Glaucoma detection with damato multifixation campimetry online

Abstract

Purpose To evaluate Damato Multifixation Campimetry Online (DMCO), a free-of-charge internet-based visual field test. DMCO exists in three versions: DMCO BASIC, DMCO STANDARD, and DMCO ADVANCED. The main focus was (i) to investigate the sensitivity and the specificity of the existing DMCO versions in the detection of glaucomatous visual field loss and (ii) to define and evaluate algorithms for the interpretation of DMCO results. Methods The study design was an evaluation of a diagnostic test and included 97 individuals performing DMCO and whiteon-white perimetry. Interpretation algorithms were devised to define abnormality, and these were evaluated using the Glaucoma Staging System as gold standard. Receiver operating characteristic (ROC) curves and area under the ROC (AUC) were calculated. Results AUCs from 15 algorithms ranged from 0.79 to 0.90. The most promising algorithm combined results from two successive DMCO STANDARD tests. The sensitivity was highly dependent on the severity of glaucoma. Hence, for eyes with mild, moderate, advanced, and severe glaucoma, the DMCO test demonstrated a sensitivity of 11.8, 71.4, 100, and 100%, respectively. The specificity was as high as 98.1%. Median duration per eye to complete the DMCO STANDARD test was 86 s for the control group and 125 s in participants with glaucoma. Conclusions DMCO shows promise as a freeof-charge online tool to identify glaucomatous visual field defects in a preselected population. Ongoing studies are evaluating the use of DMCO in a nonselected population.

Can DMCO Detect Visual Field Loss in Neurological Patients? A Secondary Validation Study

“…When MD was used as reference, the results revealed that DMCO correctly identified the homonymous quadrantanopia with a sensitivity and specificity of 72.7 and 96.3%, respectively ( Table 2 ). In comparison, the previous results with DMCO had a sensitivity of 64.2% and a specificity of 98.1% [7] . Since the chosen MD value ≤ 6 dB accounts for moderate glaucoma and since MD fails to differentiate between generalized depression and focal defects, we included a second reference standard specially made to fit this specific population.…”

“…In the repeated test, 5 missed points in the same eye was considered abnormal, and the patient was defined as having definite visual field defects. The prespecified algorithm named "DMCO STANDARD 4,5" sums up the above explanation [7] .…”

“…We recently validated and showed the promising results of DMCO as a tool to detect visual field loss in glaucoma patients [7] . Since neurological disorders constitute the second-commonest cause of unrecognized visual field defects, this study aimed to test if DMCO could detect unknown visual field loss caused by brain pathology with the current DMCO algorithm [16] .…”

“…The DMCO test has been described previously [4,7] . Briefly, a stimulus is momentarily presented at a known location in the visual field.…”

“…Since glaucoma is the prime reason for visual field defects, we performed a validation study on DMCO, comparing it to results obtained with the Humphrey Field Analyzer (HFA; 30: 2 SITA-Fast; Carl Zeiss Meditec Inc., Dublin, CA, USA), a gold standard in glaucoma care. Different algorithms were designed to optimize DMCO for the detection of glaucomatous visual field loss, and we found that it detects moderate and severe visual field defects with adequate sensitivity and specificity [7] . To strengthen the viability of the final DMCO algorithm, it is important to investigate its applicability on a population other than patients suffering from glaucoma.…”