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The Optic Disc Hemifield Test in Glaucoma Diagnosis

Nestel A., Budde W. M.,
Ruprecht-Karls-Universität Heidelberg, Fakultät für klinische Medizin Mannheim, Augenklinik (Mannheim)

Purpose: To evaluate whether an Optic Disc Hemifield Test, in analogy to the perimetric Hemifield Test comparing the superior half of the optic disc with the inferior disc half, is useful for glaucoma diagnosis.
Method: The clinical observational study included 1268 patients with primary or secondary open-angle glaucoma and 649 normal subjects. The glaucoma group was divided into 1118 patients with glaucomatous visual field defects (“perimetric glaucoma”), and 150 patients with optic nerve head changes and normal visual fields („preperimetric glaucoma“). Color stereo optic disc photographs were morphometrically evaluated. Area and width of the neuroretinal rim were measured, and the ratio of superotemporal-to-inferotemporal rim area and the ratio of superior-to-inferior rim width were calculated.
Results: For the differentiation between the normal group and the whole glaucoma group, and for the separation between the normal group and the preperimetric glaucoma group, respectively, areas under the ROC curves were smaller for the parameters of the Optic Disc Hemifield Test, i.e. superior-to-inferior rim width ratio (44.8% and 41.2%, resp.) and superotemporal-to-inferotemporal rim area ratio (39.5% and 43.4%, reps.) than for any other rim parameter tested such as inferotemporal rim area (82.7% and 74.5%, reps.), total rim area (81.4% and 74.1%, resp.) and superotemporal rim area (78.1% and 70.5%, resp).
Conclusions: An Optic Disc Hemifield Test with the parameters superior-to-inferior rim width ratio and superotemporal-to-inferotemporal rim area ratio is not markedly helpful for the morphometric diagnosis of glaucomatous optic nerve damage, neither in the preperimetric stage nor in the perimetric stage of the disease.