Abstract
ObjectiveThis study was done to determine the validity of amsler grid test black on white (BOW), as well as white on black (WOB) for identifying central visual field (VF) defects in patients with advanced glaucoma.DesignProspective study.ParticipantsWe prospectively included 100 consecutive eyes of 88 adult patients with advanced glaucoma and 100 eyes of 100 normal individuals. We used a lottery method to choose the side of the eye for the control groups.MethodsAll participants had reliable Humphrey 10–2 Swedish Interactive Threshold Algorithm (SITA) standard VF. Both the BOW and WOB amsler grid tests were done for each group. Sensitivity, specificity, and positive and negative predictive values of the amsler grid scotoma area were calculated with the 10–2 VF as the reference standard.ResultsThe mean ± standard deviation (SD) of age and the 10–2 VF mean deviation (MD) of advanced glaucoma eyes were 59.8 ± 11.8 (range 34–84) years and -19.94 ± 9.8(range -34.98–-0.52) respectively. Among 108 eyes with normal 10–2 VF test, 103 had a normal BOW amsler grid test and 5 had an abnormal BOW test. Among 92 eyes with an abnormal 10–2 VF test, 74 had an abnormal and 18 had normal BOW amsler grid test. Sensitivity, specificity, and positive and negative predictive values of the BOW amsler grid test were 80.4%, 95.4%, 93% and 85.1% respectively whereas that of the WOB amsler grid test were 71.7%, 95.4%, 93% and 72.8% respectively.ConclusionThe sensitivity and specificity of both BOW and WOB amsler grid tests were high in detecting VF defects in advanced glaucoma.
Highlights
Glaucoma is the leading cause of irreversible blindness worldwide[1], and the second cause of blindness from various conditions in Sub-Saharan Africa (SSA)[2]
The sensitivity and specificity of both black on white (BOW) and white on black (WOB) amsler grid tests were high in detecting visual field (VF) defects in advanced glaucoma
Central vision is more important for patients than peripheral VF loss and visual acuity is strongly related to VF sensitivity in the central area of the 10–2 VF[5]
Summary
Glaucoma is the leading cause of irreversible blindness worldwide[1], and the second cause of blindness (after cataract) from various conditions in Sub-Saharan Africa (SSA)[2]. Detection is important to reduce the risk of advanced glaucomatous disease and loss of quality of life and productivity. In the disease process, patients with glaucoma are asymptomatic and central vision and the central visual field (VF) is typically intact. In advanced stage the remaining central island of vision is in imminent danger of loss, in SSA settings where detection and treatment are far from optimal. Detecting glaucoma at this stage is of utmost importance since aggressive treatment can prevent blindness[4]. If patients can be diagnosed in advanced stage, while they still have the central vision intact and treated, it has multiple benefits in terms of personal, social and economic factors and is likely to maintain a reasonable quality of life
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