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Pamela A. Sample, Charles F. Bosworth, Eytan Z. Blumenthal, Christopher Girkin, Robert N. Weinreb; Visual Function–Specific Perimetry for Indirect Comparison of Different Ganglion Cell Populations in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2000;41(7):1783-1790. doi: https://doi.org/.
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purpose. To compare short-wavelength automated perimetry, frequency-doubling
technology perimetry, and motion-automated perimetry, each of which
assesses different aspects of visual function, in eyes with
glaucomatous optic neuropathy and ocular hypertension.
methods. One hundred thirty-six eyes from 136 subjects were evaluated with all
three tests as well as with standard automated perimetry. Fields were
not used in the classification of study groups to prevent bias, because
the major purpose of the study was to evaluate each field type relative
to the others. Seventy-one of the 136 eyes had glaucomatous optic
neuropathy, 37 had ocular hypertension, and 28 served as age-matched
normal control eyes. Glaucomatous optic neuropathy was defined by
assessment of stereophotographs. Criteria were asymmetrical cupping,
the presence of rim thinning, notching, excavation, or nerve fiber
layer defect. Ocular hypertensive eyes had intraocular pressure of 23
mm Hg or more on at least two occasions and normal-appearing optic disc
stereophotographs. Criteria for abnormality on each visual field test
were selected to approximate a specificity of 90% in the normal eyes.
Thresholds for each of the four tests were compared, to determine the
percentage that were abnormal within each patient group and to assess
the agreement among test results for abnormality, location, and extent
of visual field deficit.
results. Each test identified a subset of the eyes with glaucomatous optic
neuropathy as abnormal: 46% with standard perimetry, 61% with
short-wavelength automated perimetry, 70% with frequency-doubling
perimetry, and 52% with motion-automated perimetry. In the ocular
hypertensive eyes, standard perimetry was abnormal in 5%, short
wavelength in 22%, frequency doubling in 46%, and motion in 30%.
Fifty-four percent (38/71) of eyes with glaucomatous optic neuropathy
were normal on standard fields. However, 90% were identified by at
least one of the specific visual function tests. Combining tests
improved sensitivity with slight reductions in specificity. The
agreement in at least one quadrant, when a defect was present with more
than one test, was very high at 92% to 97%. More extensive deficits
were shown by frequency-doubling perimetry followed by short-wavelength
automated perimetry, then motion-automated perimetry, and last,
standard perimetry. However, there were significant individual
differences in which test of any given pairing was more extensively
affected. Only 30% (11/37) of the ocular hypertensive eyes showed no
deficits at all compared with 71% (20/28) of the control eyes
(P < 0.001).
conclusions. For detection of functional loss standard visual field testing is not
optimum; a combination of two or more tests may improve detection of
functional loss in these eyes; in an individual, the same retinal
location is damaged, regardless of visual function under test;
glaucomatous optic neuropathy identified on stereophotographs may
precede currently measurable function loss in some eyes; conversely,
function loss with specific tests may precede detection of abnormality
by stereophotograph review; and short-wavelength automated perimetry,
frequency-doubling perimetry, and motion-automated perimetry continue
to show promise as early indicators of function loss in
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