Original articleVisual Field Progression in Glaucoma: What Is the Specificity of the Guided Progression Analysis?
Section snippets
Patients
Thirty patients were recruited from the glaucoma clinics at the Queen Elizabeth Health Sciences Centre in Halifax, Nova Scotia. Inclusion criteria were a clinical diagnosis of open-angle glaucoma, a mean deviation (MD) >−15.0 decibels (dB) in at least 1 eye, the absence of ocular or systemic pathology known to reduce visual field sensitivity, and the ability and willingness to participate for 12 consecutive weekly sessions. All patients were experienced with static automated perimetry and had
Results
The median age of the patients was 69.1 years (interquartile range, 64.4–70.7 years). Patients had early to moderate visual field damage (median MD, −2.5 dB; interquartile range, −4.4 to −1.3 dB) as illustrated in Figure 1 (available at www.aaojournal.org). All patients were experienced test-takers, and there were no clinically important learning or practice effects—the mean MD of the 30 patients changed by <0.1 dB between the first and last tests (Fig 2, available at www.aaojournal.org).
Discussion
The aim of our study was to investigate the specificity of the Glaucoma Progression Analysis, that is, the likelihood of encountering a “possible progression” or “likely progression” alert in a series of visual fields in which no meaningful change has taken place. Stable series were established by testing patients frequently over a short period during which disease progression was unlikely, such that any GPA progression alert could be regarded as a false-positive event. Under the assumption
Acknowledgments
The authors thank Gary Lee and Mary Durbin of Carl Zeiss Meditec for generating the GPA output for the permuted visual fields and Ivan Marin Franch of the Open Perimetry Initiative for critical comments and incorporating the dataset in the R visualFields package.
References (27)
- et al.
Primary open-angle glaucoma
Lancet
(2004) - et al.
The United Kingdom Glaucoma Treatment Study: a multicenter, randomized, placebo-controlled clinical trial: design and methodology
Ophthalmology
(2013) - et al.
A comparison of visual field progression criteria of 3 major glaucoma trials in Early Manifest Glaucoma Trial patients
Ophthalmology
(2008) - et al.
Glaucoma Progression Analysis software compared with expert consensus opinion in the detection of visual field progression in glaucoma
Ophthalmology
(2012) - et al.
Determinants of agreement between the confocal scanning laser tomograph and standardized assessment of glaucomatous progression
Ophthalmology
(2010) - et al.
Agreement for detecting glaucoma progression with the GDx guided progression analysis, automated perimetry, and optic disc photography
Ophthalmology
(2010) Glaucoma: an area of darkness
Eye (Lond)
(2009)- et al.
Interobserver agreement on visual field progression in glaucoma: a comparison of methods
Br J Ophthalmol
(2003) - et al.
Perimetric probability maps to separate change caused by glaucoma from that caused by cataract
Acta Ophthalmol Scand
(1997) - et al.
Detection of visual field progression in glaucoma with standard achromatic perimetry: a review and practical implications
Graefes Arch Clin Exp Ophthalmol
(2011)
A comparison of the pattern- and total deviation-based Glaucoma Change Probability programs
Invest Ophthalmol Vis Sci
Measuring visual field progression in the Early Manifest Glaucoma Trial
Acta Ophthalmol Scand
Visual field progression in glaucoma: total versus pattern deviation analyses
Invest Ophthalmol Vis Sci
Cited by (52)
Long-term Impact of Immediate Versus Delayed Treatment of Early Glaucoma: Results From the Early Manifest Glaucoma Trial
2023, American Journal of OphthalmologyRisk of Normal Tension Glaucoma Progression From Automated Baseline Retinal-Vessel Caliber Analysis: A Prospective Cohort Study
2023, American Journal of OphthalmologyVisual Field Endpoints for Neuroprotective Trials: A Case for AI-Driven Patient Enrichment
2022, American Journal of OphthalmologyEstimating Global Visual Field Indices in Glaucoma by Combining Macula and Optic Disc OCT Scans Using 3-Dimensional Convolutional Neural Networks
2021, Ophthalmology GlaucomaCitation Excerpt :The median values for MAC, ONH, and MAC + CONH were 1.1, 0.7, and 0.8, respectively, for VFI, and 0.42 dB, 0.29 dB, and 0.30 dB, respectively, for MD. The variability was smaller than the variability of visual field tests.28 Like accuracy, estimation variability was also dependent on the severity of the disease (Fig 8).
Supplemental material is available at www.aaojournal.org.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the Glaucoma Research Foundation, United States (P.H.A. and D.P.C.). Grant Number MOP-11357, Canadian Institutes of Health Research (B.C.C.).