Interpretation of Frequency Doubling Technology Perimeter in Diagnosis of Glaucoma and Glaucoma Suspect

Jin A Choi; Chan Kee Park

doi:10.3341/jkos.2007.48.8.1096-1105

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Choi and Park: Interpretation of Frequency Doubling Technology Perimeter in Diagnosis of Glaucoma and Glaucoma Suspect

Original Article

J Korean Ophthalmol Soc 2007;48(8):1096-1105.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.8.1096-1105

Interpretation of Frequency Doubling Technology Perimeter in Diagnosis of Glaucoma and Glaucoma Suspect

Jin A Choi, M.D., Chan Kee Park, M.D.

Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Chan Kee Park, M.D., Department of Ophthalmology, Gangnam St. Mary's Hospital, College of Medicine, The Catholic University, #505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea, Tel: 82-2-590-2760, Fax: 82-2-533-6718, E-mail: ckpark@catholic.ac.kr

Received 19 September 2006 Accepted 8 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To find applicable parameters of the frequency doubling technology perimeter (FDP), which is known to be useful in detecting early visual field loss.

Methods

The subjects were 65 eyes of normal individuals, 58 eyes of glaucoma suspects, and 37 eyes of glaucoma patients. FDP (MD, PSD), SAP (MD, PSD, CPSD), and 5 parameters of OCT were analyzed. The receiver operating characteristic (ROC) curve, sensitivity, and specificity of each parameter were evaluated, and the comparison of FDP parameters by Pearson's chi-square was made between the glaucoma suspect group and the normal group. The same comparison was made among the normal+glaucoma suspect and glaucoma group.

Results

In discriminating between the normal and glaucoma suspect groups, the FDP-PSD revealed an AUC of 0.745 (cutoff: 3.17dB), which was significantly larger than that of SAP-PSD with an AUC of 0.660 (cutoff: 1.73dB). In comparing FDP, PSD by Anderson criteria was most reliable with a hit ratio of 0.732. On the other hand, in discriminating among the normal+glaucoma suspect group and glaucoma group, the SAP-PSD showed an AUC 0.971 (cutoff: 2.92dB), much larger than the FDP-PSD with an AUC of 0.863 (cutoff: 3.78dB). In addition, in comparing the parameters of FDP by Pearson chi-square, PSD 1% was the most reliable with a hit ratio of 0.813.

Conclusions

FDP is a valuable screening tool in detecting early visual field loss. PSD by Anderson criteria can be a reliable parameter for the diagnosis of pre-perimetric glaucoma, and PSD 1% can be used in the discrimination of perimetric glaucoma.

Keywords: FDP, Anderson criteria, Frequency doubling technology, Preperimetric glaucoma, PSD

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Figure 1.

ROC (receiver operator characteristic) curve of the discriminant formula. (Between glaucoma suspect and normal)

Figure 2.

ROC (receiver operator characteristic) curve of the discriminant formula. (Between ‘glaucoma’ and ‘or not’)

Table 1.

Patient characteristics and MD^∗, PSD^†, CPSD^‡ in normal (N), glaucoma suspect (GS), glaucoma (G) group (N=160)

	Normal	Glaucoma suspect	Glaucoma	P value		Post Hoc
Number (eye)	65	58	37
Gender (Male/Female)	32/33	36/22	25/12
Age (year±SD)	38.75±13.80	44.51±14.73	46.97±17.04	0.017	N  GS	0.113
					N  G	0.104
					GS  G	0.021
MD (dB±SD)	-2.03±1.72	-2.33±1.72	-7.85±5.60	<0.001	N  GS	0.864
					N  G	<0.001
					GS  G	<0.001
PSD (dB±SD)	1.91±1.27	2.06±0.51	6.65±3.67	<0.001	N  GS	0.907
					N  G	<0.001
					GS  G	<0.001
CPSD (dB±SD)	1.10± 1.32	1.22±0.69	6.31±3.91	<0.001	N  GS	0.941
					N  G	<0.001
					GS  G	<0.001

^∗ MD : mean deviation.

