Blue-on-yellow perimetry and optical coherence tomography in patients with preperimetric glaucoma

Purpose: To investigate the diagnostic ability of blue‐on‐yellow perimetry (B/YP) and Stratus optical coherence tomography (OCT) in discriminating preperimetric glaucoma from normal eyes. Methods: A total 40 eyes of 40 normal subjects, 38 eyes of 38 preperimetric glaucoma patients (normal standard automated perimetry [SAP] and retinal nerve fibre layer [RNFL] defects or localized optic disc notching and thinning) were enrolled in the study. All the patients underwent SAP and B/YP tests, and OCT measurements. The correlation between B/YP indices and OCT parameters in the eyes with preperimetric glaucoma was analysed. Receiver operating characteristic (ROC) curve area was calculated to discriminate preperimetric glaucoma from normal eyes. Results: In preperimetric glaucoma, 42% eyes (16/38) had B/YP visual field loss, and 68% eyes (26/38) had RNFL defects with OCT measurements. A mild significant correlation was found between B/YP pattern standard deviation (PSD) and average RNFL thickness (Avg.Thi) (R² = 0.112, P = 0.012), superior maximum (Smax) (R² = 0.140, P = 0.005) and maximum‐minimum (Max‐Min) (R² = 0.074, P = 0.042) in the preperimetric glaucoma group. The areas under the ROC curve for B/YP PSD and B/YP mean deviation were 0.721 and 0.665, respectively, and the three OCT parameters with the widest areas under the ROC curve were Avg.Thi (0.719), inferior average (Iavg) (0.718) and nasal average (Navg) (0.706). The highest sensitivity of the individual B/YP indices and OCT parameters for detection of preperimetric glaucoma was B/YP mean deviation (32%) and Smax/Navg (40%) at 90% specificity; the highest sensitivity of the individual B/YP indices and OCT parameters was B/YP PSD (49%) and Iavg (56%) at 80% specificity. Conclusion: The sensitivity of B/YP indices and Stratus OCT RNFL thickness parameters is low for detecting preperimetric glaucoma, suggesting that BYP and OCT as utilized in this study have limited utility in the detection of preperimetric glaucoma.     

Diagnostic accuracy of the Matrix 24-2 and original N-30 frequency-doubling technology tests compared with standard automated perimetry

PURPOSE: To compare the diagnostic accuracy of the Matrix frequency-doubling technology (FDT) 24-2, first-generation FDT N-30 (FDT N-30), and standard automated perimetry (SAP) tests of visual function. METHODS: One eye of each of 85 glaucoma patients and 81 healthy controls from the Diagnostic Innovations in Glaucoma Study was included. Evidence of glaucomatous optic neuropathy on stereophotographs was used to classify the eyes. Matrix FDT 24-2, first-generation FDT N-30, and SAP-SITA 24-2 tests were performed on all participants within 3 months. Receiver operating characteristic (ROC) curves were generated and used to determine sensitivity levels at 80% and 90% specificity for mean deviation (MD), pattern standard deviation (PSD), number of total deviation (TD), and pattern deviation (PD) points triggered at less than 5% and 1%. The tests were compared using the best parameter for each test (that with the highest area under the ROC curve) and with the PSD. RESULTS: The best parameters were MD for SAP (0.680), PSD for FDT N-30 (0.733), and number of TD less than 5% points for FDT 24-2 (0.774). Using the best parameter, the area under the ROC curve was significantly larger for FDT 24-2 than for SAP (P = 0.01). No statistically significant differences were observed between SAP and FDT N-30 (P = 0.21) and FDT N-30 and FDT 24-2 (P = 0.26). Similar results were obtained when the PSD was used to compare the tests, with the exception that the area under the ROC curve for the FDT N-30 test (0.733) was significantly larger than that of the SAP-SITA (0.641; P = 0.03). CONCLUSIONS: The performance of the Matrix FDT 24-2 was similar to that of the first-generation FDT N-30. The Matrix FDT 24-2 test was consistently better than SAP at discriminating between healthy and glaucomatous eyes. Further studies are needed to evaluate the ability of the Matrix FDT 24-2 to monitor glaucoma progression.     

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.     

