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ABSTRACT: Purpose: To evaluate the reproducibility of measurements of area of β-zone parapapillary atrophy (β-PPA) using blue laser fundus autofluorescence (FAF) and confocal scanning laser ophthalmoscopy reflectance (CSLO) measurements and to assess agreement between the two imaging modalities. Methods: Sixty-five eyes of 45 patients (mean age, 68.2 ± 11.3 years) with established or suspected glaucoma from the Diagnostic Innovations in Glaucoma Study (DIGS) were prospectively included. FAF scans were obtained with the Spectralis HRA+OCT and CSLO reflectance images with the HRTII (both from Heidelberg Engineering, Heidelberg, Germany). Two masked graders independently measured β-PPA area on 3 consecutive scans using the semi-automated BluePeak RegionFinder software (BPRF) and on CSLO reflectance images using the optic disc contour line. Reproducibility of β-PPA area measurements was assessed using intraclass correlation coefficients (ICC). Results: Intragrader reproducibility was 0.997 (95% CI, 0.996-0.998) and 0.995 (95% CI, 0.992-0.996) for grader 1 and 2, respectively, using FAF-BPRF, and by CSLO, it was 0.991 (95% CI, 0.986-0.994) and 0.988 (95% CI, 0.982-0.992). Intergrader agreement (ICC) was 0.53 (95% CI, 0.331-0.685) for FAF-BPRF and 0.404 (95% CI, 0.149-0.601) for CSLO (comparison between ICC, p = 0.368). Agreement (ICC) between the two devices was worse for grader 1 (0.356; 95% CI, 0.129-0.549) than grader 2 (0.856; 95% CI, 0.774-0.910) (p < 0.001). Conclusions: Despite excellent intragrader reproducibility for β-PPA measurements with FAF-BPRF and CSLO, intergrader reproducibility is low to moderate. Measurements of β-PPA area obtained with the two instruments are of moderate agreement and, therefore, are not interchangeable.
Acta ophthalmologica 03/2013; · 2.44 Impact Factor
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ABSTRACT: PURPOSE: To present a method to analyze circadian intraocular pressure (IOP) patterns in glaucoma patients and suspects undergoing repeated continuous 24-h IOP monitoring. Methods: Forty patients with established (n=19) or suspected glaucoma (n=21) underwent ambulatory 24-h IOP monitoring on two sessions 1 week apart using a contact lens sensor (CLS; Sensimed AG, Switzerland). The CLS provides its output in arbitrary units (a.u.). A modified cosinor rhythmometry method was adapted to the CLS output to analyze 24-h IOP patterns and their reproducibility. Nonparametric tests were used to study differences between sessions 1 and 2 (S1 and S2). Patients pursued their routine daily activities and their sleep was uncontrolled. Diary entries were used to assess sleep times. Results: Complete 24-h data from both sessions were available for 35 patients. Mean (SD) age of the patients was 55.8 ± 15.5 years. The correlation of the cosinor fitting and measured CLS values was r = 0.38 (Spearman r; P <0.001) for S1, r = 0.50 (P < 0.001) for S2 while the correlation between S1 and S2 cosinor fittings was r = 0.76 (P < 0.001). Repeated nocturnal acrophase was seen in 62.9%, 17.1% had no repeatable acrophase. The average amplitude of the 24-h curve was 143.6 ± 108.1 a.u. (S1) and 130.8 ± 68.2 a.u (S2) (P = 0.936). Conclusions: Adapting the cosinor method to CLS data is a useful way for modeling the rhythmic nature of 24-h IOP patterns and evaluating their reproducibility. Repeatable nocturnal acrophase was seen in 62.9% of patients.
Investigative ophthalmology & visual science 11/2012; · 3.43 Impact Factor
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ABSTRACT: Purpose: To evaluate the repeatability and interoperator reproducibility of the Pascal dynamic contour tonometry (DCT), ocular response analyzer (ORA), and Goldmann applanation tonometer (GAT) in a single population of normal individuals.
