Comparison of conventional and high-pass resolution perimetry in a prospective study of patients with glaucoma and healthy controls

Objective: To determine whether high-pass resolution perimetry detected glaucomatous visual field progression earlier than conventional perimetry. Methods: In a prospective longitudinal study, we observed 113 patients with open-angle glaucoma and with early to moderate visual field damage and 119 healthy control subjects. Each subject underwent testing at 6-month intervals using conventional and high-pass resolution perimetry (program 30-2 of the Humphrey Field Analyzer [Humphrey Instruments, Inc. San Leandro, Calif] and the Ring program of the Ophthilnus perimeter [Hi-Tech Vision, Goteborg, Sweden], respectively). Our predetermined criterion for progression with conventional perimetry was the presence of at least 4 overlapping nonedge locations outside the fifth percentile for test-retest variability of threshold deviations (defined by the Glaucoma Change Probability Analysis of the Statpac 2 program) in 2 of 3 consecutive visual fields. We employed the identical criterion for progression with high-pass resolution perimetry using our own test-retest variability data. We repeated this procedure in the controls to measure the false-positive rate of progression. Results: Patients were observed for a median of 4.5 years and 11 examinations with each technique. Fifty-seven patients (50.4%) did not show progression with either technique. Twenty-four patients (21.2%) showed progression with high-pass resolution perimetry alone, whereas 6 (5.3%) showed progression with conventional perimetry alone. Of the remaining 26 patients (23.0%) who showed progression with both techniques, 14 (54%) showed progression with high-pass resolution perimetry first (median, 12 months earlier); 5 (19%), with conventional perimetry first (median, 6 months earlier); and 7 (27%), with both techniques at the same time. Controls were observed for a median of 5 years and 11 examinations with each technique. One control (0.8%) showed progression with high-pass resolution perimetry. Conclusions: Our results suggest that high-pass resolution perimetry detects glaucomatous visual field progression earlier than conventional perimetry in most patients with progression.