Original articleA Comparison of Visual Field Progression Criteria of 3 Major Glaucoma Trials in Early Manifest Glaucoma Trial Patients
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)
- et al.
Early Manifest Glaucoma Trial: design and baseline data
Ophthalmology
(1999) - et al.
The Collaborative Initial Glaucoma Treatment Study: study design, methods, and baseline characteristics of enrolled patients
Ophthalmology
(1999) - et al.
Identification of progressive glaucomatous visual field loss
Surv Ophthalmol
(2002) - et al.
Statistical evaluation of the diagnostic accuracy of methods used to determine the progression of visual field defects in glaucoma
Ophthalmology
(2004) - et al.
Patterns of glaucomatous visual field progression identified by three progression criteria
Am J Ophthalmol
(2004) - et al.
Test-retest variability in glaucomatous visual fields
Am J Ophthalmol
(1989) - et al.
Infrequent confirmation of visual field progression
Ophthalmology
(2002) - et al.
Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial
Arch Ophthalmol
(2002) Advanced Glaucoma Intervention Study2: Visual field test scoring and reliability
Ophthalmology
(1994)- et al.
Analysis of progressive change in automated visual fields in glaucoma
Invest Ophthalmol Vis Sci
(1996)
Comparison of different methods for detecting glaucomatous visual field progression
Invest Ophthalmol Vis Sci
Methodological variations in estimating apparent progressive visual field loss in clinical trials of glaucoma treatment
Arch Ophthalmol
Glaucoma Hemifield Test: automated visual field evaluation
Arch Ophthalmol
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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.