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Kirou C, Khazandi A, Estevez JJ. Comparative analysis of central versus peripheral visual field test grids in the diagnosis of glaucoma. Clin Exp Optom 2024:1-11. [PMID: 39374946 DOI: 10.1080/08164622.2024.2410034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 09/09/2024] [Accepted: 09/19/2024] [Indexed: 10/09/2024] Open
Abstract
Accumulating evidence has recognised central visual field defects (CVFDs) as a common feature of glaucoma. Current glaucoma screening guidelines include peripherally biased perimetry (24-2 protocols), but test grids exist to test the integrity of the central visual field (10-2 protocols). However, the added benefit of incorporating central visual field assessments alongside peripheral-biased testing grids remains unclear. This scoping review aimed to compare the diagnostic accuracy of central versus peripheral visual field tests. A systematic search of six databases yielded relevant studies among glaucoma subjects. These studies were synthesised narratively, focusing on diagnostic performance indicators such as the area under the curve, sensitivity, specificity, diagnostic agreement, and structure-function concordance. Of the 1875 studies screened, 16 were included in the review. The comparative analyses demonstrated a similar diagnostic performance when comparing the ability of the 24-2 and 10-2 test grids to detect glaucoma or CVFDs. When utilising the mean deviation, the 24-2 area under the curve ranged between 0.81-0.87 and 0.74-0.84 for the 10-2, whilst the area under the curve of the pattern standard deviation was 0.95 and 0.82, respectively. The pattern standard deviation showed sensitivities reaching 0.75 for the 24-2 and 0.60 for the 10-2, with specificities as high as 0.95 for both test grids. Across all disease stages, CVFDs detected on the 24-2 demonstrated up to 88% agreement with functional damage detected on the 10-2. The agreement between structure-function damage was greatest when combining test grids with optical coherence tomography (88.7%). This review indicates that the 24-2 and 10-2 testing protocols offer comparable diagnostic performance for glaucoma, including detecting CVFDs. While targeted macula screening could provide additional diagnostic value in certain contexts, the evidence remains inconclusive. Further longitudinal studies, incorporating optical coherence tomography, are necessary to confirm these findings and consider the routine inclusion of CVFD screening in clinical practice.
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Affiliation(s)
- Christian Kirou
- College of Nursing and Health Sciences, Optometry and Vision Science, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Ali Khazandi
- College of Nursing and Health Sciences, Optometry and Vision Science, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Jose J Estevez
- College of Nursing and Health Sciences, Optometry and Vision Science, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Nishijima E, Fukai K, Sano K, Noro T, Ogawa S, Okude S, Tatemichi M, Lee GC, Iwase A, Nakano T. Comparative Analysis of 24-2C, 24-2, and 10-2 Visual Field Tests for Detecting Mild-Stage Glaucoma With Central Visual field Defects. Am J Ophthalmol 2024; 268:275-284. [PMID: 39094994 DOI: 10.1016/j.ajo.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE This study sought to identify the most effective testing program for detecting visual-field defects in mild-stage glaucoma with central visual-field defects. DESIGN A multicenter, retrospective diagnostic testing evaluation. PARTICIPANTS The study involved 93 eyes (83 patients) with mild-stage glaucoma (median mean deviation [interquartile range]: -1.79 [2.16] dB) with central visual-field defects and 69 eyes (63 patients; median mean deviation, -1.38 [2.31] dB) with mild-stage glaucoma without central visual-field defects, from Jikei University School of Medicine and Tajimi Iwase Eye Clinic. METHODS Patients underwent 10-2 Swedish Interactive Thresholding Algorithm (SITA) Standard, 24-2 SITA Standard, and 24-2C SITA Faster tests. Central visual-field defects were defined using 10-2 SITA Standard and optical coherence tomography (OCT). A detection power of 4 points in the 24-2 that coincided with 10-2 (Center4), 12 points that lie within 10° (24-2-12), and 22 points that lie within 10° of 24-2C (24-2C-22) were analyzed using receiver operating characteristic (ROC) curves based on logistic regression analysis, using total deviation (TD) and pattern deviation (PD) probability plots. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (AUC) of the Center4, 24-2-12, and 24-2C-22 tests. RESULTS In the upper-central visual field, AUCs of the TD plot were 0.50 (0.40-0.58) for the Center4, 0.75 (0.67-0.83) for 24-2-12, and 0.85 (0.78-0.91) for 24-2C-22, with 24-2C-22 AUC significantly exceeding 24-2-12 AUC. For the PD plot, AUCs were 0.53 (0.44-0.63), 0.81 (0.74-0.89), and 0.84 (0.77-0.90), respectively. In the lower-central visual field, using a total plot, AUCs were 0.27 (0.18-0.36), 0.57 (0.47-0.69), and 0.57 (0.46-0.68) for the Center4, 24-2-12, and 24-2C-22, respectively. Using the PD plot in the upper field, AUCs were 0.27 (0.19-0.36), 0.64 (0.53-0.75), and 0.81 (0.72-0.90), respectively, with the AUC of the 24-2C-22 significantly exceeding that of 24-2-12. The 24-2C test was significantly faster than both the 24-2 and 10-2 tests, reducing testing duration by 46% and 52%, respectively. CONCLUSIONS The 24-2C SITA Faster test is highly effective and efficient for detecting mild-stage glaucoma with central visual-field defects. This, and its reduced duration, makes it a valuable tool in clinical settings.
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Affiliation(s)
- Euido Nishijima
- From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan
| | - Kota Fukai
- Department of Preventive Medicine, Tokai University School of Medicine (K.F. and M.T.), Isehara, Japan
| | - Kei Sano
- From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan
| | - Takahiko Noro
- From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan
| | - Shumpei Ogawa
- From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan
| | - Sachiyo Okude
- From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan
| | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine (K.F. and M.T.), Isehara, Japan
| | - Gary C Lee
- Carl Zeiss Meditec, Inc. (G.C.L.), Dublin, California, USA
| | - Aiko Iwase
- Tajimi Iwase Eye Clinic (A.I.), Tajimi, Japan
| | - Tadashi Nakano
- From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan.
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Shi M, Lokhande A, Tian Y, Luo Y, Eslami M, Kazeminasab S, Elze T, Shen LQ, Pasquale LR, Wellik SR, De Moraes CG, Myers JS, Zebardast N, Friedman DS, Boland MV, Wang M. Transformer-Based Deep Learning Prediction of 10-Degree Humphrey Visual Field Tests From 24-Degree Data. Transl Vis Sci Technol 2024; 13:11. [PMID: 39110574 PMCID: PMC11316452 DOI: 10.1167/tvst.13.8.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/20/2024] [Indexed: 08/12/2024] Open
Abstract
Purpose To predict 10-2 Humphrey visual fields (VFs) from 24-2 VFs and associated non-total deviation features using deep learning. Methods We included 5189 reliable 24-2 and 10-2 VF pairs from 2236 patients, and 28,409 reliable pairs of macular OCT scans and 24-2 VF from 19,527 eyes of 11,560 patients. We developed a transformer-based deep learning model using 52 total deviation values and nine VF test features to predict 68 10-2 total deviation values. The mean absolute error, root mean square error, and the R2 were evaluation metrics. We further evaluated whether the predicted 10-2 VFs can improve the structure-function relationship between macular thinning and paracentral VF loss in glaucoma. Results The average mean absolute error and R2 for 68 10-2 VF test points were 3.30 ± 0.52 dB and 0.70 ± 0.11, respectively. The accuracy was lower in the inferior temporal region. The model placed greater emphasis on 24-2 VF points near the central fixation point when predicting the 10-2 VFs. The inclusion of nine VF test features improved the mean absolute error and R2 up to 0.17 ± 0.06 dB and 0.01 ± 0.01, respectively. Age was the most important 24-2 VF test parameter for 10-2 VF prediction. The predicted 10-2 VFs achieved an improved structure-function relationship between macular thinning and paracentral VF loss, with the R2 at the central 4, 12, and 16 locations of 24-2 VFs increased by 0.04, 0.05 and 0.05, respectively (P < 0.001). Conclusions The 10-2 VFs may be predicted from 24-2 data. Translational Relevance The predicted 10-2 VF has the potential to improve glaucoma diagnosis.
