Visual field changes after cataract extraction: The AGIS experience

doi:10.1016/j.ajo.2004.08.006

American Journal of Ophthalmology

Volume 138, Issue 6, December 2004, Pages 1022-1028

https://doi.org/10.1016/j.ajo.2004.08.006 Get rights and content

Purpose

To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of glaucomatous scotomas.

Design

Experimental study with no control group.

Methods

One hundred fifty-eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study with at least two reliable visual fields within a year both before and after cataract surgery were included. Average mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD) were compared before and after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < .05) on the pattern deviation plot was compared before and after surgery. We described an index (“scotoma depth index”) to investigate changes of scotoma depth after surgery.

Results

Mean values for MD, PSD, and CPSD were –13.2, 6.4, and 5.9 dB before and –11.9, 6.8, and 6.2 dB after cataract surgery (P ≤ .001 for all comparisons). Mean (± SD) number of abnormal points on pattern deviation plot was 26.7 ± 9.4 and 27.5 ± 9.0 before and after cataract surgery, respectively (P = .02). Scotoma depth index did not change after cataract extraction (–19.3 vs –19.2 dB, P = .90).

Conclusions

Cataract extraction caused generalized improvement of the visual field, which was most marked in eyes with less advanced glaucomatous damage. Although the enlargement of scotomas was statistically significant, it was not clinically meaningful. No improvement of sensitivity was observed in the deepest part of the scotomas.

Section snippets

Methods

The AGIS is a prospective, multicenter, randomized clinical trial designed to evaluate outcomes of various management protocols in glaucoma patients uncontrolled on maximally tolerated medications.⁹ In brief, phakic patients, 35 to 80 years old, with primary open angle glaucoma were included. Eligible eyes had a best corrected visual acuity of at least 56 letters (Early Treatment Diabetic Retinopathy Study method) and met specific criteria for combinations of consistently elevated intraocular

Results

The average (± SD) age of the patients at the time of cataract extraction was 71.8 ± 7.9 years (Table 1). Average (± SD) IOP was 15.3 ± 5.2 mm Hg before surgery and 15.1 ± 4.7 mm Hg after surgery (P = .47; paired t test). To investigate possible nonhomogeneity in the study sample, we divided the patients into three groups based on postoperative MD: MD better than −6 dB (mild visual field loss), MD between −6 and −12 dB (moderate visual field loss), and MD worse than −12 dB (severe visual field

Discussion

In the large subgroup of AGIS patients who underwent cataract surgery during the study, overall sensitivity of hill of vision increased after cataract extraction. The changes in scotoma size were minimal from a clinical standpoint. The threshold sensitivity in the deepest areas of scotomas remained unchanged. In our investigation, eyes with a better MD before surgery had a greater magnitude of improvement of MD when correlation analysis was performed based on glaucoma severity. We used the MD

