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FLICKER-TOP PERIMETRY IN NORMALS AND PATIENTS WITH OCULAR HYPERTENSION AND EARLY GLAUCOMA

Purpose: To evaluate sensitivity, specificity and the capabilities of diagnosing early glaucoma using the tendency-oriented perimetry (TOP) algorithm adapted to flicker perimetry. Methods: A regular TOP Program for Octopus 1-2-3 was modified using the examination protocol proposed by Matsumoto et al. as follows: grid type 32, background 31.5 asb, size Goldmann III, constant intensity of 4000 asb, sampling time of one second and variable frequency. Taking into account the normal values described by these authors and those regularly used by the perimeter, stimuli were generated using a value-denominated dB-flicker equivalent. Each dB was equivalent to 1.25 Hz, but no other modifications were made to the TOP strategy. Forty-five eyes of 45 normal subjects were examined (17 with previous perimetric experience and 28 without), 30 patients with ocular hypertension (normal TOP standard visual field and optic nerve head) and 23 patients with early glaucoma (MD <7dB). Results: Mean duration of the TOP flicker test was 4:01 ± 0:22 minutes. The results for flicker MD were: normal, -0.94 ± 1.67dB; ocular hypertension, 6.58 ± 6.04dB; and early glaucoma, 9.37 ± 6.66dB. The majority of normal patients had normal results with TOP flicker (93.3% for MD <2dB). Some of the normal subjects without perimetric experience had hyper-normal results (36% for MD <-2dB). Twentyone (70%) eyes with ocular hypertension had pathological TOP flicker perimetry results (MD >2dB). Flicker perimetry results were abnormal in all the early glaucoma cases and more abnormal than standard perimetry in 19 (82.6%) patients. The correlation between both types of perimetry was low (r=0.39 for MD and r=0.20 for LV), but was noted to be better in Bjerrum’s area than elsewhere (r=0.50). Point-bypoint correlation was also very low (r=0.25). Conclusions: TOP flicker perimetry demonstrated a specificity of 93.3% and sensitivity of 100% in patients with early glaucoma. It classified 70% of eyes with ocular hypertension as being pathological. Flicker perimetry may prove to be a good screening system for earlier stages of glaucomatous damage.