^† PSD : pattern standard deviation.

^‡ CPSD : corrected pattern standard deviation.

Statistical significance was tested by analysis of varience (ANOVA), and post Hoc test was done by Scheffe method.

Table 2.

Comparison of mean value between normal (N), glaucoma suspect (GS) and glaucomata (G) group using FDP^∗, OCT^† ONH^‡ & RNFL^§ analysis and ophthalmoscopic exam

		Normal	Glaucoma suspect	Glaucoma	P value		Post Hoc
OCT ONH	VIRW^Π	0.27±0.21	0.16±0.07	0.11±0.07	<0.001	N  GS	<0.001
analysis						N  G	<0.001
						GS  G	0.322
	HIRA^#	1.59±0.27	1.41±0.26	1.22±0.23	<0.001	N  GS	0.001
						N  G	<0.001
						GS  G	0.002
	C/D	0.62±0.10	0.70±0.09	0.76±0.11	<0.001	N  GS	<0.001
	vert.ratio					N  G	<0.001
						GS  G	0.026
OCT RNFL	Iavg	138.98±19.36	122.45±21.44	90.14±29.20	<0.001	N  GS	0.005
analysis						N  G	<0.001
						GS  G	<0.001
	Average	101.13±12.11	93.64±12.69	74.71±19.07	<0.001	N  GS	0.016
						N  G	<0.001
						GS  G	<0.001
FDP	MD^∗∗	-3.74±3.73	-6.09±5.39	-12.43±5.61	<0.001	N  GS	0.030
						N  G	<0.001
						GS  G	<0.001
	PSD^††	3.18±0.86	4.04±1.16	5.95±2.10	<0.001	N  GS	0.002
						N  G	<0.001
						GS  G	<0.001
Opthalmo	C/D	0.47±0.15	0.62±0.13	0.70±0.14	<0.001	N  GS	<0.001
exam	hoz.ratio					N  G	<0.001
						GS  G	0.104
	C/D	0.47±0.14	0.62±0.11	0.72±0.13	<0.001	N  GS	<0.001
	vert.ratio					N  G	<0.001
						GS  G	0.001

^∗ FDP : frequency doubling technology perimeter.

^† OCT : optical coherence tomography.

^‡ ONH : optic nerve head.

^§ RNFL : retinal nerve fiber layer.

^Π VIRW : vertical integrated rim volume (mm³),

^# HIRA : horizontal integrated rim area (mm²).

^∗∗ MD : mean deviation.

^†† PSD : pattern standard deviation.

Statistical significance was tested by analysis of varience (ANOVA), and post Hoc test was done by Scheffe method.

Table 3.

Area under the receiver operating characteristic curve (AUC), sensitivity, specificity by each parameters between glaucoma suspect and normal group

		AUC	Sensitivity (%)	Specificity (%)	Cutoff value
OCT^∗ ONH^† analysis	VIRW^‡	0.727	75.90	63.10	0.205
	HIRA^§	0.675	67.20	52.30	1.545
	CDVR^Π	0.714	74.10	63.10	0.648
OCT RNFL^# analysis	Iavg	0.700	67.20	40.00	134.500
	Avg thick	0.680	67.20	40.00	99.320
FDP^∗∗	MD^††	0.620	67.20	49.20	-3.450
	PSD^‡‡	0.745	75.90	63.10	3.170
SAP^§§	MD	0.556	62.10	50.80	-2.160
	PSD	0.660	74.10	53.80	1.730
	CPSD^ΠΠ	0.600	56.90	60.00	1.190

^∗ OCT : optical coherence tomography.

^† ONH : optic nerve head.

^‡ VIRW : vertical integrated rim volume.

^§ HIRA : horizontal integrated rim area.

^Π CDVR : cup/disc vertical ratio.

^# RNFL : retinal nerve fiber layer.

^∗∗ FDP : frequency doubling technology perimeter.

^† † MD : mean deviation.