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Affiliation(s)
- Min Shi
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anagha Lokhande
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yu Tian
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yan Luo
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mohammad Eslami
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Saber Kazeminasab
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Tobias Elze
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucy Q. Shen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Louis R. Pasquale
- Eye and Vision Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah R. Wellik
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jonathan S. Myers
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nazlee Zebardast
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | | | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Phu J, Rafla D, Kalloniatis M. Which glaucoma patients benefit from 10-2 visual field testing? Proposing the functional vulnerability zone framework. Clin Exp Optom 2024; 107:171-183. [PMID: 38057282 DOI: 10.1080/08164622.2023.2288183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023] Open
Abstract
CLINICAL RELEVANCE A method for determining 10-2 deployment in glaucoma with the goal of detecting additional visual field sensitivity for the purpose of functional monitoring is proposed. BACKGROUND To provide a pilot method for determining when to deploy the 10-2 visual field (VF) test grid in glaucoma by characterising the 'functional vulnerability zone'. METHODS The cross-sectional 24-2 (central 12 locations) and 10-2 VF results from 133 eyes of 133 glaucoma subjects were used to describe the central Hill of Vision using VF sensitivity. The 'volume' (defined using arbitrary units, A.U.) under the Hill was calculated. A greater A.U. on the 10-2 indicated a functional vulnerability zone (FVZ), signifying additional clinical dynamic range for potential future monitoring. The main outcome measures were calculated A.U. and 24-2 factors which were significantly related to A.U. differences between 24-2 and 10-2. RESULTS Over 55% of patients had an FVZ (A.U. greater using 10-2). Several 24-2 features (worse mean deviation, worse central 24-2 mean defect, and a higher proportion of defective locations) were significant in the FVZ cohort compared to non-FVZ. 24-2 mean deviation levels at which 10-2 may be favoured were low at -3.16 to -3.62 dB. Specifically, 5 or more defective central 24-2 test locations were associated with an FVZ. Subjects exhibiting a less severe defect on the 10-2 were more likely to have an FVZ, indicating its potential for future VF monitoring. CONCLUSIONS The authors propose several clinical markers, focussing on the 24-2, which can guide clinicians on when the 10-2 may have utility in glaucoma assessment. The authors provide a pilot reference spreadsheet for clinicians to visualise the likelihood of 10-2 utility in the context of an FVZ.
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Affiliation(s)
- Jack Phu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, VIC, Australia
| | - Daniel Rafla
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, VIC, Australia
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WuDunn D, Takusagawa HL, Rosdahl JA, Sit AJ, Chopra V, Ou Y, Richter GM, Knight OJ, Solá-Del Valle D, Kim SJ. Central Visual Field Testing in Early Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:240-248. [PMID: 38069944 DOI: 10.1016/j.ophtha.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate the current published literature on the utility of the 10-2 visual field (VF) testing strategy for the evaluation and management of early glaucoma, defined here as mean deviation (MD) better than -6 decibels (dB). METHODS A search of the peer-reviewed literature was last conducted in June 2023 in the PubMed database. Abstracts of 986 articles were examined to exclude reviews and non-English-language articles. After inclusion and exclusion criteria were applied, 26 articles were selected, and the panel methodologist rated them for strength of evidence. Thirteen articles were rated level I, and 8 articles were rated level II. The 5 level III articles were excluded. Data from the 21 included articles were abstracted and reviewed. RESULTS The central 12 locations on the 24-2 VF test grid lie within the central 10 degrees covered by the 10-2 VF test. In early glaucoma, defects detected within the central 10 degrees generally agree between the 2 tests. Defects within the central 10 degrees of the 24-2 VF test can predict defects on the 10-2 VF test, although the 24-2 may miss defects detected on the 10-2 VF test. In addition, results from the 10-2 VF test show better association with findings from OCT scans of the macular ganglion cell complex. Modifications of the 24-2 test that include extra test locations within the central 10 degrees improve detection of central defects found on 10-2 VF testing. CONCLUSIONS Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma. However, early 10-2 VF testing may provide sufficient additional information for some patients, particularly those with a repeatable defect within the central 12 locations of the standard 24-2 VF test or who have inner retinal layer thinning on OCT scans of the macula. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Darrell WuDunn
- University of Florida College of Medicine-Jacksonville, Department of Ophthalmology, Jacksonville, Florida
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Arthur J Sit
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
| | - Vikas Chopra
- Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
| | - O'Rese J Knight
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Mahmoudinezhad G, Moghimi S, Cheng J, Ru L, Yang D, Agrawal K, Dixit R, Beheshtaein S, Du KH, Latif K, Gunasegaran G, Micheletti E, Nishida T, Kamalipour A, Walker E, Christopher M, Zangwill L, Vasconcelos N, Weinreb RN. Deep Learning Estimation of 10-2 Visual Field Map Based on Macular Optical Coherence Tomography Angiography Measurements. Am J Ophthalmol 2024; 257:187-200. [PMID: 37734638 DOI: 10.1016/j.ajo.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To develop deep learning (DL) models estimating the central visual field (VF) from optical coherence tomography angiography (OCTA) vessel density (VD) measurements. DESIGN Development and validation of a deep learning model. METHODS A total of 1051 10-2 VF OCTA pairs from healthy, glaucoma suspects, and glaucoma eyes were included. DL models were trained on en face macula VD images from OCTA to estimate 10-2 mean deviation (MD), pattern standard deviation (PSD), 68 total deviation (TD) and pattern deviation (PD) values and compared with a linear regression (LR) model with the same input. Accuracy of the models was evaluated by calculating the average mean absolute error (MAE) and the R2 (squared Pearson correlation coefficients) of the estimated and actual VF values. RESULTS DL models predicting 10-2 MD achieved R2 of 0.85 (95% confidence interval [CI], 74-0.92) for 10-2 MD and MAEs of 1.76 dB (95% CI, 1.39-2.17 dB) for MD. This was significantly better than mean linear estimates for 10-2 MD. The DL model outperformed the LR model for the estimation of pointwise TD values with an average MAE of 2.48 dB (95% CI, 1.99-3.02) and R2 of 0.69 (95% CI, 0.57-0.76) over all test points. The DL model outperformed the LR model for the estimation of all sectors. CONCLUSIONS DL models enable the estimation of VF loss from OCTA images with high accuracy. Applying DL to the OCTA images may enhance clinical decision making. It also may improve individualized patient care and risk stratification of patients who are at risk for central VF damage.
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Affiliation(s)
- Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Jiacheng Cheng
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Liyang Ru
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Dongchen Yang
- Department of Computer Science and Engineering (D.Y.), University of California San Diego, La Jolla, California
| | - Kushagra Agrawal
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Rajeev Dixit
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | | | - Kelvin H Du
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Kareem Latif
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Gopikasree Gunasegaran
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Eleonora Micheletti
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Evan Walker
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Mark Christopher
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Linda Zangwill
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Nuno Vasconcelos
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California.
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Mohammadzadeh V, Vepa A, Li C, Wu S, Chew L, Mahmoudinezhad G, Maltz E, Sahin S, Mylavarapu A, Edalati K, Martinyan J, Yalzadeh D, Scalzo F, Caprioli J, Nouri-Mahdavi K. Prediction of Central Visual Field Measures From Macular OCT Volume Scans With Deep Learning. Transl Vis Sci Technol 2023; 12:5. [PMID: 37917086 PMCID: PMC10627306 DOI: 10.1167/tvst.12.11.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose Predict central 10° global and local visual field (VF) measurements from macular optical coherence tomography (OCT) volume scans with deep learning (DL). Methods This study included 1121 OCT volume scans and 10-2 VFs from 289 eyes (257 patients). Macular scans were used to estimate 10-2 VF mean deviation (MD), threshold sensitivities (TS), and total deviation (TD) values at 68 locations. A three-dimensional (3D) convolutional neural network based on the 3D DenseNet121 architecture was used for prediction. We compared DL predictions to those from baseline linear models. We carried out 10-fold stratified cross-validation to optimize generalizability. The performance of the DL and baseline models was compared based on correlations between ground truth and predicted VF measures and mean absolute error (MAE; ground truth - predicted values). Results Average (SD) MD was -9.3 (7.7) dB. Average (SD) correlations between predicted and ground truth MD and MD MAE were 0.74 (0.09) and 3.5 (0.4) dB, respectively. Estimation accuracy deteriorated with worsening MD. Average (SD) Pearson correlations between predicted and ground truth TS and MAEs for DL and baseline model were 0.71 (0.05) and 0.52 (0.05) (P < 0.001) and 6.5 (0.6) and 7.5 (0.5) dB (P < 0.001), respectively. For TD, correlation (SD) and MAE (SD) for DL and baseline models were 0.69 (0.02) and 0.48 (0.05) (P < 0.001) and 6.1 (0.5) and 7.8 (0.5) dB (P < 0.001), respectively. Conclusions Macular OCT volume scans can be used to predict global central VF parameters with clinically relevant accuracy. Translational Relevance Macular OCT imaging may be used to confirm and supplement central VF findings using deep learning.
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Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Arvind Vepa
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Chuanlong Li
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sean Wu
- Department of Computer Science, Pepperdine University, Malibu, CA, USA
| | - Leila Chew
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Golnoush Mahmoudinezhad
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Evan Maltz
- Department of Chemistry and Biochemistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Serhat Sahin
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Apoorva Mylavarapu
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kiumars Edalati
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jack Martinyan
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Dariush Yalzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Fabien Scalzo
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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8
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Shin HJ, Oh SE, Park CK, Park HYL. Importance of Pattern Standard Deviation of Humphrey 10-2 Visual Field to Evaluate Central Visual Function in Patients with Early-Stage Glaucoma. J Clin Med 2023; 12:5091. [PMID: 37568492 PMCID: PMC10419394 DOI: 10.3390/jcm12155091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
To explore various parameters that can evaluate the central visual impairment in patients with early-stage glaucoma, we included patients into a study with central visual impairments with an MD value greater than -6.0 dB on the 24-2 VF test. A possible association between structural parameters acquired by OCT and functional parameters of VF and PERG was determined. A total of 70 eyes of patients with suspected glaucoma or NTG underwent VF, OCT, and PERG examinations. The patients were classified into two groups according to the MD of the 24-2 VF test. We used Pearson correlation analysis to evaluate the relationships between GCIPL thickness/RNFL thickness and visual functional parameters, such as PERG and perimetry. Linear regression analyses were conducted to evaluate the significant factors affecting the PSD of VF 10-2. In the low MD group, the P50 amplitude presented significant correlations (r = 0.346, p = 0.048) with GCIPL thickness. In the correlation analysis of the high MD group, it was found that only the PSD of 10-2 uniquely presented borderline significant correlations with GCIPL thickness (r = -0.327, p = 0.055), and no other functional parameter showed significant correlation. Univariate and multivariate analyses revealed that GCIPL thickness was significantly associated with a PSD of 10-2 VF (p < 0.001 and 0.013, respectively). Among various parameters, the P50 amplitude and 10-2 PSD demonstrated statistically borderline significant structure-function relationships with GCIPL thickness in early-stage glaucoma.
