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Alexander Friedrich Scheuerle, Frauke J Seibel, Stephan Schulz, Gerd Auffarth; Comparison of Optical Coherence Tomography, Heidelberg Retina Tomograph and Heidelberg Edge Perimeter for the detection of glaucoma with beginning visual field defects. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4743.
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© ARVO (1962-2015); The Authors (2016-present)
Early detection is crucial for the effective management of glaucoma. In a population of glaucoma patients with beginning visual field defects we compared the results of the Heidelberg Retina Tomograph (HRT), of the Heidelberg Edge Perimeter (HEP) and of the spectral-domain optical coherence tomography (SD-OCT).
26 eyes of 19 subjects with a median age of 64 years +/- 11 years (48 to 86) diagnosed with glaucoma defined by optic disc changes and a mean defect of -3.75 dB +/- 1.5 dB (-2 to -6.6 dB) in standard automated perimetry (Octopus, Haag Streit, Switzerland) were enrolled. In all eyes HRT for Moorfield Regression Analysis (MRA) was performed, 25 eyes underwent retinal nerve fiber measurement (cpRNFL) and 24 eyes were examined by Flicker-Defined-Form (FDF) Perimetry. The corresponding topographic locations of glaucomatous damage detected by the automated discriminant functions were matched with these three different instruments. We used a 6x6 grid in the posterior pole asymmetry analysis (PPAA) and a nerve fiber bundle defect was confirmed as 6 grey or black consecutive cells in a maximum of two adjoining rows.
For each eye a pairwise comparison of the results of the three different instruments was performed. Results were compared regarding six sectors and three categories (within normal limits/borderline/outside normal limits). The comparison of pathologic results in corresponding topographic locations using MRA and cpRNFL showed agreement in 48.7%, using FDF and MRA in 47.7% and using FDF and cpRNFL in 38.1%. Comparing pathologic results neglecting the location highest accordance was presented in MRA and cpRNFL (56.7%), followed by FDF and MRA (54.5%) and also FDF and cpRNFL (42.1%). The PPAA showed a fiber bundle defect in 91.7% of the examined eyes.
Among the three tested combinations MRA and cpRNFL demonstrated the best agreement. If borderline cases were treated as out of normal limits highest accordance was presented in MRA and FDF. Functional damage detected by FDF might better correspond to reduced cpRNFL compared to MRA. PPAA demonstrated good sensitivity for the detection of nerve fiber bundle defects in our population. Further studies are necessary to evaluate which combination of different techniques serves best in early detection of glaucoma.
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