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A Statistical Model for the Evaluation of Sensory Tests in Glaucoma, Depending on Optic Disc Damage

¹From the Department of Medical Informatics, Biometry and Epidemiology, Free University Berlin, Berlin, Germany; the ²Berlin Centre for Public Health, Berlin, Germany; the ³Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany; the ⁴Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany; and the ⁵Institute of Medical Biometry and Statistics, Medical University of Lübeck, Lübeck, Germany.

PURPOSE. To analyze the sensitivity of various sensory tests adjusted for glaucomatous optic disc damage.

METHODS. In a cross-sectional study, the results of testing of 196 control subjects (age range, 18–69 years) and 308 patients with chronic open-angle glaucoma (age range, 18–70 years) were included. The perimetric mean defect (MD), a temporal contrast sensitivity test (TCS), a spatiotemporal contrast sensitivity test (STCS), the peak time of a blue-on-yellow visual evoked potential (BYVEP), and the amplitude of a pattern-reversal electroretinogram (PERG) were evaluated by a specific logistic regression model. This model included glaucomatous damage, quantified by neuroretinal rim area corrected for disc size, as a covariate of sensitivity.

RESULTS. Sensitivity of diagnostic tests increased for all procedures with increasing loss of neuroretinal rim area. With progressing optic disc damage, MD and STCS showed higher sensitivity than did TCS. BYVEP showed a higher sensitivity than PERG in all disease stages. In general, the psychophysical tests were more sensitive than the electrophysiological ones.

CONCLUSIONS. The specific model used in this study was an appropriate tool to analyze the sensitivity of several sensory glaucoma tests in relation to disease stage. Moreover, tests that were more sensitive in early disease stages (TCS) and others that were more sensitive in more advanced stages (MD, STCS) were identified.

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