Retinal nerve fiber layer measurement by optical coherence tomography in glaucoma suspects with short-wavelength perimetry abnormalities

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements in normal and glaucoma subjects with short-wavelength automatic perimetry (SWAP) abnormalities and in chronic primary open-angle glaucoma (CPOAG) patients using optical coherence tomography (OCT). METHODS: Forty-eight eyes of normal subjects, 34 eyes of glaucoma suspects with SWAP abnormalities, and 38 eyes of early CPOAG subjects were recruited. All normal and glaucoma suspects had normal conventional automated perimetry visual field results. All participants underwent full clinical ophthalmologic evaluation followed by OCT RNFL measurements. RESULTS: Compared with normal controls, OCT RNFL thickness was significantly lower in glaucoma suspects with abnormal SWAP (inferotemporal and superotemporal thickness values) and CPOAG patients (average, superior, inferior, inferotemporal, and superotemporal thickness values) (P < 0.01). Some parameters were found to be significantly lower in CPOAG patients than the glaucoma suspects with abnormal SWAP (average, inferior, inferotemporal, and superotemporal thickness values) (P < 0.01). CONCLUSIONS: OCT RNFL measurements appear to correlate well with SWAP abnormalities in glaucoma, and may detect glaucomatous damage earlier than standard conventional automated perimetry. This study suggests that OCT may recognize the earliest evidence of structure alterations in CPOAG.     

Can frequency-doubling technology and short-wavelength automated perimetries detect visual field defects before standard automated perimetry in patients with preperimetric glaucoma?

PURPOSE: To assess the ability of frequency-doubling technology (FDT) perimetry and short-wavelength automated perimetry (SWAP) to detect glaucomatous damage in preperimetric glaucoma subjects. PARTICIPANTS: Two hundred seventy-eight eyes of 278 subjects categorized as normal eyes [n=98; intraocular pressure <20 mm Hg, normal optic disc appearance, and standard automated perimetry (SAP)]; preperimetric glaucoma eyes (n=109; normal SAP and retinal nerve fiber layer defects or localized optic disc notching and thinning); and glaucoma patients (n=71; intraocular pressure >21 mm Hg, optic disc compatible with glaucoma, and abnormal SAP). METHODS: The preperimetric glaucoma group underwent at least 2 reliable full-threshold 24-2 Humphrey SAPs, full-threshold C-20 FDT, full-threshold 24-2 SWAP, optic disc topography using the Heidelberg Retina Tomograph II, laser polarimetry using the GDx VCC, and Optical Coherence Tomography (Zeiss Stratus OCT 3000). Receiver operating characteristic curves were plotted for the main Heidelberg Retina Tomograph, Optical Coherence Tomography, and GDx VCC parameters for the normal and glaucoma patients. The area under the receiver operating characteristic curve was used to determine the parameters indicating glaucomatous damage in the optic disc or retinal nerve fiber layer, which were used to establish additional subgroups of patients with preperimetric glaucoma. FDT and SWAP sensitivities were calculated for the patient subsets with structural damage and normal SAP. RESULTS: At least 20% of the patients with preperimetric glaucoma demonstrated functional losses in FDT and SWAP. The more severe the structural damage, the greater the sensitivity for detecting glaucomatous visual field losses. CONCLUSIONS: FDT and SWAP detect functional losses in cases of suspected glaucoma before glaucomatous losses detected by SAP.     

Short wavelength automated perimetry, frequency doubling technology perimetry, and pattern electroretinography for prediction of progressive glaucomatous standard visual field defects

