Abstract

P 125

Evaluation of HRT progression analysis: TCA vs. flicker test

Eckart Schmidt1, Christian Foja2, Christoph Hirneiss3, Anselm Jünemann4, Alexander F. Scheuerle5, Kristine Volk6, Lutz E. Pillunat1, Andreas G. Böhm1
1Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, 2Universitäts-Augenklinik, Universitätsklinikum Leipzig, Leipzig, 3Augenklinik, Ludwigs-Maximilian-Universität, München, 4Universitäts-Augenklinik Erlangen, 5Universitäts-Augenklinik Heidelberg, 6Augenklinik, Katharinenhospital Stuttgart, Stuttgart

Objective
Glaucoma progression analysis with HRT can alternatively be performed with topographic change analysis (TCA) or flicker test of the intensity and topography images. Aim of this study was to evaluate these two diagnostic tools.
Methods
30 HRT follow-up (FUP) cases of 29 patients (15 left and 15 right eyes) with mean number of FUP examinations of 3.8 ± 1.8 (range 2 – 7) and mean FUP-time of 27 ± 11 month (range 9 – 43) were evaluated by 6 German HRT specialists. They each individually assessed all cases in a masked fashion with TCA and flicker and decided if there was a) progression, b) rim loss, c) localized nerve fiber loss, and d) appearance or change of disc haemorrhages (DH). Finally, all cases were discussed and a consensus was reached for each technique and an overall consensus was established. For statistics the results of the individual assessment were compared to the consensus for each technique and to the overall consensus.
Results
In 21 cases glaucoma progression was present according to the overall consensus. Flicker detected progression in all 21 cases and TCA in 14 of those. In the cases with no progression in the consensus, flicker detected progression in 1 and TCA in 2 cases. The agreement on progression was 86.1% for flicker individually versus flicker consensus, 51.1% for TCA individually versus TCA consensus, 82.8% for flicker individually versus overall consensus, 64.4% for TCA individually versus overall consensus. The agreement for the other parameter was: rim loss 83.9% / 79.4% / 81.7% / 62.8%, localized nerve fiber loss 76.1% / 84.4% / 76.1% / 71.1%, appearance or change of DH 72.2% / 93.9% / 72.2% / 67.2%, respectively.
The agreement between the individual assessment and the overall consensus for progression (P=0.017) and rim loss (P=0.021) was statistically significant better for the flicker compared to the TCA.
Conclusions
The flicker test was able to detect progression more often compared to the TCA. There was good agreement between the individual assessment and the overall consensus for both techniques. The results suggest that for the evaluation of progression with the HRT the assessment should not only be based on the TCA alone.  Therefore, the evaluation of glaucomatous progression by HRT should consist of the combination of TCA and flicker test.

Copyright: 2009 Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.