Diagnosing Glaucoma Progression with Visual Field Data Using a Spatiotemporal Boundary Detection Method.
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ABSTRACT:
SUBMITTER: Berchuck SI
PROVIDER: S-EPMC6818507 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
Publications
Diagnosing Glaucoma Progression with Visual Field Data Using a Spatiotemporal Boundary Detection Method.
Berchuck Samuel I SI Mwanza Jean-Claude JC Warren Joshua L JL
Journal of the American Statistical Association 20190401 527
Diagnosing glaucoma progression is critical for limiting irreversible vision loss. A common method for assessing glaucoma progression uses a longitudinal series of visual fields (VF) acquired at regular intervals. VF data are characterized by a complex spatiotemporal structure due to the data generating process and ocular anatomy. Thus, advanced statistical methods are needed to make clinical determinations regarding progression status. We introduce a spatiotemporal boundary detection model that ...[more]
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Project description:Glaucoma is the leading cause of irreversible blindness worldwide and requires regular monitoring upon diagnosis to ascertain whether the disease is stable or progressing. However, making this determination remains a difficult clinical task. Recently, a novel spatiotemporal boundary detection predictor of glaucomatous visual field (VF) progression (STBound) was developed. In this work, we explore the ability of STBound to differentiate progressing and non-progressing glaucoma patients in comparison to existing methods. STBound, Spatial PROGgression, and traditional trend-based progression methods (global index (GI) regression, mean regression slope, point-wise linear regression, permutation of pointwise linear regression) were applied to longitudinal VF data from 191 eyes of 91 glaucoma patients. The ability of each method to identify progression was compared using Akaike information criterion (AIC), full/partial area under the receiver operating characteristic curve (AUC/pAUC), sensitivity, and specificity. STBound offered improved diagnostic ability (AIC: 197.77 vs. 204.11-217.55; AUC: 0.74 vs. 0.63-0.70) and showed no correlation (r: -0.01-0.11; p-values: 0.11-0.93) with the competing methods. STBound combined with GI (the top performing competitor) provided improved performance over all individual metrics and compared to all metrics combined with GI (all p-values < 0.05). STBound may be a valuable diagnostic tool and can be used in conjunction with existing methods.
| S-EPMC6420602 | biostudies-literature
Project description:PurposeTo compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF).DesignValidity assessment.MethodsWe analyzed subjects with more than 4 semi-annual follow-up visits (every 6 months) in the multicenter Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance.ResultsThe analysis included 356 glaucoma suspect/preperimetric glaucoma (GS/PPG) eyes and 153 perimetric glaucoma (PG) eyes. Follow-up length was 54.1 ± 16.2 months for GS/PPG eyes and 56.7 ± 16.0 for PG eyes. Progression was detected in 62.1% of PG eyes and 59.8% of GS/PPG eyes by OCT, significantly (P < .001) more than the detection rate of 41.8% and 27.3% by VF. In severity-stratified analysis of PG eyes, OCT had significantly higher detection rate than VF in mild PG (63.1% vs. 38.7%, P < .001), but not in moderate and advanced PG. The rate of NFL thinning slowed dramatically in advanced PG, but GCC thinning rate remained relatively steady and allowed good progression detection even in advanced disease. The Kaplan-Meier time-to-event analyses showed that OCT detected progression earlier than VF in both PG and GS/PPG groups.ConclusionsOCT is more sensitive than VF for the detection of progression in early glaucoma. While the utility of NFL declines in advanced glaucoma, GCC remains a sensitive progression detector from early to advanced stages.