Methods: The study included 52 eyes from 26 normal individuals. One operator measured the intraocular pressure (IOP) with each tonometer 3 times while 2 additional operators each measured the IOP with each tonometer once. Repeatability and reproducibility were assessed by the coefficient of variation (CV) and intraclass correlation coefficient (ICC). Agreement among tonometers was also assessed using Bland-Altman plots.
Results: The mean age of included participants was 31.5+/-8.8 years and 15 (58%) were female individuals. In general, both intraoperator repeatability and interoperator reproducibility were significantly higher for DCT compared with the other tonometers. Intraoperator DCT (CV=3.7, ICC=0.89), GAT (CV=9.7, ICC=0.79), IOPg (CV=7.0, ICC=0.79), and IOPcc (CV=9.8, ICC=0.57). Interoperator DCT (CV=6.1, ICC=0.73), GAT (CV=9.0, ICC=0.82), and IOPg (CV=10.8, ICC=0.63), IOPcc (CV=11.7, ICC=0.49).
Conclusion: Overall, DCT was significantly more repeatable and reproducible than GAT, IOPg and IOPcc. The better reproducibility of the DCT may result in more precise measurements for monitoring IOP changes over time compared to GAT and ORA.
(C) 2012 Lippincott Williams & Wilkins, Inc.
Journal of Glaucoma 08/2012; Publish Ahead of Print. · 1.78 Impact Factor
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ABSTRACT: OBJECTIVE To examine the safety, tolerability, and reproducibility of intraocular pressure (IOP) patterns during repeated continuous 24-hour IOP monitoring with a contact lens sensor. METHODS Forty patients suspected of having glaucoma (n = 21) or with established glaucoma (n = 19) were studied. Patients participated in two 24-hour IOP monitoring sessions (S1 and S2) at a 1-week interval (SENSIMED Triggerfish CLS; Sensimed AG). Patients pursued daily activities, and sleep behavior was not controlled. Incidence of adverse events and tolerability (visual analog scale score) were assessed. Reproducibility of signal patterns was assessed using Pearson correlations. RESULTS The mean (SD) age of the patients was 55.5 (15.7) years, and 60% were male. Main adverse events were blurred vision (82%), conjunctival hyperemia (80%), and superficial punctate keratitis (15%). The mean (SD) visual analog scale score was 27.2 (18.5) mm in S1 and 23.8 (18.7) mm in S2 (P = .22). Overall correlation between the 2 sessions was 0.59 (0.51 for no glaucoma medication and 0.63 for glaucoma medication) (P = .12). Mean (SD) positive linear slopes of the sensor signal from wake to 2 hours into sleep were detected in both sessions for the no glaucoma medication group (S1: 0.40 [0.34], P < .001; S2: 0.33 [0.30], P < .01) but not for the glaucoma medication group (S1: 0.24 [0.60], P = .06; S2: 0.40 [0.40], P < .001). CONCLUSIONS Repeated use of the contact lens sensor demonstrated good safety and tolerability. The recorded IOP patterns showed fair to good reproducibility, suggesting that data from continuous 24-hour IOP monitoring may be useful in the management of patients with glaucoma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01319617.