A statistical approach to the evaluation of covariate effects on the receiver operating characteristic curves of diagnostic tests in glaucoma

PURPOSE: To describe an approach for the evaluation of covariate effects on receiver operating characteristic (ROC) curves and to apply this methodology to the investigation of the effects of disease severity and age on the diagnostic performance of frequency doubling technology (FDT) and standard automated perimetry (SAP) visual function tests for glaucoma detection. METHODS: The study included 370 eyes of 211 participants, with 174 eyes of 110 patients having glaucomatous optic neuropathy and 196 eyes of 101 subjects being normal. All patients underwent visual function testing with FDT 24-2 Humphrey Matrix and SAP SITA (Carl Zeiss Meditec, Inc., Dublin, CA). Disease severity was evaluated by the amount of neuroretinal rim loss assessed by confocal scanning laser ophthalmoscopy. An ROC regression model was fitted to evaluate the influence of disease severity and age on the diagnostic performance of the pattern SD (PSD) index from FDT 24-2 and SAP SITA. RESULTS: After adjustment for age, the areas under the ROC curves (AUCs) for SAP SITA PSD for 10%, 30%, 50%, and 70% loss of neuroretinal rim area were 0.638, 0.756, 0.852, and 0.920, respectively. Corresponding values for FDT 24-2 PSD were 0.766, 0.857, 0.922, and 0.962. For 10% and 30% rim loss, FDT 24-2 PSD had a significantly larger AUC than did SAP SITA PSD. CONCLUSIONS: A regression methodology to evaluate covariate effects on ROC curves can be useful for assessment of diagnostic tests in glaucoma. Using the proposed methodology, a significantly better performance of FDT 24-2 compared to SAP SITA for diagnosis of early glaucoma was demonstrated.     

Identifying glaucomatous vision loss with visual-function-specific perimetry in the diagnostic innovations in glaucoma study

PURPOSE: To compare the diagnostic results of four perimetric tests and to identify useful parameters from each for determining abnormality. METHODS: One hundred eleven eyes with glaucomatous optic neuropathy (GON), 31 with progressive optic neuropathy (PGON) 53 with ocular hypertension, and 51 with no disease were included (N = 246). Visual field results were not used to classify the eyes. Short-wavelength automated perimetry (SWAP), frequency-doubling technology perimetry (FDT), high-pass resolution perimetry (HPRP), and standard automated perimetry (SAP) were performed. Receiver operating characteristic (ROC) curves were used to compute the areas under the curves (AUC) and sensitivity levels at given specificities for a variety of abnormality criteria. The agreement among tests for abnormality, location, and extent of visual field deficit were assessed. RESULTS: AUC analysis: When the normal group was compared with the GON group, the FDT pattern SD (PSD) area was larger than the HPRP PSD (P = 0.020), and the FDT area of total deviation (TD) <5% was larger than the HPRP mean deviation (MD; P = 0.004). When the normal group was compared with the PGON group, the FDT area of pattern deviation (PD) <5% was larger than the SWAP PSD (P = 0.020). A difference from previous work was that AUCs for PSD or the best SAP were not significantly poorer than those in the function-specific tests. At set specificities, FDT yielded higher sensitivities than all other tests for all parameters. The agreement among tests for abnormality was fair to moderate (kappa = 247-0.563). When loss was present on more than one test, the quadrant of the visual field affected was the same in 95% (79/83) of eyes. The number of eyes identified and number of abnormal quadrants increased across groups with increasing certainty of glaucoma. CONCLUSIONS: At equal specificity, no single perimetric test was always affected, whereas others remained normal. Several parameters at suggested criterion values provided good sensitivity and specificity. FDT showed the highest sensitivity overall, with SAP performing better than in prior reports. Of note, the same area of the retina was identified as damaged in all tests.     

Relación entre la perimetría automatizada convencional y los parámetros de la capa de fibras nerviosas de la retina obtenidos con la polarimetría láser

PurposeTo determine the relationship between the structural parameters of the retinal nerve fiber layer (RNFL) obtained by using the scanning laser polarimetry with variable corneal compensation (GDx VCC) and the results of standard automated perimetry (SAP), in normal, ocular hypertensive, preperimetric glaucomas and glaucoma subjects.MethodsA total of 423 eyes of 423 consecutive subjects were prospectively included in the study and classified depending on the basal intraocular pressure, optic nerve head appearance and SAP results into four groups: 87 normal eyes, 192 ocular hypertensive eyes, 70 preperimetric glaucomas and 74 glaucomatous eyes. Pearson's correlation coefficients, between mean deviation (MD), pattern standard deviation, number of points altered in each quadrant, and number of points altered at different probability levels of SAP and structural parameters of RNFL obtained by using GDx VCC, were calculated in the different diagnostic groups. In the glaucoma group correlations between the 52 points tested by 24-2 SITA standard and GDx parameters were also calculated. Regression curves were plotted for the strongest correlations.ResultsWeak or non-significant correlations were found in the normal, ocular hypertensive and preperimetric glaucoma groups. However, the glaucoma group presented weak to moderate correlations between several GDx VCC parameters and the SAP variables analysed. The strongest correlation was observed between the standard deviation TSNIT and the MD (0.460).ConclusionsRNFL parameters measured with the GDx VCC presented weak to moderate correlations with the visual field indices and the number of altered points in the glaucoma group.     

