Quick full-field flicker test in glaucoma diagnosis: correlations with perimetry and papillometry

The value of a full-field flicker stimulus in glaucoma diagnosis was tested. In 69 normals, 60 ocular hypertension, and 50 manifest primary openangle glaucoma patients, the temporal contrast (flicker) thresholds were tested with a sinusoidally flickering white light of constant mean photopic luminance (10 candela/m) presented in a full-field bowl. A modulatable xenon-arc lamp was used, and only one frequency (37.1 Hz) was tested. Luminances were corrected according to pupil widths. No significant age relationships of flicker thresholds were found in normal eyes. Forty (80%) of glaucoma eyes were recognized as pathologic at a specificity of 93%. In the glaucoma group, significant correlations of flicker thresholds were found with measurements of neuroretinal rim areas of the optic disc (linear r = -0.61, nonparametric r = -0.59, p = 0.001) and with perimetric mean defects (linear r = 0.74, nonparametric r = 0.66, p = 0.0001). Because of its high sensitivity and the significant correlation with perimetric losses and neuroretinal rim areas, the full-field flicker test can be used as a quick (5 min per eye) additional examination in the diagnosis of glaucoma.