PURPOSE: To evaluate the clinical use of a test battery of short wavelength automated perimetry (SWAP), frequency doubling technology perimetry (FDT), and pattern electroretinography (PERG) in predicting progressive glaucomatous visual field defects on standard automated perimetry (SAP). STUDY DESIGN: A prospective, longitudinal, observational case series. PARTICIPANTS: One hundred and fifty-two patients with primary open-angle glaucoma (POAG) with bilateral glaucomatous visual field defects on SAP were followed at 6-month intervals over a period of 30 months. MAIN OUTCOME MEASURES: Short wavelength automated perimetry, FDT, and PERG results were compared between POAG eyes with and without progressive field loss on SAP. These two groups were used to evaluate whether PERG, SWAP, and/or FDT is predictive of future progression of field loss on SAP. RESULTS: Using the criteria of progressive field loss on SAP defined by the Collaborative Normal Tension Glaucoma Study, 54 eyes (study group) of 54 POAG patients showed progressive defects, whereas 84 eyes (control group) of 84 POAG patients showed no progression. Only 11.1% (6 of 54) of the eyes with a progression of field loss on SAP showed no increase of deficits on the three functional tests before progression. Short wavelength automated perimetry detected early progressive defects on SAP in 43 of the 54 eyes (79.6%). Of these 54 POAG eyes, FDT showed progressive deficits in 40 eyes (74.1%), whereas PERG amplitude P1N2 showed progressive deficits in 35 eyes (64.8%) before progression of field loss on SAP. A test battery consisting of SWAP and PERG P1N2-amplitude was able to detect 88.9% of eyes before a prediction of field loss on SAP. When comparing the results of the two functional tests, SWAP and FDT in the 84 eyes without progression of field loss on SAP between baseline and at 30 months, SWAP and FDT showed progressive deficits in 34.5% and 35.7%, respectively. CONCLUSIONS: All three tests (SWAP, FDT, and PERG) have been successful in detecting glaucoma eyes with a future progression of standard visual field defects. A test battery of SWAP and PERG P1N2-amplitude improved the power to predict these progressive defects on SAP. It remains to be seen whether the long-term follow-up in POAG eyes will improve the false-positive rate of SWAP and FDT.     

Comparison of diagnostic ability of standard automated perimetry,short wavelength automated perimetry,retinal nerve fiber layer thickness analysis and ganglion cell layer thickness analysis in early detection of glaucoma

Purpose:The aim of this study was to compare the diagnostic ability of macular ganglion cell layer (GCL) analysis using spectral domain optical coherence tomography against retinal nerve fiber layer analysis (RNFL), short-wavelength automated perimetry (SWAP), and standard automated perimetry (SAP) in early detection of glaucoma.Methods:Participants fulfilling the inclusion criteria were consecutively enrolled from the glaucoma clinic of tertiary care eye hospital in Western India from November 2015 to October 2016. The subjects underwent a detailed evaluation by trained glaucoma specialists. On suspicion of glaucoma, the patients underwent SAP, SWAP, and SD-OCT for GCL and RNFL analysis.Results:There were 91 patients in total of which experts classified 54 eyes into GON and 37 eyes into nonglaucomatous group. Sensitivity of SAP (42.59%) was significantly lower (P < 0.05) than that of average GCL thickness (79.63%) and average RNFL thickness (72.22%). Specificity and positive LR of SWAP (97.3% and 19.19, respectively) and SAP (94.6% and 7.88, respectively) were greater than those of GCL (81.08% and 4.21) and RNFL (67.57% and 2.23) parameters. Negative LR of average GCL thickness (0.25) was superior to that of average RNFL thickness (0.411), SWAP (0.495), and SAP (0.607).Conclusion:Macular GCL parameters perform better than RNFL parameters in patients with early glaucomatous damage. There is superior ability of SWAP over SAP in detecting glaucomatous changes in glaucoma suspect group. GCL thickness analysis has higher sensitivity and negative likelihood ratio, whereas SWAP had higher specificity and positive likelihood ratio. Thus, combining both tests can lead to better diagnostic ability for early glaucomatous damage.     