Matrix视野计N-30-F程序与倍频视野计N-30程序检测结果一致性的初步分析

目的 评价Humphery Matrix视野计的N-30-F程序与倍频视野计(frequency-doublingtechnology,FDT)N-30程序的检查结果是否具有一致性.方法 对受检眼32例32只眼(原发性开角型青光眼10例10只眼,可疑青光眼患者13例13只眼,正常人3例3眼,高眼压症6例6只眼)进行上述两种视野程序检查,比较两种检查结果的平均偏差(Mean Deviation,MD)、图型标准偏差(Pattern Standard Deviation,PSD)、总体偏差概率图中概率小于5%的缺损点数以及检查所需时间.结果 MD、PSD及总体偏差概率图中概率小于5%的缺损点数,在两种视野程序检查结果间差异均无有统计学意义(分别为P=0.958,P=0.932,P=0.496),这些参数在这两种程序检查结果有显著相关性(分别为r=0.898,P＜0.01;r=0.559,P＜0.01;r=0.734,P＜0.01),并且两种检测结果有很高的一致性.检查所需时间,Humphery Matrix为3'26",FDT为5'14"(P＜0.01).结论 Humphery Matrix视野计的N-30-F程序与FDTN-30程序的检查结果高度一致,并且前者检查所需时间更短.

Abstract：

Objective To determine the comparability of the N-30-F test with the new Humphrey Matrix instrument to the traditional frequency-doubling technology(FDT)N-30 test.Methods A sample of 32 eyes from 32 patients(3 normal subjects,6 with ocular hypertension,10 with primary open-angle glaucoma (POAG),13 with suspect glaucoma)underwent visual field testing with standard automated perimetry,and with FDT,using the FDT N-30 program,and the Matrix N-30-F program.The plots,mean deviation(MD),pattern standard deviation(PSD),defect locations on the Total Deviation Probability(TDP)and test time were compared.Results No statistically significant differences were found between corresponding parameters of the two tests.High coefficients and the agreement were associated with the MD values,the PSD values and the total number of abnormal test locations on the TDP plot of the two tests.The test time for the Matrix test was significantly shorter.Conclusions The FDT N-30 and Matrix N-30-F tests are comparable in screening for early diagnosis of glaucoma,and the test time for the Matrix test is significantly shorter.     

Correlation between early retinal nerve fiber layer loss and visual field loss determined by three different perimetric strategies: white-on-white,frequency-doubling,or flicker-defined form perimetry

Purpose

To compare the significance of white-on-white standard automated perimetry (SAP), matrix frequency doubling technology (FDT), and flicker-defined form perimetry (FDF) for early detection of nerve fiber layer loss in early glaucoma patients.

Methods

Fifty-one healthy controls and 40 patients with early glaucomatous nerve fiber loss were enrolled in this study. Patients had retinal nerve fiber layer (RNFL) imaging and visual field testing by SAP, FDT matrix, and FDF perimetry at the same visit. Visual field defects were confirmed with two or more consecutive examinations by the same types of perimetry. Significant retinal nerve fiber layer loss and thus early glaucoma was defined with the reference to the RNFL thickness deviation map. The sensitivity, specificity, correlation, MD (mean deviation) and PSD (pattern standard deviation) visual field indexes, and area under the receiver operating characteristic curve (AUC) of MD and PSD of the perimetries were compared.

Results

There was a significant difference in nerve fiber layer thickness between healthy patients (97.7 ± 1.34 μm and patients with early glaucoma (84.1 ± 1.58 μm) (p?p?0.6. AUCs of PSD were not reliable in all of the three VF devices.

Conclusions

The sensitivity for detection of RNFL loss in early glaucoma seems to be higher in FDF and FDT matrix than SAP perimetry, while specifity was highest in SAP. Thus, simultaneous performance of FDF/FDT matrix and SAP perimetry seems beneficial for the correct diagnosis of early glaucoma in patients.     

Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function

PURPOSE: To compare the abilities of scanning laser polarimetry (SLP), optical coherence tomography (OCT), short-wavelength automated perimetry (SWAP), and frequency-doubling technology (FDT) perimetry to discriminate between healthy eyes and those with early glaucoma, classified based on standard automated perimetry (SAP) and optic disc appearance. To determine the agreement among instruments for classifying eyes as glaucomatous. METHODS: One eye of each of 94 subjects was included. Healthy eyes (n = 38) had both normal-appearing optic discs and normal SAP results. Glaucoma by SAP (n = 42) required a repeatable abnormal result (glaucoma hemifield test [GHT] or corrected pattern standard deviation [CPSD] outside normal limits). Glaucoma by disc appearance (n = 51) was based on masked stereoscopic photograph evaluation. Receiver operating characteristic (ROC) curve areas, sensitivities, and specificities were calculated for each instrument separately for each diagnosis. RESULTS: The largest area under the ROC curve was found for OCT inferior quadrant thickness (0.91 for diagnosis based on SAP, 0.89 for diagnosis based on disc appearance), followed by the FDT number of total deviation plot points of < or =5% (0.88 and 0.87, respectively), SLP linear discriminant function (0.79 and 0.81, respectively), and SWAP PSD (0.78 and 0.76, respectively). For diagnosis based on SAP, the ROC curve area was significantly larger for OCT than for SLP and SWAP. For diagnosis based on disc appearance, the ROC curve area was significantly larger for OCT than for SWAP. For both diagnostic criteria, at specificities of > or =90% and > or =70%, the most sensitive OCT parameter was more sensitive than the most sensitive SWAP and SLP parameters. For diagnosis based on SAP, the most sensitive FDT parameter was more sensitive than the most sensitive SLP parameter at specificities of > or =90% and > or =70% and was more sensitive than the most sensitive SWAP parameter at specificity of > or =70%. For diagnosis based on disc appearance at specificity of > or =90%, the most sensitive FDT parameter was more sensitive than the most sensitive SWAP and SLP parameters. At specificity > or = 90%, agreement among instruments for classifying eyes as glaucomatous was poor. CONCLUSIONS: In general, areas under the ROC curve were largest (although not always significantly so) for OCT parameters, followed by FDT, SLP, and SWAP, regardless of the definition of glaucoma used. The most sensitive OCT and FDT parameters tended to be more sensitive than the most sensitive SWAP and SLP parameters at the specificities investigated, regardless of diagnostic criteria.     

Humphrey matrix frequency doubling technology perimetry and optical coherence tomography measurement of the retinal nerve fiber layer thickness in both normal and ocular hypertensive subjects

PURPOSE: The purpose of this study was to determine by means of the Humphrey Matrix frequency doubling technology (FDT) perimetry and the optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurement whether functional and/or structural differences exist between normal and ocular hypertensive (OHT) subjects. PATIENTS AND METHODS: One eye of 60 consecutive normal individuals and 60 OHT subjects was enrolled in this prospective observational comparative case series study. All subjects were examined at either the Ophthalmology Clinic, University of Chieti-Pescara, Chieti, Italy or the Department of Ophthalmology, S. Maria della Misericordia Hospital, Udine, Italy. All subjects underwent a full ophthalmic examination, including visual acuity, slit-lamp biomicroscopy, central corneal thickness ultrasound pachymetry measurement, achromatic automated perimetry, Matrix FDT perimetry, stereoscopic optic nerve head photography, and OCT. Matrix FDT perimetry mean deviation (MD), pattern standard deviation, glaucoma hemifield test, and 12 OCT RNFL thickness parameters were examined. Student t test, Bonferroni correction for multiple comparisons and receiver operator characteristics curve areas (AUROCs) were used to find any discrimination function between healthy and OHT eyes. Sensitivities at 83% and 92% specificities were reported. RESULTS: The FDT MD scores ranged from -1.10 to +3.80 decibels (db) in normal individuals and from -4.75 to +3.20 db in OHT subjects. The comparison between the average MD in the 2 groups showed a statistically significant difference (P=0.024). OCT showed a statistically significant difference between the 2 groups when examining the ratio between the inferior and the superior mean RNFL thickness (P=0.004). For OCT, the parameter with the largest AUROC for discriminating between healthy and hypertensive eyes was the ratio between the mean inferior and superior RNFL thickness (AUROC=0.85, sensitivity=75% at specificity=83%, sensitivity=67% at specificity=92%). For Matrix FDT perimetry, the parameter with the largest AUROC was MD (AUROC=0.78, sensitivity=67% at specificity=83%, sensitivity=58% at specificity=92%). CONCLUSIONS: Our results suggest that OHT eyes having a normal achromatic automated perimetry and a normal clinical disc appearance cannot be differentiated from normal eyes using conventional OCT parameters. When analyzing the ratio between inferior and superior average RNFL thickness, however, a significant difference is evident between healthy and hypertensive eyes. Using Matrix FDT perimetry, a significant difference in MD seems to exist between these 2 groups of eyes. The AUROCs confirm that OCT Iavg/Savg and Matrix FDT MD show the greatest sensitivity and specificity among the examined OCT and Matrix FDT parameters.     