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Affiliation(s)
| | | | | | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (H.J.S.); (S.E.O.); (C.K.P.)
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9
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Rafla D, Khuu SK, Kashyap S, Kalloniatis M, Phu J. Visualising structural and functional characteristics distinguishing between newly diagnosed high-tension and low-tension glaucoma patients. Ophthalmic Physiol Opt 2023; 43:771-787. [PMID: 36964934 PMCID: PMC10946885 DOI: 10.1111/opo.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE To determine whether there are quantifiable structural or functional differences that can distinguish between high-tension glaucoma (HTG; intraocular pressure [IOP] > 21 mm Hg) and low-tension glaucoma (LTG; IOP ≤ 21 mm Hg) at diagnosis. METHOD This was a retrospective, cross-sectional study. Clinical results of one eye from 90 newly diagnosed HTG and 319 newly diagnosed LTG patients (117 with very-low-tension glaucoma [vLTG; ≤15 mm Hg] and 202 with middling LTG [mLTG; >15 mm Hg, ≤21 mm Hg]) were extracted, which included relevant demographic covariates of glaucoma, quantitative optical coherence tomography (including the optic nerve head, retinal nerve fibre layer and ganglion cell-inner plexiform layer) measurements and standard automated perimetry global metrics. We used binary logistic regression analysis to identify statistically significant clinical parameters distinguishing between phenotypic groups for inclusion in principal component (PC) (factor) analysis (PCA). The separability between each centroid for each cohort was calculated using the Euclidean distance (d(x,y)). RESULTS The binary logistic regression comparing HTG and all LTG identified eight statistically significant clinical parameters. Subsequent PCA results included three PCs with an eigenvalue >1. PCs 1 and 2 accounted for 21.2% and 20.2% of the model, respectively, with a d(x,y) = 0.468, indicating low separability between HTG and LTG. The analysis comparing vLTG, mLTG and HTG identified 15 significant clinical parameters, which were subsequently grouped into five PCs. PCs 1 and 2 accounted for 24.1% and 17.8%, respectively. The largest separation was observed between vLTG and HTG (d(x,y) = 0.581), followed by vLTG and mLTG (d(x,y) = 0.435) and lastly mLTG and HTG (d(x,y) = 0.210). CONCLUSION Conventional quantitative structural or functional parameters could not distinguish between pressure-defined glaucoma phenotypes at the point of diagnosis and are therefore not contributory to separating cohorts. The overlap in findings highlights the heterogeneity of the primary open-angle glaucoma clinical presentations among pressure-defined groups at the cohort level.
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Affiliation(s)
- Daniel Rafla
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
| | - Sieu K. Khuu
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
| | - Sahana Kashyap
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
- School of Medicine (Optometry)Deakin UniversityVictoriaGeelongAustralia
| | - Jack Phu
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneyNew South WalesCamperdownAustralia
- Concord Clinical SchoolConcord Repatriation General HospitalNew South WalesConcordAustralia
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10
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Xu C, Saini C, Wang M, Devlin J, Wang H, Greenstein SH, Brauner SC, Shen LQ. Combined Model of OCT Angiography and Structural OCT Parameters to Predict Paracentral Visual Field Loss in Primary Open-Angle Glaucoma. Ophthalmol Glaucoma 2023; 6:255-265. [PMID: 36252920 PMCID: PMC10102259 DOI: 10.1016/j.ogla.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess a model combining OCT angiography (OCTA) and OCT parameters to predict the severity of paracentral visual field (VF) loss in primary open-angle glaucoma (POAG). DESIGN Cross-sectional study. PARTICIPANTS Forty-four patients with POAG and 42 control subjects underwent OCTA and OCT imaging with a swept-source OCT device. METHODS The circumpapillary microvasculature was quantified for vessel density (cpVD) and flow (cpFlow) after delineation of Bruch's membrane opening and removal of large vessels. Retinal nerve fiber layer thickness (RNFLT) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured from structural OCT. Paracentral total deviation (PaTD) was defined as the average of the total deviation values within the central 10 degrees on Humphrey VF testing (24-2) for upper and lower hemifields. The OCT and OCTA parameters were measured in the affected hemisphere corresponding to the hemifield with lower PaTD for POAG patients. Models were created to predict affected PaTD based on RNFLT alone; RNFLT and BMO-MRW; OCTA alone; or RNFLT, BMO-MRW and OCTA parameters. The models were compared using coefficient of determination (r2) and Bayesian information criterion (BIC) score. Bayesian information criterion decrease of ≥6 indicates strong evidence for model improvement. MAIN OUTCOME MEASURES Performance of models containing OCT and OCTA parameters in predicting PaTD. RESULTS Patients with POAG and controls were similar in age and sex (65.9 ± 9.5 years and 38.4% male overall, P ≥ 0.56 for both). Average RNFLT, minimum RNFLT, average BMO-MRW, minimum BMO-MRW, cpVD, and cpFlow were all significantly lower (all P < 0.001) in the affected hemisphere in patients with POAG than in controls. In patients with POAG, the average mean deviation was -4.33 ± 3.25 dB; the PaTD of the affected hemifield averaged -4.55 ± 5.26 dB and correlated significantly with both OCTA and structural OCT parameters (r ≥ 0.43, P ≤ 0.004 for all). The model containing RNFLT, BMO-MRW, and OCTA parameters was superior in predicting affected PaTD (r2 = 0.47, BIC = 290.7), with higher r2 and lower BIC compared with all 3 other models. CONCLUSIONS A combined model of OCTA and structural OCT parameters can predict the severity of paracentral VF loss of the affected hemifield, supporting clinical utility of OCTA in patients with POAG with paracentral VF loss. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Christine Xu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Julia Devlin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Haobing Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Scott H Greenstein
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Stacey C Brauner
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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11
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Onyekaba NAE, Estrela T, Naithani R, McCarthy KM, Jammal AA, Medeiros FA. Comparison of 10-2 and 24-2 Perimetry to Diagnose Glaucoma Using OCT as an Independent Reference Standard. Ophthalmol Glaucoma 2023; 6:187-197. [PMID: 36084839 PMCID: PMC10281760 DOI: 10.1016/j.ogla.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare the performance of the 10-2 test versus 24-2 standard automated perimetry (SAP) test for the diagnosis of glaucoma using OCT as an independent standard for glaucomatous damage. DESIGN Cross-sectional study. PARTICIPANTS A total of 1375 pairs of 10-2 and 24-2 SAP tests from 569 eyes of 339 subjects were used for the analysis. A total of 440 (77%) eyes had a diagnosis of glaucoma, and 129 (23%) eyes were normal. All participants underwent 10-2 and 24-2 SAP tests within 30 days. METHODS Glaucomatous severity was quantified based on OCT macula ganglion cell layer (mGCL) and circumpapillary retinal nerve fiber layer. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare 10-2 and 24-2 metrics for discriminating healthy eyes from those of glaucoma, at different levels of disease severity. MAIN OUTCOME MEASURES Areas under the ROC curves and sensitivities at fixed specificities of 80% and 95%. RESULTS The overall AUC for mean deviation (MD) for the 24-2 test (0.808) was significantly higher than that of the 10-2 test (0.742; P < 0.001). When compared at different stages of the disease, the 24-2 test performed generally better than the 10-2 test, notably in the earlier stages of the disease. For early damage (first quartile), the 24-2 MD had an AUC of 0.658 versus 0.590 for 10-2 MD (P = 0.018). For advanced damage (fourth quartile), corresponding values were 0.954 vs. 0.903 (P = 0.013). Similar trends were observed when glaucoma severity was defined based on structural macular damage with mGCL thickness. CONCLUSIONS The 24-2 SAP test had better diagnostic accuracy compared with that of the 10-2 test for detecting equivalent levels of glaucomatous damage, as measured by quantitative assessment of retinal nerve fiber layer and macula by OCT. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ndidi-Amaka E Onyekaba
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Tais Estrela
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Rizul Naithani
- Campbell University School of Medicine, Lillington, North Carolina
| | | | - Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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12
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The number of examinations required for the accurate prediction of the progression of the central 10-degree visual field test in glaucoma. Sci Rep 2022; 12:18843. [PMID: 36344722 PMCID: PMC9640563 DOI: 10.1038/s41598-022-23604-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
The purpose of the study was to investigate the number of examinations required to precisely predict the future central 10-degree visual field (VF) test and to evaluate the effect of fitting non-linear models, including quadratic regression, exponential regression, logistic regression, and M-estimator robust regression model, for eyes with glaucoma. 180 eyes from 133 open angle glaucoma patients with a minimum of 13 Humphrey Field Analyzer 10-2 SITA standard VF tests were analyzed in this study. Using trend analysis with ordinary least squares linear regression (OLSLR), the first, second, and third future VFs were predicted in a point-wise (PW) manner using a varied number of prior VF sequences, and mean absolute errors (MAE) were calculated. The number of VFs needed to reach the minimum 95% confidence interval (CI) of the MAE of the OLSLR was investigated. We also examined the effect of applying other non-linear models. When predicting the first, second, and third future VFs using OLSLR, the minimum MAE was obtained using VF1-12 (2.15 ± 0.98 dB), VF1-11 (2.33 ± 1.10 dB), and VF1-10 (2.63 ± 1.36 dB), respectively. To reach the 95% CI of these MAEs, 10, 10, and 8 VFs were needed for the first, second and third future VF predictions, respectively. No improvement was observed by applying non-linear regression models. As a conclusion, approximately 8-10 VFs were needed to achieve an accurate prediction of PW VF sensitivity of the 10-degree central VF.