Archives of ophthalmology 08/2012; · 3.86 Impact Factor
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ABSTRACT: PURPOSE: To evaluate the diagnostic accuracy of spectral domain optical coherence tomography (SD-OCT) for detection of preperimetric glaucoma and compare it with the performance of confocal scanning laser ophthalmoscopy (CSLO). DESIGN: Cohort study. PARTICIPANTS: A cohort of 134 eyes of 88 glaucoma suspects based on the appearance of the optic disc. METHODS: Patients were recruited from the Diagnostic Innovations in Glaucoma Study (DIGS). All eyes underwent retinal nerve fiber layer (RNFL) imaging with Spectralis SD-OCT (Heidelberg Engineering, Carlsbad, CA) and topographic imaging with Heidelberg Retinal Tomograph III (HRT-III) (Heidelberg Engineering) CSLO within 6 months of each other. All patients had normal visual fields at the time of imaging and were classified on the basis of history of documented stereophotographic evidence of progressive glaucomatous change in the appearance of the optic nerve occurring before the imaging sessions. MAIN OUTCOME MEASURES: Areas under the receiver operating characteristic curves (AUCs) were calculated to summarize diagnostic accuracies of the SD-OCT and CSLO. Likelihood ratios (LRs) were reported using the diagnostic categorization provided by each instrument after comparison to its normative database. RESULTS: Forty-eight eyes of 42 patients had evidence of progressive glaucomatous change and were included in the preperimetric glaucoma group. Eighty-six eyes of 46 patients without any evidence of progressive glaucomatous change followed untreated for an average of 14.0±3.6 years were included in the control group. The parameter with the largest AUC obtained with the SD-OCT was the temporal superior RNFL thickness (0.88±0.03), followed by global RNFL thickness (0.86±0.03) and temporal inferior RNFL thickness (0.81±0.04). The parameter with the largest AUC obtained with the CSLO was rim area (0.72±0.05), followed by rim volume (0.71±0.05) and linear cup-to-disk ratio (0.66±0.05). Temporal superior RNFL average thickness measured by SD-OCT performed significantly better than rim area measurements from CSLO (0.88 vs. 0.72; P=0.008). Outside normal limits results for SD-OCT parameters were associated with strongly positive LRs. CONCLUSIONS: The RNFL assessment with SD-OCT performed well in detecting preperimetric glaucomatous damage in a cohort of glaucoma suspects and had a better performance than CSLO. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Ophthalmology 08/2012; · 5.45 Impact Factor
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ABSTRACT: To evaluate repeatability and positional independence of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) thickness measurements in sitting and supine body positions using portable spectral-domain optical coherence tomography (iVue SD-OCT; Optovue Inc).
Evaluation of diagnostic technology.
Sixty eyes of 30 subjects (10 healthy younger adults aged 20-27 years, 10 healthy older adults aged 50-66 years, and 10 glaucoma patients aged 38-82 years) were included prospectively. For each participant, all measurements were taken in a single session. After 5 minutes in the supine position, 5 scans were obtained from both eyes. Following a 5-minute sitting adaptation, 5 scans were then obtained in the sitting position. The same instrument was used for all measurements. Repeatability and correlation between supine and sitting measurements of 4 ONH and 3 RNFL parameters were assessed using intraclass correlation coefficients (ICC), concordance correlation coefficients (ρ), and Bland-Altman plots.
Measurements were highly repeatable within individual eyes, both for ONH (ICC range, 73%-99%) and RNFL (ICC range, 72%-99%) parameters. The correlation between supine and sitting ONH measurements was strong and ranged from ρ = 97%-99% (younger healthy) to ρ = 98%-99% (older healthy) and ρ = 84%-99% (glaucoma). Bland-Altman plots indicated good agreement between sitting and supine readings of ONH and RNFL parameters.
Repeatability of measurements of ONH and RNFL is high and measurements between sitting and supine are highly correlated. The ability of the iVue SD-OCT to evaluate ONH and RNFL parameters is good to excellent in both body positions.
American journal of ophthalmology 07/2012; 154(4):712-721.e1. · 3.83 Impact Factor
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ABSTRACT: To present and evaluate a new method of integrating risk factors into the analysis of rates of visual field progression in glaucoma.
The study included 352 eyes of 250 glaucoma patients followed up for an average of 8.1 ± 3.5 years. Slopes of change over time were evaluated by the mean deviation (MD) from standard automated perimetry. For each eye, the follow-up time was divided into two equal periods: the first half was used to obtain the slopes of change and the second period was used to test the predictions. Slopes of change were calculated with two methods: the conventional approach of ordinary least squares (OLS) linear regression and a Bayesian regression model incorporating information on risk factors and presence of progressive optic disc damage on stereophotographs. The mean square error (MSE) of the predictions was used to compare the predictive performance of the different methods.
