Dataset Information

Improving Visual Field Examination of the Macula Using Structural Information.

ABSTRACT:

Purpose

To investigate a novel approach for structure-function modeling in glaucoma to improve visual field testing in the macula.

Methods

We acquired data from the macular region in 20 healthy eyes and 31 with central glaucomatous damage. Optical coherence tomography (OCT) scans were used to estimate the local macular ganglion cell density. Perimetry was performed with a fundus-tracking device using a 10-2 grid. OCT scans were matched to the retinal image from the fundus perimeter to accurately map the tested locations onto the structural damage. Binary responses from the subjects to all presented stimuli were used to calculate the structure-function model used to generate prior distributions for a ZEST (Zippy Estimation by Sequential Testing) Bayesian strategy. We used simulations based on structural and functional data acquired from an independent dataset of 20 glaucoma patients to compare the performance of this new strategy, structural macular ZEST (MacS-ZEST), with a standard ZEST.

Results

Compared to the standard ZEST, MacS-ZEST reduced the number of presentations by 13% in reliable simulated subjects and 14% with higher rates (?20%) of false positive or false negative errors. Reduction in mean absolute error was not present for reliable subjects but was gradually more important with unreliable responses (?10% at 30% error rate).

Conclusions

Binary responses can be modeled to incorporate detailed structural information from macular OCT into visual field testing, improving overall speed and accuracy in poor responders.

Translational relevance

Structural information can improve speed and reliability for macular testing in glaucoma practice.

SUBMITTER: Montesano G

PROVIDER: S-EPMC6314223 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

Improving Visual Field Examination of the Macula Using Structural Information.

Montesano Giovanni G Rossetti Luca M LM Allegrini Davide D Romano Mario R MR Crabb David P DP

Translational vision science & technology 20181101 6

<h4>Purpose</h4>To investigate a novel approach for structure-function modeling in glaucoma to improve visual field testing in the macula.<h4>Methods</h4>We acquired data from the macular region in 20 healthy eyes and 31 with central glaucomatous damage. Optical coherence tomography (OCT) scans were used to estimate the local macular ganglion cell density. Perimetry was performed with a fundus-tracking device using a 10-2 grid. OCT scans were matched to the retinal image from the fundus perimete ...[more]

PMID: 30619656

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Project description:PurposeThere have been concerns that short-term clinical trials for evaluating new treatments in glaucoma would require prohibitively large sample sizes when using visual field endpoints, given that glaucoma is often a slowly progressive disease. This study sought to determine the required sample size for such trials using event-based analyses, and whether it can be reduced using trend-based analyses.DesignLongitudinal, observational study.Participants321 eyes of 240 glaucoma participants followed under routine clinical care using 242 visual field for an average of 10 years.MethodsSample size requirements were derived using computer simulations that reconstructed "real-world" visual fields by combining estimates of point-wise variability according to different threshold levels and rates of change obtained from the clinical glaucoma cohort. A clinical trial lasting 2 years with testing every 3 months was simulated, assuming that the new treatment halted visual field change in various percentages of participants (or "responders"). Treatment efficacy was evaluated by: (a) Difference in incidence of point-wise event-based progression (similar to the commercially available Guided Progression Analysis), and (b) Difference in rate of visual field mean deviation (MD) change between groups using linear mixed models (LMMs).Main outcome measuresSample size to detect a statistically significance difference between groups.ResultsBetween-group trend-based analyses using LMMs reduced sample size requirements by 85-90% across the range of new treatment effects when compared to the conventional point-wise event-based analysis. To detect the effect of a new treatment that halted progression in 30% of the participants under routine clinical care (equal to a 30% reduction in average rate of MD change) with 90% power, for example, 1924 participants would be required per group using event-based analysis, but only 277 participants per group if LMMs were used.ConclusionsThe feasibility of future glaucoma clinical trials can be substantially improved by evaluating differences in the rate of visual field change between groups.

Dataset Information

Improving Visual Field Examination of the Macula Using Structural Information.

Purpose

Methods

Results

Conclusions

Translational relevance

Publications

Improving Visual Field Examination of the Macula Using Structural Information.

Similar Datasets

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