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Specification of progression in glaucomatous visual field loss, applying locally condensed stimulus arrangements.

ABSTRACT: PURPOSE: The goal of this work was to (i) determine patterns of progression in glaucomatous visual field loss, (ii) compare the detection rate of progression between locally condensed stimulus arrangements and conventional 6 degrees x 6 degrees grid, and (iii) assess the individual frequency distribution of test locations exhibiting a local event (i.e., an abrupt local deterioration of differential luminance sensitivity (DLS) by more than -10 dB between any two examinations). METHODS: The visual function of 41 glaucomatous eyes of 41 patients (16 females, 25 males, 37 to 75 years old) was examined with automated static perimetry (Tuebingen Computer Campimeter or Octopus 101-Perimeter). Stimuli were added to locally enhance the spatial resolution in suspicious regions of the visual field. The minimum follow-up was four subsequent sessions with a minimum of 2-month (median 6-month) intervals between each session. Progression was identified using a modified pointwise linear regression (PLR) method and a modified Katz criterion. The presence of events was assessed in all progressive visual fields. RESULTS: Eleven eyes (27%) showed progression over the study period (median 2.5 years, range 1.3-8.6 years). Six (55%) of these had combined progression in depth and size and five eyes (45%) progressed in depth only. Progression in size conformed always to the nerve fiber course. Seven out of 11 (64%) of the progressive scotomata detected by spatially condensed grids would have been missed by the conventional 6 degrees x 6 degrees grid. At least one event occurred in 64% of all progressive eyes. Five of 11 (46%) progressive eyes showed a cluster of events. CONCLUSIONS: The most common pattern of progression in glaucomatous visual fields is combined progression in depth and size of an existing scotoma. Applying individually condensed test grids remarkably enhances the detection rate of glaucomatous visual field deterioration (at the expense of an increased examination time) compared to conventional stimulus arrangements.

SUBMITTER: Nevalainen J

PROVIDER: S-EPMC2776145 | biostudies-other | 2009 Dec

REPOSITORIES: biostudies-other

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Project description:Importance:?-zone parapapillary atrophy (?PPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of ?PPA differs between individuals of African descent (AD) and European descent (ED). Objective:To test whether the association between the presence and progression of ?PPA vs visual field progression of glaucoma differs between these 2 ancestry groups. Design, Setting, and Participants:In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of ?PPA at baseline and ?PPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. Exposures:Disc stereophotographs. Main Outcomes and Measures:Progression of ?PPA in AD and ED individuals. Results:In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between ?PPA at baseline and visual field progression was not significantly different between AD and ED eyes (??=?0.071; 95% CI, -0.016 to 0.158; P?=?.11), nor was the association between ?PPA progression and visual field progression (??=?0.020; 95% CI, -0.465 to 0.506; P?=?.93). In the GON group, ED eyes with baseline ?PPA progressed faster than did AD eyes with baseline ?PPA (??=?-0.124; 95% CI, -0.241 to -0.007; P?=?.04), although the association between ?PPA progression and visual field progression did not differ significantly between race groups (??=?-0.101; 95% CI, -0.323 to 0.119; P?=?.37). Conclusions and Relevance:Race had a significant effect on the association between baseline ?PPA and rates of visual field progression in eyes with GON. Progression of ?PPA was not associated with faster visual field progression in either racial group.

Project description:PurposeRisk factors for visual field progression in glaucoma can affect both eyes, meaning that progression rates (in decibels per year) between eyes likely are correlated. We investigated whether incorporating information about the progression rate in one eye can improve the estimate of the rate in the fellow eye.DesignProspective cohort analysis.ParticipantsWe analyzed series of 10 visual field results drawn from the Portland Progression Project and the Rotterdam Eye Study.MethodsWe determined visual field progression rates using linear regression of the summary index mean deviation (MD) over time. We determined best-fitting linear models for the rates over the entire series based on the rate across n visual fields (n = 3 to 6) and used an analysis of variance to determine if incorporating the fellow eye's level of visual field damage (MD) or rate significantly improved these models.Main outcome measureVisual field progression rate (in decibels per year).ResultsVisual field progression rates were correlated positively between eyes for the 262 individuals analyzed (r = 0.51; P < 0.0001). For short series (n = 3 to 4), predicting the rate over the entire 10 fields was improved significantly by incorporating rate information from the fellow eye (P < 0.05), but not by incorporating knowledge about the level of damage in the fellow eye (P > 0.61). The fellow eye no longer aided predictions for n = 5 or 6 fields (P = 0.11 and P = 0.42, respectively). Although the coefficient quantifying the influence of the fellow eye's rate changed relatively little for n = 3 to 5 fields, the coefficient for the rate of the eye under consideration increased markedly with the n value.ConclusionsThe long-term rate of visual field change in an eye is, in part, predicted by the rate in the fellow eye, particularly when only a few visual field results are available for each eye. Because of this, apparent rapid progression in an eye is more likely to be real if the fellow eye also seems to be progressing rapidly.

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Specification of progression in glaucomatous visual field loss, applying locally condensed stimulus arrangements.

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