Functional and structural measurements in a multifactorial glaucoma risk model

PURPOSE: To evaluate the relationship between a multifactorial probability risk model of developing glaucomatous visual field defects and the assessment of the retinal nerve fiber layer (RNFL) and short-wavelength automated perimetry (SWAP) in glaucoma suspects. METHODS: 157 eyes of 157 glaucoma suspects were included in the study. The risk of developing glaucomatous defects was assessed by applying a multifactorial model that included intraocular pressure, vertical cup-to-disk ratio, age and family history. Photographs of the RNFL and SWAP were performed. RESULTS: The SWAP was abnormal in 54 cases (34.3%); 21% of abnormal perimetries were obtained in the low-risk group, 37% in the moderate risk group and 56% in the high risk group. The nerve fiber layer evaluation in the different risk stages showed a pattern similar to the results obtained with SWAP. Multiple regression analyses, performed with the four variables included in the model with SWAP and RNFL evaluation, showed the relationship between the risk factors and the presence of glaucomatous damage--evaluated by RNFL and SWAP (p<0001). CONCLUSIONS: The probability model showed a good correlation between the risk scale and the RNFL and SWAP assessment.     

Structure and function evaluation (SAFE): II. Comparison of optic disk and visual field characteristics

PURPOSE: To evaluate the relationship between glaucomatous structural damage to the optic nerve and development of visual field loss with standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). DESIGN: Cohort study. METHODS: Patients with elevated intraocular pressure and normal SAP visual fields were enrolled in this prospective study. Stereo optic disk photographs, SAP, and SWAP visual fields were obtained annually over a period of 4 or more years. Trained readers evaluated baseline and follow-up optic disk photographs for evidence of glaucomatous damage. Standard automated perimetry and SWAP examinations were evaluated according to previously validated criteria for development of confirmed visual field changes. RESULTS: Two-hundred ninety-five subjects (479 eyes) were enrolled. Following masked assessment of stereo photographs by an optic disk reading center, 272 of the 479 eyes were judged to have glaucomatous optic neuropathy at the time of study entry. Depending on the criteria employed, approximately 10% to 17.5% of all eyes developed confirmed visual field loss for SAP (conversions). Of the conversions, 75% to 80% had baseline glaucomatous optic disk damage, whereas normal and glaucomatous optic disks were equally divided (50%) among the nonconversion eyes. This difference was statistically significant (P <.003). Depending on the criteria employed, 4% to 12% of the eyes had confirmed SWAP deficits at baseline, and 4% to 8% developed confirmed SWAP defects at a follow-up examination. There was a greater percentage of eyes with a glaucomatous optic neuropathy in the group with SWAP deficits (75%-100%) than for those eyes in which SWAP remained normal (45%-60%). Some of these differences were statistically significant (P <.05). CONCLUSIONS: A strong relationship exists between glaucomatous optic disk damage at study entry and the subsequent development of a confirmed glaucomatous SAP visual field defect. A higher percentage of glaucomatous optic disks were also found in patients with SWAP deficits at baseline and in those who later developed SWAP deficits. These findings support the premise that a glaucomatous optic disk is predictive of the subsequent development of glaucomatous visual field loss.     

Glaucomatous damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects

PURPOSE: To determine the glaucomatous visual field damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects, and to compare the frequency of diffuse visual field losses and localized defects. METHODS: 157 eyes of 157 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm Hg and normal standard visual fields) were studied. SWAP was done with a modified Humphrey Field Analyzer. Total (TD) and Pattern Deviation (PD) probability maps were calculated for SWAP. The frequency of abnormlities in the TD and PD were determined, analyzing the visual field loss components. RESULTS: The involvement of the test points was more frequent on the TD plots than on the PD plots for all levels of defects (p< 0.001). The glaucomatous defects also showed certain topographical distribution. CONCLUSIONS: A diffuse sensitivity component of visual field loss was found at all SWAP defect depths in glaucoma suspects.     

