Course of Glaucomatous Visual Field Loss Across the Entire Perimetric Range

Otárola, Francisco Jiménez; Chen, Andrew; Morales, Esteban; Yu, Fei; Afifi, Abdelmonem A.; Caprioli, Joseph

doi:10.1001/jamaophthalmol.2016.0118

Cited by 32 publications

(36 citation statements)

References 19 publications

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“…To obtain longitudinal estimates of the “true” point-wise visual field sensitivity for each eye included in this study, a sigmoid regression model was fitted to the measured threshold sensitivities at each location over time using a method described previously. 7 The sigmoid model assumes a nonlinear rate of visual field loss, with natural asymptotes occurring at normal levels of sensitivity and the perimetric floor. The model can be expressed as follows: s = γ / (1 + e α + βx ), where s denotes the measured sensitivity in decibels, γ indicates the estimate of the initial sensitivity, α indicates how soon the sigmoid function begins a steep decline, β indicates the steepness of this decline, and x indicates the time.…”

Section: Methodsmentioning

confidence: 99%

“… 1 , 2 It also remains an important outcome measure for clinical trials in glaucoma, as it represents a clinically relevant endpoint. 3 – 5 However, detecting progressive visual field loss remains a challenging task due to the extent and complexity of its measurement variability 6 and nature of change over time 7 in eyes with visual field damage.…”

Section: Introductionmentioning

confidence: 99%

“… 34 Second, the assumption of linearity held for changes in point-wise visual field sensitivity over time is unlikely to remain valid over a long follow-up duration, with nonlinear models better capturing such changes. 7 …”

Section: Introductionmentioning

confidence: 99%

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Development of a Visual Field Simulation Model of Longitudinal Point-Wise Sensitivity Changes From a Clinical Glaucoma Cohort

Medeiros

2018

Trans. Vis. Sci. Tech.

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PurposeTo develop a new visual field simulation model that can recreate real-world longitudinal results at a point-wise level from a clinical glaucoma cohort.MethodsA cohort of 367 glaucoma eyes from 265 participants seen over 10.1 ± 2.5 years were included to obtain estimates of “true” longitudinal visual field point-wise sensitivity and estimates of measurement variability. These two components were then combined to reconstruct visual field results in a manner that accounted for correlated measurement error. To determine how accurately the simulated results reflected the clinical cohort, longitudinal variability estimates of mean deviation (MD) were determined by calculating the SD of the residuals from linear regression models fitted to the MD values over time for each eye in the simulated and clinical cohorts. The new model was compared to a previous model that does not account for spatially correlated errors.ResultsThe SD of all the residuals for the clinical and simulated cohorts was 1.1 dB (95% confidence interval [CI]: 1.1–1.2 dB) and 1.1 dB (95% CI: 1.1–1.1 dB), respectively, whereas it was 0.4 dB (95% CI: 0.4–0.4 dB) using the previous simulation model that did not account for correlated errors.ConclusionsA new simulation model accounting for correlated measurement errors between visual field locations performed better than a previous model in estimating visual field variability in glaucoma.Translational RelevanceThis model can provide a powerful framework to better understand use of visual field testing in clinical practice and trials and to evaluate new methods for detecting progression.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of a Visual Field Simulation Model of Longitudinal Point-Wise Sensitivity Changes From a Clinical Glaucoma Cohort

Medeiros

2018

Trans. Vis. Sci. Tech.

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“…They found that this model was a robust indicator of rates across a wide range of disease severity and could predict future global indices accurately (Azarbod et al, 2012). Finally, Otarola et al modeled the process of glaucomatous visual field decay over the entire perimetric range from normal to perimetric blindness and found that a pointwise sigmoid regression had a better ability to fit perimetric decay (Otarola et al, 2016). These study results support the concept that the measured behavior of glaucomatous visual field loss within the entire range of damage is probably non-linear and that its course of deterioration may change with the course of disease.…”

Section: Nature Of Glaucomatous Visual Field Progressionmentioning

confidence: 99%

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

Moraes

Liebmann

Levin

2017

Progress in Retinal and Eye Research

149

123

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Glaucomatous visual field progression has both personal and societal costs and therefore has a serious impact on quality of life. At the present time, intraocular pressure (IOP) is considered to be the most important modifiable risk factor for glaucoma onset and progression. Reduction of IOP has been repeatedly demonstrated to be an effective intervention across the spectrum of glaucoma, regardless of subtype or disease stage. In the setting of approval of IOP-lowering therapies, it is expected that effects on IOP will translate into benefits in long-term patient-reported outcomes. Nonetheless, the effect of these medications on IOP and their associated risks can be consistently and objectively measured. This helps to explain why regulatory approval of new therapies in glaucoma has historically used IOP as the outcome variable. Although all approved treatments for glaucoma involve IOP reduction, patients frequently continue to progress despite treatment. It would therefore be beneficial to develop treatments that preserve visual function through mechanisms other than lowering IOP. The United States Food and Drug Administration (FDA) has stated that they will accept a clinically meaningful definition of visual field progression using Glaucoma Change Probability criteria. Nonetheless, these criteria do not take into account the time (and hence, the speed) needed to reach significant change. In this paper we provide an analysis based on the existing literature to support the hypothesis that decreasing the rate of visual field progression by 30% in a trial lasting 12–18 months is clinically meaningful. We demonstrate that a 30% decrease in rate of visual field progression can be reliably projected to have a significant effect on health-related quality of life, as defined by validated instruments designed to measure that endpoint.

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“…Embora haja discussão sobre o uso de métodos de regressão não lineares para sensibilidades perimétricas pontuais (47,48) , a regressão linear é amplamente utilizada e considerada robusta para análises de índices globais e com períodos de seguimento relativamente curtos (de 1 a 5 anos) (41,45,49) .…”

Section: Progressão Funcionalunclassified

Progressão estrutural e funcional da lesão glaucomatosa na mácula

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Course of Glaucomatous Visual Field Loss Across the Entire Perimetric Range

Cited by 32 publications

References 19 publications

Development of a Visual Field Simulation Model of Longitudinal Point-Wise Sensitivity Changes From a Clinical Glaucoma Cohort

Development of a Visual Field Simulation Model of Longitudinal Point-Wise Sensitivity Changes From a Clinical Glaucoma Cohort

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

Progressão estrutural e funcional da lesão glaucomatosa na mácula

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