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Editors Selection IGR 11-1

Clinical Examination Methods: Visual Field progression

Comment by Murray Fingeret on:

57477 Evaluation of Octopus Polar Trend Analysis for detection of glaucomatous progression, Holló G; Naghizadeh F, European Journal of Ophthalmology, 2014; 24: 862-868

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The detection of visual field progression is an important part of the management of individuals with glaucoma. To improve the recognition of field progression, the manufacturers continue to modify their displays to alert clinicians when change is developing. The Octopus Polar Trend Analysis (PTA) (Haag-Streit AG, Koeniz-Berne, Switzerland) is part of the software analysis package for the Octopus perimeter. PTA provides a visual display of points getting worse (or better), using the spatial relationship between the test location and retinal nerve fiber layer (RNFL) angle to the optic disc as its method of display. Quantified data are not provided as this display is meant to alert the clinician the change and the need to evaluate other parts of the progression software package. PTA is based upon linear pointwise linear regression analysis, which is an analytic tool also used in other progression tools. In this study by Hollo and Naghizadeh, the ability of PTA to detect change in 52 individuals with glaucoma followed over a 5 year period was investigated. Subjects were divided between progressors and non-progressors. OCT RNFL and Ganglion Cell complex (GCC) linear regression analysis was also performed over time. Only up to 50% of the group showing change with PTA also showed progression upon OCT analysis. This finding has been seen before and is always surprising as there are differing ways that progression develops. The correlation between structural and functional tests often is not strong. For the progression group in this study, change was identified earlier with PTA. This study confirmed that the PTA display was able to recognize change and importantly, provided an alert to clinicians that they need to be concerned that the condition was not stable and their patients require further assessment.

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