Nerve fiber analyzer and short-wavelength automated perimetry in glaucoma suspects: a pilot study

PURPOSE: To test the relationship between the results of short-wavelength automatic perimetry (SWAP) and retinal nerve fiber layer (RNFL) measurements with scanning laser polarimetry (Nerve Fiber Analyzer, NFA) in age-matched normal subjects, glaucoma suspects, and early glaucoma patients. DESIGN: Case-control study. PARTICIPANTS AND METHODS: Thirty-eight normal subjects, 32 glaucoma suspects, and 14 early glaucoma patients were recruited. All subjects underwent RNFL assessment by NFA, achromatic visual field testing (24-2 threshold), and repeated SWAP (24-2 threshold blue-on-yellow). MAIN OUTCOME MEASURES: Mean deviation (MD) of visual field testing and RNFL values were obtained. RESULTS: Glaucoma suspects were divided into two groups according to their SWAP results: high risk (with SWAP abnormalities) and low risk (with normal SWAP result). No statistically significant difference in SWAP MD and RNFL values were observed between normal and low-risk groups (P > 0.05), but these values were found to be significantly lower in high-risk and early glaucoma groups (P < 0.01). CONCLUSIONS: This study suggests that RNFL examination by NFA may be a useful test for the early detection of glaucomatous damage of glaucoma suspects. It appears to provide agreement with SWAP abnormalities and is more sensitive than conventional standard automated perimetry.     

Progression of glaucomatous visual field damage detected by short-wavelength automated perimetry

The efficacy of short-wavelength automated perimetry (SWAP) and conventional automated perimetry (CAP) in detecting the progression of glaucomatous visual field loss was compared. After 3 years, CAP detected progressive visual field damage in 3 (13.6%) of 22 eyes, while SWAP detected progressive visual field damage in 8 (36.6%) of 22 eyes. Thus, SWAP was more efficient than CAP in detecting progressive visual field losses in glaucomatous patients with incipient defects. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Study of patients with ocular hypertension with scanning laser polarimetry and short-wavelength automatic perimetry

AIMS: To compare and correlate retinal nerve fiber layer (RNFL) measurements obtained by scanning laser polarimetry (SLP) with defects detected by short-wavelength automatic perimetry (SWAP) in eyes with ocular hypertension (OHT). METHODS: SLP and SWAP were performed in 96 eyes of 48 consecutive patients with OHT. RESULTS: Twenty-five eyes (26%) had SWAP visual field defects. Twenty-seven eyes (28.1%) had abnormal RNFL evaluation defined by the GDx neural network ('number' > 29). Fourteen eyes of 10 patients (14.5%) had abnormal RNFL evaluation and SWAP visual field defects. RNFL thickness measurements were significantly reduced in eyes with abnormal SWAP. A weak but statistically significant correlation between the 'number' and pattern standard deviation (r = 0.3, p = 0.006) and the corrected pattern standard deviation (r = 0.3, p = 0.007) in SWAP was found. Areas of abnormal RNFL thickness corresponded to the localization of the SWAP visual field defects in corrected pattern deviation plots in 10 of the 14 eyes with defects in both tests. CONCLUSIONS: SWAP visual field defects frequently coexist and correspond with abnormalities of RNFL detected by SLP in eyes with OHT. In certain eyes, however, the two methods detect different glaucoma properties.     

Correlation of functional and structural measurements in eyes suspected of having glaucoma.

PURPOSE: This study was conducted to determine the correlation between structural changes in the retinal nerve fiber layer (RNFL) and functional loss detected on short-wavelength automated perimetry (SWAP) in a population of patients with suspected glaucoma. METHODS: With a selection criteria of intraocular pressure (IOP) more than 21 mmHg and normal results of conventional automated perimetry, 49 eyes of 49 patients with ocular hypertension were enrolled in the study. The SWAP was performed with a modified Humphrey field analyzer, and visual field indexes (mean deviation [MD], corrected pattern standard deviation [CPSD]) were calculated. Semiquantitative RNFL scores were given separately to diffuse and localized defects of the RNFL. RESULTS: The MD increased significantly with higher diffuse and total RNFL scores, with good correlation coefficients. A weak correlation was found between CPSD and diffuse, total, and localized RNFL scores. CONCLUSION: Diffuse RNFL loss are associated with abnormalities in visual field indexes (MD), whereas focal structural damage showed no correlation with visual field loss.     

