An Evaluation of a New 24-2 Metric for Detecting Early Central Glaucomatous Damage.
Hood Donald C, Thenappan Abinaya A, Tsamis Emmanouil, Liebmann Jeffrey M, De Moraes C Gustavo
AI Summary
This study found that new 24-2 and 10-2 visual field metrics often miss early central glaucoma damage. A topographic approach combining OCT and 10-2 visual fields is recommended for better detection.
Abstract
Purpose
We sought to test the hypothesis that a recently proposed pattern standard deviation (PSD) metric, based upon the 24-2 visual field (VF) test, as well as the PSD of the 10-2 VF, will miss central glaucomatous damage confirmed with an objective structure-function method.
Design
Cross-sectional study.
Methods
A glaucoma (G) group (70 eyes/patients) diagnosed with glaucoma and a 24-2 mean deviation better than -6 dB and a healthy (H) group (45 eyes/patients) had 24-2 and 10-2 VFs and optical coherence tomography (OCT) scans twice within 4 weeks. The PSD(C24-2), based upon the central 12 points of the 24-2, was compared with the PSD(10-2). To evaluate central damage (CD) in G eyes with normal PSD(C24-2) values, a post hoc analysis was combined with a CD reference standard (CD-RS), which was based upon an objective, topographic comparison between abnormal points on the 10-2 VF and OCT probability maps.
Results
The 115 PSD(C24-2) and PSD(10-2) values were significantly correlated (Spearman correclation coefficient: rho = 0.55; P < .001) and the number of G eyes (19) identified as abnormal by the PSD(C24-2) was not significantly different from the number (22) identified by the PSD(10-2) (P = .15). However, based upon the CD-RS, 44 of 70 G eyes were classified as abnormal. The PSD(C24-2) missed 27 (61%) of these 44 eyes, and the PSD(10-2) missed 23 (52%) of these eyes. Post hoc analysis revealed clear CD in most of these eyes.
Conclusion
Neither the PSD(C24-2) nor the PSD(10-2) metric is good measure of early CD. Instead we recommend a topographic approach based upon OCT probability maps and a 10-2 VF.
MeSH Terms
Shields Classification
Key Concepts6
The PSD(C24-2) missed 27 (61%) of the 44 glaucoma eyes classified with central damage by the central damage reference standard (CD-RS), and the PSD(10-2) missed 23 (52%) of these 44 eyes.
Neither the PSD(C24-2) nor the PSD(10-2) metric is a good measure of early central glaucomatous damage.
A topographic approach based upon OCT probability maps and a 10-2 visual field is recommended for detecting early central glaucomatous damage.
The PSD(C24-2) (pattern standard deviation based on the central 12 points of the 24-2 visual field test) and the PSD(10-2) (pattern standard deviation of the 10-2 visual field test) values were significantly correlated (Spearman correlation coefficient: rho = 0.55; P < .001) in 115 eyes (70 glaucoma eyes, 45 healthy eyes).
The number of glaucoma eyes (19) identified as abnormal by the PSD(C24-2) was not significantly different from the number (22) identified by the PSD(10-2) (P = .15) in a study of 70 glaucoma eyes.
Based on a central damage reference standard (CD-RS) derived from objective, topographic comparison between abnormal points on the 10-2 VF and OCT probability maps, 44 of 70 glaucoma eyes were classified as having central damage.
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