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13
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Kamalipour A, Moghimi S, Eslani M, Nishida T, Mohammadzadeh V, Micheletti E, Girkin CA, Fazio MA, Liebmann JM, Zangwill LM, Weinreb RN. A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor of Central Visual Field Progression in Glaucoma. Am J Ophthalmol 2022; 240:159-169. [PMID: 35278360 PMCID: PMC10249485 DOI: 10.1016/j.ajo.2022.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the role of corneal hysteresis (CH) as a risk factor of central visual field (VF) progression in a cohort of glaucoma suspect and glaucoma patients. DESIGN Prospective cohort study. METHODS Two hundred forty-eight eyes of 143 subjects who were followed for an average of 4.8 years with a minimum of 5 visits with 10-2 and 24-2 VF tests were included. Univariable and multivariable linear mixed-effects models were used to identify characteristics associated with the rate of change over time in 10-2 and 24-2 mean deviation (MD). Mixed-effects logistic regression was used to evaluate characteristics associated with an increased likelihood of event-based 10-2 VF progression based on the clustered pointwise linear regression criterion. RESULTS CH was significantly associated with 10-2 and 24-2 VF progression in the univariable trend-based analysis. In multivariable trend-based analyses, lower CH was associated with a faster rate of decline in 10-2 MD (0.07 dB/y per 1 mm Hg, P < .001) but not with 24-2 MD (P = .490). In multivariable event-based analysis, lower CH was associated with an increased likelihood of 10-2 VF progression (odds ratio = 1.35 per 1 mm Hg lower, P = .025). Similar results were found in eyes with early glaucomatous damage at the baseline (baseline: 24-2 MD ≥ -6 dB). CONCLUSIONS Lower CH was associated with a statistically significant, but relatively small, increased risk of central VF progression on the 10-2 test grid. Given the substantial influence of central VF impairment on the quality of life, clinicians should consider using CH to assess the risk of progression in patients with primary open-angle glaucoma including those with early disease.
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Affiliation(s)
- Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Medi Eslani
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | | | - Massimo A Fazio
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology and Visual Sciences, Heersink School of Medicine; Department of Biomedical Engineering, School of Engineering
| | - Jeffrey M Liebmann
- University of Alabama at Birmingham, Alabama, and Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California.
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14
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Melchior B, Valenzuela IA, De Moraes CG, Paula JS, Fazio MA, Girkin CA, Proudfoot J, Cioffi GA, Weinreb RN, Zangwill LM, Liebmann JM. Glaucomatous Visual Field Progression in the African Descent and Glaucoma Evaluation Study (ADAGES): Eleven Years of Follow-up. Am J Ophthalmol 2022; 239:122-129. [PMID: 35172170 DOI: 10.1016/j.ajo.2022.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare the rates of visual field (VF) progression between individuals of Black and White race and to investigate whether treatment effects may help explain differences previously reported between racial groups. DESIGN Multicenter prospective observational cohort study. METHODS Participants were patients in referral tertiary care glaucoma clinics with open angle glaucoma. Eyes were excluded who had <5 VF tests and <2 years of follow-up or any disease that could affect the optic nerve or the VF. The VF mean deviation (MD) slopes over time (dB/y) were calculated with linear regression models. Socioeconomic variables, rates of glaucoma surgery, medications, treated intraocular pressure (IOP), and central corneal thickness (CCT) were investigated. RESULTS A total of 516 eyes were included with a mean (95% CI) follow-up time of 11.0 (range, 10.5-11.5) years and 15.0 (range, 14.1-15.8) visits. Participants of Black race were significantly younger (59.7 vs 66.9 years, P < .01) than those of White race. The mean CCT and socioeconomic variables were similar between Black and White groups (P = 0.20 and P = .56, respectively), as were treatment with topical medications (P = .90) and the rate of VF MD change (-0.24 [-0.31 to -0.17] dB/year vs -0.32 [-0.36 to -0.27], P = .11), despite higher treated mean IOP (14.9 [14.5 to 15.4] vs 14.0 [13.6 to 14.4] mm Hg, P = .03) and fewer trabeculectomies (29.5% vs 50.0%, P < .01) in the Black race group. CONCLUSIONS Rates of VF progression were similar despite higher treated IOP in the Black race group. Mitigation of health access disparities in this study may have equalized previously reported different rates of VF progression between racial groups.
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15
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Tsamis E, La Bruna S, Leshno A, De Moraes CG, Hood D. Detection of Early Glaucomatous Damage: Performance of Summary Statistics From Optical Coherence Tomography and Perimetry. Transl Vis Sci Technol 2022; 11:36. [PMID: 35353149 PMCID: PMC8976935 DOI: 10.1167/tvst.11.3.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the diagnostic performance of optical coherence tomography (OCT) and visual field (VF) summary statistics (metrics) that are available in OCT and VF reports. Methods OCT disc and macular scans and 24-2 and 10-2 VFs were obtained from 56 healthy control (HC) eyes/participants and 61 eyes/patients with 24-2 mean deviation of better than –6 dB. All metrics were obtained from OCT radial, circle, and posterior pole cube scans and 24-2 and 10-2 VFs. Their diagnostic performances were evaluated, in isolation and in combinations. For specificity, the 56 HC eyes were used. For sensitivity, 40 of the 61 patient eyes were deemed likely glaucomatous based on an automated topographic method that evaluates structure–function (S–F) agreement. Any 1 of these 40 eyes not judged as abnormal by any given metric was considered a false negative. Results All single OCT and VF metrics misclassified HCs as glaucomatous and missed likely glaucomatous eyes. The best performing single metric was the temporal inferior thickness of the 3.5-mm circle scan, with 96% specificity and 83% sensitivity. Combinations of OCT–OCT and OCT–VF metrics markedly improved specificity. A newly proposed metric that evaluates structure–structure (S–S) agreement at a hemifield level had the highest accuracy. This S–S metric had 98% specificity and 80% sensitivity. Conclusions OCT and VF metrics, single or in combinations, have only moderate sensitivity for eyes with early glaucoma. Translational Relevance OCT and VF metrics combinations evaluating S–S or S–F agreement can be highly specific, which is an important implication for clinical and research purposes.
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Affiliation(s)
- Emmanouil Tsamis
- Department of Psychology, Columbia University, New York, NY, USA
| | - Sol La Bruna
- Department of Psychology, Columbia University, New York, NY, USA
| | - Ari Leshno
- Bernard and Shirlee Glaucoma Research Lab, Department of Ophthalmology, Columbia University, New York, NY, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Sheba Talpiot Leader Program, Sheba Medical Center Hospital- Tel Hashomer, Ramat Gan, Israel
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Glaucoma Research Lab, Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Donald Hood
- Department of Psychology, Columbia University, New York, NY, USA.,Bernard and Shirlee Glaucoma Research Lab, Department of Ophthalmology, Columbia University, New York, NY, USA
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16
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Microperimetry, Humphrey field analyzer, and optical coherence tomography in detecting glaucoma: a comparative performance study. Int Ophthalmol 2022; 42:2155-2165. [PMID: 35023012 DOI: 10.1007/s10792-022-02215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate and compare the diagnostic performance of microperimetry (MP), visual field (VF) 10-2 and 24-2 tests, and spectral-domain optical coherence tomography (SD-OCT) in primary open-angle glaucoma (POAG). METHODS The study consisted of 35 POAG and 42 control eyes were enrolled in this prospective study. Eligible participants were ≥ 50 years old. VF assessments were carried out using the Humphrey field analyzer (HFA) and Macular Integrity Assessment. Optic nerve head (ONH), retinal nerve fiber layer thickness (RNFLT), and ganglion cell inner-plexiform-layer thickness (GCIPLT) were measured by SD-OCT. Areas under the receiver operating characteristic curves (AUC) and sensitivities at 95% specificity were calculated for each parameter. RESULTS HFA 24-2 had the largest AUC value among the functional parameters to differentiate POAG from control eyes [AUC: 0.950 (0.906-0.994), sensitivity at 95%:60]. HFA 24-2 showed a significantly better performance than the 10-2 test (p = 0.036). Among the SD-OCT structural parameters, minimum GCIPLT had the largest AUC value to differentiate POAG from control eyes [AUC: 0.952 (0.905-0.999), sensitivity at 95%:80]. In comparison of the functional and structural parameters, HFA 24-2 showed a significantly better performance than the 10-2 test (p = 0.036). In macular parameters, minimum GCPLT performed significantly better than HFA 10-2 (p = 0.015) in detecting POAG. There was no statistically significant difference between the comparative diagnostic performance of the RNFL, ONH, HFA, and MP (p > 0.05 for all comparisons). CONCLUSION The structural and functional test results revealed that GCIPLT measurements had the highest diagnostic performance in detecting POAG. HFA 24-2 test performed better than 10-2 test in distinguishing glaucoma from healthy eyes. MP showed a similar performance with HFA 10-2 and may be considered a complementary diagnostic tool.
