Modelling series of visual fields to detect progression in normal-tension glaucoma

McNaught, Andrew; Crabb, David P.; Fitzke, F.W.; Hitchings, Roger A.

doi:10.1007/bf00184085

Cited by 94 publications

(74 citation statements)

References 9 publications

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“…This question cannot easily be solved, because the phenotype of continuous loss may resemble that of stepwise progression, and vice versa, due to perimetric variability and discrete sampling. Both types of progression have been reported [6,7]. The current study showed adaptive testing to be the preferred approach for continuous loss; an earlier study yielded the same conclusion for stepwise progression [4].…”

Section: Discussionsupporting

confidence: 70%

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Progression detection in glaucoma can be made more efficient by using a variable interval between successive visual field tests

Jansonius

2007

Graefes Arch Clin Exp Ophthalmol

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Background This study aimed to gain insight into the optimal spacing in time for visual field tests for progression detection in glaucoma.Methods Three perimetric strategies for progression detection were compared by means of simulation experiments in a theoretical cohort. In strategies 1 and 2, visual field testing was performed with fixed-spaced inter-test intervals, using intervals of 3 and 6 months respectively. In strategy 3, the inter-test interval was kept at 1 year as long as the fields appeared unchanged. Then, as soon as progression was suspected, confirmation or falsification were performed promptly. Follow-up fields were compared against a baseline assuming linear deterioration, using various progression criteria. Outcome measures were: (1) specificity, (2) time delay until the diagnosis of definite progression, and (3) number of required tests. Results Strategies 2 and 3 had a higher specificity than strategy 1. Strategies 1 and 3 detected progression earlier than strategy 2. The number of required visual field tests was lowest for strategy 3. Conclusion Perimetry in glaucoma can be optimised by postponing the next test under apparently stable field conditions and bringing the next test forward once progression is suspected.

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Section: Discussionsupporting

confidence: 70%

“…Whether glaucomatous deterioration is a stepwise or a continuous process has not yet been settled. Stepwise progression has been reported, but arguments in favour of continuous loss have also been published [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Progression detection in glaucoma can be made more efficient by using a variable interval between successive visual field tests

Jansonius

2007

Graefes Arch Clin Exp Ophthalmol

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“…Although trend analysis does make the assumption that change can be expressed linearly, this seems appropriate as it provides the best 'fit' in untreated visual field series. 71 Analysis using pointwise linear progression agrees well with expert observers. 72 The ability to subdivide the visual field into progressing sections rather than rely on median values is an advantage, for the latter will overlook small but significant changes even though the effects of lens opacities have been removed.…”

Section: Eyesupporting

confidence: 56%

Glaucoma: an area of darkness

Hitchings

2008

Eye

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This review of Primary Open Angle Glaucoma looks at the management of the condition today. It does this by looking at the following areas: (a) the size of the problem; (b) the position of IOP, with respect to its elevation and fluctuation; (c) optic nerve head changes; and (d) visual function changes. In doing so, it contrasts what is known now with ideas and concepts that were prevalent at the time of the two previous Bowman lecturers, Duke Elder and Drance, as well as noting concepts about the disease that were current at the time of William Bowman. The review concludes by suggesting challenges in this area that lie ahead.

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“…Trend analysis suggests that the linear model is the best 'fit', at least for NTG (Figure 3). 8 Using the linear model, it has been shown that the rate of progression in untreated NTG patients varies greatly despite similar ages and MD at baseline.…”

Section: Resultsmentioning

confidence: 99%

Update on the natural history of glaucoma

Hitchings

2007

Eye

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Glaucoma is a progressive disease, and the rate of visual field (VF) progression is an important parameter that determines management decisions and is frequently used as an outcome measure in clinical trials. Different scoring systems have been used in the large randomized clinical studies, and have been found to vary in terms of sensitivity and specificity. All these systems measure change in VF from baseline, and the measurements are confounded by variability due to learning effect and test fatigue. For better patient management, the rate of change needs to be considered as well as the time to progression. Rate can be evaluated using trend analysis, as mean deviation (MD), clusters or points. Trend analysis suggests that the linear model is the 'best fit', at least for normal tension glaucoma. Using this model, it has been shown that the rate of progression in untreated normal-pressure glaucoma patients varies greatly despite similar ages and MD at baseline.

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Modelling series of visual fields to detect progression in normal-tension glaucoma

Abstract: A linear model of the pointwise sensitivity values against time of follow-up can provide a framework for detecting and forecasting glaucomatous field progression. Linear modelling allows the clinically important rate of sensitivity loss to be estimated.

Cited by 94 publications

References 9 publications

Progression detection in glaucoma can be made more efficient by using a variable interval between successive visual field tests

Progression detection in glaucoma can be made more efficient by using a variable interval between successive visual field tests

Glaucoma: an area of darkness

Update on the natural history of glaucoma

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