Early Glaucoma Detection Using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and Retinal Nerve Fiber Layer Photography

doi:10.1016/j.ophtha.2006.09.021

Ophthalmology

Volume 114, Issue 2, February 2007, Pages 210-215

Presented as a poster at: American Academy of Ophthalmology Annual Meeting, October 2005, Chicago, Illinois.

https://doi.org/10.1016/j.ophtha.2006.09.021 Get rights and content

Purpose

To compare the effectiveness of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and retinal nerve fiber layer (RNFL) photography using the Heidelberg Retina Angiograph 1 (HRA1) for early glaucoma detection.

Design

Cross-sectional comparative study.

Participants

Seventy-two primary open-angle glaucoma patients with early-stage visual field defects and 48 healthy controls were included.

Methods

Measurements using Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1, as well as standard automated perimetry, were obtained. We constructed receiver operating characteristic (ROC) curves for all available parameters and calculated the area under the ROC curves (AUC) to seek the best discriminating parameter of each test. Subsequently, the ROC curves were calculated for the combinations of the best discriminating parameters of each test to seek the most effective combination for early glaucoma detection.

Main Outcome Measure

The AUC for various parameters of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1.

Results

The AUCs of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1 with the best discriminating parameter were 0.990, 0.906, 0.794, and 0.751, respectively. The AUC of the following best combination was 0.972, more than 5 points depressed below the level of 5% on the pattern deviation plot from Humphrey Matrix perimetry, and the nerve fiber indicator was larger than 20 from GDx VCC.

Conclusions

The AUC of the Humphrey Matrix perimetry was greater than that of the GDx VCC, Stratus OCT, and RNFL photography using HRA1.

Section snippets

Patients

After obtaining the approval of the Institutional Review Board and informed consent from the patients, this study included 72 primary open-angle glaucoma (POAG) patients with early visual field defects and 48 healthy controls. One eye of each patient was selected randomly for study if both eyes satisfied the entry criteria. Each eye had a best-corrected visual acuity of 20/25 or better, a spherical-equivalent refractive error between −5 and +5 diopters, clear ocular media with no clinically

Results

Seventy-two POAG patients and 48 normal subjects were recruited. The mean ages (±standard deviation) for the glaucoma patients and controls were 37.8 (±15.6) and 38.7 (±13.6) years, respectively. Thirty-four patients (47%) in the glaucoma group and 20 patients (42%) in the control group were men. The mean mean deviation from SAP was −2.90 (±1.12) dB in glaucoma patients and −0.43 (±0.87) dB in healthy subjects, and the mean pattern standard deviation from SAP was 3.26 (±0.76) dB in glaucoma

Discussion

This study provides a comparison, using the same population, of the diagnostic accuracy of 4 instruments: the Humphrey Matrix perimetry, GDx VCC scanning laser polarimetry, Stratus OCT optical coherence tomography, and RNFL photography using HRA1. Each instrument represents the current commercially available version of a different technology for the evaluation of early glaucoma patients. In particular, the Humphrey Matrix perimeter is a new device for automated perimetry that uses FDT. The FDT

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The Moorfields Motion Displacement Test (MMDT; Enhanced Standard Threshold Algorithm [ESTA] version 1, London, UK) is a new 31-point suprathreshold test for visual field assessment using moving line stimuli displayed on a standard laptop computer. This study evaluated the diagnostic performance of the MMDT for discriminating between healthy eyes and eyes with glaucoma.
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Hong et al42 first compared normal subjects with glaucoma subjects with early visual field loss (MD no worse than –6 dB) on 30-2 SITA standard SAP perimetry using the Matrix and determined that the number of points with a P value <0.05 was the best discriminating parameter. The same group subsequently compared the Matrix with GDx VCC (Carl Zeiss Meditec), Stratus OCT, and RNFL photography using the Heidelberg Retina Angiograph 1 (Heidelberg Engineering GmbH) in a similar group of subjects.43 Using the number of points with P<0.05 on the pattern deviation plot, the AUC for the Matrix was 0.99, corresponding to a sensitivity of 100% and a specificity of 92% when a cutoff of 5 abnormal points was used.
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Standard white-on-white automated perimetry remains the most commonly performed test for assessing the visual field, with the Swedish interactive threshold algorithm (SITA) largely replacing full-threshold testing strategies. Frequency-doubling technology and its refinement into Matrix perimetry, as well as short-wavelength automated perimetry, now available with SITA, have been evaluated extensively. Machine learning classifiers seem to be ready for incorporation into software to help distinguish glaucomatous from nonglaucomatous fields. Other technologies, such as multifocal visual-evoked potential and electroretinography, which were designed as objective measures of visual function, provide testing free of patient input, but issues prevent their adoption for glaucoma management.
Advances in technology and analytic tools over the past decade have provided us with more rapid and varied ways of assessing visual function in glaucoma, but they have yet to produce definitive guidance on the diagnosis of glaucoma or its progression over time. Further research on an objective measure of visual function is needed.
Proprietary or commercial disclosure may be found after the references.
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Manuscript no. 2005-915.

The authors do not have any financial conflict of interest regarding the article’s subject matter.

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Original ArticleEarly Glaucoma Detection Using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and Retinal Nerve Fiber Layer Photography

Purpose

Design

Participants

Methods

Main Outcome Measure

Results

Conclusions

Section snippets

Patients

Results

Discussion

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Number of people with glaucoma worldwide

Br J Ophthalmol

A population-based evaluation of glaucoma screening: the Baltimore Eye Survey

Am J Epidemiol

The Finnish evidence-based guideline for open-angle glaucoma

Acta Ophthalmol Scand

Original Article
Early Glaucoma Detection Using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and Retinal Nerve Fiber Layer Photography