Purpose

To compare the performance of the pattern standard deviation (PSD) values derived from the central 12 locations of the 24-2 visual field test (C24-2) to the entire 10-2 test for detecting central visual field abnormalities in eyes with, suspected of having, or at risk of having glaucoma.

Design

Cross-sectional case-control study.

Methods

Eyes with, suspected of having, or at risk of having glaucoma, based on masked grading of optic disc stereophotographs and/or ocular hypertension (intraocular pressure ≥ 22 mm Hg) were included as cases (n = 523). Eyes from healthy participants were included as controls (n = 107) to allow the 2 tests to be compared at matched specificities. The sensitivity to detect cases at 95% specificity using PSD values derived from the entire 10-2 test and C24-2 were compared.

Results

The sensitivity of the 10-2 and C24-2 PSD values was not significantly different between the 10-2 and C24-2 at matched specificities (35.9% and 35.4% respectively; P = .900). There was also a substantial agreement between the cases detected by both methods (kappa = 0.80 ± 0.04), and a very strong association between the PSD values from the 2 methods (R² = 0.91).

Conclusions

10-2 and 24-2 tests identified a similar number of eyes with, suspected of having, or at risk of having glaucoma as having central visual field abnormalities using PSD values. These findings do not mean that 10-2 tests are not useful, but highlight the need for further studies to determine the potential advantages of 10-2 tests through equivalent comparisons against 24-2 tests to ensure appropriate recommendations are made about its incorporation into the glaucoma standard of care.

Purpose

To compare the performance of the pattern standard deviation (PSD) values derived from the central 12 locations of the 24-2 visual field test (C24-2) to the entire 10-2 test for detecting central visual field abnormalities in eyes with, suspected of having, or at risk of having glaucoma.

Design

Cross-sectional case-control study.

Methods

Eyes with, suspected of having, or at risk of having glaucoma, based on masked grading of optic disc stereophotographs and/or ocular hypertension (intraocular pressure ≥ 22 mm Hg) were included as cases (n = 523). Eyes from healthy participants were included as controls (n = 107) to allow the 2 tests to be compared at matched specificities. The sensitivity to detect cases at 95% specificity using PSD values derived from the entire 10-2 test and C24-2 were compared.

Results

The sensitivity of the 10-2 and C24-2 PSD values was not significantly different between the 10-2 and C24-2 at matched specificities (35.9% and 35.4% respectively; P = .900). There was also a substantial agreement between the cases detected by both methods (kappa = 0.80 ± 0.04), and a very strong association between the PSD values from the 2 methods (R² = 0.91).

Conclusions

10-2 and 24-2 tests identified a similar number of eyes with, suspected of having, or at risk of having glaucoma as having central visual field abnormalities using PSD values. These findings do not mean that 10-2 tests are not useful, but highlight the need for further studies to determine the potential advantages of 10-2 tests through equivalent comparisons against 24-2 tests to ensure appropriate recommendations are made about its incorporation into the glaucoma standard of care.

Purpose

To compare the ability of 10-2 visual field tests and central 12 locations of the 24-2 tests (C24-2) to detect central visual field progression in glaucoma eyes with early central visual field abnormalities.

Design

Observational cohort study.

Participants

Three-hundred eyes of 180 participants with glaucoma or ocular hypertension.

Methods

Participants with both 10-2 and 24-2 tests performed on ≥3 visits over ≥1-year period were included to estimate the longitudinal variability of 10-2 and C24-2 visual field mean deviation (MD). The variability estimates were then used to reconstruct real-world visual field results by computer simulations, in a scenario where eyes had a baseline 10-2 and C24-2 MD was -2 dB and exhibited various rates of change (-0.25, -0.50, -0.75 and -1.00 dB/year), and the time to detect these changes were evaluated using trend-based analyses.

Main outcome measures

Time required to detect progression.

Results

Overall, the time to detect central visual field progression was reduced by 7-9% using the 10-2 compared to C24-2 MD values, equivalent to a total reduction of 0.1-0.3 dB lost. For example, 90% of eyes with a central 10-2 or C24-2 MD loss of -0.50 dB/year would be detected after 5.0 and 5.5 years of semi-annual testing respectively, or after 3.4 and 3.7 years respectively for eyes with a -1.00 dB/year loss.

Conclusions

Trend-based analyses using 10-2 MD resulted in a mild reduction (7-9%) in the time to detect central visual field progression compared to C24-2 MD in glaucoma eyes with early central visual field abnormalities. Further studies are needed to determine whether other progression analyses can better exploit the increased sampling of 10-2 tests. These findings provide evidence-based guidance on the potential value-add of 10-2 testing in the clinical management of glaucoma patients.

