ABSTRACT
PURPOSE: To compare methods to assess visual field (VF) progression in glaucoma. METHODS: 4,950 VFs of 253 primary open angle-glaucoma patients were evaluated for progression with the following methods: clinical evaluation, guided progression analysis (GPA), mean deviation (MD), and visual field index (VFI) rates, Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS) scores, pointwise linear regression (PLR), permutation of PLR (PoPLR), and glaucoma rate index (GRI). A separate simulated series of longitudinal VFs was assessed with all methods except for GPA and clinical evaluation. RESULTS: The average (±SD) age of the patients at baseline was 65.4 (±11.5) years. The average (±SD) follow-up was 11.8 (±4.6) years, and the mean (±SD) number of VFs was 16.8 (±7.0). Proportion of series detected as progressing was 65% for PoPLR, 58% for GRI, 41% for GPA, 40% for PLR, 36% for CIGTS, 35% for clinicians, 31% for MD rate, 29% for AGIS, and 22% for VFI rate. Median times to detection of progression were 7.3 years for PoPLR, 7.5 years for GRI, 11 years for clinicians, 14 years for GPA, 16 years for PLR, 17 years for CIGTS, 19 years for AGIS, and more than 20 years for MD and VFI rates. In simulated VF series, GRI had the highest partial area under the receiver operator characteristic curve (0.040) to distinguish between glaucoma progression and aging/cataract decay, followed by VFI rate (0.028), MD rate (0.024), and PoPLR (0.006). CONCLUSIONS: GRI and PoPLR showed the highest proportion of series detected as progressing and shortest times to progression detection. GRI exhibited the best ability to detect progression in the simulated VF series. TRANSLATIONAL RELEVANCE: Knowledge of the properties of every method would allow tailoring application in both clinical and research settings.
ABSTRACT
PURPOSE: To develop a method to measure the rate of glaucomatous visual field (VF) deterioration and to identify fast progressors. METHODS: Retrospective, longitudinal, observational study of 8486 eyes of 4610 glaucomatous patients with ≥6 VFs and ≥3 years of follow-up. A Glaucoma Rate Index (GRI) was calculated. VF locations were partitioned into exponential decay or exponential improvement models. A pointwise rate of change (PRC) was estimated with an exponential fit and expressed as the percent/year change of the age- and location-matched normal perimetric range, presented as a spatially conserved VF map. PRCs were summed and normalized with boundary rates set by simulated decaying and improving VF series on a scale of -100 to +100, respectively. RESULTS: A total of 89,704 VF examinations with 425,039 test location series was used. Median follow-up and number of VFs/eye were 9.7 years and 9 VFs, respectively. Initial and final mean deviations (±SD) were -4.2 (±5.2) and -5.7 (±6.4) dB. The proportions of test locations designated as decayed, improved, and unchanged were 13%, 4%, and 83%, respectively. Mean PRCs for decay, improvement, and no change were -3.7 (±4.7)%/y, 2.5 (±2.6)%/y, and -0.5 (±2.1)%/y, respectively. The number of eyes with negative and positive GRIs was 5802 (68%) and 2390 eyes (28%), respectively. The proportion of eyes defined as fast progressors was 6.8%. CONCLUSIONS: GRI provides a robust measure of glaucomatous VF change, operates without discontinuity over the entire perimetric range, and can be used to identify fast progressors. TRANSLATIONAL RELEVANCE: This study describes a novel method that can help the clinician to determine VF progression.
