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Folkert K. Horn, Anselm M. Juenemann, Christian Y. Mardin, Robert Laemmer, Peter Martus; Predictive Value Of FDT-Perimetry For Detection Of Progressive Optic Nerve Damage In Early Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):223.
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To evaluate whether screening with FDT-perimetry is of predictive value for progression of optic nerve damage in glaucoma suspects and early glaucomas. Progression was defined morphometrically (2D), results were compared to HRT measurements.
The longitudinal observational clinical study includes 438 preperimetric patients, OHT patients, and glaucoma suspects from the Erlangen Glaucoma Registry. Inclusion criteria at baseline: visual acuity better 20/40, refractive error between -8 and +6 D, age: 30-72 years. All subjects had normal white-on-white perimetry at baseline (Octopus, mean defect less than 2dB). Two or more annual visual field examinations using FDT-screening were performed. FDT evaluation used a published method with casewise calculation of an ‘FDT-score’, including missed localized probability levels in all stimulus fields and in quadrants. For prospective analysis of the predictive value of FDT, the first measurement was always discarded because of learning effects described earlier. During follow-up, all patients underwent repeated standardized ophthalmological evaluation including morphometric analysis of color optic disk photographs, HRT, and conventional computerized perimetry. Progression of glaucoma was defined as neuroretinal rim loss during the study period based on disk photographs. Eyes in the whole study group were divided into progressive (n= 95) and non-progressive (n= 343). The median time of observation was 67 months. Statistical analysis included comparison of results at baseline, Kaplan-Meier curves and COX regression to identify covariates from clinical data and HRT.
In OHT and preperimetric patients increased FDT-score was a significantly predictive factor for disease progression. Because of the present structural definition of glaucomatous progression, morphometric measures were significant covariates. The combination of the area of the neuroretinal rim (hazard ratio 0.49, p = 0.003), FDT nasal upper quadrant (1.28, p < 0.001), FDT temporal lower quadrant (1.15, p= 0.006), and global GPS from HRT (3.7, p = 0.002) delivered highest prognostic value.
The longitudinal evaluation showed initial higher screening-score of FDT-perimetry in patients with ongoing glaucomatous defects than in non-progressive subjects. Here we used a structural diagnostic criterion for progression. The results suggest that not only morphometric measure (i.e. area of rim area) but also functional testing with FDT can be helpful to predict glaucomatous progression. The combination of FDT-perimetry and structural results further increases discrimination.
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