Higher mean IOP, thinner central corneal thickness (CCT), and presence of progressive optic disc damage were associated with faster rates of MD change. Incorporation of risk factor information into the calculation of individual slopes of MD change with the Bayesian method resulted in better prediction of future MD values than with the OLS method (MSE: 4.31 vs. 8.03, respectively; P < 0.001).
A Bayesian regression model incorporating structural and risk factor information into the estimation of glaucomatous visual field progression resulted in more accurate and precise estimates of slopes of functional change than the conventional method of OLS regression. (ClinicalTrials.gov number, NCT00221897.).
Investigative ophthalmology & visual science 03/2012; 53(4):2199-207. · 3.43 Impact Factor
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ABSTRACT: To investigate the association between corneal biomechanical parameters using the Ocular Response Analyzer (ORA) and glaucoma severity.
Observational cross-sectional study.
Two hundred ninety-nine eyes of 191 patients with confirmed or suspect glaucoma were recruited at the University of California, San Diego. Corneal hysteresis (CH) and corneal resistance factor (CRF) were obtained from all participants. Standard automated perimetry was done using the 24-2 Swedish Interactive Threshold Algorithm. Retinal nerve fiber layer (RNFL) thickness measurements were obtained using GDx ECC and spectral-domain optical coherence tomography (SD-OCT). The association between ORA parameters and disease severity was evaluated using univariable and multivariable regression models.
CH and CRF were both positively associated with mean defect (MD) (R(2) = 0.03; P < .01 and R(2) = 0.10; P < .01, respectively). In multivariable analysis, the association between CRF and MD remained significant while CH to MD did not (P < .01 and P = .77). In the GDx ECC subgroup (204 eyes), there was a weak association between CH and CRF and average RNFL thickness (R(2) = 0.07; P < .01 and R(2) = 0.05; P < .01, respectively), which was not observed in the SD-OCT subgroup (146 eyes) (R(2) = 0.01; P = .30 and R(2) = 0.01; P = .21). After adjusting for central corneal thickness, age, and axial length, the relationship of CH and CRF to RNFL thickness no longer reached statistical significance.
The current study found only a weak relationship between corneal biomechanical parameters and measures of structural and functional damage in glaucoma.
American journal of ophthalmology 03/2012; 153(3):419-427.e1. · 3.83 Impact Factor
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ABSTRACT: To investigate the 24 h effects of bimatoprost 0.01% monotherapy on intraocular pressure (IOP) and ocular perfusion pressure (OPP).
Prospective, open-label experimental study.
Single tertiary ophthalmic clinic.
Sixteen patients with diagnosed primary open-angle glaucoma (POAG) or ocular hypertension (ages, 49-77 years).
Baseline data of 24 h IOP in untreated patients were collected in a sleep laboratory. Measurements of IOP were taken using a pneumatonometer every 2 h in the sitting and supine body positions during the 16 h diurnal/wake period and in the supine position during the 8 h nocturnal/sleep period. After baseline measurements were taken, patients were treated with bimatoprost 0.01% one time per day at bedtime for 4 weeks, and then 24 h IOP data were collected under the same laboratory conditions. PRIMARY AND SECONDARY OUTCOME MEASURES: Diurnal and nocturnal IOP and OPP means under bimatoprost 0.01% treatment were compared with baseline.
The diurnal and nocturnal IOP means were significantly lower under the bimatoprost 0.01% treatment than baseline in both the sitting and supine positions. The diurnal and nocturnal OPP means were significantly higher under treatment than baseline in both the sitting and supine positions.
Bimatoprost 0.01% monotherapy significantly lowered IOP and increased OPP during the 24 h period.
BMJ open. 01/2012; 2(4).
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ABSTRACT: To assess the agreement of parapapillary retinal nerve fiber layer (RNFL) thickness measurements among 3 spectral-domain optical coherence tomography (SD-OCT) instruments.
Observational, cross-sectional study.
