Clinical classification of glaucomatous visual field loss by frequency doubling perimetry

doi:10.1016/S0002-9394(98)00047-6

American Journal of Ophthalmology

Volume 125, Issue 6, June 1998, Pages 830-836

https://doi.org/10.1016/S0002-9394(98)00047-6 Get rights and content

Abstract

Purpose: To determine whether the frequency doubling perimeter (FDP) can grade glaucomatous visual function loss in a clinically relevant manner. Sinusoidal gratings <1 cpd that undergo counterphase flicker >15 Hz appear to have twice as many bands of light, a phenomenon referred to as the “frequency doubling illusion.” Evidence suggests that this psychophysical effect is mediated in part by large-diameter ganglion cells, which are reported to be lost early in the glaucomatous disease process. A portable, commercially available FDP has already demonstrated high diagnostic potential for glaucoma screening.

Methods: Sixty-four eyes of 42 glaucomatous patients and 22 eyes of 14 normal subjects were evaluated by means of both frequency doubling perimetry and Humphrey perimetry. A clinical scoring algorithm modeled after the Hodapp-Parrish-Anderson criteria for scoring Humphrey visual field defects was derived for the FDP at the halfway point of the study, and all participants were reassessed with this algorithm upon its completion.

Results: FDP mean and pattern deviation showed strong linear correlations with Humphrey 30-2 mean deviation (R = 0.75; P < .0001) and corrected pattern standard deviation values (R = 0.64; P < .0001). Despite this, neither global index could consistently categorize the graded glaucomatous visual fields in a manner consistent with the Hodapp-Parrish-Anderson criteria. The new FDP scoring algorithm did provide good segregation (73% precise parity, 93% parity within one Humphrey grade).

Conclusions: Sixteen-zone frequency doubling perimetry can segregate glaucomatous visual field loss into pathologic categories approximating those obtained with Humphrey 30-2 perimetry by means of a formula modeled after the Hodapp-Parrish-Anderson criteria.

Section snippets

Subjects and methods

Eighty-six eyes of 53 subjects were evaluated by both FDP and Humphrey 30-2 full threshold perimetry. Sixty-four eyes of 42 glaucoma patients (mean age ± SD, 59.8 ± 14.9 years) and 22 eyes of 14 normal individuals of typical age for glaucoma (mean age, 58.8 ± 12.3 years) were included. Informed consent was obtained from each participant for this noninvasive study under an approved institutional review board protocol. Each subject underwent testing on the same day with the Humphrey Field

Results

Full threshold frequency doubling perimetry, including patient setup, required an average testing time of less than 5 minutes per eye, one third of the time required for Humphrey 30-2 testing. According to the Hodapp-Parrish-Anderson criteria, 15 of the glaucoma patients’ eyes had severe Humphrey field defects, five were moderate, and 20 were early defects. The remaining Humphrey fields did not reach the minimum criteria for glaucomatous pathology, encompassing all 22 normal eyes and 24 of the

Discussion

There is very large proportion of individuals with clinically significant glaucoma whose disease remains undetected and untreated, largely as a consequence of overreliance on tonometry as a mainstay for the diagnosis and monitoring of the disease.1, 2, 3, 4, 5, 6 If a rapid and inexpensive visual function test could be used, not only to diagnose but also to monitor the progression of disease, a higher proportion of patients could be assessed at greater frequency than is currently practical.

References (32)

B.E. Klein et al.
Prevalence of glaucomathe Beaver Dam eye study
Ophthalmology
(1992)
W.E. Sponsel et al.
Prevent Blindness America visual field screening study
Am J Ophthalmol
(1995)
W.E. Sponsel et al.
Prevent Blindness America visual field screening study [letter]
Am J Ophthalmol
(1996)
L.B. Stelmach et al.
Two-pulse temporal resolution in patients with glaucoma, suspected glaucoma and in normal observers
Am J Ophthalmol
(1986)
M.E. Tytla et al.
Flicker sensitivity in treated ocular hypertension
Ophthalmology
(1990)
A. Atkin et al.
Abnormalities of contrast sensitivity in glaucoma
Am J Ophthalmol
(1979)
P.A. Sample et al.
Isolating the effects of primary open-angle glaucoma on the contrast sensitivity function
Am J Ophthalmol
(1991)
J.M. Tielsch et al.
A population-based evaluation of glaucoma screeningthe Baltimore eye survey
Am J Epidemiol
(1991)
H.M. Leibowitz et al.
The Framingham eye study monographan ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973–1975
Surv Ophthalmol
(1990)
M.C. Leske
The epidemiology of open-angle glaucomaa review
Am J Epidemiol
(1983)

W.E. Sponsel

Tonometry in questioncan visual screening tests play a more decisive role in glaucoma diagnosis and management?

Surv Ophthalmol

(1989)

W.E. Sponsel

Prevent Blindness America visual field screening studyupdate

T.D. Qach et al.

Evaluating the delphi system for rapid assessment of visual function using the Humphrey perimeter

C.A. Johnson et al.

Screening for glaucomatous visual field loss with frequency-doubling perimetry

Invest Ophthalmol Vis Sci

(1997)

D.H. Kelly

Frequency doubling in visual responses

J Opt Soc Am

(1996)

T. Asai et al.

Retinal ganglion cell damage in human glaucoma, 2studies on damage pattern

Nippon Ganka Gakka Zasshi

(1987)

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A new improved version of this system, which can also be used with the current Humphrey Matrix N-30-F, 30-2, and 24-2 threshold tests, has been recently published.24 In 1998, Sponsel et al used the FDT C-20 threshold test data to differentiate defects into three severity classes:87 Early visual field loss: more than 4 abnormal sectors at 1% to 5%
Classification of glaucomatous visual field defects for different severity levels is important. The reasons for this are numerous, and include: to distinguish between healthy and diseased individuals, to have homogeneous grouping criteria when perimetry is used to define the severity of glaucoma, to adjust therapy on the basis of disease severity, to describe visual field conditions in a short and simple format, to monitor the progression of the disease, and to provide a common language for both clinical and research purposes. Many severity classification methods have been proposed, although none have had widespread use in clinical practice. Other methods, like the cumulative defect curve (Bebie curve), can be used to distinguish the type of visual field loss as diffuse, localized, or mixed. This article provides a review of the main classification methods that have been proposed in the past 40 years.
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^☆: Supported in part by Welch-Allyn, Skaneateles, New York, and an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York.

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Original ArticlesClinical classification of glaucomatous visual field loss by frequency doubling perimetry☆

Abstract

Section snippets

Subjects and methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

A population-based evaluation of glaucoma screeningthe Baltimore eye survey

Am J Epidemiol

The Framingham eye study monographan ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973–1975

Surv Ophthalmol

The epidemiology of open-angle glaucomaa review

Am J Epidemiol

Tonometry in questioncan visual screening tests play a more decisive role in glaucoma diagnosis and management?

Surv Ophthalmol

Prevent Blindness America visual field screening studyupdate

Evaluating the delphi system for rapid assessment of visual function using the Humphrey perimeter

Screening for glaucomatous visual field loss with frequency-doubling perimetry

Invest Ophthalmol Vis Sci

Frequency doubling in visual responses

J Opt Soc Am

Retinal ganglion cell damage in human glaucoma, 2studies on damage pattern

Nippon Ganka Gakka Zasshi

Original Articles
Clinical classification of glaucomatous visual field loss by frequency doubling perimetry☆