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Abstract #99112 Published in IGR 22-4
Clinicians' Use of Quantitative Information when Assessing the Rate of Functional Progression in Glaucoma
Gardiner SK; Kinast RM; De Moraes CG; Budenz DL; Jeoung JW; Lind JT; Myers JS; Nouri-Mahdavi K; Rhodes LA; Strouthidis NG; Chen TC; Mansberger SLOphthalmology. Glaucoma 2022; 5: 498-506
PURPOSE: Clinicians use both global and pointwise information from visual fields to assess the rate of glaucomatous functional progression. We asked which objective, quantitative measures best correlate with the subjective assessment by glaucoma experts. In particular, we aimed to determine how much that judgment was based on localized rates of change, versus the global indices reported by the perimeter. DESIGN: Prospective cohort study. PARTICIPANTS: Eleven academic expert glaucoma specialists independently scored the rate of functional progression from 1 (improvement) to 7 (very rapid progression), for series of 5 biannual clinical printouts from 100 glaucoma or glaucoma suspect eyes of 51 participants, 20 of which were scored twice to assess repeatability. METHODS: Regression models were used to predict the average of the 11 clinicians' scores from the objective rates of change of Mean Deviation (MD), Visual Field Index (VFI), Pattern Standard Deviation (PSD), the Nth fastest progressing location, and the Nth fastest progressing of ten anatomically-defined clusters of locations after weighting by eccentricity. MAIN OUTCOME MEASURES: The correlation between objective rates of change and the average of the 11 clinicians' scores. RESULTS: The average MD of study eyes was -2.4dB (range -16.8 to +2.8dB). The mean clinician score was highly repeatable, with intraclass correlation coefficient 0.95. It correlated better with the rate of change of VFI (pseudo-R=0.73, 95% confidence interval [0.60, 0.83]) than MD (0.63 [0.45, 0.76]) or PSD (0.41 [0.26, 0.55]). Using pointwise information, the highest correlations were with the 5 fastest progressing location (pseudo-R=0.71 [0.56, 0.80]), or the fastest progressing cluster after eccentricity weighting (0.61 [0.48, 0.72]). Among 25 eyes with average VFI>99%, the highest observed pseudo-R values was 0.34 [0.16 to 0.61] for PSD. CONCLUSIONS: Expert academic glaucoma specialists' assessment of rate of change correlated best with VFI rates, except in eyes near VFI's ceiling of 100%. Sensitivities averaged within clusters of locations have been shown to detect change sooner, but expert opinions more closely correlated to global VFI. This could be because it is currently the only index for which the perimeter automatically provides a quantitative estimate of the rate of functional progression.
Devers Eye Institute, Legacy Health, Portland, OR, USA. Electronic address: sgardiner@deverseye.org.
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