Three hundred thirty eyes (88 with glaucoma, 206 glaucoma suspects, 36 healthy) from 208 individuals enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) were imaged using RTVue, Spectralis and Cirrus in a single visit. Agreement among RNFL thickness measurements was assessed using Bland-Altman plots. The influence of age, axial length, disc size, race, spherical equivalent, and disease severity on the pairwise agreements between different instruments was assessed by regression analysis.
Although RNFL thickness measurements between different instruments were highly correlated, Bland-Altman analyses indicated the presence of fixed and proportional biases for most of the pairwise agreements. In general, RTVue measurements tended to be thicker than Spectralis and Cirrus measurements. The agreement in average RNFL thickness measurements between RTVue and Spectralis was affected by age (P = .001) and spherical equivalent (P < .001), whereas the agreement between Spectralis and Cirrus was affected by axial length (P = .004) and spherical equivalent (P < .001). Disease severity influenced the agreement between Spectralis and both RTVue and Cirrus (P = .001). Disc area and race did not influence the agreement among the devices.
RNFL thickness measurements obtained by different SD-OCT instruments were not entirely compatible and therefore they should not be used interchangeably. This may be attributable in part to differences in RNFL detection algorithms. Comparisons with histologic measurements could determine which technique is most accurate.
American journal of ophthalmology 10/2010; 151(1):85-92.e1. · 3.83 Impact Factor
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ABSTRACT: To compare the diagnostic accuracy of the pattern electroretinogram (pattern ERG) to that of standard automated perimetry (SAP), short-wavelength automated perimetry (SWAP), and frequency-doubling technology (FDT) perimetry for discriminating between healthy and glaucomatous eyes.
Cross-sectional study.
Eighty-three eyes of 42 healthy recruits and 92 eyes of 54 glaucoma patients (based on optic disc appearance) from the University of California, San Diego, Diagnostic Innovations in Glaucoma Study were tested with pattern ERG for glaucoma detection (PERGLA; Lace Elettronica, Pisa, Italy), SAP, SWAP, and FDT within 9 months. Receiver operating characteristic (ROC) curves were generated and compared for pattern ERG amplitude and SAP, SWAP, and FDT mean deviation and pattern standard deviation (PSD). Sensitivities and specificities were compared and agreement among tests was described.
The area under the ROC curve for pattern ERG amplitude was 0.744 (95% confidence interval = 0.670, 0.818). The ROC curve area was 0.786 (0.720, 0.853) for SAP PSD, 0.732 (0.659, 0.806) for SWAP PSD, and 0.818 (0.758, 0.879) for FDT PSD. At 95% specificity, sensitivities of SAP and FDT PSD were significantly higher than that of pattern ERG amplitude; at 80% specificity, similar sensitivities were observed among tests. Agreement among tests was slight to moderate.
The diagnostic accuracy of the pattern ERG amplitude was similar to that of SAP and SWAP, but somewhat worse than that of FDT. Nevertheless, the pattern ERG may hold some advantage over psychophysical testing because of its largely objective nature.
American journal of ophthalmology 03/2010; 149(3):488-95. · 3.83 Impact Factor
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ABSTRACT: To determine the within-trial and between-trial repeatability of pattern electroretinogram (PERG) measurements in healthy and patient eyes, using a new clinical instrument, the PERGLA.
In all, 70 eyes of 35 healthy individuals (intraocular pressure <22 mm Hg, healthy optic disc by stereophotograph assessment, standard visual fields within normal limits) and 90 eyes of 45 clinic patients (ocular hypertensive, glaucomatous optic neuropathy by stereophotograph assessment and/or repeatable abnormal visual fields) enrolled in the University of California, San Diego Diagnostic Innovations in Glaucoma Study (DIGS) were evaluated. Average mean deviation of patient eyes on standard automated perimetry was -1.81 dB (SD=2.61).
The PERG was recorded using the PERGLA paradigm from both eyes simultaneously twice (ie, 2 trials) by a single operator with electrodes being removed and reattached between recordings. Repeatability of PERG amplitude (microV) and phase (pi rad) between 2 runs within a single trial (within-trial condition) was compared with repeatability between 2 trials (ie, after electrode replacement, between-trial condition) by calculating the coefficients of variability (CVs) and the intraclass correlation coefficients (ICCs) and displaying Bland-Altman plots.
