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Peter Martus, Anselm Jünemann, Martin Wisse, Wido M. Budde, Folkert Horn, Matthias Korth, Jost B. Jonas; Multivariate Approach for Quantification of Morphologic and Functional Damage in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2000;41(5):1099-1110.
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purpose. To determine the usefulness of confirmatory factor analysis in
examination of morphometric, electrophysiological, and psychophysical
quantitative methods that measure the extent of global glaucomatous
damage without referring to a preselected gold standard.
methods. In a cross-sectional clinical study, 406 eyes of 203 glaucoma patients
and 200 eyes of 100 normal control subjects 18 to 70 years old
underwent optic disc morphometry, automated perimetry, measurement of
temporal contrast sensitivity by a full-field flicker test,
blue-on-yellow visually evoked potential (VEP), and black-and-white
pattern-reversal electroretinogram (ERG). Diagnosis of glaucoma was
based on a qualitative classification of the optic nerve head and
retinal nerve fiber layer independent of intraocular pressure and
visual field. Confirmatory factor analysis was performed in the patient
group as a whole and in a subgroup showing moderate to advanced
glaucomatous optic nerve head damage.
results. The confirmatory factor analysis models explained the data
satisfactorily (P > 0.18, all patients; P > 0.34, subgroup). Global glaucomatous damage
was quantified best by the mean defect of automated perimetry
(r = 0.81; r = 0.87), followed
by the area of the neuroretinal rim (r = 0.64; r = 0.73), the full-field flicker test
(r = 0.59; r = 0.65), the
pattern-reversal ERG amplitude (r = 0.54; r = 0.55), and the VEP peak time
(r = 0.55; r = 0.54).
conclusions. Confirmatory factor analysis allows quantification of the validity of
established and new procedures that measure global glaucomatous damage
using cross-sectional data. The results are not dependent on the
preselection of a specific gold standard. Psychophysical testing and
morphometry quantified glaucomatous damage best, compared with
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