Clinical Validation of Visual Field Index in Glaucoma Patients with Central Visual Field Defects

Ji-Hye Park; Chung Kwon Yoo; Yong Yeon Kim

doi:10.3341/jkos.2011.52.6.709

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

Original Article

J Korean Ophthalmol Soc 2011;52(6):709-715.

Published online: 31 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.6.709

Clinical Validation of Visual Field Index in Glaucoma Patients with Central Visual Field Defects

Ji-Hye Park, MD, Chung Kwon Yoo, MD, PhD, Yong Yeon Kim, MD, PhD

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

Address reprint requests to Yong Yeon Kim, MD, PhD, Department of Ophthalmology, Korea University Guro Hospital #97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: yongykim@korea.ac.kr

Received 14 September 2010 Revised 10 January 2011 Accepted 23 March 2011

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 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.

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Keywords: Mean deviation, Pattern standard deviation, Retinal nerve fiber layer thickness, Visual field index

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.

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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.

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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.

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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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