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P.A. Sample, F.A. Medeiros, L. Racette, J.P. Pascual, C. Boden, L.M. Zangwill, C. Bowd, R.N. Weinreb; Visual Function Specific Perimetry to Identify Glaucomatous Vision Loss in the Diagnostic Innovations in Glaucoma Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3988.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the diagnostic results of three visual function specific perimetric tests and standard automated perimetry and to identify useful parameters from each for determining abnormality.
111 eyes with glaucomatous optic neuropathy (GON), 31 eyes with progressive optic neuropathy (PGON), 53 eyes with ocular hypertension, and 51 healthy eyes were included (N=246). Visual field results were not used to classify eyes. Short–wavelength automated perimetry (SWAP) full threshold, frequency–doubling technology perimetry (FDT) N–30, high pass resolution perimetry (HPRP) and standard automated perimetry (SAP)–SITA were performed. Areas under the receiver operating characteristic (ROC) curves were used to compute sensitivity levels at given specificities. Likelihood ratios and the agreement among tests for abnormality, location, and extent of visual field deficit were assessed.
ROC analysis: FDT PSD area was larger than HPRP PSD (p=0.020) and FDT TD 5% area was larger than HPRP MD (p=0.004) in the GON group; FDT PD 5% area was larger than SWAP PSD (p=0.020) in the PGON group. At set specificities, FDT yielded higher sensitivities than all other tests for many parameters. The agreement among tests for abnormality was fair to moderate (kappa values ranging from 0.247 to 0.563). When loss was present on more than one test, the area of the visual field affected was the same in 95% (79/83) of eyes. The number of eyes identified and number of abnormal quadrants increased across groups with increasing certainty of glaucoma. Moderate (>3.80) to strong (>6.00) likelihoods of glaucoma were found.
At equal specificity, no single visual function specific perimetric test was always affected while others remained normal. FDT continues to show promise for diagnosing glaucoma. Use of two tests in combination increased specificity. Several parameters at suggested cut–offs provided good sensitivity and specificity. The likelihood ratios derived for many visual field parameters can be used to assist clinicians in diagnosing glaucoma.
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