Diagnostic capability of Pulsar perimetry in pre-perimetric and early glaucoma

Abstract

This study aimed to compare the diagnostic capability of Pulsar perimetry (Pulsar) in pre-perimetric glaucoma (PPG) and early glaucoma (EG) with that of Flicker perimetry (Flicker) and spectral-domain optical conference tomography (SD-OCT). This prospective cross-sectional study included 25 eyes of 25 PPG patients, 35 eyes of 35 EG patients, and 42 eyes of 42 healthy participants. The diagnostic capability using the area under the curve (AUC) of the best parameter and agreement of detectability between structural and functional measurements were compared. For PPG patients, the AUC of Pulsar, Flicker, OCT-disc, and OCT-macular was 0.733, 0.663, 0.842, and 0.780, respectively. The AUC of Flicker was significantly lower than that of OCT-disc (p = 0.016). For EG patients, the AUC of Pulsar, Flicker, OCT-disc, and OCT-macular were 0.851, 0.869, 0.907, and 0.861, respectively. There was no significant difference in AUC among these methods. The agreement between structural and functional measurements expressed by kappa value ranged from -0.16 to 0.07 for PPG and from 0.01 to 0.25 for EG. Although the diagnostic capability of Pulsar in the PPG and EG groups was equal to that of Flicker and SD-OCT, the agreements between structural and functional measurements for both PPG and EG were poor.

Figure 1

Receiver operating characteristic curve of each device. Area under the curve (AUC) of the best parameters from Pulsar perimetry, Flicker perimetry, optical coherence tomography (OCT) disc measurement, and OCT macular measurement in pre-perimetric glaucoma (PPG) and early glaucoma (EG). The (*) shows significance at p = 0.016 by the DeLong test.

Figure 2

Venn diagram of the eyes detected as abnormality in each device. Abnormality is based on the cut-off value of the best parameter of Pulsar perimetry, Flicker perimetry, optical coherence tomography (OCT) disc measurement, and OCT macular measurement. The agreement values between structural and functional measurements are expressed by kappa coefficients under the Venn diagram.