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17
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Agreement between Compass Fundus Perimeter New Grid and 10-2 Testing Protocols for Detecting Central Visual Field Defects. Ophthalmol Glaucoma 2022; 5:179-187. [PMID: 34293492 PMCID: PMC9936818 DOI: 10.1016/j.ogla.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the agreement between Compass New Grid (NG) and 10-2 test protocols for detecting early glaucomatous defects in the central 10 degrees of the visual field (CVFD). DESIGN Cross-sectional study. PARTICIPANTS A total of 123 eyes of 14 healthy individuals, 17 glaucoma suspects, and 32 glaucoma patients were enrolled. METHODS Subjects performed NG and 10-2 Compass automated perimetry testing within 1 week. For both test protocols, total deviation (TD) and pattern deviation (PD) plot CVFDs were defined by 3 contiguous points with probabilities of <5%, <2%, <2% or <5%, <1%, <1%. Cohen's Kappa statistic was used to assess agreement between NG and 10-2 for identifying CVFDs. The Spectralis GMPE Hood Glaucoma Report (investigational software version) macula deviation analysis obtained within 1 year was used for calculating sensitivities and specificities of test protocols. MAIN OUTCOME MEASURES Protocols' agreement, sensitivity, and specificity. RESULTS Fair to moderate agreement was observed between NG and 10-2 protocols for detecting presence of superior CVFDs on TD (k = 0.57) and PD (k = 0.26) plots and for detecting inferior CVFDs on TD (0.49) and PD (0.27) plots. With the use of OCT macula deviation maps, specificity for detecting CVFD was consistently higher with NG than 10-2 tests for TD plots of the superior hemifield (0.82 and 0.65), inferior hemifield (0.92 and 0.84), and PD plots of the superior hemifield (0.81 and 0.36) and inferior hemifield (0.86 and 0.52). Sensitivity of NG was consistently lower than TD plots of the superior hemifield (0.48 and 0.72), inferior hemifield (0.28 and 0.46), and PD plots of the superior hemifield (0.48 and 0.78) and inferior hemifield (0.20 and 0.52). By using pattern standard deviation (PSD) criterion, the mean PSD values for 10-2 and NG VF tests were 1.61 (95% confidence interval [CI], 1.26-1.96) and 1.81 (95% CI, 1.45-2.17) (P < 0.001), respectively. CONCLUSIONS Although the Compass NG detected fewer CVFDs than the 10-2 test protocol, it did detect CVFDs that were not observed in the Compass 24-2 test in patients with early glaucoma. Therefore, NG may be particularly useful in clinical situations when higher specificity is desired or PSD criterion is used.
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David RCC, Moghimi S, Do JL, Hou H, Proudfoot J, Zangwill LM, Kamalipour A, Nishida T, De Moraes CG, Girkin CA, Liebmann JM, Weinreb RN. Characteristics of Central Visual Field Progression in Eyes with Optic Disc Hemorrhage. Am J Ophthalmol 2021; 231:109-119. [PMID: 34107310 DOI: 10.1016/j.ajo.2021.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the characteristics and rate of central visual field loss after optic disc hemorrhage (DH). DESIGN Prospective cohort study. METHODS Three hundred forty-three eyes of 220 subjects who had ≥3 years of follow-up with a minimum of 5 visits with 10-2 and 24-2 visual field (VF) were recruited. Rates of 10-2 mean deviation (MD) loss in each hemifield and predefined zones were compared using linear mixed-effects models in DH and non-DH eyes. Clustered pointwise regression analysis was also used to define central VF progressors and compared with 24-2 VF loss using guided progression analysis. RESULTS Thirty-nine eyes with DH and 304 eyes without DH had a mean follow-up of 5.2 years. Eyes with DH had rates of 10-2 MD loss that were 3 times faster than non-DH eyes (mean difference -0.36 dB/year [95% confidence interval 0.54-0.18]; P < .001) and were 3.7 times more likely to progress (P = .002). A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression in the DH group (30.8% vs. 20.5%) compared with the non-DH group (10.9% vs. 9.2%). In early glaucoma, the rate of 10-2 MD loss was 5.5 times faster in DH eyes than in non-DH eyes (P < .001). Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in DH eyes. CONCLUSION Central VF loss is accelerated in glaucoma eyes with DH and it corresponds topographically to the DH location. In patients with glaucoma with DH, one should consider supplementing 10-2 VFs with 24-2 VFS to monitor the disease.
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Affiliation(s)
- Ryan Caezar C David
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Jiun L Do
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Huiyuan Hou
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - James Proudfoot
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory (C.G.D.M., J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Christopher A Girkin
- and the Bernard School of Medicine (C.A.G.), University of Alabama-Birmingham, AL, United States
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory (C.G.D.M., J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (R.C.C.D., S.M., J.L.D., H.H., J.P., L.M.Z., A.K., T.N., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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19
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Wu Y, Szymanska M, Hu Y, Fazal MI, Jiang N, Yetisen AK, Cordeiro MF. Measures of disease activity in glaucoma. Biosens Bioelectron 2021; 196:113700. [PMID: 34653715 DOI: 10.1016/j.bios.2021.113700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness globally which significantly affects the quality of life and has a substantial economic impact. Effective detective methods are necessary to identify glaucoma as early as possible. Regular eye examinations are important for detecting the disease early and preventing deterioration of vision and quality of life. Current methods of measuring disease activity are powerful in describing the functional and structural changes in glaucomatous eyes. However, there is still a need for a novel tool to detect glaucoma earlier and more accurately. Tear fluid biomarker analysis and new imaging technology provide novel surrogate endpoints of glaucoma. Artificial intelligence is a post-diagnostic tool that can analyse ophthalmic test results. A detail review of currently used clinical tests in glaucoma include intraocular pressure test, visual field test and optical coherence tomography are presented. The advanced technologies for glaucoma measurement which can identify specific disease characteristics, as well as the mechanism, performance and future perspectives of these devices are highlighted. Applications of AI in diagnosis and prediction in glaucoma are mentioned. With the development in imaging tools, sensor technologies and artificial intelligence, diagnostic evaluation of glaucoma must assess more variables to facilitate earlier diagnosis and management in the future.
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Affiliation(s)
- Yue Wu
- Department of Surgery and Cancer, Imperial College London, South Kensington, London, United Kingdom; Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom.
| | - M Ihsan Fazal
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - M Francesca Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom; The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom; Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom.
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20
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Orbach A, Ang GS, Camp AS, Welsbie DS, Medeiros FA, Girkin CA, Fazio MA, Oh WH, Weinreb RN, Zangwill LM, Wu Z. Qualitative Evaluation of the 10-2 and 24-2 Visual Field Tests for Detecting Central Visual Field Abnormalities in Glaucoma. Am J Ophthalmol 2021; 229:26-33. [PMID: 33626360 DOI: 10.1016/j.ajo.2021.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine whether glaucomatous central visual field abnormalities can be more effectively detected using a qualitative, expert evaluation of the 10-2 test compared with the topographically corresponding central 12 locations of the 24-2 test (C24-2). DESIGN Cross-sectional study. METHODS Eyes with a glaucomatous optic nerve appearance or ocular hypertension (n = 523) and healthy eyes (n = 107) were included as cases and control subjects, respectively. The 10-2 and C24-2 visual field results of all eyes were graded by 4 glaucoma specialists for the probability that central visual field abnormalities were present. RESULTS The sensitivity of the 10-2 and C24-2 tests for detecting the cases at 95% specificity were not significantly different (e.g., 32.2% and 31.4%, respectively, for grader 1, P = .87; all graders P ≥ .25). At 95% specificity, the pattern standard deviation values from these tests had a similar sensitivity to the qualitative evaluation for the C24-2 test for all graders (P ≥ .083), but it had a significantly higher sensitivity than the qualitative evaluation for the 10-2 test for 3 graders (P ≤ .016). CONCLUSIONS The similarity in performance of the 10-2 and C24-2 test suggests that the increased sampling density of the former does not significantly improve the detection of central visual field abnormalities, even when based on expert assessment. These findings should not be taken to mean that the 10-2 test is not useful, but it underscores the need for its utility to be clearly established before incorporating it as routine glaucoma standard of care.
