Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography.
ABSTRACT To compare the effectiveness of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and retinal nerve fiber layer (RNFL) photography using the Heidelberg Retina Angiograph 1 (HRA1) for early glaucoma detection.
Cross-sectional comparative study.
Seventy-two primary open-angle glaucoma patients with early-stage visual field defects and 48 healthy controls were included.
Measurements using Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1, as well as standard automated perimetry, were obtained. We constructed receiver operating characteristic (ROC) curves for all available parameters and calculated the area under the ROC curves (AUC) to seek the best discriminating parameter of each test. Subsequently, the ROC curves were calculated for the combinations of the best discriminating parameters of each test to seek the most effective combination for early glaucoma detection.
The AUC for various parameters of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1.
The AUCs of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1 with the best discriminating parameter were 0.990, 0.906, 0.794, and 0.751, respectively. The AUC of the following best combination was 0.972, more than 5 points depressed below the level of 5% on the pattern deviation plot from Humphrey Matrix perimetry, and the nerve fiber indicator was larger than 20 from GDx VCC.
The AUC of the Humphrey Matrix perimetry was greater than that of the GDx VCC, Stratus OCT, and RNFL photography using HRA1.
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ABSTRACT: Introduction: Glaucoma is a progressive optic neuropathy associated with neural rim loss of the optic disc and the retinal nerve fibre layer typically causing visual field (VF) deterioration. Generally, glaucomatous lesions in the eye and in the visual field progress slowly over the years. In population-based cross-sectional studies, the percentage of unilateral or bilateral visual impairment varied between 3-12%. In screening studies, 0.03-2.4% of patients have been found to suffer visual impairment. Glaucoma has previously been associated with substantial healthcare costs and resource consumption attributable to the treatment of the disease. The disease also causes reduction in health-related quality of life (HRQoL) in patients with glaucoma. Objective and Methods: This study compares patients with diagnosed open-angle glaucoma from two geographically different regions in Finland. A total of 168 patients were examined, 85 subjects from an area with higher per patient treatment costs (Oulu) and 83 patients from a region with lower per patient treatment costs (Turku). All patients had a history of continuous glaucoma medication use for a period of 11 years. For each patient, the total direct costs from glaucoma treatment were calculated and the total amount of resource consumption was determined from registries and patient records. Each patient underwent a clinical examination with visual field assessment and fundus photography. These data were used to determine the current stage of disease for each patient. Health-related quality of life questionnaire (15D) was used in determining each patient's subjective HRQoL score. Results: When applying the current diagnostic criteria for open-angle glaucoma, a total of 40% of patients did not to display any structural or functional damage suggesting glaucoma after 11 years of continuous medical treatment and follow-up. Patients with higher glaucoma stage (worse disease) were found to have statistically higher treatment costs compared with those at lower disease stages. Resource consumption was also greater in the patients in higher glaucoma stage. Patients in the Oulu district consumed more resources, and glaucoma treatment was more expensive than in the Turku area. The total treatment cost in Oulu and Turku was 6010 € and 4452 €, respectively, for the whole 11-year period. There was no statistically significant difference in quality-of-life scores between the two areas. No difference was noted between the higher-spending and lower-spending areas in this respect. However, when the population was analysed as a whole, patients with higher glaucoma stage were found to have lower vision-based 15D scores compared with those at lower disease stages. This observation was made also at both districts independently. Conclusions: Major cost source in open-angle glaucoma treatment is medication, up to 74% of annual costs. In addition, it seems that higher resource consumption and higher treatment costs do not increase the patients' HRQoL as assessed by the 15D instrument.Acta ophthalmologica 05/2013; 91(thesis3):1-47. DOI:10.1111/aos.12141 · 2.51 Impact Factor
Article: Primary open-angle glaucoma.[Show abstract] [Hide abstract]
ABSTRACT: Glaucoma is a significant global health problem. As of the year 2000, 67 million people worldwide were affected with “primary” glaucoma. Of these patients, 6.7 million were bilaterally blind. Glaucoma is second only to cataracts as a cause of blindness worldwide. In the United States, where glaucoma accounts for 11% of all cases of blindness, it is the number two cause of blindness behind macular degeneration. Among African-Americans, primary open angle glaucoma (POAG) is the leading cause of blindness and POAG is also more prevalent in Hispanics relative to Caucasians. More than two million Americans are affected with one variety or another of glaucoma, with most patients in the USA having POAG.The Practitioner 03/1992; 236(1511):199-202. DOI:10.1007/978-0-387-76700-0_34
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ABSTRACT: Humphrey Matrix perimetry is a recent development in automated perimetry that uses frequency-doubling technology (FDT). We evaluated the learning effect of Humphrey Matrix perimetry with a full-threshold 30-2 strategy. Twenty-four patients with primary open-angle glaucoma and early visual field defects as assessed by standard automated perimetry and 24 healthy control subjects participated. All subjects had no prior experience with FDT visual field tests. Humphrey Matrix perimetry using a full-threshold 30-2 strategy was performed 3 times within 1 month. Various visual field indices were compared across multiple tests. Mean deviation (MD) showed a larger defect at the first test than at the second and third tests (p < 0.001), and the mean total improvement of the MD was 2.80 decibels (dB) in the glaucoma group and 1.71 dB in the control group. Pattern standard deviations (PSDs) were decreased as the tests were repeated, but test duration, fixation losses, and false-positive or false-negative rate were not changed significantly. Additionally, the Glaucoma Hemifield Test (GHT) showed unstable results. In patients naive to the FDT test, Humphrey Matrix perimetry showed a large learning effect on MD and PSD among the various visual field indices. The GHT results of Humphrey Matrix perimetry showed a large instability.Canadian Journal of Ophthalmology 10/2007; 42(5):707-11. DOI:10.3129/i07-135 · 1.30 Impact Factor