^‡ ‡ PSD : pattern standard deviation.

^§§ SAP : standard automated perimetry.

^ΠΠ CPSD : corrected pattern standard deviation.

Table 4.

Area under the receiver operating characteristic curve (AUC), sensitivity, specificity by each parameters between ‘glaucoma’ and ‘or not’

		AUC	Sensitivity (%)	Specificity (%)	Cutoff value
OCT^∗ ONH^† analysis	VIRW^‡	0.761	71.40	71.50	0.139
	HIRA^§	0.790	71.40	76.40	1.335
	CDVR^Π	0.765	77.10	65.00	0.699
OCT RNFL^# analysis	Iavg	0.876	88.60	74.80	118.500
	Avg thick	0.832	85.70	58.50	95.780
FDP^∗∗	MD^††	0.855	91.40	66.70	-5.540
	PSD^‡‡	0.863	88.60	65.90	3.775
SAP^§§	MD	0.849	74.30	83.70	-3.665
	PSD	0.971	91.40	92.70	2.920
	CPSD^ΠΠ	0.959	94.30	90.20	1.940

^∗ OCT : optical coherence tomography.

^† ONH : optic nerve head.

^‡ VIRW : vertical integrated rim volume.

^§ HIRA : horizontal integrated rim area.

^π CDVR : cup/disc vertical ratio.

^# RNFL : retinal nerve fiber layer.

^∗∗ FDP : frequency doubling technology perimeter.

^†† MD : mean deviation.

^‡‡ PSD : pattern standard deviation.

^§§ SAP : standard automated perimetry.

^ΠΠ CPSD: corrected pattern standard deviation.

Table 5.

Comparisons of FDP^∗ by Pearson chi-square between glaucoma suspect and normal

	Hit ratio	P value	sensitivity (%)	specificity (%)	False positive	False negative	chi-square
GHT^†	0.608	<0.001	63.64	58.46	43.55	34.48	5.826
MD^‡ <1%	0.585	<0.001	29.31	84.62	37.04	42.71	3.469
MD<5%	0.610	<0.001	53.45	67.69	40.38	38.03	5.613
MD by ads^Π	0.634	<0.001	70.69	56.92	40.58	31.48	9.489
PSD^§<1%	0.626	<0.001	29.31	92.31	22.73	40.59	9.753
PSD<5%	0.683	<0.001	62.07	73.85	32.08	31.43	16.122
PSD by ads^Π	0.732	<0.001	70.69	75.38	28.07	25.76	26.166
PSD by cutoff (3.17)	0.691	<0.001	75.86	63.08	35.29	25.45	18.799

^∗ FDP : frequency doubling technology perimeter.

^† GHT : glaucoma hemifield test.

^‡ MD : mean deviation.

^§ PSD : pattern standard deviation.

^Π ads : Anderson criteria.

Table 6.

Comparison of FDP^∗ by Pearson chi-square between ‘glaucoma’ and ‘or not’

	Hit ratio	P value	Sensitivity π%)	Specificity π%)	False positive	False negative	chi-square
GHT^†	0.592	<0.001	94.59	48.33	63.92	3.33	22.072
MD^‡ <1%	0.781	<0.001	78.38	78.05	48.21	7.69	39.809
MD<5%	0.656	<0.001	91.89	57.72	60.47	4.05	28.166
MD by ads^Π	0.563	<0.001	97.30	43.70	65.71	1.82	21.402
PSD^§<1%	0.813	<0.001	78.38	82.11	43.14	7.34	47.932
PSD<5%	0.650	<0.001	91.89	56.91	60.92	4.11	27.307
PSD by ads^Π	0.625	<0.001	91.89	53.66	62.64	4.35	24.061
PSD by cutoff (3.78)	0.713	<0.001	89.19	65.85	56.00	4.71	34.606

^∗ FDP : frequency doubling technology perimeter.

^† GHT : glaucoma hemifield test.

^‡ MD : mean deviation.

^§ PSD : pattern standard deviation.

^Π ads : Anderson criteria.

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