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21
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Karvonen E, Stoor K, Luodonpää M, Hägg P, Leiviskä I, Liinamaa J, Tuulonen A, Saarela V. Combined structure-function analysis in glaucoma screening. Br J Ophthalmol 2021; 106:1689-1695. [PMID: 34230023 DOI: 10.1136/bjophthalmol-2021-319178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/11/2021] [Indexed: 11/03/2022]
Abstract
AIM To assess the applicability of a structure-function (S-F) analysis combining spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in glaucoma screening in a middle-aged population. METHODS A randomised sample of 3001 Caucasian participants aged 45-49 years of the Northern Finland Birth Cohort Eye Study was examined. We performed an eye examination, including 24-2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and SD-OCT of the peripapillary RNFL. The S-F report was generated by Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated against clinical glaucoma diagnosis, that is, the positive '2 out of 3' rule based on the clinician's evaluation of ONH and RNFL photographs and visual fields (VFs). RESULTS At a specificity of 97.5%, the sensitivity for glaucomatous damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive predictive values were 8 %, 10% and 12%, respectively. By applying a classification tree approach combining OCT, SAP and defect localisation data, a sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of glaucomatous structural and functional defects, the correlation with glaucoma increased significantly if the abnormal VF test points were located on borderline or abnormal OCT zones. CONCLUSION SAP performs slightly better than OCT in glaucoma screening of middle-aged population. However, the diagnostic capability can be improved by S-F analysis.
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Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland .,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland.,Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Marja Luodonpää
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Pasi Hägg
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Ilmari Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
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22
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Montesano G, McKendrick AM, Turpin A, Brusini P, Oddone F, Fogagnolo P, Perdicchi A, Johnson CA, Lanzetta P, Rossetti LM, Garway-Heath DF, Crabb DP. Do Additional Testing Locations Improve the Detection of Macular Perimetric Defects in Glaucoma? Ophthalmology 2021; 128:1722-1735. [PMID: 34153384 DOI: 10.1016/j.ophtha.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the ability of additional central testing locations to improve detection of macular visual field (VF) defects in glaucoma. DESIGN Prospective cross-sectional study. PARTICIPANTS Four hundred forty healthy people and 499 patients with glaucomatous optic neuropathy (GON) were tested with a fundus tracked perimeter (CMP; CenterVue) using a 24-2 grid with 12 additional macular locations (24-2+). METHODS Glaucomatous optic neuropathy was identified based on expert evaluation of optic nerve head photographs and OCT scans, independently of the VF. We defined macular defects as locations with measurements outside the 5% and 2% normative limits on total deviation (TD) and pattern deviation (PD) maps within the VF central 10°. Classification was based on the total number of affected macular locations (overall detection) or the largest number of affected macular locations connected in a contiguous cluster (cluster detection). Criteria based on the number of locations and cluster size were used to obtain equivalent specificity between the 24-2 grid and the 24-2+ grids, calculated using false detections in the healthy cohort. Partial areas under the receiver operating characteristic curve (pAUCs) were also compared at specificities of 95% or more. MAIN OUTCOME MEASURES Matched specificity comparison of the ability to detect glaucomatous macular defects between the 24-2 and 24-2+ grids. RESULTS At matched specificity, cluster detection identified more macular defects with the 24-2+ grid compared with the 24-2 grid. For example, the mean increase in percentage of detection was 8% (95% confidence interval, 5%-11%) and 10% (95% confidence interval [CI], 7%-13%) for 5% TD and PD maps, respectively, and 5% (95% CI, 2%-7%) and 6% (95% CI, 4%-8%) for the 2% TD and PD maps, respectively. Good agreement was found between the 2 grids. The improvement measured by pAUCs was also significant but generally small. The percentage of eyes with macular defects ranged from about 30% to 50%. Test time for the 24-2+ grid was longer (21% increase) for both cohorts. Between 74% and 98% of defects missed by the 24-2 grid had at least 1 location with sensitivity of < 20 dB. CONCLUSIONS Visual field examinations with additional macular locations can improve the detection of macular defects in GON modestly without loss of specificity when appropriate criteria are selected.
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Affiliation(s)
- Giovanni Montesano
- Optometry and Visual Sciences, City, University of London, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew Turpin
- School of Computing and Information System, University of Melbourne, Melbourne, Australia
| | - Paolo Brusini
- Department of Ophthalmology, "Città di Udine" Health Center, Udine, Italy
| | | | | | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza," Rome, Italy
| | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Paolo Lanzetta
- Ophthalmology Unit, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | | | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - David P Crabb
- Optometry and Visual Sciences, City, University of London, London, United Kingdom.
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Antwi-Boasiako K, Carter-Dawson L, Harwerth R, Gondo M, Patel N. The Relationship Between Macula Retinal Ganglion Cell Density and Visual Function in the Nonhuman Primate. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 33393971 PMCID: PMC7794274 DOI: 10.1167/iovs.62.1.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Loss of ganglion cell inner plexiform layer (GCIPL) and visual sensitivity in the macula region are known to occur at all stages of glaucoma. While both are dependent on the underlying retinal ganglion cells (RGCs), the relationship between structure and function is modest. We hypothesize that the imprecise relationship is due to a lack of direct correspondence between in vivo measures and RGC counts, as well as the relatively large stimulus size used by standard perimetry, which exceeds spatial summation. Methods The relationship between optical coherence tomography (OCT)–derived GCIPL thickness and corresponding inner cell density from retinal flat mounts was determined for four nonhuman primates with varying stages of neuropathy. Normative data for 10-2 threshold using Goldman size I to V stimuli were established for 10 animals, 4 of which were then followed longitudinally with OCT and perimetry. The relationship between GCIPL volume, which incorporated stimulus size after removal of residual thickness, and differential light sensitivity was determined for both experimental glaucoma and healthy eyes. Results Peak inner retinal cell density was 63,052 ± 9238 cells/mm2 in the healthy eye. Cell density was related to both GCIPL thickness and eccentricity (R2 = 0.74, P < .01). For all 10-2 eccentricities, size III stimuli were greater than the critical area (P < 0.01). Based on the structural and histologic relationship, the critical area corresponds to approximately 156 RGCs. Conclusions The relationship between cell density and GCIPL thickness is dependent on retinal eccentricity. For 10-2 perimetry, perimetric loss, especially at earlier stages of neuropathy, may best be detected using size II or smaller stimuli.
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Affiliation(s)
| | | | - Ronald Harwerth
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Margaret Gondo
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Nimesh Patel
- College of Optometry, University of Houston, Houston, Texas, United States
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24
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Chakravarti T, Moghadam M, Proudfoot JA, Weinreb RN, Bowd C, Zangwill LM. Agreement Between 10-2 and 24-2C Visual Field Test Protocols for Detecting Glaucomatous Central Visual Field Defects. J Glaucoma 2021; 30:e285-e291. [PMID: 33813563 PMCID: PMC8169576 DOI: 10.1097/ijg.0000000000001844] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/16/2021] [Indexed: 11/27/2022]
Abstract
PRECIS Moderate to substantial agreement between 10-2 and 24-2C perimetry for detecting central field defects suggests that adding central test points to the 24-2 protocol may improve efficiency of visual field (VF) testing for glaucoma management. PURPOSE The purpose of this study was to assess agreement between Humphrey Visual Field Analyzer 10-2 and 24-2C test protocols for detecting glaucomatous defects in the central 10 degrees of the visual field (CVFDs). MATERIALS AND METHODS VFs from 165 eyes of 18 healthy individuals, 12 glaucoma suspects and 62 glaucoma patients who completed 10-2 and 24-2C VF testing protocols within 6 months were included. CVFDs on 10-2 and 24-2C (within the central 22 points) test grids required a cluster of 3 contiguous points with P<5%, 5%, and 1% or <5%, 2%, and 2% within a hemifield on the total deviation (TD) or pattern deviation (PD) plot. Cohen kappa (k) was used to assess agreement between 10-2 and 24-2C test grids in identifying CVFDs. Specificity of each testing strategy was assessed in VFs from healthy eyes. RESULTS CVFDs in suspect and glaucoma eyes were combined and reported as localized to superior, inferior or both hemifields based on TD and PD plots for 10-2 and 24-2C test grids. Moderate to substantial agreement was observed between 10-2 and 24-2C grids for detecting any CVFD from PD (k=0.551) and TD (k=0.651) plots. Specificity was high in healthy eyes ranging from 0.94 to 1.0 for both test protocols. CONCLUSION Substantial agreement for identifying CVFDs using the 24-2C and 10-2 protocols suggests that combining tests by adding central test points to the 24-2 test grid may supplant the need for 2 perimetry regimens for detecting central and peripheral glaucomatous VF damage.
