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F.N. Kanadani, T.M. Grippo, B. Wangsupadilok, N. Harizman, V.C. Greenstein, D.C. Hood, J.M. Liebmann, R. Ritch; Structural and Functional Assessment of the Macular Region in Patients With Glaucoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4003.
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To assess the agreement between functional [Static automated perimetry (SAP) and multifocal visual evoked potential (mfVEP)] and structural [optical coherence tomography (OCT)] tests of the macular region in glaucoma.
Thirty–seven patients (47 eyes) with open–angle glaucoma were prospectively enrolled and tested with Humphrey Field Analyzer (HVF) (10–2 program), mfVEP and OCT3 (macular scan). Inclusion criteria were glaucomatous optic neuropathy and defects on 24–2 HVF. They also had defects within the central 10 degrees with clusters of ≥3 points in the pattern deviation plot in a hemifield with a P value of <5%, one of which had a P value of <1%. Monocular mfVEPs were obtained using a pattern reversal dartboard stimulus pattern. The mfVEP was considered abnormal if the interocular or monocular probability plot had two or more adjacent points with P values < 1%, or 3 or more adjacent points with P < 5% and at least one of these points with a P value < 1%. The HVF 10–2 was analyzed using the same cluster criteria as used for the HVF 24–2. Two criteria were used for the macular OCT: 1) 2 or more sectors with P<5% or 1 sector with P<1% and 2) 1 sector with P<5%.
Forty–six of the 47 eyes (97.9%) showed a 10–2 HVF defect. Forty–two (89.4%) had an mfVEP defect in the central 10 deg. The two OCT criteria resulted in sensitivities of 85.1% and 91.5%. When both functional tests showed a defect [41/47 eyes (87.2%)], the OCT was abnormal in 36/41 eyes (87.8%) (criterion 1) and in 38/41 eyes (92.7%) (criterion 2). When HVF and OCT were abnormal, the mfVEP was normal in 4/42 (9.7%) and when mfVEP and OCT were abnormal, HVF was normal in 1/39 (2.5%) eyes. The inferior sectors of OCT had the most abnormalities, corresponding to the region (superior hemifield) with the most defects on both the mfVEP and HVF. The central region was the least affected on OCT, HVF and mfVEP.
Macular abnormalities in glaucoma can be detected by OCT and are consistent with both SAP and mfVEP. 1. Hood & Greenstein (2003) Prog Ret Eye Res.
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