ABSTRACT
PURPOSE: To determine the diagnostic capability of PULSAR-T30W, FDT-Threshold-N30 and HRT-II in glaucoma suspects. METHODS: Forty-seven eyes from 47 referred glaucoma suspects (GS) were examined twice with each technique. Cases with TOP-WW-MD>6dB were excluded. Results were compared with those of 70 eyes from 70 normal controls (C). RESULTS: Mean MD value using TOP-WW in the GS group (0.96dB. sd=1.7) was not significantly different from C (0.8dB. sd=1.77) (p>0.05). Disc area in GS group (2.12 mm(2). sd=0.34) was significantly greater than in C (1.97 mm2. sd=0.45) (p<0.01). For 95.7% specificity, PULSAR-sLV showed the highest sensitivity of 30.9% in individual examinations. The highest reproducible sensitivity in the two examinations was obtained using HRT-II maximum contour elevation (23.4%) and reference height (23.4%), and was 14.9% for various indices after correcting for the influence of disc area (cup area, cup/disc area ratio, maximum contour depression and mean RNFL thickness). Reproducible sensitivity of the perimetric indices was: PULSAR-MD=8.5%, PULSAR-sLV=17%, FDT-MD=6.4%, FDT-PSD=4.3%. The association of perimetric and HRT-II indices achieved high sensitivity but low diagnostic reproducibility. CONCLUSIONS: The most effective indices were maximum contour elevation, reference height and PULSAR-sLV, although the inclusion of the optic nerve head assessment in the selection of the GS sample may have favored the HRT-II results.
Subject(s)
Glaucoma/diagnosis , Microscopy, Confocal , Optic Disk/ultrastructure , Visual Field Tests/methods , Equipment Design , Glaucoma/pathology , Glaucoma/physiopathology , Gonioscopy , Humans , Microscopy, Confocal/instrumentation , Microscopy, Confocal/methods , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Tomography/instrumentation , Tomography/methods , Visual Field Tests/instrumentationABSTRACT
Objetivos: Determinar la capacidad diagnóstica de TOP-32, PULSAR-T30W, FDT-Umbral-N30 y HRT-II en glaucoma de sospecha. Métodos: 47 ojos de 47 sujetos remitidos por sospecha de glaucoma (SG) se examinaron dos veces. Se excluyeron los casos con defecto medio (MD) superior a 6dB en TOP-32. Los resultados se compararon con los obtenidos en 70 sujetos normales control (C). Resultados: No se observaron diferencias significativas entre los valores de MD obtenidos en TOP- 32, en los grupos SG (0,96dB. DE=1,7) y C (0,8dB. DE=1,77) (p>0.05). El área papilar de SG (2,12 mm2. DE=0.34) fue significativamente superior que en C (1,97 mm2. DE=0,45) (p<0,01). Para una especificidad del 95%, la raíz cuadrada de la varianza de pérdida (sLV) de PULSAR presentó la mayor sensibilidad (30,9%) en exámenes individuales. La mayor reproducibilidad diagnóstica se obtuvo con la máxima elevación del contorno de HRT-II (23%) y con el Plano de referencia (23,4%), siendo del 14,9% para varios índices, después de corregir la influencia del tamaño papilar (área de la excavación, cocientes de área excavación/papila, máxima depresión del contorno y espesor de la capa de fibras). La reproducibilidad de los índices perimétricos fue: PULSAR-MD=8,5%, PULSARsLV= 17%, FDT-MD=6,4%, FDT-PDT=4,3%. La asociación entre índices perimétricos y HRT-II elevó la sensibilidad pero redujo la reproducibilidad diagnóstica. Conclusiones: Los índices de mayor eficacia fueron la máxima elevación del contorno, el plano de referencia y PULSAR-sLV, aunque la inclusión del aspecto papilar en la selección del grupo SG favoreció los resultados de HRT-II
