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Editors Selection IGR 14-4
Perimetry: Guidelines and real-life practice
Comment by Don Budenz on:
53600 Are practical recommendations practiced? A national multi-centre cross-sectional study on frequency of visual field testing in glaucoma, Fung SS; Lemer C; Russell RA et al., British Journal of Ophthalmology, 2013; 97: 843-847
The article by Fung et al. addresses an important issue in glaucoma management. It asks the question whether patients followed by glaucoma consultants in the UK are receiving visual fields at frequencies recommended by published guidelines; namely, those outlined by the European Glaucoma Society (EGS) and the National Institute of Clinical Excellence (NICE) in the UK. None of the 73 patients included in the analysis received visual field testing according to frequencies recommended by the EGS (three times per year during the first two years after diagnosis) and 87% had visual fields performed at frequencies recommended in the NICE guidelines (which are not defined, but are referenced, in the manuscript). In addition, the study shows that the frequency of visual field testing is related more to the perceived adequacy of IOP control or clinical impression of progression of disease rather than severity of damage or stability of the visual field. The authors acknowledge the limitation of only surveying six centers on generalizability, but do not acknowledge that there were simply too few subjects in the study to effectively generalize to practice patterns in the UK. The conclusions are based on review of only 73 patients' charts with the minimum two years of follow-up required. They offer no rationale for only including patients seen during a single week in time, which may be why the sample size is so low. Be that as it may, the authors imply that glaucoma consultants are not adhering to published guidelines on interval of testing with visual fields. They appropriately question whether the EGS criteria, although based on sound statistical inference, are practical and sustainable given resource availability. In this respect, by highlighting the discrepancy between clinical guidelines and clinical practice, the authors successfully open up the dialogue.
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