Portsmouth visual field database: an audit of glaucoma progression

Kirwan, James; Hustler, Adam; Bobat, Hannaa; Toms, Laurence; Crabb, David P.; McNaught, Andrew

doi:10.1038/eye.2013.294

Cited by 28 publications

(36 citation statements)

References 34 publications

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“…Some definitions of fast progression have been fairly arbitrary with round numbers such as a VF MD rate of -1.5 dB/year [30, 33]or -2 dB/year [18, 40], commonly chosen. Without doubt, these rates would almost always have a deleterious impact on a patient’s visual health.…”

Section: Rates Of Visual Field Lossmentioning

confidence: 99%

What rates of glaucoma progression are clinically significant?

Saunders

Medeiros

Weinreb

et al. 2016

Expert Review of Ophthalmology

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Summary Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life. Rates of progression can be evaluated through measuring structural or functional changes of the optic nerve. Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3-17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of -1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease. As a result, it is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.

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Section: Rates Of Visual Field Lossmentioning

confidence: 99%

What rates of glaucoma progression are clinically significant?

Saunders

Medeiros

Weinreb

et al. 2016

Expert Review of Ophthalmology

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“…In total, 23.9% of eyes in our study were non-progressors compared with 65.9% in Kirwan et al cohort (Table 3). 1 We also had proportionally more fast progressors than Chauhan et al, who in a study of 2324 eyes reported only 1.5% of eyes as having a progression rate of faster than 2 dB/year, eyes they labelled as catastrophic progressors. 4 Similarly, Saunders et al found only 3% of glaucomatous eyes lost 41.5 dB/year.…”

Section: Discussionmentioning

confidence: 95%

“…Figure 2b shows fitted slopes of change in MD for all eyes. According to the criteria defined by Kirwan et al, 1 …”

Section: Resultsmentioning

confidence: 99%

“…3,4,[15][16][17] We favoured the taxonomy proposed by Kirwan et al to group rates of VF progression, as it represents a large clinical audit of glaucoma progression conducted in the United Kingdom. 1 Nevertheless, it is important to emphasise that a direct comparison of progression rates is likely-to some degree-to be confounded by variation in the demographics of included subjects. The high proportion of fast progressors reported in the Swedish population exposes the large variation in rates of VF deterioration between geographical regions, and highlights the importance of population demographics in determining rates of progression.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is only recently that investigators have explored rates of change in VF in large 'real-life' clinical cohorts. [1][2][3][4] These studies have reported average rates of VF loss in glaucoma and identified fast, moderate, slow, and nonprogressors.…”

Section: Introductionmentioning

confidence: 99%

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Prior rates of visual field loss and lifetime risk of blindness in glaucomatous patients undergoing trabeculectomy

Foulsham

Tatham

2015

Eye

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Purpose Trend-based analyses examining rates of visual field (VF) loss in glaucoma are useful for predicting risk of vision-related morbidity. Although patients with faster losses are likely to require treatment escalation, little is known about rates that might trigger a decision to intervene surgically. The aims of this study were to investigate prior rates of VF loss in patients attending for trabeculectomy and to estimate, in the absence of surgical intervention, lifetime risk of visual impairment, and blindness. Patients and methods A retrospective analysis of 117 eyes of 86 consecutive patients with glaucoma attending for trabeculectomy, including 53 patients referred from general ophthalmology clinics and 33 patients from specialist glaucoma clinics. Rates of change in standard automated perimetry mean deviation were examined using linear regression and random coefficient models. Risk of lifetime visual impairment and blindness was calculated using life expectancy data. Results Mean age at surgery was 71.0 ± 9.7 years. Patients were followed for 10.7 ± 7.5 years prior to surgery with an average of seven useable fields per eye. On average patients referred from general clinics lost 1.04 dB/year compared with 0.77 dB/year in those referred from glaucoma clinics (P = 0.070). Patients referred from general clinics had more medication changes prior to surgery (3.4 and 2.6 changes, respectively; P = 0.004). Given Scottish life expectancy data, untreated, 61 eyes (52%) would have passed the threshold for visual impairment, whereas 40 (34%) would have passed the threshold demarcating blindness.Conclusion Patients attending for trabeculectomy had faster average rates of field loss prior to surgery than published values for the general glaucoma population with over one-third of eyes studied predicted to have become blind without intervention. Those managed by glaucoma specialists had fewer changes in medication and tended to slower rates of VF loss, although the latter did not reach statistical significance.

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Estimated Utility of the Short-term Assessment of Glaucoma Progression Model in Clinical Practice

et al. 2021

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IMPORTANCE Clinical trials of glaucoma therapies focused on protecting the optic nerve have required large sample sizes and lengthy follow-up to detect clinically relevant change due to its slow rate of progression. Whether shorter trials may be possible with more frequent testing and use of rate of change as the end point warrants further investigation.OBJECTIVE To describe the design for the Short-term Assessment of Glaucoma Progression (STAGE) model and provide guidance on sample size and power calculations for shorter clinical trials. DESIGN, SETTING, AND PARTICIPANTSA cohort study of patients with mild, moderate, or advanced open-angle glaucoma recruited from the Diagnostic Innovations in Glaucoma Study at the University of California, San Diego. Enrollment began in May 2012 with follow-up for every 3 months for 2 years after baseline examination. Follow-up was concluded in September 2016. Data were analyzed from July 2019 to January 2021. Visual fields (VF) and optic coherence tomography (OCT) scans were obtained at baseline and for 2 years with visits every 3 months.EXPOSURES Glaucoma was defined as glaucomatous appearing optic discs classified by disc photographs in at least 1 eye and/or repeatable VF damage at baseline. MAIN OUTCOMES AND MEASURESLongitudinal rates of change in retinal nerve fiber layer (RNFL) thickness and VF mean deviation (MD) are estimated in study designs of varying length and observation frequency. Power calculations as functions of study length, observation frequency, and sample size were performed. RESULTSIn a total referred sample of 97 patients with mild, moderate, or advanced glaucoma (mean [SD] age, 69 [11.4] years; 50 [51.5%] were female; 19 [19.6%]), over the 2-year follow-up, the mean VF 24-2 MD slope was −0.32 dB/y (95% CI, −0.43 to −0.21 dB/y) and the mean RNFL thickness slope was −0.54 μm/y (95% CI, −0.75 to −0.32 μm/y). Sufficient power (80%) to detect similar group differences in the rate of change in both outcomes was attained with total follow-up between 18 months and 2 years and fewer than 300 total participants. CONCLUSIONS AND RELEVANCEIn this cohort study, results from the STAGE model with reduction of the rate of progression as the end point, frequent testing, and a moderate effect size, suggest that clinical trials to test efficacy of glaucoma therapy can be completed within 18 months of follow-up and with fewer than 300 participants.

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Portsmouth visual field database: an audit of glaucoma progression

Cited by 28 publications

References 34 publications

What rates of glaucoma progression are clinically significant?

What rates of glaucoma progression are clinically significant?

Prior rates of visual field loss and lifetime risk of blindness in glaucomatous patients undergoing trabeculectomy

Estimated Utility of the Short-term Assessment of Glaucoma Progression Model in Clinical Practice

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