Visual Field Progression With Frequency-Doubling Matrix Perimetry and Standard Automated Perimetry in Patients With Glaucoma and in Healthy Controls

Abstract

IMPORTANCE A new analysis method called permutation of pointwise linear regression measures the significance of deterioration over time at each visual field location, combines the significance values into an overall statistic, and then determines the likelihood of change in the visual field. Because the outcome is a single P value, individualized to that specific visual field and independent of the scale of the original measurement, the method is well suited for comparing techniques with different stimuli and scales.OBJECTIVE To test the hypothesis that frequency-doubling matrix perimetry (FDT2) is more sensitive than standard automated perimetry (SAP) in identifying visual field progression in glaucoma. DESIGN, SETTING, AND PARTICIPANTSPatients with open-angle glaucoma and healthy controls were examined by FDT2 and SAP, both with the 24-2 test pattern, on the same day at 6-month intervals in a longitudinal prospective study conducted in a hospital-based setting. Only participants with at least 5 examinations were included.INTERVENTION Data were analyzed with permutation of pointwise linear regression.MAIN OUTCOME AND MEASURE Permutation of pointwise linear regression is individualized to each participant, in contrast to current analyses in which the statistical significance is inferred from population-based approaches. Analyses were performed with both total deviation and pattern deviation. RESULTS Sixty-four patients and 36 controls were included in the study. The median age, SAP mean deviation, and follow-up period were 65 years, −2.6 dB, and 5.4 years, respectively, in patients and 62 years, +0.4 dB, and 5.2 years, respectively, in controls. Using total deviation analyses, statistically significant deterioration was identified in 17% of patients with FDT2, in 34% of patients with SAP, and in 14% of patients with both techniques; in controls these percentages were 8% with FDT2, 31% with SAP, and 8% with both. Using pattern deviation analyses, statistically significant deterioration was identified in 16% of patients with FDT2, in 17% of patients with SAP, and in 3% of patients with both techniques; in controls these values were 3% with FDT2 and none with SAP. CONCLUSIONS AND RELEVANCENo evidence was found that FDT2 is more sensitive than SAP in identifying visual field deterioration. In about one-third of healthy controls, age-related deterioration with SAP reached statistical significance.

How to detect progression in glaucoma

“…In glaucoma suspects, Meira-Freitas et al (2014) reported that faster rates of increase of FDT pattern deviation were related to higher chance of progression in SAP, and Liu et al (2014b) reported that approximately the same number of suspects developed reproducible defects in FDT or in SAP. In glaucoma patients, Liu et al (2014a) identified more progressing patients with FDT than SAP; however, Redmond et al (2013) identified more progressing patients with SAP than FDT. While some studies suggest that FDT may be useful to evaluate progression of glaucoma functional damage, further research is required to better assess its additional value to SAP, before recommending frequent clinical use.…”

SITA-Standard perimetry has better performance than FDT2 matrix perimetry for detecting glaucomatous progression

“…Redmond and coworkers13 using PoPLR found HFA SAP detected progression in about twice as many subjects as FDT2 but far more normal subjects were identified as progressing with HFA SAP. Hu et al found no benefit of FDT2 over HFA SAP in monitoring glaucoma progression.…”

“…Using FDT2, Redmond and coworkers13 studied 64 subjects with primary open angle glaucoma and 36 controls. Subjects were tested every 6 months with FDT2 and HFA SAP using the 24–2 pattern on the same day.…”

Evaluation of Visual Field Progression in Glaucoma

“…Conversely, in a cohort of glaucoma subjects and normal controls monitored for a median of about 5 years, progression was identified in fewer glaucoma patients with FDT compared with SAP using permutation analyses of PLR of either total deviation or pattern deviation data [25]. About one-third of control subjects were identified as having deterioration with SAP, using total deviation data, but in only 8 % with FDT.…”