title: Brightness discrimination test is not useful in screening for open angle glaucoma.
abstract: OBJECTIVE
  Brightness discrimination test (BDT) is routinely employed to assess asymmetrical optic nerve dysfunction and has been suggested as a screening test for primary open angle glaucoma (POAG). We tested the reliability and validity of BDT in the diagnosis of POAG.
  
  
  METHODS
  The study groups included 34 patients with established primary open angle glaucoma, 20 glaucoma suspects, and 33 age-sex matched controls. Cataract was not an exclusion criterion in these groups. The normal brightness score was determined to be 88% (mean score, 94%-2 SD) in a pilot study. Brightness discrimination test was performed in all subjects by two observers independently. BDT showed an excellent interobserver agreement (weighted Kappa 0.84).
  
  
  RESULTS
  The presence of a cataract alone increased the risk of brightness impairment twofold, glaucoma alone increased the risk eightfold, and the presence of both conditions by 17 times compared to those with neither condition. BDT was not a useful test in the diagnosis of POAG (sensitivity 67% and specificity 93%); the ability to detect a significant field defect was also poor (sensitivity 53% and specificity 76%).
  
  
  CONCLUSIONS
  There was poor association between decreased brightness scores and asymmetrical field defects as determined by the Humphrey's field analyzer (HFA).
authors.affiliation: Department of Ophthalmology, Schell Eye Hospital, Christian Medical College and Hospital, Vellore, India.
authors.forename: E
authors.initials: E
authors.lastname: Peter
authors.forename: R
authors.initials: R
authors.lastname: Thomas
authors.forename: J
authors.initials: J
authors.lastname: Muliyil
mesh_terms: D000328:Adult; D000368:Aged; D002386:Cataract / Q000150:complications / Q000175:diagnosis; D003430:Cross-Sectional Studies; D004192:Discrimination, Psychological; D005069:Evaluation Studies as Topic; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000379:methods*; D014794:Visual Fields