Purpose: To determine the diagnostic capability of PULSAR-T30W, FDT-Threshold-N30 and HRT-II in glaucoma suspects. Methods: Forty-seven eyes from 47 referred glaucoma suspects (GS) were examined twice with each technique. Cases with TOP-WW-MD>6dB were excluded. Results were compared with those of 70 eyes from 70 normal controls (C). Results: Mean MD value using TOP-WW in the GS group (0.96dB. sd=1.7) was not significantly different from C (0.8dB. sd=1.77) (p>0.05). Disc area in GS group (2.12 mm2. sd=0.34) was significantly greater than in C (1.97 mm2. sd=0.45) (p<0.01). For 95.7% specificity, PULSAR-sLV showed the highest sensitivity of 30.9% in individual examinations. The highest reproducible sensitivity in the two examinations was obtained using HRT-II maximum contour elevation (23.4%) and reference height (23.4%), and was 14.9% for various indices after correcting for the influence of disc area (cup area, cup/disc area ratio, maximum contour depression and mean RNFL thickness). Reproducible sensitivity of the perimetric indices was: PULSARMD= 8.5%, PULSAR-sLV=17%, FDT-MD=6.4%, FDT-PSD=4.3%. The association of perimetric and HRT-II indices achieved high sensitivity but low diagnostic reproducibility. Conclusions: The most effective indices were maximum contour elevation, reference height and PULSAR-sLV, although the inclusion of the optic nerve head assessment in the selection of the GS sample may have favored the HRT-II results (AU)
Subject(s)
Male , Female , Middle Aged , Humans , Tomography/methods , Visual Field Tests/methods , Glaucoma/diagnosis , Diagnostic Techniques, Ophthalmological , Reproducibility of Results , Case-Control Studies , Sensitivity and SpecificityABSTRACT
PURPOSE: To propose a classification of glaucoma visual fields based on affected ganglion cells axons on their way through the optic nerve head. MATERIAL AND METHOD: 255 Octopus 1-2-3 visual fields from glaucoma patients and glaucoma suspected patients were analyzed. Determination coefficients (r(2)) between the 10 points closest to the blind spot and the 73 reminding ones were calculated by linear regression. RESULTS: Significant correlation was found (r(2)>0.33) with very distant points sensitivity related to the ones closer to the optic disc due to the fibers path. Seven areas could be defined by this method: three of them are not affected or latterly affected by the disease: S1 and I1 corresponding to the upper and lower papillo-macular bundle and T, located on the temporal aspect of the blind spot. Areas S2 and L2 correspond to the nasal and para-central upper and lower sensitivities. Areas S3 and I3 are in the border of upper and lower nasal fields where axons enter the optic disc at the apical portion. CONCLUSIONS: There is a relationship between the anatomical arrangement of ganglion cells axons on their way to the optic nerve and topography of glaucoma defects which may justify this proposed classification.
Subject(s)
Glaucoma/pathology , Glaucoma/physiopathology , Visual Field Tests , Visual Fields , Diagnostic Techniques, Ophthalmological , Female , Humans , Male , Middle AgedABSTRACT
Objetivo: Clasificar los campos visuales glaucomatosos, atendiendo al haz de axones de células ganglionares afectado en el momento de su transcurrir por la cabeza del nervio óptico. Métodos: Se analizaron 255 campos visuales de archivo de pacientes con sospecha de glaucoma o glaucoma establecido, realizados con el programa 32 del perímetro Octopus 1-2-3. Excluyendo la mancha ciega, se calculó el coeficiente de determinación (r2) utilizando regresión lineal, entre los umbrales de los 10 puntos situados en torno a la mancha ciega y los 73 puntos restantes. Resultados: Se alcanzaron correlaciones significativas (r2>0,33) con la sensibilidad de puntos muy distantes pero relacionados con los situados junto a la papila a causa del trayecto de las fibras. De esta forma pudieron definirse 7 regiones: tres de ellas se afectan poco o tardíamente por la enfermedad: S1 e I1 correspondientes al haz papilo-macular superior e inferior y T situada temporalmente respecto a la mancha ciega. Las regiones S2 e I2 recogen la sensibilidad nasal y para-central superior e inferior. Las regiones S3 e I3 delimitan los campos supero-nasales e infero-nasales cuyos axones penetran por los polos apicales de la papila. Conclusiones: Existe una correspondencia entre la disposición anatómica de los axones de las células ganglionares al penetrar en el nervio óptico y la topografía de los defectos glaucomatosos, que permite su sistematización en la clasificación que se propone (AU)
