Abstract
PurposeIt has been recommended that multiple visual field examinations be performed in the first 2 years after glaucoma diagnosis so that rapid visual field progression (≤−2 dB/year, using ordinary least squares regression over time of the summary index mean deviation [MD]) can be detected. Here I investigate how predictive a statistically significant regression slope is of truly rapid visual field progression.MethodsI simulated visual field series (N = 100,000) spaced at 4 monthly intervals for the first 2 years. MD values had a standard deviation of 1 dB. The true underlying rates of progression were selected from a modified hyperbolic secant with parameters averaged from fits to large data sets from Canada, Sweden, and the United States.ResultsThe positive predictive value (PPV) for rapid progression was 0.47 after 2 years, whereas the negative predictive value (NPV) was > 0.99. When using the criterion that a significant regression also had to have a slope of ≤ −2 dB/year, the PPV for rapid progression reduced substantially to 0.18 but the NPV was essentially unchanged (NPV >0.99).ConclusionAlthough performing multiple visual fields in the first 2 years provides appropriate power to detect rapid progression, a significant regression slope in the first 2 years is not highly predictive of rapid progression, particularly so if slopes ≤ −2 dB/year are considered only.Translational RelevanceStatistically significant visual field progression in a short period after diagnosis may not necessarily indicate the presence of rapid progression, and so confirmatory signs of rapid progression should be sought before implementing treatment changes.
Highlights
Estimating the rate of visual field loss in glaucoma is vital for assessing whether a patient’s current treatment is adequately controlling the disease, as a large proportion of patients continue to lose vision on standard glaucoma intraocular pressure-lowering therapies.[1]
It has been recommended that six visual field examinations be performed in the first 2 years after diagnosis so that rapid visual field progression ( À2 dB/ year, using a linear regression over time of the summary index mean deviation [MD]) can be detected.[3]
This recommendation is based on achieving a sufficient power to detect a significant rate of decline in MD when progression is rapid,[3] and has been influential in shaping glaucoma management guidelines.[4]
Summary
Estimating the rate of visual field loss in glaucoma is vital for assessing whether a patient’s current treatment is adequately controlling the disease, as a large proportion of patients continue to lose vision on standard glaucoma intraocular pressure-lowering therapies.[1]. Variability can produce rate estimates ,À2 dB/year after six visual fields in people who do not have rapid visual field progression.[5]
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