To compare two forms of perimetry that use large contrast-modulated grating stimuli in terms of: their relative diagnostic power, their independent diagnostic information about glaucoma and their utility for mfVEPs. We evaluated a contrast-threshold mfVEP in normal controls using the same stimuli as one of the tests.
We measured psychophysical contrast thresholds in one eye of 16 control subjects and 19 patients aged 67.8 ± 5.65 and 71.9 ± 7.15, respectively, (mean ± SD). Patients ranged in disease severity from suspects to severe glaucoma. We used the 17-region FDT-perimeter C20-threshold program and a custom 9-region test (R9) with similar visual field coverage. The R9 stimuli scaled their spatial frequencies with eccentricity and were modulated at lower temporal frequencies than C20 and thus did not display a clear spatial frequency-doubling (FD) appearance. Based on the overlapping areas of the stimuli, we transformed the C20 results to 9 measures for direct comparison with R9. We also compared mfVEP-based and psychophysical contrast thresholds in 26 younger (26.6 ± 7.3 y, mean ± SD) and 20 older normal control subjects (66.5 ± 7.3 y) control subjects using the R9 stimuli.
The best intraclass correlations between R9/C20 thresholds were for the central and outer regions: 0.82 ± 0.05 (mean ± SD, p ≤ 0.0001). The areas under receiver operator characteristic plots for C20 and R9 were as high as 0.99 ± 0.012 (mean ± SE). Canonical correlation analysis (CCA) showed significant correlation (r = 0.638, p = 0.029) with 1 dimension of the C20 and R9 data, suggesting that the lower and higher temporal frequency tests probed the same neural mechanism(s). Low signal quality made the contrast-threshold mfVEPs non-viable. The resulting mfVEP thresholds were limited by noise to artificially high contrasts, which unlike the psychophysical versions, were not correlated with age.
The lower temporal frequency R9 stimuli had similar diagnostic power to the FDT-C20 stimuli. CCA indicated the both stimuli drove similar neural mechanisms, possibly suggesting no advantage of FD stimuli for mfVEPs. Given that the contrast-threshold mfVEPs were non-viable, we used the present and published results to make recommendations for future mfVEP tests.
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This paper is dedicated to our late colleague Gordon F Sanderson. We are grateful for the very constructive comments of the reviewers.
This research was supported by the Australian Research Council through the ARC Centre of Excellence in Vision Science (CE0561903) and intramural funding from the Australian National University.
Conflict of interest
Some readers will know that Maddess held the patents for the FDT/Matrix perimeters; however, those patents lapsed in 2015 and Maddess retains no interest in those Carl Zeiss products. Indeed, the R9 method of the paper might be seen as a competitor of FDT. Maddess has a small holding in and is on the advisory board of, EyeCo Pty Ltd, which is developing treatments for retina oedema and dry macular degeneration. He could also earn royalty income from patents assigned to Konan Medical USA Inc for a pupillography based perimetry system, but which has no features like R9 or FDT. R9 could be seen as a competitor to that potential product. Author SNA declares that she has no conflict of interest. Author GFS is deceased. Author MAH declares that he has no conflict of interest.
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Abdullah, S.N., Sanderson, G.F., Husni, M.A. et al. Insights for mfVEPs from perimetry using large spatial frequency-doubling and near frequency-doubling stimuli in glaucoma. Doc Ophthalmol (2020). https://doi.org/10.1007/s10633-020-09750-7
- Frequency doubling
- Neural mechanisms
- Multifocal VEPs