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D. Ng, L.M. Zangwill, J.P. Pascual, R.R. Bourne, C. Bowd, C. Boden, R.N. Weinreb, P.A. Sample; Agreement Between Standard Automated Perimetry and Heidelberg Retina Tomograph for Detecting Glaucoma in the Diagnostic Innovations in Glaucoma Study (DIGS) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3746.
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Purpose:To assess the agreement between structural and functional testing for detecting glaucoma using standard automated perimetry (SAP) and Heidelberg Retina Tomograph I (HRT I) at 2 different visits. Methods:Fifty–nine eyes of 59 glaucoma patients or suspects (mean age 61.8 ± SD 11.9) were tested at two visits completed within 15 months with both SAP (Swedish Interactive Threshold Algorithm, program 24–4) and HRT I. The agreement between detecting abnormality using SAP (pattern standard deviation at p<1% or a glaucoma hemifield test of outside normal limits) and the HRT (Moorfields Classification Result outside normal limits) at the 2 visits was compared. Results:At Visit 1, 11 eyes (18.6%) were classified as glaucoma by both SAP and HRT, 9 eyes (15.3%) by SAP alone, 9 eyes (15.3%) by HRT alone and 30 eyes (50.8%) were classified as normal by both tests (kappa=0.32 with 69% agreement). At Visit 2, 17 eyes (28.8%) were classified as glaucoma by both SAP and HRT, 11 eyes (18.6%) by SAP alone, 4 eyes (6.8%) by HRT alone and 27 eyes (45.8%) were classified as normal by both tests (kappa=0.48 with 74% agreement). All 11 eyes classified by both tests at Visit 1 were also classified by both tests at Visit 2. Of the 9 eyes classified by SAP alone at Visit 1, 7 were classified by SAP alone at Visit 2 and the remaining 2 eyes were classified by both SAP and HRT. Of the 9 eyes classified by HRT alone at Visit 1, 3 were classified by HRT alone at Visit 2, 4 were classified by HRT and SAP, and 2 were normal on both tests. 25 of the 30 eyes classified as normal by both SAP and HRT at Visit 1 were classified as normal at Visit 2. The 18 eyes that were classified as glaucoma by only one test at Visit 1 had less severe glaucoma (median MD=–1.56) than the 11 eyes (median MD=–4.39) that were classified as glaucoma by both tests. Conclusions:Agreement between SAP SITA and HRT for classifying eyes as glaucoma or normal was high and repeatable over time. The result that eyes classified as glaucoma by either SAP or HRT, but not both, had less severe visual field damage suggests that both structural and functional tests are important for detecting early glaucoma.
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