Background/Aim To investigate the clinical validity of the Guided Progression Analysis definition (GPAD) and cluster-based definition (CBD) with the Humphrey Field Analyzer 10-2 test in diagnosing glaucomatous visual field (VF) progression, and to introduce a novel definition with optimised specificity by combining the ‘any-location’ and ‘cluster-based’ approaches (hybrid definition).
Methods 64 400 stable glaucomatous VFs were simulated from 664 pairs of 10-2 tests (10 sets × 10 VF series × 664 eyes; data set 1). Using these simulated VFs, the specificity to detect progression and the effects of changing the parameters (number of test locations or consecutive VF tests, and percentile cut-off values) were investigated. The hybrid definition was designed as the combination where the specificity was closest to 95.0%. Subsequently, another 5000 actual glaucomatous 10-2 tests from 500 eyes (10 VFs each) were collected (data set 2), and their accuracy (sensitivity, specificity and false positive rate) and the time needed to detect VF progression were evaluated.
Results The specificity values calculated using data set 1 with GPAD and CBD were 99.6% and 99.8%. Using data set 2, the hybrid definition had a higher sensitivity than GPAD and CBD, without detriment to the specificity or false positive rate. The hybrid definition also detected progression significantly earlier than GPAD and CBD (at 3.1 years vs 4.2 years and 4.1 years, respectively).
Conclusions GPAD and CBD had specificities of 99.6% and 99.8%, respectively. A novel hybrid definition (with a specificity of 95.5%) had higher sensitivity and enabled earlier detection of progression.
- field of vision
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Contributors Substantial contributions to the conception or design of the work: SA, HM and RA. Acquisition, analysis or interpretation of data for the work: SA, HM, YF, TY, AM, YI, KM, MT and RA. Drafting the work or revising it critically for important intellectual content: SA, HM and RA. Final approval of the version to be published: SA, HM, YF, TY, AM, YI, KM, MT and RA. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SA, HM, YF, TY, AM, YI, KM, MT and RA.
Funding The study was supported by grants (nos. 20K18337, 20K09785, 19H01114, 18KK0253, and 20K09784) from the Ministry of Education, Culture, Sports, Science and Technology of Japan and The Translational Research program; Strategic Promotion for practical application of Innovative medical Technology (TR-SPRINT) from the Japan Agency for Medical Research and Development (AMED), grant AIP acceleration research from the Japan Science and Technology Agency.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Institutional Review Board of the University of Tokyo, Kagoshima University, Osaka University, Kyoto Prefectural University, Oike-Ganka Ikeda Clinic and Shimane University, and adhered to the tenets of the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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