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Csilla Ajtony, Gnanapragasam Nithyanandarajah, Rupert Bourne; Comparing performance of the Flicker-Defined Form (FDF) stimulus and Standard Automated Perimetry (SAP) using the Heidelberg Edge Perimeter (HEP) in patients newly referred with suspect glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3952.
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To compare the performance of Heidelberg Edge Perimeter (HEP) Flicker-Defined Form (FDF) and Standard Automated Perimetry (SAP) strategies to Humphrey SAP, in terms of reliability, duration of test and agreement between tests.
Consecutive new glaucoma suspects referred to a hospital’s glaucoma service received all 3 tests. A screening pre-test familiarised patients to the FDF stimulus followed by HEP-SAP and HEP-FDF tests. Agreement between tests was analysed using visual fields of patients with normal optic discs as judged by experienced optic disc graders using optic disc photographs.
137 patients (50 men, 57 women) with non-glaucomatous optic discs were included (average age, 61.1 years [SD, 9.9 years], range 22-89 years). 30 patients who performed unreliable HEP-FDF visual fields were excluded. Significantly lower values for test duration time compared to HFA-SAP (HEP-FDF: mean 276.3 seconds, SD 77.2 s; HEP-SAP: mean 214.9 s, SD 37.9 s; HFA-SAP: mean 307.1 s, SD 47.9 s). Among the reliability indexes, Fixation Losses were significantly fewer with the HEP-FDF (mean %, 1.19, SD 4.21; HEP-SAP: mean 5.21, SD 16.25; HFA-SAP: mean, 14.87, SD 23.69) . False Positive values (%) for HFA-SAP (mean 2.66; SD 4.62) were significantly higher than both HEP-FDF (mean 0.75; SD 1.17), or HEP-SAP (mean 0.79; SD 3.01). The mean False Negative ratios for HEP-FDF, HEP-SAP and HFA-SAP visual fields were 7.1 (SD 10.7), 3.9 (SD 8.0), 1.9 (SD 3.7), respectively. Significantly higher values for Mean Deviation (HEP-FDF: mean, -2.69, SD 2.59; HEP-SAP: mean, -0.52, SD 1.45; HFA-SAP: mean -0.64, SD 1.78; p<0.001) and Pattern Standard Deviation (HEP-FDF: mean 2.16, SD 1.13; HEP-SAP: mean, 1.53, SD, 0.91; p<0.001) were found in HEP-FDF tests.
The FDF test is intended for early detection of glaucomatous visual fields. Tests using this instrument were associated with higher false negative values than HEP-SAP and HFA-SAP. However, patients performed better on the HEP-FDF in terms of fewer fixation losses and lower false positive rates. Additionally test duration was faster with the HEP-FDF. Higher MD values were found with HEP-FDF visual fields than both HEP-SAP and HFA-SAP strategies, but PSD more closely agreed with HFA-SAP when testing these patients with normal optic nerves.
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