| S-EPMC5894829 | biostudies-literature
Project description:Glaucoma disease progression, as measured by visual field (VF) data, is often defined by periods of relative stability followed by an abrupt decrease in visual ability at some point in time. Determining the transition point of the disease trajectory to a more severe state is important clinically for disease management and for avoiding irreversible vision loss. Based on this, we present a unified statistical modeling framework that permits prediction of the timing and spatial location of future vision loss and informs clinical decisions regarding disease progression. The developed method incorporates anatomical information to create a biologically plausible data-generating model. We accomplish this by introducing a spatially varying coefficients model that includes spatially varying change points to detect structural shifts in both the mean and variance process of VF data across both space and time. The VF location-specific change point represents the underlying, and potentially censored, timing of true change in disease trajectory while a multivariate spatial boundary detection structure is introduced that accounts for the complex spatial connectivity of the VF and optic disc. We show that our method improves estimation and prediction of multiple aspects of disease management in comparison to existing methods through simulation and real data application. The R package spCP implements the new methodology.
| S-EPMC6438211 | biostudies-literature
Project description:To explore visual field (VF) progression in a cohort of secondary care-treated glaucoma and ocular hypertensive (OHT) patients.We extracted VFs from our database drawn from our normal clinical practice. VF series from 4177 eyes from 2208 patients who had five or more VFs were obtained, the 'better' eye was selected and the rate of VF progression was calculated using mean deviation (MD) data.The median rate of progression for the whole sample was -0.1 dB/year (interquartile range (IQR) -4 to 0 dB/year) over a median of 6.7 years (IQR 4.9-8.7). Of 2208 patients, 477 (21.2%) progressed at > -0.5 dB/year; 46 (2.1%) progressed at >-2.0 dB/year. Of those with a 'final MD' of worse than -10 dB (N=244) in their better eye; 14.0% were 'fast progressors' (>-2 dB/year), 33.7% 'moderate progressors' (-1 to -2 dB/year), and 28.8% 'slow progressors' (-0.3 dB to -1 dB/year). Of those with 'initial MD' better than -3 dB and those with worse than -3 dB, 31/1679 (1.8%) and 213/529 (40.3%) respectively, had a final MD of worse than -10 dB.Fast progressors, while important, are relatively rare. Moderate and slow progressors make up the majority of the progressing population within this data set. The risk of significant visual loss is much higher in those with initial damage. With increasing life expectancy, moderate and slow progressors may become increasingly clinically important.
| S-EPMC4135248 | biostudies-other
Project description:PurposeIt has been suggested that the detection of visual field progression can be improved by modeling statistical properties of the data such as the increasing retest variability and the spatial correlation among visual field locations. We compared a method that models those properties, Analysis with Non-Stationary Weibull Error Regression and Spatial Enhancement (ANSWERS), against a simpler one that does not, Permutation of Pointwise Linear Regression (PoPLR).MethodsVisual field series from three independent longitudinal studies in patients with glaucoma were used to compare the positive rate of PoPLR and ANSWERS. To estimate the false-positive rate, the same visual field series were randomly re-ordered in time. The first dataset consisted of series of 7 visual fields from 101 eyes, the second consisted of series of 9 visual fields from 150 eyes, and the third consisted of series of more than 9 visual fields (17.5 on average) from 139 eyes.ResultsFor a statistical significance of 0.05, the false-positive rates for ANSWERS were about 3 times greater than expected at 15%, 17%, and 16%, respectively, whereas for PoPLR they were 7%, 3%, and 6%. After equating the specificities at 0.05 for both models, positive rates for ANSWERS were 16%, 25%, and 38%, whereas for PoPLR they were 12%, 33%, and 49%, or about 5% greater on average (95% confidence interval = -1% to 11%).ConclusionsDespite being simpler and less computationally demanding, PoPLR was at least as sensitive to deterioration as ANSWERS once the specificities were equated.Translational relevanceClose control of false-positive rates is key when visual fields of patients are analyzed for change in both clinical practice and clinical trials.