Isolation of short-wavelength sensitive mechanisms in normal and glaucomatous visual field regions

PURPOSE: To determine whether "isolation" of short wavelength sensitive mechanisms (i.e., exclusive detection of a threshold stimulus by a short wavelength sensitive mechanism) is maintained in areas of glaucomatous visual field damage as measured with short-wavelength automated perimetry (SWAP). METHODS: Data from conventional automated perimetry and SWAP were analyzed for both eyes of 60 normal control subjects, 38 patients with ocular hypertension, and 22 patients with early to moderate glaucomatous field damage (mean defect better than -12 dB). Comparisons of results of SWAP and conventional perimetry were performed by determining the deviation from the mean normal sensitivity for the two procedures. Locations with sensitivity <3 dB for either procedure were rejected, as 3 dB is near the maximum stimulus luminance and may have introduced a bias by underestimating defects. The interval between deviation from normal (the isolation interval) on conventional perimetry and SWAP was examined to determine the likelihood of short wavelength mechanism isolation loss for different levels of glaucomatous visual field damage. RESULTS: Using normal isolation estimates of 13 dB and 10 dB as bases for determining the likelihood that isolation of short wavelength sensitive mechanisms may have been lost, it was found that this was an infrequent possibility, as low as 0.39 to 1.63% for normal control subjects and 2.53 to 10.44% for patients with glaucoma. CONCLUSION: Analyses indicate that isolation of short wavelength sensitive mechanisms is mostly maintained for SWAP, even in areas of moderate glaucomatous field damage. One limitation of SWAP for evaluating extensive glaucomatous damage is its dynamic range. This could be overcome by using a more intense stimulus light source.     

GDxVCC和SWAP及SAP在开角型青光眼早期诊断中的敏感性及特异性

目的:评价并比较青光眼早期诊断仪GDxVCC、短波视野计(SWAP)、标准自动视野计(SAP)各参数诊断早期开角型青光眼的敏感性和特异性。方法:采用GDxVCC和SWAP及SAP对正常人42例42眼和早期开角型青光眼患者84例84眼进行检查,绘制GDxVCC各参数(TSNIT,SA,IA,IES,NFI)ROC(receive operating characteristic curve)曲线,比较GDxVCC,SAP,SWAP的敏感性和特异性。结果:TSNIT,SA,IA,IES,NFI的ROC面积分别为0.77,0.76,0.80,0.85,0.87。GDxVCC,SWAP,SAP的敏感性分别为80.6%,74.2%,67.8%;特异性分别为95.2%,85.7%,76.2%。结论:GDxVCC参数中,NFI和IES是区分正常人和青光眼最有效指标。GDxVCC诊断能力优于SWAP,SWAP优于SAP。     

Relationship of optic disk topography and visual function in patients with large cup-to-disk ratios

PURPOSE: To determine if topographic differences exist between large cup-to-disk ratio (C/D) eyes with standard achromatic automated perimetry (SAP) abnormalities and those with only short-wavelength automated perimetry (SWAP) abnormalities. DESIGN: Cross-sectional study. METHODS: The setting was a referral university-based clinical practice. We selected one eye of 72 patients with a vertical C/D of at least 0.8 by ophthalmoscopy. Patients performed SWAP, SAP, and confocal scanning laser ophthalmoscopy. We compared optic disk topography in eyes with and without visual field abnormalities and controlled for the influence of disk area. RESULTS: Disk area was a confounder of many topographic measures. After controlling for disk area, eyes with abnormal SAP had differences in rim volume, cup shape, rim area, retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area when compared with eyes with normal SAP (P <.05). Rim volume and rim area were different in the SWAP comparison (P <.05). CONCLUSIONS: Investigators should control for disk area when evaluating topographic measures by confocal scanning laser ophthalmoscopy. In eyes with a large C/D, optic disk topography is more glaucomatous in eyes with SAP abnormalities than in those with only SWAP abnormalities. Eyes with large C/D and only SWAP abnormalities may have fewer glaucomatous optic disk changes than such eyes with SAP abnormalities. This indicates that SWAP is likely to correspond to abnormalities in optic disk topography at an earlier stage of glaucomatous optic neuropathy than SAP. Therefore, clinicians should consider SWAP testing in glaucoma suspects to detect glaucomatous visual field loss at an earlier stage of structural loss.     

