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Abstract #11349 Published in IGR 6-3
The Advanced Glaucoma Intervention Study (AGIS): 14. Distinguishing progression of glaucoma from visual field fluctuations
Kim J; Dally LG; Ederer F; Gaasterland DE; VanVeldhuisen PC; Blackwell B; Sullivan EK; Prum B; Shafranov G; Beck AOphthalmology 2004; 111: 2109-2116
PURPOSE: To determine the least worsening of a visual field (VF) and the least number of confirming tests needed to identify progression of glaucomatous VF defects. DESIGN: Cohort study of participants in a clinical trial. PARTICIPANTS: Seven hundred fifty-two eyes of 565 patients with advanced glaucoma. METHODS: Visual field tests were quantified with the Advanced Glaucoma Intervention Study (AGIS) VF defect score and the Humphrey Field Analyzer mean deviation (MD). Follow-up was 8 to 13 years. MAIN OUTCOME MEASURES: Two measures based on the AGIS VF defect score: (1) sustained decrease of VF (SDVF), a worsening from baseline by 2 (alternatively, 3 or 4) or more units and sustained for 2 (alternatively, 3) consecutive 6-month visits; and (2) after the occurrence of SDVF, the average percent of eyes with worsening by 2 (alternatively, 3 or 4) or more units from baseline. Two similar measures based on MD. RESULTS: Based on the original AGIS criteria for SDVF (a worsening of 4 units in the AGIS score sustained during 3 consecutive 6-month visits), 31% of eyes had an SDVF. The percent of eyes with a sustained event increases by approximately 10% when either the minimum number of units of field loss or the minimum number of 6-month visits during which the loss is sustained decreases by 1. During 3 years of follow-up after a sustained event, a worsening of at least 2 units was found in 72% of eyes that had a 2-visit sustained event. The same worsening was found in 84% of eyes that had a 3-visit sustained event. Through the next 10 years after a sustained event, based on worsening of 2, 3, or 4 units at 2 or 3 consecutive tests, the loss reoccurred, on average, in ≥ 75% of study eyes. Results for MD are similar. CONCLUSIONS: In patients with advanced glaucoma, a single confirmatory test 6 months after a VF worsening indicates with at least 72% probability a persistent defect when the worsening is defined by at least 2 units of AGIS score or by at least 2 decibels of MD. When the number of confirmatory tests is increased from 1 to 2, the percentage of eyes that show a persistent defect increases from 72% to 84%.
Dr. Paul C. VanVeldhuisen, MS, The Advanced Glaucoma Intervention Study, AGIS Coordinating Center, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA
Classification:
6.20 Progression (Part of: 6 Clinical examination methods)