| S-EPMC8684309 | biostudies-literature
Project description:PurposeTo evaluate the association of macular superficial vessel density (SVD) and projection-resolved deep vessel density (DVD) with past visual field (VF) progression in patients with primary open-angle glaucoma.DesignRetrospective cohort.MethodsIn this longitudinal study, 208 eyes of 147 patients with glaucoma from the Diagnostics Innovations in Glaucoma Study were included. Eligible participants were required to have at least five 24-2 VF tests over a minimum follow-up period of 3 years before macular optical coherence tomography angiography imaging. VF progression was defined based on both event-based pointwise linear regression and trend-based methods. The association of macular SVD and DVD with the probability and rate of past VF progression was evaluated using a linear mixed effects model.ResultsFifty-two (25%) eyes had VF progression based on the pointwise linear regression based criterion at the end of a mean ± standard deviation follow-up duration of 6.9 ± 1.2 years. In the event-based multivariable analysis, a lower baseline SVD was associated with a higher likelihood of past VF progression (odds ratio per 1% lower. 1.28; 95% confidence interval, 1.02-1.59). Similarly, in the trend-based multivariable analysis, lower macular SVD was associated with a faster past rate of mean deviation decline (coefficient = -0.03 dB/year; 95% confidence interval, -0.04 to -0.01). Event-based and trend-based analyses found no significant associations for macular DVD with the likelihood/rate of past VF progression (P > .05).ConclusionsLower macular SVD, and not DVD, was associated with a higher probability of past VF progression. Macular optical coherence tomography angiography imaging shows promise for identifying eyes at risk of VF progression in patients with glaucoma.
| S-EPMC9469932 | biostudies-literature
Project description:ImportanceRates of visual field (VF) progression vary among patients with glaucoma. Knowing the rate of progression of individual patients would allow appropriately aggressive therapy for patients with high rates of visual loss and protect those with low rates from unnecessary therapy.ObjectiveTo compare 3 pointwise methods of estimating the rate of VF progression in glaucoma.Design, setting, and participantsThis retrospective, observational cohort study included 729 eyes of 567 consecutive patients with primary open-angle glaucoma who had at least 6 reliable VFs and at least 3 years of follow-up. One hundred seventy-six patients (257 eyes) were treated at a tertiary glaucoma center; in addition, data were collected from 391 participants (472 eyes) in the Advanced Glaucoma Intervention Study. Data were collected from May 1988 to November 2004 and analyzed from October 2018 to February 2019.ExposuresEstimates of VF progression were measured with guided progression analysis (GPA), pointwise linear regression (PLR), and the glaucoma rate index (GRI). A subgroup analysis was performed in a subset of patients with likely VF progression and likely VF stability.Main outcomes and measuresProportion of VF series detected as progressing, estimates of false-positive proportions, time to detect progression, and agreement among measures.ResultsAmong the 567 patients included in the analysis, mean (SD) age was 65.6 (9.7) years, 300 (52.9%) were female, and 295 (52.0%) were white. The median baseline mean deviation was -6.7 (interquartile range [IQR], -11.6 to -3.5) dB; the median follow-up time, 8.9 (IQR, 7.3-10.4) years. The proportion of eyes labeled as progressing was 27.7% according to the GPA, 33.5% according to the PLR, and 52.9% according to the GRI; pairwise differences for GRI vs PLR were 20% (95% CI, 17%-23%); for GRI vs GPA, 25% (95% CI, 22%-29%); and for PLR vs GPA, 6% (95% CI, 3%-9%; P < .001 for all comparisons, McNemar test). The shortest median time to progression was with the GRI (8.8 [IQR, 2.4-10.5 years), compared with the GPA and PLR (both >16 years). The hazard ratio of VF progression for GRI vs PLR (reference) was 11.3 (95% CI, 9.2-13.7); for GRI vs GPA (reference), 18.1 (95% CI, 14.5-22.6); and for PLR vs GPA (reference), 1.5 (95% CI, 1.3-1.9; P < .001 for all comparisons, Cox proportional hazards regression). These results held in the subgroup with likely progression; the proportions of progressing eyes were 73.7% (115 of 156) for GPA, 81.4% (127 of 156) for PLR, and 92.9% (145 of 156) for GRI. Pairwise difference for GRI vs PLR was 11.5% (95% CI, 7.4%-17.6%; P < .001, McNemar test); for GRI vs GPA, 19.2% (95% CI, 12.6%-26.4%; P < .001, McNemar test); and for PLR vs GPA, 7.7% (95% CI, 0.3%-15.7%; P = .08, McNemar test).Conclusions and relevanceThese results suggest GRI can detect long-term VF progression in glaucoma earlier than PLR or GPA. Validation with prospective designs may strengthen the generalizability and value of this method.
