Comparison of Diagnostic Ability between a Fast Strategy, Tendency-Oriented Perimetry, and the Standard Bracketing Strategy

Abstract

Purpose: To compare the diagnostic abilities of the standard bracketing strategy (BR) and a fast strategy, the tendency-oriented perimetry (TOP). Methods: Seventy-seven controls and 91 eyes from patients with glaucoma were analyzed with the strategies TOP and BR. Sensitivity (Se), specificity (Sp), the area under the receiver operating characteristic (ROC) curve (AC) and the optimum cutoff value (CO) were calculated for the visual field indices mean defect (MD), the square root of the loss variance (sLV) and the number of pathological points (NPP). Results: In the glaucoma group, the mean MD value using TOP and BR was 7.5 and 8.3 dB, respectively. The mean sLV value using TOP and BR was 5.0 and 5.3 dB, respectively. Indices provided by TOP had higher ROC values than the ones provided by BR. Using TOP, the index with the best diagnostic ability was sLV (Sp = 94.8, Se = 90.1, AC = 0.966, CO = 2.5 dB), followed by NPP and MD. Using BR, the best results were obtained for MD (Sp = 92.2, Se = 81.3, AC = 0.900, CO = 2.5 dB) followed by sLV and NPP. Conclusions: A fast strategy, TOP, had superior diagnostic ability than the standard BR. Although TOP provided lower LV values than BR, the diagnostic ability of this index was higher than that of the conventional strategy.

Capacidad diagnóstica del HRT-II y de las perimetrías TOP, PULSAR y FDT en pacientes sospechosos de sufrir glaucoma

“…Los principales componentes de LV son la fluctuación del umbral, su irregularidad topográfica y los errores. Los errores se limitan en TOP al reducirse el «efecto fatiga» neurológico, las faltas de atención y los defectos metodológicos causados por examinar los puntos de forma independiente (27)(28)(29). Flammer (30) indicó que el primer signo de glaucoma no son los defectos focales o difusos sino el incremento de la fluctuación del umbral.…”

Oculus–Spark Perimetry Compared with 3 Procedures of Glaucoma Morphologic Analysis (GDx, HRT, and OCT)

“…In the initial stages of glaucoma, retinal dysfunction manifests as alterations in the homogeneity of responses more than as the presence of evident defects. This has been shown in examinations using the TOP strategy with both conventional stimuli (18–20) and Pulsar stimuli (21–23).…”

Stabilization and comparison of TOP and Bracketing perimetric strategies using a threshold spatial filter

“…In previous studies we have indicated that BRA tends to produce excessively high sLV values in normal subjects, whereas in TOP this index has the best diagnostic capacity [18]. Filtering corrects this tendency in BRA and tends to equalize results of the two strategies in this regard.…”

“…It has been suggested that this procedure involves loss of spatial information [1,25]. However, in light of the results described using filtered threshold procedures, it seems that the short duration TOP procedure actually provides a more reliable threshold value since it reduces "fatigue effect" and simultaneously acts as an averaging filter of the area [17,18].…”