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Original Investigation | Clinical Sciences

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

Tony Redmond, PhD1; Neil O’Leary, PhD1; Donna M. Hutchison, BSc1; Marcelo T. Nicolela, MD1; Paul H. Artes, PhD1; Balwantray C. Chauhan, PhD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, Dalhousie University, and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
JAMA Ophthalmol. 2013;131(12):1565-1572. doi:10.1001/jamaophthalmol.2013.4382.
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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 Participants  Patients 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 Relevance  No 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.

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Figures

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Figure 1.
Individual Mean Deviation (MD) Rates With Frequency-Doubling Matrix Perimetry (FDT2) and Standard Automated Perimetry (SAP) and Their SEs

The SEs are shown on log axes for better visualization. Cases shown in eFigures 1-3 in the Supplement are represented by red symbols.

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Figure 2.
Agreement Between Frequency-Doubling Matrix Perimetry (FDT2) and Standard Automated Perimetry (SAP) in Identifying Overall Deterioration in Patients With Glaucoma at the 1% Significance Level (P < .01) for Total Deviation and Pattern Deviation Analyses

Agreement of P values between FDT2 and SAP is shown in the bottom panels. Squares within dotted lines indicate good agreement. The light shaded region represents P > .01. The dark shaded region represents P > .05.

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Figure 3.
Agreement Between Frequency-Doubling Matrix Perimetry (FDT2) and Standard Automated Perimetry (SAP) in Identifying Overall Deterioration in Healthy Controls at the 1% Significance Level (P < .01) for Total Deviation and Pattern Deviation Analyses

Agreement of P values between FDT2 and SAP is shown in the bottom panels. Squares within dotted lines indicate good agreement. The light shaded region represents P > .01. The dark shaded region represents P > .05.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Distribution of Baseline Sensitivity Values for All Visual Field Locations in All Participants Using Frequency-Doubling Matrix Perimetry (FDT2) and Standard Automated Perimetry (SAP)

The yellow region shows the number of locations with baseline sensitivity in the corresponding strata. The blue region shows the number of locations with statistically significant deterioration (P < .05). The green region shows the percentage of locations in each stratum with statistically significant deterioration.

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