Visual Field Tests for Glaucoma Patients with Initial Macular Damage: Comparison between Frequency-doubling Technology and Standard Automated Perimetry Using 24-2 or 10-2 Visual Fields

Purpose: The purpose of this study was to compare standard automated perimetry (SAP) and frequency-doubling technology (FDT) perimetry for detecting macular damage in glaucoma. Materials and Methods: A total of 112 glaucomatous eyes with localized retinal nerve fiber layer defects on red-free photographs and corresponding macular ganglion cell/inner plexiform layer (mGC/IPL) thinning on the deviation map of macular optical coherence tomography, and 35 healthy eyes were enrolled in the study. All participants underwent SAP 24-2, SAP 10-2, FDT 24-2, and FDT 10-2 visual field (VF) tests. Significantly depressed points, with confidence limits of 5% and 1%, were checked for in the pattern deviation plots of the VF tests. Detection rate of the macular damage, sensitivity, and specificity were compared among various VF tests. Patients were divided into eyes with mGC/IPL thinning within the normative database, depressed <5% or <1%. Comparison of VF parameters between various VF tests were performed according to the degree of mGC/IPL thinning. Results: All of the macular damage in glaucoma were detected using FDT 10-2 and 83.3% to 90.0% were detected using FDT 24-2 when the mGC/IPL thickness was <5%. Even when mGC/IPL thickness was within normal range, the detection rate of macular damage were 96% for FDT 10-2 and 80% for FDT 24-2. FDT 10-2 had the best diagnostic ability (areas under the receiver operating characteristics curve, 0.96) followed by FDT 24-2 (areas under the receiver operating characteristics curve, 0.76) for discriminating normal controls from glaucoma patients with macular damage. Comparing 10-2 and 24-2 tests with same strategy showed that FDT 10-2 was more sensitive than FDT 24-2 (P= 0.004), with better specificity (P= 0.010). Also, SAP 24-2 had similar specificity with SAP 10-2 (P= 0.373), which was better than FDT 24-2 (P= 0.016). The mean deviation of SAP 10-2 and the pattern standard deviation of SAP 10-2 were significantly related to mGC/IPL thickness. Conclusions: We found the detection rate of functional depression related to early macular damage were significant using FDT and parameters of SAP significantly predicted the degree of mGC/IPL thinning in glaucoma patients.