Abstract
The purpose of this article is to investigate the diagnostic value of Pulsar perimetry (PP), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) in pre-perimetric glaucoma (PPG) and perimetric glaucoma (PG). This retrospective cross-sectional study included 202 eyes (145 eyes in the control group, 40 eyes in the PPG group, and 17 eyes in the PG group) from 105 subjects. The results were analyzed by paired t-tests and Wilcoxon signed-rank test. The area under the curve (AUC), sensitivity, and specificity were used to evaluate the diagnostic accuracy. Pearson correlation was used to investigate the relationships of each parameter. The most sensitive parameters for differentiating the control group from the PPG group by using Pulsar, OCT, and OCTA were square loss variance of PP (AUC = 0.673, p < 0.001), superior ganglion cell complex thickness (AUC = 0.860, p < 0.001), and superior-hemi retina thickness (AUC = 0.817, p < 0.001). In the PG group, the most sensitive parameters were mean defect of PP (AUC = 0.885, p < 0.001), whole image of ganglion cell complex thickness (AUC = 0.847, p < 0.001), and perifoveal retina thickness (AUC = 0.833, p < 0.001). The mean defect of PP was significantly correlated with vascular parameters (radial peripapillary capillary (RPC), p = 0.008; vessel density of macular superficial vascular complex (VDms), p = 0.001; vessel density of macular deep vascular complex (VDmd), p = 0.002). In conclusion, structural measurements using OCT were more sensitive than vascular measurements of OCTA and functional measurements of PP for PPG, while PP was more sensitive than the structural and vascular measurements for PG. The mean defect of PP was also shown to be highly correlated with the reduction of vessel density.
Highlights
Glaucoma, an irreversible and progressive optic neuropathy, is the second-leading cause of blindness in the world [1]
We reported that the most accurate functional parameter was mean defect (MD) of Pulsar perimetry (PP) with area under the curve (AUC) = 0.885 (p < 0.001) and sensitivity at the best cut-off value = 100%, while the structural parameter using superior-hemi retinal nerve fiber layer (RNFL) thickness had an AUC = 0.856 (p < 0.001) and sensitivity at the best cut-off value = 82.4% (Table 4)
We revealed that PP was more significantly correlated with vessel density of radial peripapillary capillary (RPC) and macula than standard automated perimetry (SAP) in pre-perimetric glaucoma eyes (Table 5), with high sensitivity at the best cut-off value in both PPG and PG groups (Tables 3 and 4)
Summary
An irreversible and progressive optic neuropathy, is the second-leading cause of blindness in the world [1]. Improving the diagnostic capability of tests for glaucoma is needed, since this disease is mostly asymptomatic until the late stage, where irreversible and often severe visual deficits occur [3]. There may be structural or functional abnormalities in early glaucoma, including changes in the optic disc, the retinal nerve fiber layer (RNFL), the macular retinal ganglion cell complex (GCC), or visual field [4,5,6,7,8]. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) are used to evaluate structural and capillary abnormalities, and standard automated perimetry (SAP) is used to detect functional defects. Due to the various diagnostic capabilities of the above-mentioned instruments at different stages of glaucoma, associated researches and utilities in diagnosing and monitoring glaucoma are still developing
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