Visual field quality control in the Ocular Hypertension Treatment Study (OHTS).

OBJECTIVE: To report the impact of visual field quality control (QC) procedures on the rates of visual field unreliability, test parameter errors, and visual field defects attributed to testing artifacts in the Ocular Hypertension Treatment Study (OHTS). METHODS: OHTS technicians were certified for perimetry and were required to submit 2 sets of visual fields that met study criteria before testing study participants. The OHTS Visual Field Reading Center (VFRC) evaluated 46,777 visual fields completed by 1618 OHTS participants between February 1994 and December 2003. Visual field QC errors, rates of unreliability, and defects attributed to testing artifacts were assessed. The OHTS QC system addressed 3 areas of clinic performance: (1) test parameter errors, (2) patient data errors, and (3) shipment errors. A visual field was classified as unreliable if any of the reliability indices exceeded the 33% limit. Clinical sites were immediately contacted by the VFRC via fax, e-mail, and/or phone and instructed on how to prevent further testing errors on fields with defects attributed to testing artifacts. MAIN OUTCOME MEASURES: QC errors (test parameter errors) and unreliability rates. RESULTS: A total of 2.4% (1136/ 46,777) of the visual fields were unreliable and 0.23% (107/46,777) had incorrect test parameters. Visual field defects attributed to testing artifacts occurred in approximately 1% (483/46,777) of the visual fields. CONCLUSIONS: Prompt transmission of visual fields to the VFRC for ongoing and intensive QC monitoring and rapid feedback to technicians helps to reduce the frequency of unreliable visual fields and incorrect testing parameters. Visual field defects attributed to testing artifacts were infrequent in the OHTS.

Classification of visual field abnormalities in the ocular hypertension treatment study.

OBJECTIVES: (1) To develop a classification system for visual field (VF) abnormalities, (2) to determine interreader and test-retest agreement, and (3) to determine the frequency of various VF defects in the Ocular Hypertension Treatment Study. METHODS: Follow-up VFs are performed every 6 months and are monitored for abnormality, indicated by a glaucoma hemifield test result or a corrected pattern SD outside the normal limits. As of January 1, 2002, 1636 patients had 2509 abnormal VFs. Three readers independently classified each hemifield using a classification system developed at the VF reading center. A subset (50%) of the abnormal VFs was reread to evaluate test-retest reader agreement. A mean deviation was calculated separately for the hemifields as an index to the severity of VF loss. MAIN OUTCOME MEASURES: A 97% interreader hemifield agreement. RESULTS: The average hemifield classification agreement (between any 2 of 3 readers) for 5018 hemifields was 97% and 88% for the 1266 abnormal VFs that were reread (agreement between the first and second classifications). Glaucomatous patterns of loss (partial arcuate, paracentral, and nasal step defects) composed the majority of VF defects. CONCLUSION: The Ocular Hypertension Treatment Study classification system has high reproducibility and provides a possible nomenclature for characterizing VF defects.