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Detection of Visual Field Deterioration by Glaucoma Progression Analysis and Threshold Noiseless Trend Programs
  1. Valentin Tinguaro Diaz Aleman (vtdac{at}hotmail.com),
  2. Alfonso Anton (anton{at}icrcat.com),
  3. Manuel Gonzalez de la Rosa (mgdelarosa1950{at}gmail.com),
  4. Zoe Johnson, Ms (zkjohnson{at}doctors.org.uk),
  5. Shona McLeod,
  6. Augusto Azuara-Blanco (aazblanco{at}aol.com)
  1. Hospital Universitario de Canarias, La Laguna, Spain
  2. Institut Catala de Retina and Hospital de la Esperanza y el Mar, Barcelona, Spain
  3. Hospital Universitario de Canarias, La Laguna, Spain
  4. Leicester Royal Infirmary, Leicester, United Kingdom, United Kingdom
  5. Raigmore Hospital, Inverness, United Kingdom
  6. Grampian University Hospitals NHS Trust, University of Aberdeen, Aberdeen, United Kingdom

    Abstract

    Background: To compare the ability of Glaucoma Progression Analysis (GPA) and Threshold Noiseless Trend (TNT) programs to detect visual field deterioration.

    Methods: Patients with open angle glaucoma followed for a minimum of two years and a minimum of seven reliable visual fields were included. Progression was assessed subjectively by four masked glaucoma experts, and compared with GPA and TNT results. Each case was judged to be stable, deteriorated or suspicious of deterioration

    Results: A total of 56 eyes of 42 patients were followed with a mean (SD) of 7.8 (+ 1.0) tests over an average of 5.5 (+ 1.04) years. Interobserver agreement to detect progression was good (mean Kappa = 0.57). Progression was detected in 10-19 eyes by the experts, in six by GPA and in 24 by TNT. Using the consensus expert opinion as the gold standard (four clinicians detected progression), GPA sensitivity and specificity was 75% and 83%, respectively, while TNT sensitivity and specificity was 100% and 77%, respectively.

    Conclusion: TNT showed greater concordance with the experts than GPA in the detection of visual field deterioration. GPA showed high specificity but lower sensitivity, mainly detecting cases of high focality and pronounced MD slopes.

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