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Cataract Surgery and Rate of Visual Field Progression in Primary Open-Angle Glaucoma
2019, American Journal of Ophthalmology
Citation Excerpt :
Among the studied parameters, higher postoperative peak IOP and worse baseline MD were significantly correlated with faster postoperative VF decay rates, suggesting that these variables are risk factors for further glaucoma deterioration. Cataract causes a generally diffuse visual field loss in patients with glaucoma, and several studies have dissected the impact of cataract progression and cataract surgery on global visual field indices (ie, MD, PSD, VFI), with discordant results.5–7,13,20–25 The degree of postoperative change in global indices varies according to the severity of both glaucoma and cataract.6,24
To test the hypothesis that cataract surgery slows the apparent rate of visual field (VF) decay in primary open-angle glaucoma patients compared with rates measured during cataract progression.
Retrospective cohort study.
Consecutive open-angle glaucoma patients who underwent cataract surgery and who had ≥4 VFs and ≥3 years of follow-up before and after surgery were retrospectively reviewed. Mean deviation (MD) rate, visual field index (VFI) rate, pointwise linear regression (PLR), pointwise rate of change (PRC), and the Glaucoma Rate Index (GRI) were compared before and after cataract surgery.
A total of 134 eyes of 99 patients were included. Median (interquartile range) follow-up was 6.5 (4.7-8.1) and 5.3 (4.0-7.3) years before and after cataract surgery, respectively. All intraocular pressure (IOP) parameters (mean IOP, standard deviation of IOP, and peak IOP) significantly improved (P < .001) after cataract surgery. All VF indices indicated an accelerated VF decay rate after cataract surgery: MD rate (-0.18 ± 0.40 dB/year vs -0.40 ± 0.62 dB/year, P < .001), VFI rate (-0.44% ± 1.09%/year vs -1.19% ± 1.85%/year, P < .001), GRI (-5.5 ± 10.8 vs -13.5 ± 21.5; P < .001), and PRC (-0.62% ± 2.47%/year before and -1.35% ± 3.71%/year after surgery; P < .001) and PLR (-0.20 ± 0.82 dB/year before and -0.42 ± 1.16 dB/year after surgery; P < .001) for all VF locations. Worse baseline MD and postoperative peak IOP were significantly associated with the postoperative VF decay rate and the change in the decay rate after cataract surgery.
Although all IOP parameters improved after cataract surgery, VFs continued to progress. Cataract surgery does not slow the apparent rate of glaucomatous VF decay as compared to rates measured during the progression of the cataract.
Detection of Longitudinal Visual Field Progression in Glaucoma Using Machine Learning
2018, American Journal of Ophthalmology
Global indices of standard automated perimerty are insensitive to localized losses, while point-wise indices are sensitive but highly variable. Region-wise indices sit in between. This study introduces a machine learning–based index for glaucoma progression detection that outperforms global, region-wise, and point-wise indices.
Development and comparison of a prognostic index.
Visual fields from 2085 eyes of 1214 subjects were used to identify glaucoma progression patterns using machine learning. Visual fields from 133 eyes of 71 glaucoma patients were collected 10 times over 10 weeks to provide a no-change, test-retest dataset. The parameters of all methods were identified using visual field sequences in the test-retest dataset to meet fixed 95% specificity. An independent dataset of 270 eyes of 136 glaucoma patients and survival analysis were used to compare methods.
The time to detect progression in 25% of the eyes in the longitudinal dataset using global mean deviation (MD) was 5.2 (95% confidence interval, 4.1–6.5) years; 4.5 (4.0–5.5) years using region-wise, 3.9 (3.5–4.6) years using point-wise, and 3.5 (3.1–4.0) years using machine learning analysis. The time until 25% of eyes showed subsequently confirmed progression after 2 additional visits were included were 6.6 (5.6–7.4) years, 5.7 (4.8–6.7) years, 5.6 (4.7–6.5) years, and 5.1 (4.5–6.0) years for global, region-wise, point-wise, and machine learning analyses, respectively.
Machine learning analysis detects progressing eyes earlier than other methods consistently, with or without confirmation visits. In particular, machine learning detects more slowly progressing eyes than other methods.
Reversal of Glaucoma Hemifield Test Results and Visual Field Features in Glaucoma
2018, Ophthalmology
Citation Excerpt :
Although clinicians naturally rely on other clinical data to make glaucoma management decisions, especially information about optic nerve integrity, our model based purely on VF features may augment the clinical decision-making process. Studies have shown that eye surgeries, including intraocular pressure-lowering surgeries,26–29 cataract extraction,30,31 and ranibizumab treatment,32,33 can lead to enhanced VF sensitivity, which may trigger GHT results reversals. For our 97 eyes, we did not find any significant effects of eye surgeries on GHT results reversals (Table S2, available at www.aaojournal.org).
To develop a visual field (VF) feature model to predict the reversal of glaucoma hemifield test (GHT) results to within normal limits (WNL) after 2 consecutive outside normal limits (ONL) results.
Retrospective cohort study.
Visual fields of 44 503 eyes from 26 130 participants.
Eyes with 3 or more consecutive reliable VFs measured with the Humphrey Field Analyzer (Swedish interactive threshold algorithm standard 24-2) were included. Eyes with ONL GHT results for the 2 baseline VFs were selected. We extracted 3 categories of VF features from the baseline tests: (1) VF global indices (mean deviation [MD] and pattern standard deviation), (2) mismatch between baseline VFs, and (3) VF loss patterns (archetypes). Logistic regression was applied to predict the GHT results reversal. Cross-validation was applied to evaluate the model on testing data by the area under the receiver operating characteristic curve (AUC). We ascertained clinical glaucoma status on a patient subset (n = 97) to determine the usefulness of our model.
Predictive models for GHT results reversal using VF features.
For the 16 604 eyes with 2 initial ONL results, the prevalence of a subsequent WNL result increased from 0.1% for MD < −12 dB to 13.8% for MD ≥−3 dB. Compared with models with VF global indices, the AUC of predictive models increased from 0.669 (MD ≥−3 dB) and 0.697 (−6 dB ≤ MD < −3 dB) to 0.770 and 0.820, respectively, by adding VF mismatch features and computationally derived VF archetypes (P < 0.001 for both). The GHT results reversal was associated with a large mismatch between baseline VFs. Moreover, the GHT results reversal was associated more with VF archetypes of nonglaucomatous loss, severe widespread loss, and lens rim artifacts. For a subset of 97 eyes, using our model to predict absence of glaucoma based on clinical evidence after 2 ONL results yielded significantly better prediction accuracy (87.7%; P < 0.001) than predicting GHT results reversal (68.8%) with a prescribed specificity 67.7%.
Using VF features may predict the GHT results reversal to WNL after 2 consecutive ONL results.
Functional assessment of glaucoma: Uncovering progression
2020, Survey of Ophthalmology
Citation Excerpt :
A visual field is classified as progressing if a negative slope is significant with a P < 0.05. The MD is affected not only by glaucomatous progression, but also by other factors such as media opacities and poor refraction.108 The trend analyses of MD ignore the detailed spatial information within the field and were shown to be poorly correlated with clinical judgment.
Clinicians who manage glaucoma patients carefully monitor the visual field to determine if treatments are effective or interventions are needed. Visual field tests may reflect disease progression or variability among examinations. We describe the approaches and perimetric tests used to evaluate glaucomatous visual field progression and factors that are important for identifying progression. These include stimulus size, which area of the visual field to assess (central versus peripheral), and the testing frequency, evaluating which is important to detect change early while minimizing patient testing burden. We also review the different statistical methods developed to identify change. These include trend- and event-based analyses, parametric and nonparametric tests, population-based versus individualized approaches, as well as pointwise and global analyses. We hope this information will prove useful and important to enhance the management of glaucoma patients. Overall, analysis procedures based on series of at least 5 to 6 examinations that require confirmation and persistence of changes, that are guided by the pattern and shape of the glaucomatous visual field deficits, and that are consistent with structural defects provide the best clinical performance.
Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis
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Association Between Longitudinal 10-2 Central Visual Field Change and the Risk of Visual Acuity Loss in Mild-to-Moderate Glaucoma
2023, Journal of Glaucoma

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: Supported by an unrestricted grant from Research to Prevent Blindness and National Institute of Health grant R01 EY12738.

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Visual field changes after cataract extraction: The AGIS experience

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

The Advanced Glaucoma Intervention Study: 6. Effect of cataract on visual field and visual acuity

Arch Ophthalmol