Purpose

To compare the ability of 10-2 visual field tests and central 12 locations of the 24-2 tests (C24-2) to detect central visual field progression in glaucoma eyes with early central visual field abnormalities.

Design

Observational cohort study.

Participants

Three-hundred eyes of 180 participants with glaucoma or ocular hypertension.

Methods

Participants with both 10-2 and 24-2 tests performed on ≥3 visits over ≥1-year period were included to estimate the longitudinal variability of 10-2 and C24-2 visual field mean deviation (MD). The variability estimates were then used to reconstruct real-world visual field results by computer simulations, in a scenario where eyes had a baseline 10-2 and C24-2 MD was -2 dB and exhibited various rates of change (-0.25, -0.50, -0.75 and -1.00 dB/year), and the time to detect these changes were evaluated using trend-based analyses.

Main outcome measures

Time required to detect progression.

Results

Overall, the time to detect central visual field progression was reduced by 7-9% using the 10-2 compared to C24-2 MD values, equivalent to a total reduction of 0.1-0.3 dB lost. For example, 90% of eyes with a central 10-2 or C24-2 MD loss of -0.50 dB/year would be detected after 5.0 and 5.5 years of semi-annual testing respectively, or after 3.4 and 3.7 years respectively for eyes with a -1.00 dB/year loss.

Conclusions

Trend-based analyses using 10-2 MD resulted in a mild reduction (7-9%) in the time to detect central visual field progression compared to C24-2 MD in glaucoma eyes with early central visual field abnormalities. Further studies are needed to determine whether other progression analyses can better exploit the increased sampling of 10-2 tests. These findings provide evidence-based guidance on the potential value-add of 10-2 testing in the clinical management of glaucoma patients.

Purpose

To compare hemifield differences in the vessel density of the peripapillary and macula in open-angle glaucoma eyes with visual field (VF) defect confined to one hemifield using optical coherence tomography angiography (OCT-A).

Design

Cross-sectional study.

Participants

A total of 58 eyes of 58 patients with glaucoma with VF loss confined to a single hemifield and 28 healthy eyes.

Methods

Retinal vasculature information was summarized as circumpapillary vessel density (cpVD) and perifoveal vessel density (pfVD). Circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (mGCC) thickness were calculated using spectral domain optical coherence tomography (SD OCT). Paired and unpaired t tests were used to evaluate differences between the perimetrically affected and intact hemiretinae and healthy hemiretinae. Linear regression analyses were performed to evaluate the associations between VF measures with vascular and structural measurements.

Main outcome measures

Total and hemispheric cpVD, pfVD, cpRNFL, mGCC, and mean sensitivity (MS).

Results

Mean cpVD and pfVD in the intact hemiretinae of glaucoma eyes (59.0% and 51.1%, respectively) were higher than in the affected hemiretinae (54.7% and 48.3%, respectively; P < 0.001) but lower than in healthy eyes (62.4% and 53.8%, respectively; P < 0.001). Similar results were noted with cpRNFL and mGCC thickness measurements (P < 0.05 for both). The strongest associations between MS in the affected hemifields were found for cpVD (r = 0.707), followed by pfVD (r = 0.615), cpRNFL (r = 0.496), and mGCC (r = 0.482) in the corresponding hemiretinae (P < 0.001 for all). Moreover, the correlations in the intact hemifields between MS with cpVD and pfVD were higher (r = 0.450 and 0.403) than the correlations between MS and cpRNFL and mGCC thickness measurements (r = 0.340 and 0.290; P values <0.05 for all).

Conclusions

Reduced peripapillary and macular vessel density was detectable in the perimetrically intact hemiretinae of glaucoma eyes with a single-hemifield defect. Vessel density attenuation in both affected and intact hemiretinae was associated with the extent of VF damage in the corresponding hemifields. Optical coherence tomography angiography potentially shows promise for identifying glaucomatous damage before focal VF defects are detectable.

Purpose

To compare hemifield differences in the vessel density of the peripapillary and macula in open-angle glaucoma eyes with visual field (VF) defect confined to one hemifield using optical coherence tomography angiography (OCT-A).

Design

Cross-sectional study.

Participants

A total of 58 eyes of 58 patients with glaucoma with VF loss confined to a single hemifield and 28 healthy eyes.

Methods

Retinal vasculature information was summarized as circumpapillary vessel density (cpVD) and perifoveal vessel density (pfVD). Circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (mGCC) thickness were calculated using spectral domain optical coherence tomography (SD OCT). Paired and unpaired t tests were used to evaluate differences between the perimetrically affected and intact hemiretinae and healthy hemiretinae. Linear regression analyses were performed to evaluate the associations between VF measures with vascular and structural measurements.

