A New Index to Monitor Central Visual Field Progression in Glaucoma (original) (raw)
Related papers
Suitability of the Visual Field Index according to Glaucoma Severity
Journal of current glaucoma practice
To investigate the suitability of the visual field index (VFI) in different degrees of disease severity in glaucoma patients. In this cross-sectional study, we consecutively enrolled patients with primary open-angle glaucoma and glaucoma suspects (ocular hypertension). All eyes required a reliable standard automated perimetry (SAP) test to be included. Subjects were categorized into five groups based on glaucoma severity using SAP's mean deviation (MD). To evaluate the correlation among VFI, MD and pattern standard deviation (PSD), a linear regression model was built. To evaluate the nature of the correlation (i.e. linear vs nonlinear), results were plotted in a scatterplot graph. One hundred and twenty-two eyes of 81 patients (mean age, 59.8 ± 14.5 years) were included. A strong, positive association was found between MD and VFI values (R(2) = 0.98, p < 0.001), showing a 3.2% reduction in the VFI for each dB loss in the MD index. It was noticed that 15% of eyes with mild gla...
Central Field Index Versus Visual Field Index for Central Visual Function in Stable Glaucoma
Journal of Glaucoma, 2017
To compare the variability of central field index (CFI) versus visual field index (VFI) in stable glaucoma with central fixation involvement. Materials and Methods: For this retrospective study, we identified multiple visual fields (VFs) of patients with repeatable central fixation involvement on Humphrey VFs (24-2 and 10-2 program) which were stable (clinically and on VFs) over a very short period of 2 to 3 months. The VFI and CFI were calculated as described in earlier reports. We graded the fields as early [mean deviation (MD) > À6 dB], moderate (À 6.1 to À12 dB), and severe glaucoma (< À 12 dB) based on MD on 24-2 program. The variability of CFI and VFI between visits and across different severity of glaucoma was compared. Relation of the divergence to field indices and clinical parameters were assessed. Results: The intervisit difference for VFI was greater than CFI ranging from À4% to 9% versus À1% to 8% in early (P = 0.9), À 13% to 18% versus À 6% to 17% (P = 0.056) in moderate, and À 21% to 19% versus À 9% to 9% (P < 0.001) in severe glaucoma. The CFI within each group had narrower range than VFI with maximum range in severe glaucoma (33% to 95%). The divergence of CFI from VFI started at MD 24-2 beyond (worse) À10 dB. This difference between CFI and VFI was associated significantly with number of points with P < 1% on 24-2 (R 2 = 80.3%). Conclusions: CFI is less variable than VFI in stable eyes with fixation involvement especially in severe glaucoma indicating need for incorporating CFI calculation for monitoring advanced disease in eyes with central defects.
Improvement of the visual field index in clinical glaucoma care
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2016
This article investigates the prevalence and attributes of patients with open-angle glaucoma who exhibit improvement of visual field loss in a clinical setting. We conducted a retrospective chart review of patients in a clinical glaucoma practice. We identified 719 glaucoma patients with at least 5 SITA strategy visual field tests and a minimum continuous follow-up period of 5 years. The change in the slope of the visual field index (VFI) over time was illustrated using histogram analysis for the study eye with the worst VFI at baseline. Multiple variables were analyzed to determine their impact on rates of visual field progression, including sex, age, disease staging, intraocular pressure (IOP), and incisional surgeries. Eyes with severe nonophthalmic and ophthalmic comorbidities were excluded. Considering 582 eligible eyes, 232 (39.9%) showed significantly positive slopes of the VFI as a function of time, 76 (13.1%) showed nonsignificant slopes, and 276 (47.4%) showed significantl...
American Journal of Ophthalmology, 2014
PURPOSE: To explore the relationship between the visual field index (VFI) and the visual field mean deviation (MD) in glaucoma patients with moderately advanced perimetric damage and to identify the magnitude of the boundary effect of VFI that occurred when the VFI estimation strategy changed from pattern deviation probability value to total deviation probability value as the MD crossed L20 dB in longitudinal visual field (VF) series.
Reliability of Visual Field Index in Staging Glaucomatous Visual Field Damage
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Standard automated perimetry is integral to the testing of visual function in glaucoma. In the initial tests, it detects and quantifies damage, and in follow-up of a diagnosed patient, it detects stability or progression of glaucomatous damage [1]. Classification of glaucomatous visual field defects and staging its severity is important for effective glaucoma management. This classification is utilized to distinguish between healthy and glaucomatous individuals, to adjust therapy on the basis of disease severity, to describe visual field conditions in a short and simple format, to monitor the progression of the disease, and to provide a common language for both clinical and research purposes [2]. More than 20 severity classification methods have been proposed since 1958 [3]. The staging systems commonly used in research are HPA classification, The Glaucoma Severity Staging System (GSS: this is HPA classification which has been modified by Mills RP et al.,), the Enhanced Glaucoma Severity Staging System (eGSS), the Advanced Glaucoma Intervention Study scoring system (AGIS) [2,4]. The classification systems used in research may be cumbersome and impractical on a daily basis in a busy glaucoma/ophthalmic practice. Availability of a simpler staging system is the need of the hour. GSI has been introduced in the Humphrey Visual Field single field analysis reports. It is the visual field staging system devised by Vessani RM and Susanna R, at University of São Paulo, Brazil [1,5]. This is a staging system readily available on the print out and is dependent on the VFI to stage the fields into Early, Moderate or Severe damage. Visual Field Index is a global index developed by Bengtsson and Heijl in 2008 as a new index intended to be less affected by cataract than the Mean Deviation (MD) [6]. It is expressed as a percentage of visual function; with 100% being a perfect age-adjusted visual field and 0% represents a perimetrically blind field. The pattern deviation probability plot (or total deviation probability plot when MD is worse than-20dB) is used to identify abnormal points and age corrected sensitivity at each point is calculated using total deviation numerical map. The central points are given more weightage and the mean of all points is expressed as a percentage i.e., the VFI. Results: Analysis of 170 visual fields of 95 patients showed that VFI was significantly different between Normal, Early defect, Moderate defect and Severe defects as classified with HPA staging, p<0.001. VFI had strong positive correlation with Mean Deviation (MD), r=0.984, p<0.001 and non-linear correlation with Pattern Standard Deviation (PSD), r =-0.472, p<0.001. On comparing HPA staging with GSI, κ=0.633, p<0.001. VFI, MD and PSD in each of the severity stages across the two classification systems showed no significant differences (p>0.05). Conclusion: In established glaucoma, GSI is a good dependable staging system. It is readily available on the single field print out and can be a quick reference for decision making in the management of glaucoma patients.
