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.