WHAT IS THE MOORFIELDS MDT? MOORFIELDS MDT TEST TASK EASILY UNDERSTOOD. New advances in Moorfields Motion Displacement Perimetry
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1 New advances in Moorfields Motion Displacement Perimetry UKEGS Meeting Dublin 5 th December 28 Ciara Bergin WHAT IS THE MOORFIELDS MDT? A new perimetric computer-based test for detection of glaucoma CE 26 Collaborative Team: C Bergin, 1 DP Crabb, 1 GM Verdon-Roe, 2 MC Westcott, 2,3 AC Viswanathan, 1,2 FW Fitzke, 2 DF Garway-Heath 1,2 1 Department of Optometry and Visual Science, City University, London, UK 2 NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK 3 St Bartholomew s Hospital, London, UK 32 line stimuli scaled by estimate of retinal ganglion cell density Moosavi et al Invest Ophthalmol Vis Sci 28:E-Abstract 183 Verdon-Roe GM et al Invest Ophthalmol Vis Sci 28:E-Abstract 1156 MOORFIELDS MDT TEST TASK EASILY UNDERSTOOD CE 26 look very steadily at central spot press the computer mouse each time you see a line move anywhere on the screen
2 Aims MOORFIELDS MDT THRESHOLD minimum discernable displacement measured in minutes of arc (min arc) To develop a fast reliable test strategy for casefinding Using response time as an indicator of reliability Adopting cluster analysis based spatial relationships between locations (Strouthidis et al, IOVS 26;47: ) to decide locations for retest Spatial Information & Function Spatial information: The best fit model:
3 Cluster analysis After 1 st circuit of ESTA: Update Results Array Calculate Probability Of True Damage PTD=High PTD=LOW Present + Record results Enhanced Suprathreshold Testing Algorithm Select points for retesting Test begins: Every location has a presentation at 95% level Select presentation Intensity No points selected for retesting ESTA Terminates Pilot Study Results: Test Duration 13 mild to moderate glaucoma patients 13 age matched controls 4 35 Test Duration Age: average 665yrs, range 31 to 77yrs 3 Mean Defect: average -41dB, range -5 to -88 db Examined with SAP SITA MDT ESTA MDT MultiSSp (2/3) Time (seconds) Glaucoma Patients Normal subjects ESTA Multisampling (2/3) SITA (SAP)
4 Agreement/disagreement: Case Example 1 Agreement/disagreement: Case Example 2 2 point fail criterion ESTA (MDT 32 locations) No healthy subjects failed 12/13 glaucoma subjects failed 2/3 MultiSampling (MDT 32 locations) 2/13 healthy subjects failed All glaucoma patients failed SITA (SAP 52 locations 995% PD map) No healthy subjects failed 12/13 glaucoma patients failed Conclusions ESTA offers a promising new strategy for casefinding In this pilot study it appears to offers significantly greater speed without loss of diagnostic precision Next step validation in a large cohort (32 patient & age matched controls)
5 ACKNOWLEDGEMENTS MOORFIELDS MDT TEAM Mr Ted Garway-Heath FRCOphth Mr Ananth Viswanathan FRCOphth Mr Mark Westcott FRCOphth Dr Gay Mary Verdon-Roe PhD Mr Reza Moosavi MRCOphth Professor Fred Fitzke PhD Dr David Crabb PhD Ms Ciara Bergin MSc MOORFIELDS MDT SOFTWARE Designed by Mr Ananth Viswanathan Developed by Whitespace Software Ltd SPONSORS UNRESTRICTED GRANTS RECEIVED WITH THANKS Friends of Moorfields 2 21 Trustees of Moorfields ; Future Work Validation 16 Glaucoma Patients and 16 age matched controls MDT ESTA FDT1 (C2-5) HEP (?) 6 to 1 subjects are being screened in a population sample of Barcelona Fields MDT ESTA Suprathreshold algorithms Selecting locations for retesting ESTA (66) /3: (14) 2/3: (68) sensitivity PTD >A RETEST: A>PTD>B Failing:B>PTD 3/3 (44) specificity Failed: 2 unseen presentations at or above 95% level Passed: 2 seen presentations at or above 95% level
6 Suprathreshold versus Threshold 2/3 MS (68) OPTIC NERVE HEAD -45 degrees 45-9 degrees degrees degrees degrees degrees degrees degrees 9 CURRENT MOORFIELDS MDT (RIGHT EYE) SAMPLED BY GARWAY-HEATH MAP (OPHTHALMOLOGY 2) Temporal field remains under-sampled º ESTA (66) TD 995% (68) location format fits 15-inch laptop NB retained Humphrey format for pointwise comparison Garway-Heath DF et al Opthalmology 2;17:
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