Frequency doubling technology perimetry with the Humphrey Matrix 30-2 test

PURPOSE: To assess the Humphrey Matrix 30-2 test in detecting functional glaucomatous damage. PATIENTS AND METHODS: One eye in each of 60 healthy individuals, 108 patients with ocular hypertension (OHT), and 150 patients with preperimetric (48) or perimetric (102) high-tension primary open-angle glaucoma (POAG) were considered. Visual fields were assessed by the standard automated perimetry (SAP) Humphrey Field Analyzer 30-2, frequency doubling technology (FDT) N-30, and Humphrey Matrix 30-2 tests. Significantly abnormal points in the pattern deviation probability plot, testing time, sensitivity, specificity, and area under the receiver operating characteristic curve of the FDT tests were evaluated. RESULTS: FDT revealed a significantly greater percentage of depressed points than did SAP in OHT and preperimetric POAG eyes. The FDT-N-30 test showed a significantly greater percentage of areas with P < 5% in the OHT, preperimetric POAG, and early POAG groups. The Matrix-30-2 test provided an area under the receiver operating characteristic curve slightly lower than the FDT-N-30 test in the preperimetric POAG group, and significantly greater in the perimetric POAG group. CONCLUSIONS: FDT perimetry appeared more sensitive than SAP in detecting early glaucomatous VF loss. The FDT-N-30 test showed a slightly higher ability to detect early glaucomatous damage in patients at risk for the development of glaucoma, whereas the Matrix-30-2 test provided a more detailed characterization of the glaucomatous VF loss pattern, although it required 30% more time.     

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.     

Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by optical coherence tomography

PURPOSE: To evaluate the strength and pattern of the relationship between visual field (VF) sensitivity and retinal nerve fiber layer (RNFL) thickness as measured by StratusOCT (Carl Zeiss Meditec, Inc., Dublin, CA). METHODS: Three hundred eleven subjects--45 normal, 102 with preperimetric glaucoma (PPG), and 164 with primary open-angle glaucoma (POAG)--were enrolled in this cross-sectional study. The relationship between RNFL thickness and VF sensitivity, expressed as mean deviation (MD) and mean sensitivity (MS), were evaluated with linear and nonlinear regression models, and the coefficient of determination (R(2)) was calculated. The association between RNFL/VF was described by bivariate Pearson correlation coefficients. RESULTS: The correlation of RNFL and the VF parameters MS and MD in normal and PPG eyes was not significant. In POAG eyes, RNFL and both MS (r = 0.733) and MD (r = 0.718) correlated significantly. Linear regression plots of MS or MD against RNFL thickness demonstrated a negligible degree of determination in normal (R(2) = 0.0378 and 0.0121, respectively) and PPG groups (R(2) = 0.0215 and 0.0151, respectively), whereas their relationship fit a curvilinear regression model (R(2) = 0.6947 and 0.723) in the POAG group. Receiver operating characteristic (ROC) curves describing the VF parameters and average RNFL thickness (AVG) were evaluated to differentiate PPG from POAG eyes. Repeated analysis with the best-performing test parameter, pattern standard deviation (PSD) (AUROC = 0.937) with a cutoff of 1.9 dB, showed that regression profiles in the POAG group with PSD >1.9 dB maintained a strong curvilinear RNFL/VF relationship, whereas those with PSD <1.9 dB exhibited a relationship almost indistinguishable from the PPG group. CONCLUSIONS: Evaluation of the structure-function relationship in normal subjects and those with PPG or POAG showed strong curvilinear regression in POAG eyes with PSD >1.9 dB and RNFL AVG thickness below 70 microm, whereas no correlation was detectable above these values.     