For healthy eyes, amplitude CVs (SD) were 11.5% (11.5) and 9.9% (0.79) for within-trial and between-trial conditions, respectively. ICCs were 0.91 and 0.85. Phase CVs were 1.3% (1.5) (within-trials) and 1.5% (1.4) (between-trials) and ICCs were 0.85 and 0.88. For patient eyes, amplitude CVs (SD) were 12.2% (10.1) and 11.2% (7.5) for within-trial and between-trial conditions, respectively. ICCs were 0.92 and 0.89. Phase CVs were 2.2% (2.2) (within-trials) and 2.4% (2.2) (between-trials) and ICCs were 0.82 and 0.83. Bland-Altman plots indicated good agreement between the repeated recordings and were similar within-trials and between-trials for healthy and patient eyes.
Repeatability of PERGLA recordings is good and is similar within-trials and between-trials for both healthy and patient eyes suggesting this technique is promising for monitoring change over time.
Journal of glaucoma 09/2009; 18(6):437-42. · 1.74 Impact Factor
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ABSTRACT: To evaluate the effect of operator and optical defocus on the variability of pattern electroretinogram optimized for glaucoma detection (PERGLA).
Two different operators obtained 2 PERGLA recordings each from 10 healthy participants (5 women, mean age 32.1+/-10.3 y). In addition, one of the operators obtained recordings in which corrective lenses of various diopters (+/-0.5, +/-1, +/-2, and +/-3) were used to generate optical defocus in both eyes. The effect of operator on PERGLA amplitude and phase variability was determined using a single nested variance components' analysis model and by using Bland-Altman plots. One-way analysis of variance (ANOVA) was used to determine the effect of optical defocus on amplitude and phase.
Differences in measurements between operators accounted for approximately 26.6% and 18.2% of the total variance for amplitude and phase, respectively. Results were confirmed by the use of Bland-Altman plots. ANOVA identified a significant effect of defocus on mean amplitude (F=2.65, P=0.01), but not phase (F=1.02, P=0.42).
Measurements obtained by different operators can result in significant differences in PERGLA amplitude. In addition, although optical defocus leads to a decrease in PERGLA amplitude by reducing visual acuity, this can be avoided by obtaining J1 or better vision before testing.
Journal of glaucoma 05/2009; 19(2):77-82. · 1.74 Impact Factor
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ABSTRACT: To assess the ability of the new pattern electroretinogram optimized for glaucoma detection (PERGLA) paradigm to discriminate between healthy individuals and individuals with glaucomatous optic neuropathy (GON).
Cross-sectional study.
One hundred forty-two eyes of 71 participants (42 healthy and 29 with GON in at least 1 eye) enrolled in the University of California, San Diego, Diagnostic Innovations in Glaucoma Study were studied. Healthy individuals were those recruited as healthy with healthy-appearing optic disc by examination and masked stereoscopic optic disc photograph evaluation. Glaucomatous optic neuropathy was defined based on stereophotograph evaluation.
The PERGLA (Glaid Elettronica, Pisa, Italy) recordings were obtained within 6 months of standard automated perimetry (SAP) testing. Dependent variables were PERGLA amplitude, phase, amplitude asymmetry, phase asymmetry, and SAP pattern standard deviation (PSD) and mean deviation (MD).
Diagnostic accuracy (sensitivity and specificity) of the PERGLA normative database for classifying healthy and glaucomatous individuals was determined. In addition, performance (areas under receiver operating characteristic curves [AUCs]) of PERGLA amplitude and phase for classifying healthy (n=84) and GON (n=50) eyes was determined. Results from both analyses were compared with those from SAP.
