Comparison of matrix frequency-doubling technology perimetry and standard automated perimetry in monitoring the development of visual field defects for glaucoma suspect eyes

Abstract

Background: Perimetry is indispensable for the clinical management of glaucoma suspects. Our goal is to compare the performance of standard automated perimetry (SAP) and Matrix frequency-doubling technology (FDT) perimetry in monitoring the development of visual field (VF) defects in glaucoma suspect eyes.

Methods: Longitudinal data of paired SAP and FDT from 221 eyes of 155 glaucoma suspects enrolled in the Diagnostic Innovations in Glaucoma Study or the African Descent and Glaucoma Evaluation Study were included. All eyes had glaucomatous optic neuropathy or ocular hypertension, but normal SAP and FDT results at baseline. The development of glaucomatous VF defects was defined as the presence of a cluster of ≥ 3 (less conservative) or ≥ 4 (more conservative) locations confirmed on ≥ 2 additional consecutive tests. Risk factors for the development of VF defects were analyzed by COX proportional hazard models. After conversion into common logarithmic units, the rates of change of global VF indices were fitted with linear mixed models.

Results: FDT detected more eyes that developed VF defects than SAP using the less conservative criterion, and no significant difference was observed using the more conservative criterion. For those eyes detected by both SAP and FDT, FDT detected the development of VF defects either earlier than SAP or simultaneously in most cases. Baseline structural measurements were not significantly associated with an increased risk for the development of glaucomatous VF defects on either SAP or FDT. Older age was significantly associated with the development of VF defects on FDT but not on SAP. Both SAP and FDT detected a progressing worsening trend of pattern standard deviation over time with a similar rate of change between these test types.

Conclusions: Matrix FDT would be useful to monitor the onset of VF defects in glaucoma suspects and may outperform SAP in the early stage of glaucomatous VF damage.

Fig 1. The Kaplan-Meier survival analysis for the development of glaucomatous VF defects.

The Kaplan Meier survival curves show the survival probability of SAP and FDT for detection of VF development using the less conservative criterion. The hash marks represent the censored follow-ups for eyes that did not develop VF defects in the present study.

Fig 2. The numbers of eyes that developed glaucomatous VF defects.

The Venn diagrams show the number of eyes with the development of glaucomatous VF defects detected by Matrix FDT and SAP using the less conservative criterion (A) and more conservative criterion (B).

Fig 3. Longitudinal pattern deviation plots of an ocular hypertensive eye followed by SAP and Matrix FDT.

The light-grey points and dark-grey points represent the visual field locations worse than a P level of 5% and 1% respectively. The red border marks the three locations on three consecutive tests used to identify the development of glaucomatous VF defects based on the less conservative criterion, respectively for SAP and FDT. The 3^rd test of the three consecutive tests is shown in thicker border.