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Editors Selection IGR 16-4

Clinical Examination Methods: How best to assess Visual Field loss in Glaucoma?

Chris Johnson

Comment by Chris Johnson on:

96026 Comparing Five Criteria for Evaluating Glaucomatous Visual Fields: 5 Visual Field Criteria for Evaluating Glaucoma, Stubeda H; Quach J; Gao J et al., American Journal of Ophthalmology, 2022; 237: 154-163

See also comment(s) by Vincent Michael Patella •


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The determination of structural and functional progression in glaucoma has been evaluated by many investigators,1-19 and a review of many of the procedures for visual field progression, ranging from simple to highly complex, has recently been published.1 Previous comparisons have reported large differences in the sensitivity and specificity of various procedures, and only moderate amounts of agreement among the methods that have been applied to the various procedures.2-6 Stubeda and colleagues indicate that there is currently no consensus as to which progression analysis provides the most informative information regarding visual field progression. In their recent publication, they compared five different criteria for assessing glaucomatous visual field progression by applying them to a large visual field data set that included a wide range of levels of visual field damage. The five procedures consisted of the Glaucoma Hemifield Test (GHT) criteria, the Hodapp, Anderson and Parrish2 (HAP2) criteria, the Foster (FOS) criteria, the United Kingdom Glaucoma Treatment Study (UKGTS) criteria, and the Low-pressure Glaucoma Treatment Study LoGTS) criteria. In conjunction with prior studies, the authors found that there were considerable differences in the performance of the five procedures. HAP2 and UKGTS had the highest sensitivity but low specificity, whereas LoGTS had the highest specificity but lower sensitivity. Basically, the differences were related to degree of conservative versus liberal criteria employed by the five techniques, which accounts for the variable amount of agreement among the procedures. Only 37% of the visual fields yielded positive results for all five progression analysis procedures.

These findings confirm that there is presently no consensus on a single procedure that is optimal for determining glaucomatous visual field progression. Rather than regarding this as a problem it is helpful to regard this as an opportunity for new investigators to pursue

These findings confirm that there is presently no consensus on a single procedure that is optimal for determining glaucomatous visual field progression. Rather than regarding this as a problem it is helpful to regard this as an opportunity for new investigators to pursue. Perhaps deep learning, archetypal analysis and artificial intelligence techniques will be able to provide comprehensive comparisons of the current procedures, as well as generating new approaches. In this view, it should be kept in mind that new techniques must be clinically meaningful and simple enough to be rapidly understood and useful in a busy clinical setting.

References

  1. .Hu R, Racette L, Chen KS, Johnson CA. Functional assessment of glaucoma: Uncovering progression. Surv Ophthalmol. 2020,65:639-661.
  2. Vesti E, Johnson CA, Chauhan BC. Comparison of different methods for detecting glaucomatous visual field progression. Invest Ophthalmol Vis Sci. 2003,44:3873-3879.
  3. Vesti E, Chauhan BC and Johnson CA: Comparison of different methods for detecting glaucomatous visual field progression. Perimetry Update 2002/2003 (Henson and Wall, eds), The Hague: Kugler Publications, 2004, pp 39-40.
  4. Katz, J. Scoring systems for measuring progression of visual field loss in clinical trials of glaucoma treatment. Ophthalmol. 1999,106:391-395.
  5. Heijl A, Bengtsson B, Chauhan BC, Lieberman MF, Cunliffe I, Hyman L, Leske MC. A comparison of visual field progression criteria of 3 major glaucoma trials in early manifest glaucoma trial patients. Ophthalmol. 2008,115:1557-1565.
  6. Viswanathan AC, Crabb DP, McNaught AI, et al. Interobserver agreement on visual field progression in glaucoma: a comparison of methods. Br J Ophthalmol. 2003,87:726-730.
  7. Schulzer M, Anderson DR, Drance SM. Sensitivity and specificity of a diagnostic test determined by repeated observations in the absence of an external standard. J Clin Epidemiol. 1991,44:1167-1179.
  8. Brusini P, Johnson CA. Staging functional damage in glaucoma: Review of different classification methods. Surv Ophthalmol. 2007,52:156-179.
  9. Advanced Glaucoma Intervention Study. 2. Visual field scoring and reliability. Ophthalmol. 1994,101:1445-1455.
  10. Musch DC, Lichter PR, Guire KE, tandardi CL. The Collaborative Initial Glaucoma Treatment Study: study design, methods and baseline characteristics of enrolled patients. Ophthalmol. 1999,106:653-662.
  11. Leske MC, Heijl A, Hyman L, Bengtsson B. Early Manifest Glaucoma Trial: design and baseline data. Ophthalmol. 1999,106:2144-2153.
  12. Heijl A, Leske MC, Bengtsson B, Bengtsson B, Hussein M, Early Manifest Glaucoma Trial Group. Measuring visual field progression in the Early Manifest Glaucoma Trial. Acta Ophthalmol. 2003,81:286-293.
  13. Artes PH, O’Leary N, Nicolela MT, Chauhan BC, Crabb DP. Visual field progression in glaucoma: what is the specificity of the Guided Progression Analysis? Ophthalmol. 2014,121:2023-2027.
  14. Nguyen AT, Greenfield DS, Bhakta AS, Lee J, Feuer WJ. Detecting glaucoma progression using Guided Progression Analysis with OCT and visual field assessment in eyes classified by international classification of disease severity codes. Ophthalmol Glaucoma. 2019,2:36-46.
  15. Hitchings RA, Migdal CS, Wormald R, Poinooswamy D, Fitze F. The primary treatment trial: changes in the visual field analysis by computer assisted perimetry. Eye. 1994,8:117-120.
  16. Kummet CM, Zamba KD, Doyle CK, Johnson CA, Wall M. Refinement of pointwise linear regression criteria for determining glaucoma progression. Invest Ophthalmol Vis Sci. 2013,54:6234-6241.
  17. Naghizadeh F, Hollo G. Detection of glaucomatous progression with Octopus cluster trend analysis. J Glaucoma. 2014,23:269-275.
  18. Gardiner SK, Mansberger SL. Detection of functional deterioration in glaucoma analysis by trend analysis using overlapping clusters of locations. Transl Vis Sci Technol. 2020,9:12. Doi 10.116/tvst 9.9.12
  19. Wu Z, Medeiros FA. Comparison of visual field point-wise event-based and global trend-based analysis for detecting glaucomatous progression. Transl Vis Sci Technol. 2018,7:20. Doi 10.1167/tvst 7.4.20.

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