Individuals with and without normal tension glaucoma exhibit comparable performance on tests of cognitive function

AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.

Validation and reproducibility of the Heidelberg Edge Perimeter in the detection of glaucomatous visual field defects

AIM: To validate the ability of the Heidelberg Edge Perimeter(HEP) in detecting glaucomatous visual field(VF) defects compared to the Octopus Visual Field(OVF) Analyzer and to determine the test-retest repeatability of both modalities.METHODS: This prospective, cross-sectional study was conducted at Wills Eye Hospital, Philadelphia, PA. Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry(SAP) Ⅲ 30-2 Adaptive Staircase Thresholding Algorithm(ASTA) FAST protocol and OVF G-TOP white-on-white strategy. Testing order was randomized. Pearson's correlation coefficient was calculated for both mean deviation(MD) and pattern standard deviation/square root of loss of variance(PSD/s LV). Receiver operating characteristic(ROC) curves were used to determine the diagnostic abilities of both modalities. Glaucoma subjects returned for repeat testing and intraclass correlation coefficients(ICCs) were calculated to assess test-retest repeatability. RESULTS: Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled. HEP and OVF were significantly correlated for both MD(r=-0.84; P<0.01) and PSD/s LV(r=0.79; P<0.01). Areas under the ROC curves(AUCs) were also comparable between HEP and OVF for both MD(0.74 and 0.79, respectively; P=0.26) and PSD/sL V(0.74 and 0.82; P=0.08). ICC was high for both HEP (0.96 for MD, 0.95 for PSD/s LV) and OVF(0.82 and 0.88, respectively). Mean test duration(min) was significantly shorter for OVF(2.63) compared to HEP(5.15; P<0.01). CONCLUSION: HEP and OVF show strong correlation for both MD and PSD/s LV, and have similar validity for detecting glaucoma. The test-retest repeatability is high for both HEP and OVF, however the average testing duration of HEP is significantly longer than that of OVF.