Elsevier

Ophthalmology

Volume 115, Issue 9, September 2008, Pages 1557-1565
Ophthalmology

Original article
A Comparison of Visual Field Progression Criteria of 3 Major Glaucoma Trials in Early Manifest Glaucoma Trial Patients

https://doi.org/10.1016/j.ophtha.2008.02.005Get rights and content

Purpose

Three major glaucoma trials, all using the same Humphrey visual field tests, specified different criteria to define visual field progression. This article compares the performance of these criteria with a reference standard of unanimous classifications by 3 independent glaucoma experts.

Design

Longitudinal, comparative study of diagnostic criteria.

Participants and Controls

Two hundred forty-five patients with manifest glaucoma in the Early Manifest Glaucoma Trial (EMGT).

Methods

Visual field series of 1 eye of each of 245 EMGT patients were classified by 3 independent glaucoma specialists as definitely progressing, definitely nonprogressing, or neither. Field series that were classified in the first 2 categories by all 3 experts met the reference standards for the progressing and nonprogressing groups and were analyzed according to the progression criteria of the Advanced Glaucoma Intervention Study (AGIS), the Collaborative Initial Glaucoma Treatment Study (CIGTS), and the EMGT. Sensitivity, specificity, time to progression, and sustainability were calculated.

Main Outcome Measures

Progression, nonprogression, sensitivity, specificity, time to progression, and sustainability.

Results

Seventy-seven field series were definitely progressing, and 95 series were definitely nonprogressing. Among progressing eyes, 45 (58%) of 77 were identified using AGIS criteria, 58 (75%) of 77 were identified with CIGTS criteria, and 74 (96%) of 77 were identified with EMGT criteria; all comparisons of sensitivities were significant, simultaneous (P<0.001), and pairwise (P<0.01). The specificity for EMGT criteria was 89%, lower (P<0.05) than that of AGIS (98%) and CIGTS (99%) criteria. Median time to progression was considerably shorter with EMGT criteria (33 months; 95% confidence interval [CI], 30–36 months) than with AGIS (66 months; 95% CI, 57–78 months) and CIGTS (55 months; 95% CI, 48–66 months) criteria. Sustainability increased with time after progression; it averaged 79%, 84%, and 81%, respectively, for AGIS, CIGTS, and EMGT criteria during the first year after the first progression and 95%, 100%, and 93% during the fourth year after progression.

Conclusions

The EMGT criteria identified progression earlier and more often than AGIS and CIGTS criteria. Specificity was good for all criteria but was better with AGIS and CIGTS than with EMGT criteria. Sustainability was high for all 3 sets of criteria and best for CIGTS criteria and increased with time after progression.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients and Data

Data consisted of a series of visual field test results from the EMGT. The EMGT study design has been described in detail previously.1, 2 Very briefly, the EMGT is a clinical trial comparing a standard therapy to lower intraocular pressure with no initial treatment in patients with open-angle glaucoma. Study eyes already had repeatable glaucomatous visual field defects, as defined by the Glaucoma Hemifield Test,11 at baseline. The EMGT patients had relatively early visual field loss at

Results

The agreement among the glaucoma experts (BCC, MFL, IC) in the classification of eyes was substantial both for the progressing group (κ = 0.760; P < 0.0001) and for the nonprogressing group (κ = 0.735; P<0.0001). Among the 245 field series, 77 formed the progressing group and 95 formed the nonprogressing group. Mean follow-up time in all patients was 5.7 years (range, 0.8–8.6 years), or 6.0 years in the progressing and 5.3 years in the nonprogressing group. Mean number of tests was 25 (range,

Discussion

There is no generally accepted best method to demonstrate or analyze progression of glaucomatous visual field loss, and more research is needed in this important area. Generally two types of analyses are recognized. (1) Event-based analyses strive to determine whether progression has occurred. These types of analyses naturally are of great importance in studies where management will change if progression can be demonstrated, for example, in randomized studies with untreated control arms, as

Acknowledgments

Martin Dahl wrote the computer program that was used to analyze the visual field series. Jonny Olsson was statistical consultant.

References (26)

  • E. Vesti et al.

    Comparison of different methods for detecting glaucomatous visual field progression

    Invest Ophthalmol Vis Sci

    (2003)
  • N. Katz et al.

    Methodological variations in estimating apparent progressive visual field loss in clinical trials of glaucoma treatment

    Arch Ophthalmol

    (1999)
  • P. Åsman et al.

    Glaucoma Hemifield Test: automated visual field evaluation

    Arch Ophthalmol

    (1992)
  • Cited by (105)

    • Glaucoma progression. Clinical practice guide

      2023, Archivos de la Sociedad Espanola de Oftalmologia
    • The 24-2 Visual Field Guided Progression Analysis Can Miss the Progression of Glaucomatous Damage of the Macula Seen Using OCT

      2022, Ophthalmology Glaucoma
      Citation Excerpt :

      In particular, the 24-2 GPA, with the default settings typically used in the clinic, missed 6 (60%) of the 10 eyes identified as having progression based on the RS, which included combined OCT and VF information. In previous studies that evaluated the sensitivity of the 24-2 GPA in cases with early and moderate glaucomatous damage, based on the average 24-2 MD at the baseline, the sensitivity ranged from 75% to 96%.16–19 Although the range was fairly wide, even the lowest reported sensitivity was markedly higher than the sensitivity of 40% reported in our study.

    View all citing articles on Scopus

    Manuscript no. 2007-1269.

    Financial Disclosure(s): Anders Heijl is or has served as a consultant to Carl Zeiss Meditec, Allergan, Alcon, and Pfizer and has received research support from Carl Zeiss Meditec, Allergan, Alcon, and Santen. Boel Bengtsson is a consultant to Carl Zeiss Meditec and has received research support from the same company. The other authors have no financial interests.

    Supported by the Swedish Research Council, Stockholm, Sweden (grant no.: K2005-74X-10426-13A); The Järnhardt Foundation, Mälmo, Sweden; Canadian Institutes of Health Research (grant no.: MOP-11357); and by unrestricted grants from Alcon Research Ltd., Fort Worth, Texas, and Allergan, Inc., Irvine, California.

    View full text