Testing for glaucoma with frequency-doubling perimetry in normals, ocular hypertensives, and glaucoma patients

Background: The aim of this study was to evaluate the diagnostic usefulness of the FDT perimeter protocol (C-20-5) in combination with a database system for analysis of single test locations. Methods: One hundred seventy-three ocular hypertensive eyes, 116 preperimetric open-angle glaucoma eyes (glaucomatous optic disc atrophy, elevated intraocular pressure, no visual field defects in standard white-on-white perimetry), 199 perimetric open-angle glaucoma eyes (glaucomatous optic disc atrophy and visual field defects), and 151 control eyes underwent FDT screening and conventional white-on-white perimetry. Four repeated measurements were carried out in 15 glaucoma patients at 2-h intervals to judge reproducibility of all test locations. The present screening strategy begins testing at the normal 5% probability level. If a stimulus is not detected, further targets are presented. FDT-Viewfinder and statistics software were used for case-wise recalculation of all missed localized probability levels and correlation with corresponding test locations using conventional perimetry. Results: Analysis of repeated measurements in patients reveals that variation of single test points can be considerable. However, the numbers of missed test-stimuli calculated globally or in quadrants are significantly correlated with corresponding Octopus visual field defects (Spearman rank correlation P<0.001). Using a predefined specificity of 96% in control eyes, 11% of ocular hypertensive eyes, 28.5% of preperimetric glaucoma eyes and 86.9% of perimetric glaucoma eyes have been classified glaucomatous using an overall score and with consideration of different cut-off points in right and left eyes. Conclusion: Point-wise analysis of FDT screening results can be helpful for classification of patient groups and consideration of the individual learning curve in repeated measurements. The C-20-5 protocol of the FDT perimeter is able to detect a considerable proportion of glaucomatous patients.