A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Glaucoma Panel: Henry D. Jampel, MD, MHS1; Kuldev Singh, MD, MPH2; Shan C. Lin, MD3; Teresa C. Chen, MD4; Brian A. Francis, MD5; Elizabeth Hodapp, MD, MHS6; John R. Samples, MD7; Scott D. Smith, MD, MPH8
Ophthalmology, May 2011, Vol 118, 986-1002 © 2011 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To review the published literature to summarize and evaluate the effectiveness of visual function tests in diagnosing glaucoma and in monitoring progression.
Methods: Literature searches of the PubMed and Cochrane Library databases were last conducted on May 7, 2010 and were restricted to citations published on or after January 1, 1994. The search yielded 1063 unique citations. The first author reviewed the titles and abstracts of these articles and selected 185 of possible clinical relevance for further review. The panel members reviewed the full text of these articles and determined that 85 met inclusion criteria. They conducted data abstraction of the 85 studies, and the panel methodologist assigned a level of evidence to each of the selected articles. One study was rated as level I evidence. The remaining papers were classified broadly as providing level II evidence. Studies deemed to provide level III evidence were not included in the assessment.
Results: Standard white-on-white automated perimetry remains the most commonly performed test for assessing the visual field, with the Swedish Interactive Threshold Algorithm (SITA) largely replacing full threshold testing strategies. Frequency doubling technology and its refinement into Matrix perimetry as well as short-wavelength automated perimetry, now available with SITA, have been extensively evaluated. Machine learning classifiers appear to be ready for incorporation into software to help distinguish glaucomatous from nonglaucomatous fields. Other technologies, such as multifocal visual evoked potential and electroretinography, which were designed as objective measures of visual function, provide testing free of patient input, but issues prevent their adoption for glaucoma management.
Conclusions: Advances in technology and analytical tools over the past decade have provided us with more rapid and varied ways of assessing visual function in glaucoma but they have yet to produce definitive guidance on the diagnosis of glaucoma or its progression over time. Further research on an objective measure of visual function is needed.
1Glaucoma Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
2Department of Ophthalmology, Stanford University, Stanford, California
3Department of Ophthalmology, University of California, San Francisco, San Francisco, California
4Harvard Medical School, Massachusetts Eye & Ear Infirmary, Glaucoma Service, Boston, Massachusetts
5Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
6Bascom Palmer Eye Institute, Miami, Florida
7Department of Ophthalmology, Oregon Health and Sciences University, Portland, Oregon; Department of Surgery, Rocky Vista University, Parker Colorado
8Edward S. Harkness Eye Institute, Columbia University, New York, New York