Diagnostic Ability Of Heidelberg Edge Perimetry For Glaucoma

Abstract

Purpose: : To evaluate and compare the diagnostic ability of white-on-white Heidelberg Edge perimetry (HEP) and Humphrey perimetry to detect retinal nerve fiber layer (RNFL) defects measured with spectral-domain optical coherence tomography (OCT).

Methods: : One hundred normal subjects and 65 age-matched glaucoma patients were prospectively selected. Only one eye per subject was randomly included in the statistical analysis. All participants underwent a comprehensive ophthalmologic examination, a reliable HEP (Heidelberg Engineering, Dossenheim, Germany; 24-2 ASTA Standard strategy), a reliable visual field performed with the Humphrey Field Analyzer (HFA; Zeiss Humphrey Systems, Dublin, CA; 24-2 SITA Standard strategy), and imaging with the Cirrus OCT (Carl Zeiss Meditec, Dublin, CA; optic disc cube 200x200 protocol). Glaucoma patients had intraocular pressure higher than 21 mmHg and an average RNFL thickness significantly thinned beyond the 5% level. Sensitivity-specificity pairs and the areas under the receiver operating characteristic curves (AUCs) were calculated and compared between HEP and HFA visual fields.

Results: : RNFL average thickness was 97.2±8.4 µm and 65.3±11.0 µm in the normal and glaucoma group, respectively (p<0.001). The mean deviation was -6.7±7.7 dB for HEP and -6.7±6.7 dB for HFA in the glaucoma group (p=0.986). Pattern standard deviation (PSD) of HEP (0.937) and HFA (0.934) had the largest AUCs. There was no significant difference between both AUCs (p=0.942).At a fixed specificity of 95%, sensitivity was 89.2% for PSD of HEP and 90.8% for PSD of HFA (cut-off point: >1.97 for both systems).

Conclusions: : HEP and HFA had similar diagnostic ability to differentiate between healthy and glaucoma patients with RNFL defects. PSD yielded the best sensitivity-specificity balance.

Keywords: visual fields • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • imaging/image analysis: clinical