Combined use of frequency doubling perimetry and polarimetric measurements of retinal nerve fiber layer in glaucoma detection

PURPOSE: The aim of this study was to evaluate the diagnostic usefulness of the combined use of frequency-doubling technology (FDT) perimetry and polarimetry of the retinal nerve fiber layer. DESIGN: Cross-sectional study. METHODS: Seventy ocular hypertensive patients (normal optic disk and standard perimetry, elevated intraocular pressure [>21 mm Hg]), 59 patients with "preperimetric" open-angle glaucoma (glaucomatous optic disk atrophy, elevated intraocular pressure [>21 mm Hg], no visual field defect in standard perimetry), 105 patients with "perimetric" open-angle glaucoma (glaucomatous optic disk atrophy and clearly marked visual field defect), and 73 control subjects had FDT screening (protocol: C-20-5) and polarimetric measurements (GDx). Criteria for exclusion: optic disks larger than 4 mm(2), media opacities, patients younger than 33 years or older than 66 years. None of the subjects had earlier FDT perimetry. One eye of each patient and control subject entered the statistical evaluation. Database and statistical software were used for case-wise recalculation of all missed localized probability levels to create a FDT screening score. RESULTS: At a predefined specificity of 94.5% in control eyes, discrimination between "perimetric" glaucoma and normal subjects is superior using the FDT perimetry (sensitivity = 84.8%) in comparison to polarimetry (sensitivity = 63.8%), whereas sensitivity is similar with both methods in "preperimetric" patients (GDx, FDT: 25.4%). In several cases, patients classified as glaucomatous by the GDx are not the same patients as identified by the FDT perimetry. Therefore, a two-dimensional discrimination analysis can increase correct positive classification. Using a linear combination of the present FDT screening score and polarimetry ("the number"), 92.4% of "perimetric" glaucoma eyes and 44.1% of "preperimetric" glaucoma eyes have been classified as glaucomatous. CONCLUSION: Joint usage of polarimetry and FDT perimetry indicate that a combination of different techniques which can uncover different glaucoma properties, might be helpful in early glaucoma detection.     

Relationship between Humphrey 30-2 SITA Standard Test, Matrix 30-2 threshold test, and Heidelberg retina tomograph in ocular hypertensive and glaucoma patients

PURPOSE: To evaluate the relationship between global indices of Humphrey standard automated perimetry (SAP, 30-2 SITA standard test), Humphrey Matrix frequency doubling technology (FDT, 30-2 threshold test), and Heidelberg Retina Tomograph (HRT II) parameters and measure the level of agreement among these 3 tests in classifying eyes as normal or abnormal. METHODS: The study included 1 eye of 29 ocular hypertensive and 56 glaucoma patients with a mean age of 60.9+/-10.5 years. All subjects had reliable visual fields and HRT measurements performed within a 2-week period. The eyes were classified as normal/abnormal according to visual field criteria and Moorfields regression analysis (MRA). Correlations between visual field indices (mean deviation and pattern standard deviation) and HRT parameters were analyzed using Spearman correlation coefficient (r) and the agreement between the tests in classifying eyes was defined with kappa value. RESULTS: FDT Matrix mean deviation and pattern standard deviation parameters were found to be highly correlated with those of SAP (r=0.66 and 0.69, respectively). Visual field indices showed statistically significant correlations with cup area, rim area, cup/disc (C/D) area, linear C/D, cup shape, mean retinal nerve fiber layer thickness and retinal nerve fiber layer area parameters (P<0.05). Fifty-eight patients (68.2%) had abnormal results at least with 1 of the tests and 21 subjects (24.7%) had abnormal results with all 3 tests. The kappa values were 0.6 for SAP and Matrix (P<0.001), 0.33 for SAP and MRA (P=0.002), and 0.31 for Matrix and MRA (P=0.004). CONCLUSIONS: FDT Matrix results are highly comparable with SAP in the assessment of glaucoma. Visual field global indices show statistically significant, but low-moderate correlations with most of the HRT parameters. The agreement among MRA and visual fields for abnormality is fair. Either HRT or visual fields may show the first evidence of glaucomatous damage; therefore, the combination of optic nerve head parameters and visual field results could improve glaucoma diagnosis and follow-up.     