2012
BACKGROUND AND OBJECTIVE-To evaluate the ability of structural assessment to predict glaucomatous visual field progression. PATIENTS AND METHODS-A total of 119 healthy eyes with suspected glaucoma and glaucomatous eyes with 5 or more optic nerve stereophotographs, optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy (CSLO) all acquired within 6 months of each other were enrolled. Odds ratios to predict progression were determined by generalized estimating equation models. RESULTS-Median follow-up was 4.0 years (range: 1.5 to 5.7 years). Fifteen eyes progressed by glaucoma progression analysis, 20 by visual field index, and 10 by both. Baseline parameters from stereophotographs (vertical cup-to-disc ratio and Disc Damage Likelihood Scale), OCT (global, superior quadrant, and inferior quadrant retinal nerve fiber layer thickness), and CSLO (cup shape measure and mean cup depth) were significant predictors of progression. Comparing the single best parameter from all models, only the OCT superior quadrant RNFL predicted progression. CONCLUSION-Baseline stereophotographs, OCT, and CSLO measurements may be clinically useful to predict glaucomatous visual field progression.
Baseline mean deviation and rates of visual field change in treated glaucoma patients
Eye, 2011
Purpose To evaluate the relationships between baseline visual field (VF) mean deviation (MD) and subsequent progression in treated glaucoma. Methods Records of patients seen in a glaucoma practice between 1999 and 2009 were reviewed. Patients with glaucomatous optic neuropathy, baseline VF damage, and X8 SITA-standard 24-2 VF were included. Patients were divided into tertiles based upon baseline MD. Automated pointwise linear regression determined global and localized rates (decibels (dB) per year) of change. Progression was defined when two or more adjacent test locations in the same hemifield showed a sensitivity decline at a rate of pÀ1.0 dB per year, Po0.01. Results For mild, moderate, and severe groups, progression was noted in 29.5, 31.2, and 26.0% of eyes (P ¼ 0.50) and global rates of VF change of progressing eyes were À1.3 ± 1.2, À1.01±0.7, and À0.9±0.5 dB/year (P ¼ 0.09, analysis of variance). Within these groups, intraocular pressure (IOP) in stable vs progressing eyes were 15.5±3.3 vs 17.0±3.1 (Po0.01), 15.4 ± 3.3 vs 15.9 ± 2.5 (P ¼ 0.28), and 14.0 ± 2.8 vs 14.8 ± 2.3 mm Hg (P ¼ 0.07). More glaucoma filtering surgeries were performed in eyes with worse MD. There was no significant difference between groups regarding their risk of progression in both univariate (P ¼ 0.50) and multivariate (P ¼ 0.26) analyses adjusting for differences in follow-up IOP.
Cataract Surgery and Rate of Visual Field Progression in Primary Open-Angle Glaucoma
American Journal of Ophthalmology, 2019
To test the hypothesis that cataract surgery slows the apparent rate of visual field (VF) decay in primary open-angle glaucoma patients compared with rates measured during cataract progression. Design: Retrospective cohort study. Methods: Consecutive open-angle glaucoma patients who underwent cataract surgery and who had ≥4 VFs and ≥3 years of follow-up before and after surgery were retrospectively reviewed. Mean deviation (MD) rate, visual field index (VFI) rate, pointwise linear regression (PLR), pointwise rate of change (PRC), and the Glaucoma Rate Index (GRI) were compared before and after cataract surgery. Results: 134 eyes of 99 patients were included. Median (interquartile range) follow-up was 6.5 (4.7-8.1) and 5.3 (4.0-7.3) years before and after cataract surgery, respectively. All intraocular pressure (IOP) parameters (mean IOP, SD of IOP, and peak IOP) significantly improved (p<0.001) after cataract surgery. All VF indices indicated an accelerated VF decay rate after cataract surgery: MD rate (-0.18±0.40 dB/year vs.-0.40±0.62 dB/year, p<0.001), VFI rate (-0.44±1.09%/year vs.-1.19±1.85%/year, p<0.001), GRI (-5.5±10.8 vs.-13.5±21.5; p<0.001), and PRC (-0.62±2.47%/year before and-1.35±3.71%/year after surgery; p<0.001) and PLR (-0.20±0.82 dB/year before and-0.42±1.16 dB/year after surgery; p<0.001) for all VF locations. Worse baseline MD and postoperative peak IOP were significantly associated with the postoperative VF decay rate and the change in the decay rate after cataract surgery. Conclusion: Although all IOP parameters improved after cataract surgery, VFs continued to progress. Cataract surgery does not slow the apparent rate of glaucomatous VF decay as compared to rates measured during the progression of the cataract.