Visual function-specific perimetry for indirect comparison of different ganglion cell populations in glaucoma

PURPOSE. TO compare short-wavelength automated perimetry, frequency-doublin g technology perimetry, and motion-automated perimetry, each of which asses ses different aspects of visual function, in eyes with glaucomatous optic n europathy and ocular hypertension. METHODS. One hundred thirty-six eyes from 136 subjects were evaluated with all three tests as well as with standard automated perimetry. Fields were n ot used in the classification of study groups to prevent bias, because the major purpose of the study was to evaluate each field type relative to the others. Seventy-one of the 136 eyes had glaucomatous optic neuropathy, 37 h ad ocular hypertension, and 28 served as age-matched normal control eyes. G laucomatous optic neuropathy was defined by assessment of stereophotographs . Criteria were asymmetrical cupping, the presence of rim thinning, notchin g, excavation, or nerve fiber layer defect. Ocular hypertensive eyes had in traocular pressure of 23 mm Hg or more on at least two occasions and normal -appearing optic disc stereophotographs. Criteria for abnormality on each v isual field test were selected to approximate a specificity of 90% in the n ormal eyes. Thresholds for each of the four tests were compared, to determi ne the percentage that mere abnormal within each patient group and to asses s the agreement among test results for abnormality, location, and extent of visual field deficit. RESULTS. Each test identified a subset of the eyes with glaucomatous optic neuropathy as abnormal: 46% with standard perimetry, 61% with short-wavelen gth automated perimetry, 70% with frequency-doubling perimetry, and 52% wit h motion-automated perimetry. In the ocular hypertensive eyes, standard per imetry was abnormal in 5%, short wavelength in 22%, frequency doubling in 4 6%, and motion in 30%. Fifty-four percent (38/71) of eyes with glaucomatous optic neuropathy were normal on standard fields. However, 30% were identif ied by at least one of the specific visual function tests. Combining tests improved sensitivity with slight reductions in specificity. The agreement i n at least one quadrant, when a defect was present with more than one test, was very high at 92% to 97%. More extensive deficits were shown by frequen cy-doubling perimetry followed by short-wavelength automated perimetry, the n motion-automated perimetry, and last, standard perimetry. However, there were significant individual differences in which test of any given pairing was more extensively affected. Only 30% (11/37) of the ocular hypertensive eyes showed no deficits at all compared with 71% (20/28) of the control eye s (P < 0.001). CONCLUSIONS. For detection of functional loss standard visual field testing is not optimum; a combination of two or more tests may improve detection o f functional loss in these eyes; in an individual, the same retinal locatio n is damaged, regardless of visual function under test; glaucomatous optic neuropathy identified on stereophotographs may precede currently measurable function loss in some eyes; conversely, function loss with specific tests may precede detection of abnormality by stereophotograph review; and short- wavelength automated perimetry, frequency-doubling perimetry, and motion-au tomated perimetry continue to show promise as early indicators of function loss in glaucoma.