Journal List > J Korean Ophthalmol Soc > v.52(6) > 1009061

Park, Yoo, and Kim: Clinical Validation of Visual Field Index in Glaucoma Patients with Central Visual Field Defects

Abstract

Purpose

To evaluate the glaucoma discrimination ability of visual field index (VFI), a new perimetric index of Humphrey field analyzer II, in glaucoma patients with central and peripheral visual field defects (VFD).

Methods

Humphrey visual field test and OCT were performed in 204 glaucomatous eyes and 70 healthy eyes. The associations of VFI with mean deviation (MD), pattern standard deviation (PSD), and average retinal nerve fiber layer thickness (RNFLT) were analyzed using Pearson's correlation. The diagnostic abilities of the parameters were analyzed using the areas under the receiver operating characteristic curves (AUROC). The AUROC were compared between MD-matched patients with central VFD (at least one point with p < 1% within the central most 16 points of 30-2 SITA standard automated visual field) and peripheral VFD (VFD beyond the central most 16 points of 30-2 SITA standard automated visual field).

Results

The associations between analyzed parameters and VFI were statistically significant. The MD, RNFLT, age, intraocular pressure, and central cornea thickness were not different between the two groups (p > 0.05). The AUROC value of VFI was greater than those of the MD and average RNFLT but was not different from that of PSD (p = 0.332) in the central VFD group. However, there were no significant differences between AUROC value of VFI and those of other parameters in the peripheral VFD group (all, p > 0.05).

Conclusions

The results from the present study suggest that VFI may be more useful than MD in diagnosing glaucoma, especially in patients with central VFD.

References

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Figure 1.
Visual field tests of central and peripheral visual field defect (VFD) groups. (A) Central VFD group. (B) Peripheral VFD group.
jkos-52-709f1.tif
Figure 2.
ROC curve of central VFD group. ROC = receiver operating characteristics; VFD = visual field defect; VFI = visual field index; PSD = pattern standard deviation; MD = mean deviation; AVG RNFL = average retinal nerve fiber layer thickness; REF = reference line.
jkos-52-709f2.tif
Figure 3.
ROC curve of peripheral VFD group. ROC = receiver operating characteristics; VFD = visual field defect; VFI = visual field index; PSD = pattern standard deviation; MD = mean deviation; AVG RNFL = average retinal nerve fiber layer thickness; REF = reference line.
jkos-52-709f3.tif
Table 1.
Comparison of glaucoma group and control group
  Glaucoma group (n = 204) Control group (n = 70) p-value
Age (mean ± SD, yr) 53.57 ± 14.79 47.00 ± 13.28 0.285*
Sex (M/F) 99/105 35/35 0.470
BCVA (mean ± SD, logMAR) 0.85 ± 0.180 0.91 ± 0.146 0.008
CCT (mean ± SD, μ m) 539.49 ± 38.467 541.25 ± 36.32 0.924*
IOP (mean ± SD, mm Hg) 15.41 ± 4.69 15.40 ± 5.45 0.295*
MD (mean ± SD, dB) −5.72 ± 5.32 −1.57 ± 1.97 <0.001*
PSD (mean ± SD, dB) 5.64 ± 4.28 2.12 ± 1.47 <0.001*
VFI (mean ± SD, %) 87.60 ± 16.48 98.53 ± 3.05 <0.001*
Average RNFL thickness (mean ± SD, μ m) 86.99 ± 16.45 102.68 ± 13.23 0.021*

BCVA = best corrected visual acuity; CCT = central corneal thickness; IOP = intraocular pressure; MD = mean deviation; PSD = pattern standard deviation; VFI = visual field index; RNFL = retinal nerve fiber layer.

* Independent t-test

Fisher's chi-square test

Mann-Whitney U test.

Table 2.
Correlation of visual field index with other parameters in glaucoma patients
  Correlation coefficient p-value*
MD (dB) 0.953 <0.001
PSD (dB) 0.841 <0.001
Average RNFL thickness (μ m) 0.503 <0.001

MD = mean deviation; PSD = pattern standard deviation; RNFL = retinal nerve fiber layer.

* Pearson correlation test.

Table 3.
Comparison of central VFD group and peripheral VFD group
  Central VFD group (n = 50) Peripheral VFD group (n = 50) p-value
Age (mean ± SD, yr) 52.10 ± 15.80 52.12 ± 13.51 0.291*
Sex (M/F) 29/21 25/25 0.422
BCVA (mean ± SD, logMAR) 0.83 ± 0.182 0.87 ± 0.185 0.169
CCT (mean ± SD, μ m) 539.88 ± 34.32 532.79 ± 28.54 0.225*
IOP (mean ± SD, mm Hg) 15.94 ± 4.53 15.12 ± 5.53 0.518*
MD (mean ± SD, dB) −2.89 ± 1.26 −2.88 ± 1.31 0.661*
PSD (mean ± SD, dB) 4.08 ± 2.25 3.21 ± 1.82 0.020*
VFI (mean ± SD, %) 93.82 ± 4.01 96.40 ± 3.31 0.253*
Average RNFL thickness (mean ± SD, μ m) 91.15 ± 15.61 93.53 ± 11.98 0.199*
 Superior RNFL thickness 111.20 ± 22.325 112.10 ± 21.17 0.669*
 Nasal RNFL thickness 73.68 ± 19.15 73.60 ± 5.22 0.076*
 Inferior RNFL thickness 108.84 ± 27.53 116.32 ± 19.75 0.197*
 Temporal RNFL thickness 70.94 ± 16.07 72.12 ± 13.65 0.509*

VFD = visual field defect; BCVA = best corrected visual acuity; CCT = central corneal thickness; IOP = intraocular pressure; MD = mean deviation; PSD = pattern standard deviation; VFI = visual field index; RNFL = retinal nerve fiber layer.

* Independent t-test

Chi-square test

Mann-Whitney U test.

Table 4.
The area under receiver operating curve (AUROC) of the parameters from humphrey visual field and from OCT in both groups
  AUROC
p-value for difference from VFI*
Central VFD group Peripheral VFD group Central VFD group Peripheral VFD group
MD (dB) 0.796 0.781 0.018 0.886
PSD (dB) 0.875 0.802 0.332 0.618
VFI (%) 0.915 0.772 NA NA
Average RNFL thickness (μ m) 0.744 0.706 0.015 0.322

MD = mean deviation; PSD = pattern standard deviation; VFI = visual field index; RNFL = retinal nerve fiber layer; VFD = visual field defect.

* Comparison of ROC curve.

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