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Affiliation(s)
- Tutul Chakravarti
- The Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, CA
- Eye and Glaucoma Care, Kolkata, West Bengal, India
| | - Mohamad Moghadam
- The Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, CA
| | - James A Proudfoot
- The Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, CA
| | - Robert N Weinreb
- The Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, CA
| | - Christopher Bowd
- The Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, CA
| | - Linda M Zangwill
- The Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, CA
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25
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Sullivan-Mee M, Hedayat M, Charry N, Katiyar S, Kee H, Kimura B, Pensyl D. Prediction of 10-2 Visual Field Loss Using Optical Coherence Tomography and 24-2 Visual Field Data. J Glaucoma 2021; 30:e292-e299. [PMID: 33813565 DOI: 10.1097/ijg.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
PRECIS Using standard glaucoma structural and functional tests, clinicians accurately predicted the presence/absence of 10-2 glaucomatous visual field (VF) loss in 90% of the eyes in this study. PURPOSE To investigate how well clinicians with variable experience can predict the presence and location of 10-2 VF loss using structural and functional data that are routinely obtained for glaucoma assessment. METHODS Within a test set of 416 eyes (210 subjects) who were diagnosed glaucoma suspect or primary open-angle glaucoma (with most eyes having mild disease), 6 clinicians were asked to predict the presence and hemispheric location of 10-2 VF loss using 24-2 VF and spectral-domain optical coherence tomography structural data. Prediction accuracies were calculated for each clinician and compared using the weighted κ-statistic. Receiver operating characteristic analyses were used to evaluate models for predicting 10-2 VF loss. RESULTS Among the 6 clinicians, mean (range) accuracy, false negatives, and false positives for predicting presence/absence of 10-2 VF loss were 90% (87% to 92%), 4.7% (2.4% to 7.0%), and 5.4% (1.7% to 7.5%) respectively. The mean (range) weighted κ-statistic was 0.75 (0.64 to 0.83), suggesting good or very good inter-rater agreement between examiners. Mean accuracy for correctly predicting hemispheric location was 73% (range, 65% to 82%) with the most common error occurring in eyes with both superior and inferior 10-2 VF defects in which one hemisphere was correctly identified but the other missed. CONCLUSIONS In this study, the presence/absence of 10-2 glaucomatous VF loss was highly predictable using standard functional and structural clinical metrics. These findings suggest that 10-2 VF testing is not needed to reliably recognize and confirm central VF involvement in most eyes with glaucoma. Whether error related to identifying second hemisphere involvement in 10-2 VF loss is important requires further study.
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Affiliation(s)
- Michael Sullivan-Mee
- Raymond G. Murphy VA Medical Center
- Eye Associates of New Mexico, Albuquerque, NM
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Wen Y, Chen Z, Chen S, Tan K, Kong Y, Cheng H, Yu M. Higher contrast thresholds for vanishing optotype recognition in macular visual fields among glaucoma patients: a structure-function analysis. Br J Ophthalmol 2021; 106:1530-1537. [PMID: 34031044 DOI: 10.1136/bjophthalmol-2021-318972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We aimed to explore the impact of glaucomatous macular damage, specifically retinal ganglion cell (RGC) loss, on macular pattern vision measured by the vanishing optotype (VO) recognition contrast threshold. METHODS Seventy-two patients (mean age, 33.51±7.05 years) with primary open-angle glaucoma and 36 healthy controls (mean age, 30.25±6.70 years) were enrolled. VO recognition contrast thresholds of each participant were measured at the 16 preset test locations covering the central 5° visual field (VF). Macular sensitivity (MS) was tested by macular threshold test of Humphrey Field Analyzer. Macular RGC plus inner plexiform layer (GCIPL) thickness was also measured by spectral domain optical coherence tomography. RESULTS The VO contrast threshold demonstrated weak-to-moderate correlations (rho=-0.275 to -0.653) with MS (p<0.001). There was a significantly higher VO contrast threshold in glaucoma group (p<0.0001). At similar levels of MS, patients with glaucoma with GCIPL damage showed remarkably higher VO contrast thresholds than those with preserved GCIPL (p=0.0079). The structure-function relationships between VO contrast threshold and GCIPL thickness (rho=-0.725 to -0.802) were remarkably stronger than those between MS and GCIPL thickness (rho=0.210 to 0.448). VO contrast threshold showed stronger correlation with average GCIPL thickness (rho=-0.362 to -0.778) than MS (rho=0.238 to 0.398) at multiple test locations in glaucoma group. CONCLUSIONS Glaucomatous eyes have higher contrast thresholds for VO recognition in fovea-around VF. Stronger structure-function relationships indicate that VO contrast threshold is more vulnerable to RGC damage.
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Affiliation(s)
- Yun Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zidong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shuo Chen
- School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Kaixin Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yang Kong
- School of Electronics and Communication Engineering, Sun Yat-Sen University, Shenzhen, China
| | - Hui Cheng
- School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Alluwimi MS, Swanson WH, King BJ. A Novel Stimulus to Improve Perimetric Sampling within the Macula in Patients with Glaucoma. Optom Vis Sci 2021; 98:374-383. [PMID: 33828040 PMCID: PMC8046738 DOI: 10.1097/opx.0000000000001677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Identifying glaucomatous damage to the macula has become important for diagnosing and managing patients with glaucoma. In this study, we presented an approach that provides better perimetric sampling for the macular region, by testing four locations, with a good structure-function agreement. PURPOSE We previously presented a basis for customizing perimetric locations within the macula. In this study, we aimed to improve perimetric sampling within the macula by presenting a stimulus at four locations, with maintaining a good structure-function agreement. METHODS We tested one eye each of 30 patients (aged 50 to 88 years). Patients were selected based on observed structural damage to the macula, whereas perimetric defect (using 24-2) did not reflect the locations and extent of this damage. We used en face images to visualize retinal nerve fiber bundle defects. To measure perimetric sensitivities, we used a blob stimulus (standard deviation of 0.25°) at the 10-2 locations. A perimetric defect for a location was defined as any value equal to or deeper than -4, -5, and -6 dB below the mean sensitivity for 37 age-similar controls (aged 47 to 78 years). We also presented an elongated sinusoidal stimulus for 20 patients at four locations within the macula, in which we defined a perimetric defect as any value below the 2.5th percentile from controls. RESULTS The -4, -5, and -6 dB criteria identified perimetric defects in 14, 13, and 11 patients, respectively. When testing with the elongated stimulus, 18 patients were identified with perimetric defect. The perimetric defects were consistent with the structural damage. CONCLUSIONS The elongated stimulus showed a good structure-function agreement with only four testing locations as compared with 68 locations used with the blob stimulus. This demonstrates a clinical potential for this new stimulus in the next generation of perimetry.
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Affiliation(s)
- Muhammed S. Alluwimi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, AlQassim, Saudi Arabia
| | | | - Brett J. King
- Indiana University School of Optometry, Bloomington, Indiana
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Phu J, Agar A, Wang H, Masselos K, Kalloniatis M. Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach. Clin Exp Optom 2021; 104:367-384. [DOI: 10.1111/cxo.13114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Phu J, Kalloniatis M. Comparison of 10-2 and 24-2C Test Grids for Identifying Central Visual Field Defects in Glaucoma and Suspect Patients. Ophthalmology 2021; 128:1405-1416. [PMID: 33722636 DOI: 10.1016/j.ophtha.2021.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare the ability of 24-2C and 10-2 test grids in measuring visual field global indices, identifying central visual field defects, and facilitating macular structure-function analysis with OCT scans in glaucoma and glaucoma suspect patients. DESIGN Prospective, cross-sectional study. PARTICIPANTS One eye from 131 glaucoma and 57 glaucoma suspect patients recruited from a referral-only, university-based glaucoma clinic. METHODS Each subject underwent perimetric testing using 24-2C SITA-Faster and 10-2 SITA-Fast in random order, and Cirrus OCT macular imaging (Ganglion Cell Analysis) for structure-function correlations. MAIN OUTCOME MEASURES Visual field global indices (mean deviation, pattern standard deviation, binarized "cluster" pass/fail, and central mean sensitivity), number and proportion of visual field defects, and structure-function concordance with the Cirrus OCT deviation map following visual field location displacement for correspondence with underlying retinal ganglion cell position. RESULTS Global indices (mean deviation, pattern standard deviation, and central mean sensitivity) were similar between both grids. The 10-2 detected more defects compared with the 24-2C (P < 0.0001 for all patients, P = 0.006 for glaucoma patients). This was preserved when analyzing the proportion of defects in the central visual field for all patients (P = 0.02) but was not significantly different for glaucoma patients (P = 0.051). The 10-2 identified more central "clusters" of 2+ contiguous points of deficit (P < 0.0001). Structure-function comparisons performed at locations where visual field and OCT test locations were colocalized revealed greater concordance of structural and functional deficits using the 10-2 (P < 0.0001). The 10-2 took a median of 201 seconds, and the 24-2C took a median of 154 seconds, corresponding to the different thresholding algorithms. CONCLUSIONS The 24-2C and 10-2 test grids return similar global indices of visual field performance and proportionally similar amounts of central visual field loss. The additional points in the 10-2 grid return more "clusters" of defects and a greater rate of structure-function concordance compared with the 24-2C test grid. Thus, the 24-2C can identify the presence of a clustered central visual field defect using similar probability criteria, whereas the 10-2 may be more useful in comprehensively characterizing the defect and predicting central visual function.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales.
