Pulsar Perimetry in the Diagnosis of Early Glaucoma
Accepted 16 July 2009. published online 05 October 2009.
Purpose
To assess the ability of Pulsar perimetry (Pulsar) in detecting early glaucomatous visual field (VF) damage in comparison with Frequency Doubling Technology (FDT), Scanning Laser Polarimetry (SLP, GDx VCC), and Heidelberg Retina Tomography (HRT).
Design
Prospective observational cross-sectional case study.
Methods
This multicenter study included: 87 ocular hypertensives (OHT); 67 glaucomatous optic neuropathy (GON) patients; 75 primary open-angle glaucoma (POAG) patients; and 90 normals. All patients underwent standard automated perimetry (SAP) HFA 30-2, Pulsar T30W, FDT N-30, HRT II, and GDx VCC. Area under Receiver Operating Characteristic Curves (AROCs) for discriminating between healthy and glaucomatous eyes and agreement among instruments were determined.
Results
The best parameters for Pulsar, FDT, HRT, and GDx were, respectively: loss variance square root; no. of areas with P< 5%; Cup-Shape-Measure; and Nerve Fiber Indicator (NFI). In detecting POAG eyes, Pulsar (AROC, 0.90) appeared comparable with FDT (0.89) and significantly better than HRT (0.82) and GDx (0.79). For GON, Pulsar ability (0.74) was higher than GDx (0.69) and lower than FDT (0.80) and HRT (0.83). The agreement among instruments ranged from 0.12 to 0.56. Pulsar test duration was significantly shorter than SAP and FDT (P< .001).
Conclusions
Pulsar T30W test is a rapid and easy perimetric method, showing higher sensitivity than SAP in detecting early glaucomatous VF loss. Its diagnostic ability is good for detecting early perimetric POAG eyes and fair for GON eyes. Pulsar performance was comparable with FDT, HRT, and GDx, even if the agreement between instruments was poor to fair.
aDepartment of Ophthalmology, Azienda Ospedaliero-Universitaria “Santa Maria della Misericordia,” Udine, Italy
bDiscoveries in Sight, Devers Eye Institute, Portland, Oregon
cDepartment of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
dCentro Oftalmologico Sampaolesi y Fundacion Argentina Oftalmologica, Buenos Aires, Argentina
Inquiries to Paolo Brusini, Department of Ophthalmology, Azienda Ospedaliero-Universitaria “Santa Maria della Misericordia,” p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
ABSTRACT