September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Early glaucomatous damage is missed by standard metrics of the 24-2 visual field test and OCT circumpapillary retinal nerve fiber layer thickness analysis
Author Affiliations & Notes
  • Donald Charles Hood
    Psychology, Columbia University, New York, New York, United States
    Ophthalmology, Columbia Unversity, New York, New York, United States
  • Nicole De Cuir
    Psychology, Columbia University, New York, New York, United States
  • C Gustavo De Moraes
    Ophthalmology, Columbia Unversity, New York, New York, United States
  • Ravivarn Jarukasetphon
    Einhorn Clinical Research Center of Mount Sinai, New York Eye and Ear, New York, New York, United States
  • Diane Wang
    Psychology, Columbia University, New York, New York, United States
  • Lola Grillo
    Psychology, Columbia University, New York, New York, United States
  • Jeffrey M Liebmann
    Ophthalmology, Columbia Unversity, New York, New York, United States
  • Abinaya Thenappan
    Psychology, Columbia University, New York, New York, United States
  • Daiyan Xin
    Psychology, Columbia University, New York, New York, United States
  • Robert Ritch
    Einhorn Clinical Research Center of Mount Sinai, New York Eye and Ear, New York, New York, United States
  • Footnotes
    Commercial Relationships   Donald Hood, Heidelberg Engineering (F), Topcon, Inc (F), Topcon, Inc (C), Zeiss (C); Nicole De Cuir, None; C Gustavo De Moraes, None; Ravivarn Jarukasetphon, None; Diane Wang, None; Lola Grillo, None; Jeffrey Liebmann, None; Abinaya Thenappan, None; Daiyan Xin, None; Robert Ritch, None
  • Footnotes
    Support  NH Grant EY02115
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Donald Charles Hood, Nicole De Cuir, C Gustavo De Moraes, Ravivarn Jarukasetphon, Diane Wang, Lola Grillo, Jeffrey M Liebmann, Abinaya Thenappan, Daiyan Xin, Robert Ritch; Early glaucomatous damage is missed by standard metrics of the 24-2 visual field test and OCT circumpapillary retinal nerve fiber layer thickness analysis. Invest. Ophthalmol. Vis. Sci. 201657(12):.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : In addition to an optic disc exam, glaucoma diagnosis is often based upon standard metrics of the 24-2 visual field (VF) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness analysis of optical coherence tomography (OCT) scans. We evaluated the sensitivity of these metrics in eyes with mild, but confirmed, damage.

Methods : 143 eyes of 143 patients with abnormal or suspicious discs had open angles, a 24-2 VF mean deviation better than -6dB, and spherical refractive error between +/-6D. Two glaucoma specialists classified eyes as glaucomatous, normal/suspects, or undecided using 24-2 VFs, 10-2 VFs, disc stereo-photos, a custom inner retina reports [1] consisting of 24-2 and 10-2 VF probabilities superimposed on OCT disc and macular probability plots (3D-OCT 2000, Topcon, Inc), as well as information from the patients' charts. Of the 143 eyes, 73 eyes were classified as glaucomatous, 56 eyes as normal/suspects, and 4 eyes as undecided. 53 healthy eyes of 53 individuals were also studied. The 24-2VF and OCT metrics were obtained from commercially available reports. For the 24-2 VF, the metrics were: a mean deviation (MD) with p <5%; a pattern standard deviation (PSD) with p <5%; a glaucoma hemifield test (GHT) outside normal limits; and a cluster criterion (CC) of 3 adjacent points at 5, 5, and 1% or 5, 2, and 2% or worse within a hemifield. For the OCT cpRNFL analysis, the metrics were: a temporal, inferior, or superior quadrant (Q) with p ≤5%; the associated clock hours (CH) with 2 contiguous sectors at p ≤5% or one at p ≤1%; or a mean RNFL thickness (T) less than 75.3 μm or 85.0 μm.[2]

Results : The tables contain the results. For the 73 eyes with confirmed damage, the number of eyes missed/sensitivity for the 24-2 VF ranged from 13 eyes/82% (CC) to 32 eyes/56% (MD) eyes and for the OCT from 15 eyes/79% (Q) to 42/42% (T:75.3 um). While combining metrics slightly improved sensitivity, this was minimally effective, and specificity declined (see Tables). Further, 11 eyes were missed by all 4 24-2 VF metrics and 14 eyes by all 4 OCT metrics. 11 of these were local defects clearly seen on 10-2 and/or macular scans probability plots.

Conclusions : Confirmed glaucomatous damage can be missed by standard 24-2 VF and OCT metrics. 1. Hood & Raza. BJO. 2014; 2. Wollstein et al. BJO. 2012.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table1: 24-2VF

 

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×