| S-EPMC7118669 | biostudies-literature
Project description:PurposeWe developed a statistical model to improve the detection of glaucomatous visual field (VF) progression as defined by the consensus of expert clinicians.MethodsWe developed new methodology in the Bayesian setting to properly model the progression status of a patient (as determined by a group of expert clinicians) as a function of changes in spatially correlated sensitivities at each VF location jointly. We used a spatial probit regression model that jointly incorporates all highly correlated VF changes in a single framework while accounting for structural similarities between neighboring VF regions.ResultsOur method had improved model fit and predictive ability compared to competing models as indicated by the deviance information criterion (198.15 vs. 201.29-213.38), a posterior predictive model selection metric (130.08 vs. 142.08-155.59), area under the receiver operating characteristic curve (0.80 vs. 0.59-0.72; all P values < 0.018), and optimal sensitivity (0.92 vs. 0.28-0.82). Simulation study results suggest that estimation (reduction of mean squared errors) and inference (correct coverage of 95% credible intervals) for the model parameters are improved when spatial modeling is incorporated.ConclusionsWe developed a statistical model for the detection of VF progression defined by clinician expert consensus that accounts for spatially correlated changes in visual sensitivity over time, and showed that it outperformed competing models in a number of areas.Translational relevanceThis model may easily be incorporated into routine clinical practice and be useful for detecting glaucomatous VF progression defined by clinician expert consensus.
| S-EPMC5017314 | biostudies-literature
Project description:In the glaucoma clinic, patients with normal intraocular pressure (IOP) can sometimes show visual field (VF) progression. Therefore, clarification of relationship between vascular status and glaucomatous VF deterioration is a focus of interest. We used optical coherence tomography angiography (OCTA), with the aim of evaluating the relationship between vessel density (VD) and VF progression in glaucoma patients. We included 104 eyes with open angle glaucoma who were followed up for at least 5 years in this retrospective case-control study. Superficial and deep VD of macula were assessed by OCTA. Regression analysis and Cox proportional hazards model were used to identify factors significantly associated with VF progression. In logistic regression analysis determining VF progression from Guided Progression Analysis (GPA) program, initial IOP and deep macular VD were significantly associated with VF progression in multivariate analysis (P?=?0.019 and 0.004). Cox proportional hazards model also identified deep macular VD as significantly related to VF progression (P?=?0.035). In conclusion, initial IOP and deep VD were related to VF deterioration in glaucoma. Deep VD might be used as a surrogate of glaucomatous VF progression related with vascular incompetence.
| S-EPMC6856104 | biostudies-literature
Project description:PurposeTo investigate the relationship between corneal deflection amplitude and visual field progression rate in patients with primary open-angle glaucoma (POAG).MethodsThis study included 113 eyes of 65 patients with POAG followed for an average of 4.81 ± 1.24 years. Evaluation of visual field progression rate was performed using mean deviation of standard automated perimetry. Corneal deflection amplitude was measured using Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). Linear mixed models were performed to determine the relationship between corneal deflection amplitude, intraocular pressure (IOP), and visual field progression rate.ResultsMean age was 56.36 ± 14.58 years. Baseline average mean deviation was -8.20 ± 9.12 dB and mean treated IOP was 14.38 ± 3.08 mmHg. Average deflection amplitude was 0.90 ± 0.13 mm. In both univariate and multivariate analysis, IOP (P = 0.028 and P < 0.001, respectively) and deflection amplitude (P = 0.034 and P < 0.001, respectively) significantly affected visual field progression rate. Eyes with high IOP and greater deflection amplitude showed faster progression rate.ConclusionsCorneal deflection amplitude was significantly related with glaucoma progression. Eyes with greater corneal deflection amplitude showed faster visual field progression rate in patients with POAG.
| S-EPMC6690643 | biostudies-literature