Examination of the performance of different pointwise linear regression progression criteria to detect glaucomatous visual field change.

BACKGROUND: We aimed to investigate the performance of five different trend analysis criteria for the detection of glaucomatous progression and to determine the most frequently and rapidly progressing locations of the visual field. DESIGN: Retrospective cohort. PARTICIPANTS OR SAMPLES: Treated glaucoma patients with ≥ 8 Swedish Interactive Thresholding Algorithm (SITA)-standard 24-2 visual field tests. METHODS: Progression was determined using trend analysis. Five different criteria were used: (A) ≥ 1 significantly progressing point; (B) ≥ 2 significantly progressing points; (C) ≥ 2 progressing points located in the same hemifield; (D) at least two adjacent progressing points located in the same hemifield; (E) ≥ 2 progressing points in the same Garway-Heath map sector. MAIN OUTCOME MEASURES: Number of progressing eyes and false-positive results. RESULTS: We included 587 patients. The number of eyes reaching a progression end-point using each criterion was: A = 300 (51%); B = 212 (36%); C = 194 (33%); D = 170 (29%); and E = 186 (31%) (P ≤ 0.03). The numbers of eyes with positive slopes were: A = 13 (4.3%); B = 3 (1.4%); C = 3 (1.5%); D = 2 (1.1%); and E = 3 (1.6%) (P = 0.06). The global slopes for progressing eyes were more negative in Groups B, C and D than in Group A (P = 0.004). The visual field locations that progressed more often were those in the nasal field adjacent to the horizontal midline. CONCLUSIONS: Pointwise linear regression criteria that take into account the retinal nerve fibre layer anatomy enhances the specificity of trend analysis for the detection glaucomatous visual field progression.

The region of largest ß-zone parapapillary atrophy area predicts the location of most rapid visual field progression.

PURPOSE: To determine if visual field (VF) progression occurs most rapidly in the region of largest ß-zone parapapillary atrophy (PPA). DESIGN: Retrospective cohort. PARTICIPANTS: One hundred twenty-five patients from the New York Glaucoma Progression Study with both ß-zone PPA and VF progression. METHODS: Treated open-angle glaucoma patients with 8 or more Swedish Interactive Threshold Algorithm Standard 24-2 VFs (Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) in either eye were identified. Eyes with optic disc photographs, ß-zone PPA, less than 6 diopters myopia, and VF progression were studied. Visual field progression was defined using trend analysis as the presence of at least 2 adjacent progressing points in the same hemifield using standard pointwise linear regression (PLR) criteria. MAIN OUTCOME MEASURES: The correlation between ß-zone PPA and location of most rapid future VF progression. RESULTS: One hundred twenty-five eyes (125 patients; mean age, 71.9 ± 12.3 years; 58% women; 75% European descent) with ß-zone PPA and VF progression were enrolled. The mean follow-up was 6.8 ± 1.7 years and the mean number of VFs was 12.5 ± 3.6. Ninety-three patients (74%) had more ß-zone PPA inferiorly and 32 patients (26%) had more ß-zone PPA superiorly. The fastest VF progression occurred in the superior hemifield in 77 patients (62%) and in the inferior hemifield in 48 (38%) patients. Patients with superior VF progression had a superior localized mean rate of progression of -1.57 ± 1.7 dB/year, and patients with inferior VF progression had an inferior localized mean rate of -0.94 ± 1.4 dB/year (P = 0.012). The mean number of points reaching the predefined PLR end points was 5.6±7.5 for the superior VF hemifield and 3.0±4.9 for the inferior hemifield (P = 0.006). The hemifield with more points reaching PLR progression end points, with fastest average velocity of progression, or both was spatially consistent with the location of largest ß-zone PPA in 89 (71%) patients (P = 0.0001, Fisher exact test; κ = 0.35; 95% confidence interval, 0.17-0.53). CONCLUSIONS: In treated glaucoma patients with ß-zone PPA and VF progression, the location of largest ß-zone PPA typically correlates spatially with the region of the most rapid future VF progression. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Visual field progression outcomes in glaucoma subtypes.

PURPOSE: To determine whether glaucoma subtype is an independent risk factor for visual field (VF) progression. METHODS: We reviewed the charts of glaucoma suspects and glaucoma patients seen in a referral practice between 1999 and 2009. Automated pointwise linear regression analysis determined the rates of VF change. A progression endpoint was determined when two or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of ≥1.0 dB/year with p < 0.01. RESULTS: We included 841 eyes (841 patients; mean age, 64.1 ± 12.6 years; mean number of VF tests, 10.8 ± 2.8; mean follow-up, 6.4 ± 1.7 years). The glaucomatous group consisted of angle-closure glaucoma (76 eyes), juvenile primary open-angle glaucoma (37 eyes), normal-tension glaucoma (81 eyes), pigmentary glaucoma (34 eyes), primary open-angle glaucoma (275 eyes) and exfoliative glaucoma (XFG, 84 eyes). Normal-tension glaucoma eyes were more likely to present with beta-zone parapapillary atrophy and disc haemorrhage (p < 0.01). Exfoliative glaucoma eyes had the fastest rates of global VF change (-0.65 dB/year), as well as the highest mean, fluctuation, and peak intraocular pressure during follow-up (16.5, 3.0 and 22.0 mmHg, respectively) and reached a progression endpoint more frequently (40%). After adjusting for all covariates, including the glaucoma phenotype, there was no difference among groups regarding global rates of VF change and the risk of reaching a progression endpoint. CONCLUSIONS: Despite different clinical features, epidemiology and genetics, glaucoma phenotype is not an independent risk factor for VF progression. Rather, variations in well-known, reported risk factors remain important disease parameters that affect progression.

Spatially consistent, localized visual field loss before and after disc hemorrhage.

PURPOSE: To evaluate the rate and location of visual field (VF) progression before and after detection of disc hemorrhage (DH). METHODS: Disc photographs of consecutive patients with glaucoma with >or=5 SITA-Standard 24-2 VF in either eye were evaluated for the presence and location of DH. Exclusion criteria included disorders other than glaucoma likely to affect the VF and an insufficient number of VF test results to create a slope before or after DH detection. Automated pointwise linear regression was used to calculate global and localized rates of progression before and after DH. RESULTS: One hundred sixty-eight DHs were identified in 122 patients (mean age, 68.9 +/- 11.2 years). The mean number of VF tests was 9.0 +/- 4.4, spanning a mean of 6.7 +/- 3.8 years. Mean global progression rates before and after DH were -0.6 +/- 0.8 and -1.0 +/- 1.2 dB/y, respectively (P = 0.01). The mean rate of progression points corresponding to the DH sector before and after detection were -2.02 +/- 1.0 and -3.7 +/- 3.6 dB/y, respectively (P < 0.01). All rates were significantly faster than in fellow, non-DH eyes (P < 0.05). The VF sector with the fastest progression rate predicted the location of the future DH in 85% of cases. After the detection of DH, the same VF sector maintained the fastest progression rate in almost all eyes (92%). CONCLUSIONS: Spatially consistent, localized VF change occurred in regions of subsequent DH and continued to progress in the same regions at a faster rate. This finding suggests that rapid, localized disease progression predisposes to DH and that progressive VF loss continues because of the ongoing damage at or adjacent to this location.