Structure and function evaluation (SAFE): I. criteria for glaucomatous visual field loss using standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP)

PURPOSE: To develop criteria for detecting glaucomatous visual field loss for standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). DESIGN: Longitudinal observational study.METHODS: Three populations were evaluated: (1) 348 normal subjects (348 eyes) were tested to develop normative databases and statistical analysis packages for SAP and SWAP. (2) An independent group of 47 normal subjects (94 eyes) with 4 years of longitudinal follow-up was evaluated to determine specificity of different criteria. (3) A group of 298 patients (479 eyes) with elevated intraocular pressure and normal baseline SAP visual fields were evaluated to determine the sensitivity of different criteria for detecting early glaucomatous visual field loss. RESULTS: Six criteria demonstrated high specificity for correctly identifying eyes with normal visual fields (98%-100%) for both SAP and SWAP: (1) a pattern standard deviation (PSD) worse than the normal 1% level, (2) a glaucoma hemifield test (GHT) "outside normal limits," (3) one hemifield cluster worse than the normal 1% level, (4) two hemifield clusters worse than the normal 5% level, (5) four abnormal (P <.05) locations, (6) five abnormal locations (P <.05) on the pattern deviation probability plot. For all criteria, confirmation on a second visual field was required for high specificity. The GHT "outside normal limits," two hemifield clusters worse than the normal 5% level and four abnormal (P <.05) test locations on the pattern deviation probability plot provided the highest percentages of conversion from a normal to a glaucomatous visual field. CONCLUSIONS: Criteria based on the GHT, GHT hemifield clusters, and the pattern deviation probability plot provide high sensitivity and specificity for detecting early glaucomatous visual field changes.     

Short-wavelength automated perimetry: Abnormality criteria

This study was conducted to determine the sensitivity and specificity of different perimetric algorithms and their combination in short-wavelength automated perimetry (SWAP), for detection of early glaucomatous damage. Retinal nerve fiber layer assessment and SWAP were performed in 160 eyes, of glaucoma suspects. Perimetric abnormality criteria based on presence of clusters of points with significant sensitivity losses showed higher sensitivity in detection of early glaucomatous changes than did criteria based on global visual field indexes.     

Glaucoma detection with frequency doubling perimetry and short-wavelength perimetry

PURPOSE: The aim of this analysis was to evaluate the diagnostic usefulness of frequency doubling technology (FDT) perimetry and short-wavelength perimetry (SWAP). Moreover, to study a combination of both methods using the machine-learning technique double-bagging, which was recently established in glaucoma research. METHODS: Forty-three patients with "preperimetric" open-angle glaucoma (glaucomatous optic disc atrophy and no visual field defect in standard perimetry), 26 patients with "perimetric" open angle glaucoma (glaucomatous optic disc atrophy and visual field defect in standard perimetry), and 40 control subjects had FDT screening (protocol: C-20-5) and SWAP (Octopus 101, G2). Criteria for exclusion were color vision abnormalities, media opacities, and an age below 31 years or above 63 years. Data of 1 eye of each patient and control subject entered the statistical evaluation. A point wise evaluation of the diagnostic power of SWAP values was performed to derive spatial patterns of visual field loss. A double-bagging machine-learning algorithm was used to train classification rules on the basis of a combination of FDT scores and nerve fiber related visual field losses in SWAP. The diagnostic power of the classifiers was compared regarding their misclassification error rates and area under the receiver-operating characteristic curve. RESULTS: The combination of FDT perimetry and SWAP yielded better diagnostic results compared with FDT or SWAP separately. The overall estimated misclassification error rate of the combined classifier was 24% compared with 28% for both SWAP and FDT perimetry. Regarding the estimated performance of classifier at high specificities (>80%) in control eyes as measured by the partial area under the receiver-operating characteristic curve, the combination of both instruments is also superior to the individual instruments. CONCLUSIONS: A combination of SWAP and FDT perimetry, each targeting different neuronal pathways, may improve early glaucoma detection.     

