title: Correlation between early retinal nerve fiber layer loss and visual field loss determined by three different perimetric strategies: white-on-white, frequency-doubling, or flicker-defined form perimetry.
abstract: OBJECTIVE
  To compare the significance of white-on-white standard automated perimetry (SAP), matrix frequency doubling technology (FDT), and flicker-defined form perimetry (FDF) for early detection of nerve fiber layer loss in early glaucoma patients.
  
  
  METHODS
  Fifty-one healthy controls and 40 patients with early glaucomatous nerve fiber loss were enrolled in this study. Patients had retinal nerve fiber layer (RNFL) imaging and visual field testing by SAP, FDT matrix, and FDF perimetry at the same visit. Visual field defects were confirmed with two or more consecutive examinations by the same types of perimetry. Significant retinal nerve fiber layer loss and thus early glaucoma was defined with the reference to the RNFL thickness deviation map. The sensitivity, specificity, correlation, MD (mean deviation) and PSD (pattern standard deviation) visual field indexes, and area under the receiver operating characteristic curve (AUC) of MD and PSD of the perimetries were compared.
  
  
  RESULTS
  There was a significant difference in nerve fiber layer thickness between healthy patients (97.7 ± 1.34 μm and patients with early glaucoma (84.1 ± 1.58 μm) (p < 0.001). Taking all patients with early glaucoma into consideration, the sensitivity was highest for FDF perimetry (87 %), followed by FDT matrix (62.5 %), and then SAP (40 %). The specificity was 69.2 % for SAP, 62.8 % for FDT matrix, and 38.4 % for FDF perimetry. MD (mean deviation) and PSD (pattern standard deviation) in FDF and FDT matrix were significantly different between patients with RNFL loss and those without (p < 0.05), while no difference could be found in SAP. The AUCs of MD followed a similar pattern, with FDF and FDT matrix perimetry having a suitable AUC of >0.6. AUCs of PSD were not reliable in all of the three VF devices.
  
  
  CONCLUSIONS
  The sensitivity for detection of RNFL loss in early glaucoma seems to be higher in FDF and FDT matrix than SAP perimetry, while specifity was highest in SAP. Thus, simultaneous performance of FDF/FDT matrix and SAP perimetry seems beneficial for the correct diagnosis of early glaucoma in patients.
authors: Department of Ophthalmology, University of Muenster, Domagkstraße 15, 48149, Muenster, Germany, verena.prokosch@ukmuenster.de.
authors: Verena
authors: V
authors: Prokosch
authors: Nicole
authors: N
authors: Eter
mesh_terms: D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006068:Gonioscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D012372:ROC Curve; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields