Automated flicker perimetry in glaucoma using Octopus 311: a comparative study with the Humphrey Matrix

Abstract

Purpose: We evaluated the clinical usefulness of flicker perimetry in glaucoma and glaucoma suspect patients using the new Octopus 311 automated perimeter.

Methods: A total of 52 eyes of 52 glaucoma patients, 26 eyes of 26 glaucoma suspect patients and 61 eyes of 61 normal subjects were examined using standard automated perimetry (SAP), flicker perimetry and frequency doubling technology (FDT) perimetry. Flicker perimetry was performed using the Octopus 311 and its remote software package. Suprathreshold four-zone probability strategy was used to classify the critical fusion frequency probability level. The classified levels were set at 5% and 1% of probability of normality and 5 Hz. Frequency doubling technology perimetry was performed using 24-2-5, 24-2-1, N-30-5, N-30-1 screening programs using Humphrey Matrix perimetry. Standard automated perimetry was performed using the Humphrey field analyser program 24-2 full threshold. Optical coherence tomography using Stratus OCT was used for evaluating the retinal nerve fibre layer thickness in all glaucoma and glaucoma suspect patients.

Results: Receiver operating characteristic (ROC) curves were calculated. In the early stage of glaucoma, the areas under the ROC curve (AUCs) were 0.96 in flicker and 0.90 in Matrix perimetry. In the moderate and advanced stages of glaucoma, the AUCs were almost 1.0 in all tests. In glaucoma suspect patients, the AUC of the 5% probability level in flicker was significantly higher than in Matrix perimetry.

Conclusion: The four-zone probability strategy using the Octopus 311 is a useful method for evaluating the flicker field in early glaucoma and glaucoma suspect patients.