频域OCT视盘形态及神经纤维层厚度参数在青光眼诊断中的作用μ

背景青光眼是一种可引起视神经结构改变,继而导致不可逆视功能损害的一类疾病。光学相干断层扫描（OCT）通过对视盘形态以及神经纤维层的检测,有助于青光眼的早期诊断。目的探讨频域OCT视盘形态及神经纤维层厚度各参数在青光眼诊断中的作用。方法非干预性、横断面研究。应用频域RTVue OCT测量62例正常人和67例青光眼患者的视盘参数,以及视网膜各区域的神经纤维层厚度。用受试者工作特性曲线下面积（ROC）评价OCT每个检测参数区分正常眼与青光眼的能力大小。结果各型青光眼组患者的年龄明显大于正常组,各型青光眼组视野平均缺损（MD）和视野模式标准化差（PSD）值均明显大于正常组,差异均有统计学意义（P〈0．01）。正常组、青光眼组、开角型青光眼组和闭角型青光眼组间视盘面积的总体差异均无统计学意义（P=0．101、0．741、0．652）;正常人平均视网膜神经纤维层厚度为（109．758±9．095）μm,青光眼患者为（79．539±18．986）μm,明显低于正常人（P〈0．01）。在视盘周围8个神经纤维层区域中,正常人最厚的区域在颞下方和颞上方,分别为（150．109±18．007）μm和（146．105±15．529）μm,而青光眼患者最厚处在颞上方和颞下方,分别为（104．354±27．641）μm和（102．436±32．243）μm,但均较正常参数减小。正常人和青光眼患者鼻侧和颞侧视网膜神经纤维层厚度均较薄。视盘参数中,各型青光眼诊断效能最高的是盘沿容积和垂直杯盘比,二者的ROC值在总青光眼患者中分别为0．850和0．840,其特异性在80％时的敏感性分别为73．1％和76．1％,在开角型青光眼患者中分别为0．841和0．849,其特异性在80％时的敏感性分别为73．0％和81．1％,在闭角型青光眼患者中分别为0．862和0．830,其特异性在80％时的敏感性分别为73．3％和70．O％。视网膜神经纤维层厚度各参数中,诊断效能最高的是平均神经纤维层厚度,其ROC值在总青光眼、开角型青光眼、闭角型青光眼中分别为0．925、0．910和0．942,其特异性在80％时的敏感性分别为89．6％、89．2％和90．0％。视盘周围8个神经纤维层区域中,诊断效能最高的是IT区域,诊断效能最低的是TU和TL区域。结论RTVueOCT具有很好地区别正常人和青光眼患者的能力,在青光眼诊断方面是一个较实用的工具。     

Frequency doubling technology perimetry in open-angle glaucoma eyes with hemifield visual field damage: comparison of high-tension and normal-tension groups

PURPOSE: To evaluate the performance of frequency doubling technology (FDT) perimetry in open-angle glaucoma eyes with hemifield visual field damage and to compare it between open-angle glaucoma with high pressure [high-tension glaucoma (HTG)] and those with normal pressure [normal-tension glaucoma (NTG)] groups. METHODS: FDT perimetry with the N-30 full threshold protocol and standard automated perimetry (SAP) using the Humphrey Field Analyzer with the 30-2 full threshold protocol were performed in 20 eyes of 20 HTG patients and 36 eyes of 36 NTG patients with visual field damage confirmed with SAP in only one hemifield. RESULTS: There was no significant difference in demographics, the Heidelberg Retina Tomography indices, and the Humphrey Field Analyzer indices between HTG and NTG groups. Regarding the FDT perimetry results, mean deviation in the global field (P=0.009) and mean sensitivity in the SAP-spared (P=0.001) and SAP-impaired (P=0.011) hemifields were lower; the numbers of FDT abnormal test points (probability of abnormality <5%) in the SAP-spared hemifield were significantly greater (P=0.005) in HTG than in NTG groups. Eyes in which FDT results of the SAP-spared hemifield were judged as abnormal was more frequent in HTG groups (P=0.007). CONCLUSIONS: The performance of FDT perimetry to detect early or preperimetric glaucomatous functional changes should be different between HTG and NTG eyes.     

Scanning laser polarimetry versus frequency-doubling perimetry and conventional threshold perimetry: changes during a 12-month follow-up in preperimetric glaucoma. A pilot study.