Extension and depth of perimetric defects: Comparison of short-wavelength automated perimetry vs conventional perimetry

The amount and distribution of visual field defects in conventional automated perimetry (CAP) and short-wavelength automated perimetry (SWAP) were compared in 22 glaucomatous subjects. A modified Humphrey visual field analyzer was used for SWAP. Differential location maps were used to assess the depth and distribution of the visual field defects. Visual field defects in SWAP were deeper and more extensive than the defects revealed with CAP.     

Clinical variables associated with glaucomatous injury in eyes with large optic disc cupping.

BACKGROUND AND OBJECTIVE: To characterize the range of retinal nerve fiber layer (RNFL) and standard automated perimetry damage in eyes with large vertical cup-disc ratio (VCDR). PATIENTS AND METHODS: Complete examination, standard automated perimetry, scanning laser polarimetry with variable corneal compensation, and optical coherence tomography (OCT) of the RNFL and optic nerve head were performed. Large VCDR was defined as > or = 0.80 using stereoscopic disc examination and OCT optic nerve head analysis. Structural and functional characteristics were assessed separately in eyes with a disc area of less than 2 mm2, 2 to 2.5 mm2 and greater than 2.5 mm2. RESULTS: Fifty-seven eyes of 57 subjects were enrolled. A broad range in mean deviation (2.0 to -32.8 dB) and mean RNFL thickness with OCT (24.3-100.4 microm) and scanning laser polarimetry with variable corneal compensation (24.0-61.7 microm) was identified. Predictors of standard automated perimetry severity using multiple linear regression were mean RNFL thickness using OCT (P = .001) and scanning laser polarimetry (P = .001), OCT-vertical cup diameter (P = .003), temporal, superior, nasal, inferior, temporal standard deviation (P = .03), and OCT-disc area (P = .04). Eyes with an OCT-disc area of less than 2 mm2 demonstrated significantly greater standard automated perimetry damage, RNFL loss using OCT and scanning laser polarimetry, and OCT-rim area (P = .002, .0007, .03, and < .0001, respectively) compared with eyes with a disc area of greater than 2.5 mm2. CONCLUSIONS: Eyes with large VCDR have a wide range of RNFL atrophy and standard automated perimetry damage. Small optic discs are associated with more advanced glaucomatous injury.     

The prevalence of glaucomatous defects with short-wavelength automated perimetry in patients with elevated intraocular pressures

PURPOSE: To determine the prevalence of abnormal short-wavelength automated perimetry (SWAP) visual fields in subjects with elevated intraocular pressures (IOP) for 7 existing definitions of mild glaucomatous loss, and to explore the agreement between them. PATIENTS AND METHODS: Seven hundred and forty-four eyes of 379 subjects with an IOP > or = 22 and < or = 32 mm Hg and normal visual fields with standard automated perimetry (SAP) were tested with SWAP on 3 separate occasions, of which the second and third visual field were used for analysis. The appearance of the optic disc was not an eligibility criterion. We determined the number of visual fields classified as abnormal on 2 successive occasions by 7 existing definitions. In addition, we explored the agreement between the various definitions. RESULTS: The proportion of eyes with a glaucomatous visual field with SWAP ranged between 0% and 9.9%, depending on the criterion used to define abnormality. A pairwise comparison of the various definitions showed that several definitions classified different eyes as having an abnormal field. CONCLUSIONS: We found a large variation in the proportion of visual fields with SWAP classified as abnormal by the various definitions. More importantly, various definitions identified different individuals to have an abnormal field with SWAP. Therefore, the diagnostic accuracy and clinical significance of all definitions must be determined before SWAP is used in routine clinical care.