Visual Field Progression In Glaucoma:

What is the specicity of the Guided Progression Analysis in individual patients? 4148/A601
Paul H Artes1, Glen P Sharpe1, Neil O’’Leary1, David P Crabb2 1
Ophth Vis Sci, Dalhousie University, Canada; 2Optometry & Visual Science, City University, UK
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Purpose
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Pattern Standard Deviation (PSD, dB)

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mean: 10%
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To estimate the specicity of the Guided Progression Analysis (GPA, Carl

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false-positive rate (after 12 tests) %

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Zeiss Meditec, CA), in individual patients.

SD of MD (dB)
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possible progression
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(3 points, 2 consecutive tests)

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Methods
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One eye of 30 glaucoma patients (Mean Deviation [MD], mean -3.3 dB, j
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range -10.7 to +1.2 dB) was tested 12 times in 3 months (SITA-Standard
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24-2 test). ““Likely progression”” or ““possible progression”” was determined

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likely progression
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(3 points, 3 consecutive tests) r=-0.50, p=0.005
mean MD (dB)
with an analysis similar to the GPA where black triangles identify signicant Mean Deviation (MD, dB) 20
Figure 1, left: Mean Deviation (MD) and Pattern Standard Deviation (PSD) in the 12 tests of 10
change from baseline (mean of tests 1 and 2) in 3 or 2 consecutive follow- 30 patients. Boxes mark two patients’’ series, one with high variability (red points, letter ““c””) h
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and one with low variability (green points, letter ““b””). Right: Visual eld variability (SD of MD) 5
up tests, respectively. These analyses were repeated after the visual varied by a factor of 3 between patients, with an average of approximately 0.5 dB. The overall
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elds were randomly rearranged in time (100 permutations per series). level of eld damage (mean MD) explained only about 20% of this variability. Circled dots 2 y wg mean: 1.6%
correspond to series in which the likelihood of a false-positive event for ““probable change””
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was at least 2% (cf Figure 3, lower panel).
Results <0.5 q a A i Bj p D use k tn b of m r dv x

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The average specicity of the GPA was high - for the entire sample, the mean MD (dB)
false positive (FP) rates for ““likely progression”” and ““possible progression”” Figure 3) Probability of false-positive event for ““possible progression”” (3 points with
signicant change on 2 consecutive tests) or ““likely progression”” (on 3 consecutive
after 10 follow-up tests were 1.6% and 10%. However, FP rates varied tests), over the entire series of 12 tests. The average specicity for the entire group was
high (90% and 98% with ““possible”” and ““likely”” progression), but it was considerably
substantially between patients, from <1% to 8% with ““likely progression”” lower in individual patients.
(risk ratio >8), and from <1% to 40% with ““possible progression”” (risk ratio Figure 4) Examples for series with
low (top) and high (bottom) variability.
>40). Factors associated with FP events were visual eld variability (SD Histograms show the distribution of
of MD, r2=0.38, p<0.001) and global visual eld damage (MD, Pattern ““black triangles”” when 5 visual elds
are randomly re-arranged in time. The
Standard Deviation (PSD), multiple R2=0.36, p<0.001), but not any of sequence below corresponds to the 99th
percentile.
the reliability indices (proportion of false-positive and false-negative
In the upper example (green point ““b””
responses, xation losses, R2=0.22, p=0.18). in Figs 1 & 3), more than 1 location with
change on 3 consecutive tests would be

Conclusions
expected to occur in fewer than 1% of
follow-up tests.

On average, progression criteria currently employed in the GPA have The series in the lower example (red
point ““c”” in Figs 1 & 3) exhibits greater
high specicity, but individual patients are up to 40 times more likely variability, and more locations are
agged as changing in the GPA. Random
to show a false-positive event than others. These ndings need to be Figure 2) Example of permutation analysis. Top: Greyscales of 12 visual elds obtained from one permutation shows up to 5 locations
patient within a 3-month period. Middle: The Glaucoma Progression Analysis of the original sequence with change on 3 consecutive tests. To
considered when the GPA is used in the clinical management of patients gives a false-positive result, agging ““possible progression”” and ““likely progression”” on the 9th and maintain a similarly high specicity as in
and in clinical trials. Because the consistency of visual eld results varies 10th tests, respectively. Lower: random permutation of the original sequence, with a false-positive the example above, this patient would
event for ““likely progression”” on test 6. By comparing the original sequence to a random subset of require a more conservative progression
greatly between patients, criteria for point-by-point change should be all possible permutations (n!, ~480 million), the statistical signicance of change can be estimated. criterion.

adapted to individual patients.