PURPOSE: To evaluate the possibility for detecting the progression in preperimetric primary open angle glaucoma (POAG) using scanning laser polarimetry (SLP), frequency-doubling technology (FDT), and conventional automated perimetry (AP). PATIENTS AND METHODS: 22 eyes of 11 preperimetric POAG patients were evaluated using SLP (Nerve Fiber Analyzer, GDx), AP (Humphrey 24-2 threshold test) and FDT (30 degrees threshold test). All eyes had intraocular pressure (IOP) higher than 21 mmHg before treatment, but were consistently lower than 22 mm Hg with unchanged topical medication before and during the study. At the initial evaluation session optic nerve heads showed mild glaucomatous changes but the visual fields were normal (MD better than 2.0 dB, Glaucoma Hemifield Test: within normal limits or borderline). AP and FDT measurements were repeated 6 months later, and all three tests were repeated 12 months after the first investigation. RESULTS: IOP, AP and FDT measurements showed no statistically significant changes during the 12-month follow up period. In contrast to this, a tendency for a glaucomatous type decrease was seen with SLP in the retinal nerve fibre layer (RNFL) thickness parameters (mean superior and inferior sector thickness values, ellipse average thickness and maximal modulation). The mean decrease of RNFL thickness in the superior and inferior sectors was 2.77 microm and 2.48 microm, respectively. Using the two-way nested ANOVA, which considers the relation between the right and left eyes of the subjects, the decrease was statistically significant (p=0.021) for the inferior sector RNFL thickness. CONCLUSION: The results suggest that scanning laser polarimetry is a useful technique to detect and measure glaucomatous progression in early glaucoma. Scanning laser polarimetry of the RNFL may help to detect and quantify early progression even if worsening is not seen with perimetry and FDT tests.     

Polarimetric measurement of retinal nerve fiber layer thickness in glaucoma diagnosis

PURPOSE: To evaluate reliability and diagnostic value of polarimetric measurements of the retinal nerve fiber layer (RNFL) thickness in the diagnosis of glaucoma. METHODS: The study included 81 eyes with perimetric glaucoma with glaucomatous changes of the optic disc and visual field defects; 52 eyes with preperimetric glaucoma with glaucomatous optic disc abnormalities and normal achromatic visual fields; and 70 normal eyes. For determination of reliability, four examiners repeated polarimetric measurements five times in ten normal subjects. RESULTS: The polarimetric variables were significantly correlated with increasing mean visual field defect and decreasing neuroretinal rim area. In correlation analyses with visual field defects, correlation coefficients were highest for the variable "superior/nasal ratio" and "the Number," a variable calculated by the neural network of the device. In correlations with neuroretinal rim area, correlation coefficients were highest for measurements of the inferior nerve fiber layer thickness. The preperimetric glaucoma group and the control group differed significantly in the variables "superior/nasal ratio" and "the Number" and, to a smaller degree, in the variables "superior/temporal ratio" and "superior/inferior ratio." The Number variable had a sensitivity of 82% and 58% at a predefined specificity of 80% in separating perimetric glaucoma patients and preperimetric glaucoma patients, respectively, from control subjects. Reproducibility of the polarimetric measurements ranged between 70% and 89%. CONCLUSION: Polarimetric measurements of the RNFL thickness can detect glaucomatous optic nerve damage in patients with visual field loss, and in some patients with preperimetric glaucomatous optic nerve damage. Considering the fast performance, easy handling, and low maintenance costs, RNFL polarimetry may be helpful in glaucoma diagnosis.     

Frequency doubling technology and scanning laser tomography in eyes with generalized enlargement of optic disc cupping

PURPOSE: To characterize functional and structural changes in eyes with generalized enlargement of optic disc cupping (vertical cup/disc ratio > or = 0.8), normal intraocular pressure, normal standard achromatic automated perimetry (SAP) results, and no other ophthalmoscopic findings suggesting glaucoma (large C/D eyes) using frequency doubling technology (FDT) and the Heidelberg Retina Tomograph (HRT). METHODS: This comparative observational case series included 30 large C/D eyes (30 subjects), 17 eyes (17 patients) with early-stage normal tension glaucoma with generalized enlargement of optic disc cupping (NTG eyes), and 25 eyes from 25 normal subjects (normal eyes). Results with Humphrey 30-2, FDT N-30 threshold programs, and HRT were compared among these groups. Large C/D eyes were subdivided into FDT-normal and -abnormal eyes according to the predetermined criteria and HRT parameters were compared among them. RESULTS: No significant difference was seen in HRT parameters between the large C/D and NTG eyes. In the large C/D eyes, FDT mean deviation was lower than in the normal eyes and higher than in the NTG eyes, whereas FDT pattern standard deviation was smaller than in the NTG eyes (P = 0.02-0.03). Among HRT parameters, only cup shape measure (CSM) showed significant negative correlation with FDT mean deviation in the large C/D eyes. Between FDT-normal and -abnormal subgroups, only CSM showed significant difference (P < 0.01). CONCLUSION: Frequency doubling technology showed abnormalities in large C/D eyes. Only CSM showed significant correlation with FDT result and difference between those with normal and abnormal FDT results. In management of large C/D eyes, FDT and CSM will be useful to detect functional and structural change.