Performance of the moorfields motion displacement test for identifying eyes with glaucoma

Abstract

Purpose The Moorfields Motion Displacement Test (MMDT; Enhanced Standard Threshold Algorithm [ESTA] version 1, London, UK) is a new 31-point suprathreshold test for visual field assessment using moving line stimuli displayed on a standard laptop computer. This study evaluated the diagnostic performance of the MMDT for discriminating between healthy eyes and eyes with glaucoma. Design Evaluation of diagnostic technology. Participants Seventy-eight subjects with glaucoma and 348 healthy subjects. Methods All participants underwent a standardized ophthalmologic examination, including the MMDT and Heidelberg Retina Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany) scanning of the optic disc. The diagnosis of glaucoma was based on clinical examination with glaucomatous optic neuropathy defined by the presence of neuroretinal rim thinning, notching or excavation of the cup, cup-to-disc asymmetry between eyes of 0.25 or more, nerve fiber layer thinning (focal or diffuse), or a combination thereof; and HRT-based Moorfields Regression Analysis (MRA) results of outside normal limits in any sector. Normal eyes were defined as clinically having healthy neuroretinal rims and an MRA analysis of within normal limits in all sectors. The MMDT used a Pandora response version of the ESTA without optical correction. Subjects with a false-positive response of 15% or more in MMDT were excluded. Main Outcome Measures The performance of the global probability of true damage (global PTD) for diagnosing glaucoma was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The global PTD was calculated as a sum of individual PTD values, ranging from 0% to 100% for all 31 visual locations, and was expressed as a quotient of 100. Results Seventy-eight subjects with glaucoma (mean age, 66.6±13.1 years; male gender, 55.1%) and 348 healthy subjects (mean age, 55.2±9.2 years; male gender, 35.3%) were analyzed. The AUC for the global PTD was 0.930 (95% confidence interval, 0.893-0.967) for diagnosing glaucoma. At 85% specificity, the MMDT demonstrated a sensitivity of 88.5%. This decreased to 83.3% at 95% specificity. At the global PTD cutoff point value of 2.0, the sensitivity was 85.9% and the specificity was 94.5%. Conclusions The suprathreshold MMDT showed good diagnostic performance for diagnosing glaucoma when glaucoma was defined by a structural criterion. © 2014 by the American Academy of Ophthalmology.