Main outcome measures

Total and hemispheric cpVD, pfVD, cpRNFL, mGCC, and mean sensitivity (MS).

Results

Mean cpVD and pfVD in the intact hemiretinae of glaucoma eyes (59.0% and 51.1%, respectively) were higher than in the affected hemiretinae (54.7% and 48.3%, respectively; P < 0.001) but lower than in healthy eyes (62.4% and 53.8%, respectively; P < 0.001). Similar results were noted with cpRNFL and mGCC thickness measurements (P < 0.05 for both). The strongest associations between MS in the affected hemifields were found for cpVD (r = 0.707), followed by pfVD (r = 0.615), cpRNFL (r = 0.496), and mGCC (r = 0.482) in the corresponding hemiretinae (P < 0.001 for all). Moreover, the correlations in the intact hemifields between MS with cpVD and pfVD were higher (r = 0.450 and 0.403) than the correlations between MS and cpRNFL and mGCC thickness measurements (r = 0.340 and 0.290; P values <0.05 for all).

Conclusions

Reduced peripapillary and macular vessel density was detectable in the perimetrically intact hemiretinae of glaucoma eyes with a single-hemifield defect. Vessel density attenuation in both affected and intact hemiretinae was associated with the extent of VF damage in the corresponding hemifields. Optical coherence tomography angiography potentially shows promise for identifying glaucomatous damage before focal VF defects are detectable.

Purpose

To examine whether glaucomatous central visual field abnormalities can be more effectively detected using a qualitative, expert evaluation of the 10-2 test compared with the topographically corresponding central 12 locations of the 24-2 test (C24-2).

Design

Cross-sectional study.

Methods

Eyes with a glaucomatous optic nerve appearance or ocular hypertension (n = 523) and healthy eyes (n = 107) were included as cases and control subjects, respectively. The 10-2 and C24-2 visual field results of all eyes were graded by 4 glaucoma specialists for the probability that central visual field abnormalities were present.

Results

The sensitivity of the 10-2 and C24-2 tests for detecting the cases at 95% specificity were not significantly different (e.g., 32.2% and 31.4%, respectively, for grader 1, P = .87; all graders P ≥ .25). At 95% specificity, the pattern standard deviation values from these tests had a similar sensitivity to the qualitative evaluation for the C24-2 test for all graders (P ≥ .083), but it had a significantly higher sensitivity than the qualitative evaluation for the 10-2 test for 3 graders (P ≤ .016).

Conclusions

The similarity in performance of the 10-2 and C24-2 test suggests that the increased sampling density of the former does not significantly improve the detection of central visual field abnormalities, even when based on expert assessment. These findings should not be taken to mean that the 10-2 test is not useful, but it underscores the need for its utility to be clearly established before incorporating it as routine glaucoma standard of care.

Purpose

To determine the prevalence of fast global and central visual field (VF) progression in individuals with glaucoma under routine care.

Design

Observational study.

Participants

Six hundred ninety-three eyes of 461 individuals with glaucoma followed up over a median of 4.5 years.

Methods

This study included (1) patients at a private ophthalmology clinic in Melbourne, Australia, and (2) individuals in 2 prospective longitudinal observational studies across 3 sites in the United States. All individuals had a diagnosis of glaucoma and were under routine care, and had performed 5 or more reliable 24-2 VF tests over a 1- to 5-year period. Ordinary least squares regression analyses were used to calculate the rate of global mean deviation (MD) change over time and the rate of the mean total deviation values of the 12 test locations within the central 10° region (MTD₁₀) for each eye.

Main outcome measures

Prevalence of progression based on the rate of MD and the MTD₁₀ change across various fixed cutoffs and cutoffs based on the estimated normal distribution (from the positive slopes).

Results

Based on the MD and the MTD₁₀, 12.5% and 11.7% of the eyes, respectively, exhibited a rate of change that was less than -1.0 dB/year (being a rate that typically is defined as "fast progression" for MD values), and 29.0% of the eyes showed a change of less than -0.5 dB/year on MTD₁₀. Furthermore, 12.7% and 9.1% of the eyes exhibited a rate of change that exceeded the 1% cutoff of the estimated normal distribution MD and the MTD₁₀ values, respectively.

Conclusions

This study found that approximately 1 in 8 eyes with glaucoma receiving routine care showed fast progression based on global MD values (< -1.0 dB/year) and that nearly 1 in 3 eyes showed a < -0.5 dB/year decline centrally. These findings highlight the clinical importance of assessing progressive central VF loss and reinforce the need for new therapies to prevent functional disability in a notable proportion of individuals who continue to exhibit fast progression.

Financial disclosure(s)

Proprietary or commercial disclosure may be found after the references.