RNFL thinning was present in corresponding hemifields of glaucomatous eyes with minimal visual field defect and correlated with visual field sensitivity loss. Measurement of RNFL thickness has potential for detection of early nerve fiber loss owing to glaucoma.     

Comparison of visual field test results obtained through Humphrey matrix frequency doubling technology perimetry versus standard automated perimetry in healthy children

Aims:

The aim of this study was to compare the visual field test results in healthy children obtained via the Humphrey matrix 24-2 threshold program and standard automated perimetry (SAP) using the Swedish interactive threshold algorithm (SITA)-Standard 24-2 test.

Materials and Methods:

This prospective study included 55 healthy children without ocular or systemic disorders who underwent both SAP and frequency doubling technology (FDT) perimetry visual field testing. Visual field test reliability indices, test duration, global indices (mean deviation [MD], and pattern standard deviation [PSD]) were compared between the 2 tests using the Wilcoxon signed-rank test and paired t-test. The performance of the Humphrey field analyzer (HFA) 24-2 SITA-standard and frequency-doubling technology Matrix 24-2 tests between genders were compared with Mann-Whitney U-test.

Results:

Fifty-five healthy children with a mean age of 12.2 ± 1.9 years (range from 8 years to 16 years) were included in this prospective study. The test durations of SAP and FDT were similar (5.2 ± 0.5 and 5.1 ± 0.2 min, respectively, P = 0.651). MD and the PSD values obtained via FDT Matrix were significantly higher than those obtained via SAP (P < 0.001), and fixation losses and false negative errors were significantly less with SAP (P < 0.05). A weak positive correlation between the two tests in terms of MD (r = 0.352, P = 0.008) and PSD (r = 0.329, P = 0.014) was observed.

Conclusion:

Children were able to complete both the visual test algorithms successfully within 6 min. However, SAP testing appears to be associated with less depression of the visual field indices of healthy children. FDT Matrix and SAP should not be used interchangeably in the follow-up of children.     

Correlation of localized glaucomatous visual field defects and spectral domain optical coherence tomography retinal nerve fiber layer thinning using a modified structure–function map for OCT

Purpose

To study the correlation between glaucomatous visual field (VF) defects assessed by standard automated perimetry (SAP) and peripapillary retinal nerve fiber layer (RNFL) thinning measured by spectral domain optical coherence tomography (OCT) using a modified OCT-based peripapillary RNFL structure–function map.

Patients and methods

Perimetric glaucoma patients and age-matched normal control subjects were recruited from a university hospital clinic. All eyes underwent testing with the Spectralis spectral domain OCT and SAP on the same day. An OCT-based correspondence map, which correlated VF areas with peripapillary RNFL sectors was created to evaluate the relationship between glaucomatous RNFL thinning and VF loss in six nerve fiber layer bundle areas. Correlations of RNFL thinning with corresponding VF defects were examined using Spearman rank-order correlations. To demonstrate the association between localized VF defects and RNFL thickness, the theoretical curves were made according to an established log-linear model. The measured RNFL thickness values and VF defects were presented in the same scatterplot for each sector.

Results

Fifty-six glaucoma patients and 85 normal subjects were included in the study. Significant association between localized VF loss and RNFL thinning was found in corresponding areas. Data from the current study fit well with established log-linear models, which compare RNFL thickness values with VF defects.

Conclusion

Analysis of RNFL thinning in eyes with localized glaucomatous VF defects showed good structure–function correlation in a new OCT-based structure–function correspondence map.