The benefit of combining standard automated perimetry and multifocal visual evoked potential hemifield intersector analysis in suspecious glaucomatous visual field defects

Mohamed F. Mousa, Robert P. Cubbidge, Fatima Al-Mansouri, Abdulbari Bener

Research output: Contribution to journalArticle

Abstract

Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard SAP visual field assessment, and others were not very informative and needed more adjustment and research work. In this study we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. The purpose of this study is to examine the benefit of adding mfVEP hemifield Intersector analysis protocol to the standard HFA test when there is suspicious glaucomatous visual field loss. 3 groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey visual field HFA test 24-2, optical coherence tomography of the optic nerve head, and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the Hemifield Sector Analysis HSA protocol. The retinal nerve fibre (RNFL) thickness was recorded to identify subjects with suspicious RNFL loss. The hemifield Intersector analysis of mfVEP results showed that signal to noise ratio (SNR) difference between superior and inferior hemifields was statistically significant between the 3 groups (ANOVA p<0.001 with a 95% CI). The difference between superior and inferior hemispheres in all subjects were all statistically significant in the glaucoma patient group 11/11 sectors (t-test p<0.001), partially significant 5/11 in glaucoma suspect group (t-test p<0.01) and no statistical difference between most sectors in normal group (only 1/11 was significant) (t-test p<0.9). Sensitivity and specificity of the HSA protocol in detecting glaucoma was 97% and 86% respectively, while for glaucoma suspect were 89% and 79%. The use of SAP and mfVEP results in subjects with suspicious glaucomatous visual field defects, identified by low RNFL thickness, is beneficial in confirming early visual field defects. The new HSA protocol used in the mfVEP testing can be used to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patient. Using this protocol in addition to SAP analysis can provide information about focal visual field differences across the horizontal midline, and confirm suspicious field defects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss. The Intersector analysis protocol can detect early field changes not detected by standard HFA test.

LanguageEnglish
Pages277-288
Number of pages12
JournalBiomedical Research
Volume24
Issue number3
Publication statusPublished - Jul 2013

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Visual Field Tests
Visual Evoked Potentials
Bioelectric potentials
Visual Fields
Glaucoma
Ocular Hypertension
Defects
Optical tomography
Analysis of variance (ANOVA)
Social Adjustment
Sensitivity and Specificity
Optics
Signal to noise ratio
Optic Disk
Optical Coherence Tomography
Signal-To-Noise Ratio
Nerve Fibers
Analysis of Variance
Fibers
Testing

Bibliographical note

Creative Commons License Open Access Journals by Allied Academies is licensed under a Creative Commons Attritbution 4.0 International License

Keywords

  • glaucoma suspect
  • glaucomatous field loss
  • HFA
  • multifocal VEP
  • objective perimetry
  • SAP
  • visual field testing

Cite this

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The benefit of combining standard automated perimetry and multifocal visual evoked potential hemifield intersector analysis in suspecious glaucomatous visual field defects. / Mousa, Mohamed F.; Cubbidge, Robert P.; Al-Mansouri, Fatima; Bener, Abdulbari.

In: Biomedical Research, Vol. 24, No. 3, 07.2013, p. 277-288.

Research output: Contribution to journalArticle

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