Sensitivity and specificity of the PERGLA normative database were 0.76 and 0.59, respectively, compared with 0.83 and 0.77 for SAP. The AUCs for PERGLA amplitude and phase were 0.75 and 0.50 (chance performance), respectively. The AUCs for SAP PSD and MD were 0.83 and 0.78, respectively.
Pattern electroretinograms recorded using the PERGLA paradigm can discriminate between healthy and glaucoma eyes, although this technique performed no better than SAP at this task. Low specificity of the PERGLA normative database suggests that the distribution of recordings included in the database is not ideal.
Ophthalmology 02/2009; 116(3):437-43. · 5.45 Impact Factor
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ABSTRACT: To compare the most recent versions of standard automated perimetry (SAP), short-wavelength automated perimetry (SWAP), and frequency-doubling technology (FDT) using three definitions of visual field (VF) abnormality: single-test abnormality, abnormality confirmed by the same test, and abnormality confirmed by a different test.
Data obtained from one eye of each of 174 patients with glaucoma and 164 age-matched healthy control subjects from the Diagnostic Innovations in Glaucoma Study and African Descent and Glaucoma Evaluation Study were included, based on the appearance of the optic disc on stereophotographs. Each participant had two reliable 24-2 SAP-SITA, SWAP-SITA, and Matrix FDT tests. Receiver operating characteristic (ROC) curves were generated for the PSD of each test to equate the tests at 90% and 95% specificity. SAP, SWAP, and FDT were compared under each definition of VF abnormality by assessing the sensitivities, the agreement between tests and the overlap in deficit location at these set specificities. The tests were also compared using the machine-derived PSD.
At a set specificity of 95%, single-test sensitivities of 30% (SAP), 29% (SWAP), and 28% (FDT) were observed (all P > 0.05). Sensitivities ranged from 24% to 27% (all P > 0.05) when same-test confirmation was used and from 20% to 23% (all P > 0.05) when different-test confirmation was used. SAP/SAP sensitivity was higher than all different-test combinations (all P < 0.05), and SWAP/FDT sensitivity was lower than all same-test combinations (all P < 0.05).
Confirming VF abnormality is important and optimal when an abnormal SAP is confirmed by a subsequent SAP or SWAP test.
Investigative ophthalmology & visual science 10/2008; 50(3):1234-40. · 3.43 Impact Factor
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ABSTRACT: To assess whether baseline retinal nerve fiber layer (RNFL) measurements obtained with optical coherence tomography (OCT2; Carl Zeiss Meditec, Dublin, California, USA) are predictive of the development of glaucomatous change.
Cohort study.
Participants were recruited from the University of California, San Diego (UCSD) longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). One eye was studied from each of 114 glaucoma suspects with normal standard automated perimetry (SAP) and OCT RNFL imaging at baseline. The cohort was divided into two groups based on the development of glaucomatous change (repeatable abnormal visual fields and/or a change in the stereophotographic appearance of the optic disk). Cox proportional hazards models were used to determine the predictive ability of OCT RNFL thickness measurements.
Over a 4.2-year average follow-up period, 23 eyes (20%) developed glaucomatous changes and 91 (80%) did not. At baseline, thinner RNFL measurements, higher SAP pattern standard deviation (PSD), "glaucoma" stereophotograph assessment, and thinner central corneal thickness (CCT) were associated with the study endpoints in univariate analysis. After adjusting for age, intraocular pressure (IOP), CCT, and PSD in multivariate models, a 10 mum thinner average, superior and inferior RNFL at baseline was predictive of glaucomatous change [hazard ratio (95% CI); 1.51 (1.11 to 2.12), 1.57 (1.17 to 2.18), and 1.49, (1.19 to 1.91), respectively]. Results were consistent when stereophotographic assessment was included in multivariate analysis.
Thinner OCT RNFL measurements at baseline were associated with development of glaucomatous change in glaucoma suspect eyes. RNFL thinning was an independent predictor of the glaucomatous change, even when adjusting for stereophotograph assessment, age, IOP, CCT, and PSD.
American Journal of Ophthalmology 11/2006; 142(4):576-82. · 4.22 Impact Factor