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales
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Hood DC, Thenappan AA, Tsamis E, Liebmann JM, De Moraes CG. An Evaluation of a New 24-2 Metric for Detecting Early Central Glaucomatous Damage. Am J Ophthalmol 2021; 223:119-128. [PMID: 32777374 DOI: 10.1016/j.ajo.2020.07.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We sought to test the hypothesis that a recently proposed pattern standard deviation (PSD) metric, based upon the 24-2 visual field (VF) test, as well as the PSD of the 10-2 VF, will miss central glaucomatous damage confirmed with an objective structure-function method. DESIGN Cross-sectional study. METHODS A glaucoma (G) group (70 eyes/patients) diagnosed with glaucoma and a 24-2 mean deviation better than -6 dB and a healthy (H) group (45 eyes/patients) had 24-2 and 10-2 VFs and optical coherence tomography (OCT) scans twice within 4 weeks. The PSD(C24-2), based upon the central 12 points of the 24-2, was compared with the PSD(10-2). To evaluate central damage (CD) in G eyes with normal PSD(C24-2) values, a post hoc analysis was combined with a CD reference standard (CD-RS), which was based upon an objective, topographic comparison between abnormal points on the 10-2 VF and OCT probability maps. RESULTS The 115 PSD(C24-2) and PSD(10-2) values were significantly correlated (Spearman correclation coefficient: rho = 0.55; P < .001) and the number of G eyes (19) identified as abnormal by the PSD(C24-2) was not significantly different from the number (22) identified by the PSD(10-2) (P = .15). However, based upon the CD-RS, 44 of 70 G eyes were classified as abnormal. The PSD(C24-2) missed 27 (61%) of these 44 eyes, and the PSD(10-2) missed 23 (52%) of these eyes. Post hoc analysis revealed clear CD in most of these eyes. CONCLUSION Neither the PSD(C24-2) nor the PSD(10-2) metric is good measure of early CD. Instead we recommend a topographic approach based upon OCT probability maps and a 10-2 VF.
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Central Visual Field Defects in Patients with Distinct Glaucomatous Optic Disc Phenotypes. Am J Ophthalmol 2021; 223:229-240. [PMID: 33129812 DOI: 10.1016/j.ajo.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 10/20/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate central visual field (VF) defects among 4 phenotypes of glaucomatous optic discs. DESIGN Cross-sectional study. METHODS Optic disc phenotypes were determined in eyes with definite or suspected glaucoma that had a 24-2 VF with mean deviation (MD) better than -12 dB and a 10-2 VF. 10-2 VFs were classified as abnormal based on a cluster criterion. Additionally, the average of the total deviation values at each 10-2 test point was compared by optic disc phenotype. RESULTS The following 4 glaucomatous optic disc phenotypes were identified in 448 eyes of 309 patients: focal ischemic (FI) (n = 121); generalized cup enlargement (GE) (n = 109); myopic glaucoma (MY) (n = 66); and senile sclerotic (SS) (n = 152). Although 24-2 VF MD values were similar among optic disc phenotypes, GE eyes had higher 10-2 VF MD (P = .004), as well as lower 24-2 VF pattern standard deviations (PSD) (P < .001) and VF 10-2 PSD (P < .001) than the other phenotypes. The prevalence of an abnormal VF 10-2 was highest in FI eyes (78.5%) and lowest in GE eyes (50.5%) (P < .001). In glaucoma suspects, the prevalence of an abnormal 10-2 VF was highest in the MY eyes (31.2%) and FI eyes (23.5%) and lowest in GE eyes (8.6%). In mild glaucoma, the prevalence of abnormal 10-2 VF test results was highest in FI eyes (79.2%) and lowest in GE eyes (44.4%) (P = .013). CONCLUSIONS The severity and prevalence of central VF loss varied among different glaucomatous optic disc phenotypes. Glaucomatous eyes with FI and MY optic disc phenotypes are more likely to have 10-2 VF loss, particularly in early disease, and especially may benefit from testing with both 10-2 and 24-2 VF tests.
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Abstract
PURPOSE OF REVIEW Perimetry remains important for the diagnosis and management of glaucoma despite advances in imaging technology. The purpose of this review is to describe advances in the acquisition and analysis of visual field data and highlight novel techniques for performing perimetry. RECENT FINDINGS Studies have focused on improving the detection of patients at highest risk of severe vision loss and the development of innovative testing strategies that allow for more frequent testing. Artificial intelligence has been utilized in research settings to improve detection and characterization of glaucomatous field damage. Furthermore, tablet-based strategies and virtual reality headsets show promise for glaucoma screening and remote monitoring of patients with glaucoma. SUMMARY New testing strategies and research findings have improved our ability to identify patients with both paracentral and mid-peripheral visual field progression. New strategies have the potential to make visual field testing more efficient, reliable and accessible for patients with glaucoma.
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Montesano G, Rossetti LM, Allegrini D, Romano MR, Garway-Heath DF, Crabb DP. Systematic and Random Mapping Errors in Structure - Function Analysis of the Macula. Transl Vis Sci Technol 2021; 10:21. [PMID: 34003906 PMCID: PMC7900880 DOI: 10.1167/tvst.10.2.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Quantify the spatial error in mapping perimetric stimuli for structure–function analysis resulting from the choice of mapping scheme and eye movements. Methods We analyzed data from 17 healthy and 30 glaucomatous participants. Structural data of the macula were collected with a spectral-domain optical coherence tomography. We extracted eye movement data and projection locations from a fundus tracking perimeter and quantified the retinal location mapping error (distance between the actual and the intended stimulus location in degrees from the fovea) for non-tracked perimetry in a 10-2 grid. First, we evaluated whether rotating the 10-2 grid to match the fovea–disc axis improved mapping accuracy. Second, we analyzed the effect of eccentric fixation, random eye movements, and gaze attraction from seen stimuli on projection accuracy and spread of fixation, measured with the 95% bivariate contour ellipse area (95% BCEA). We used generalized linear mixed models for our statistical analyses. Results Rotating the 10-2 grid to match the fovea–disc axis significantly increased the mapping error (P < 0.001). Eye movements evoked by seen stimuli significantly increased the projection error during the test (P < 0.001). Removing such eye movements significantly reduced the 95% BCEA (P < 0.001). Eccentric fixation also significantly contributed to the projection error (P < 0.001), and its effect was larger in glaucoma patients (P < 0.001). Conclusions Rotating the perimetric grid to match the fovea–disc axis is not recommended. Fixation eccentricity and instability should be taken into account for structure–function analyses. Translational Relevance Accounting for fixation can improve structure–function mapping in glaucoma.
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Affiliation(s)
- Giovanni Montesano
- Optometry and Visual Sciences, City, University of London, London, UK.,ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | | | - Davide Allegrini
- Eye Unit, Humanitas Gavazzeni Hospital, Humanitas University, Bergamo, Italy
| | - Mario R Romano
- Eye Unit, Humanitas Gavazzeni Hospital, Humanitas University, Bergamo, Italy
| | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - David P Crabb
- Optometry and Visual Sciences, City, University of London, London, UK
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Phu J, Kalloniatis M. Ability of 24-2C and 24-2 Grids to Identify Central Visual Field Defects and Structure-Function Concordance in Glaucoma and Suspects. Am J Ophthalmol 2020; 219:317-331. [PMID: 32621896 DOI: 10.1016/j.ajo.2020.06.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to compare the ability of the 24-2 test grid with that of the 24-2C test grid to measure visual field global indices, identify central visual field defects, and facilitate macular structure-function analysis with optical coherence tomography (OCT) scans in glaucoma suspects and glaucoma patients. DESIGN Prospective, cross-sectional study. METHODS One eye from each of 100 glaucoma suspects and glaucoma patients (60 undergoing SITA-Faster [Zeiss Meditec] testing on 24-2 and 24-2C; 40 undergoing SITA-Standard [Zeiss Meditec] testing on 24-2 and SITA-Faster on 24-2C) were included in the study. Global visual field indices, test duration, and pattern deviation results were extracted. The deviation map from the Cirrus OCT (Carl Zeiss Meditec) Ganglion Cell Analysis (GCA) was extracted, and structure-function relationships were compared after correction of the visual field test stimulus location that stimulated the corresponding retinal ganglion cell. RESULTS Global index results of the 24-2 grid were similar to those of the 24-2C grid, and both identified a comparable number of clusters of visual field defects. Centrally, the 24-2C grid identified more clusters of defects than the 24-2 grid, but this was not statistically significant. Although the 24-2C test locations resulted in more instances of structure-function concordance than the 24-2 locations, half the locations in the 24-2C grid fell close to or outside the GCA grid when corrected for ganglion cell displacement. CONCLUSIONS The 24-2C returned global visual field indices similar to the 24-2 grid but tended to identify more clusters of central functional defects. Central structure-function concordance was better achieved using the 24-2C grid, but half of the visual field test locations did not coincide with the commonly used macular thickness scan.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia.
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
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West ME, Sharpe GP, Hutchison DM, Rafuse PE, Shuba LM, Nicolela MT, Vianna JR, Chauhan BC. Value of 10-2 Visual Field Testing in Glaucoma Patients with Early 24-2 Visual Field Loss. Ophthalmology 2020; 128:545-553. [PMID: 32898515 DOI: 10.1016/j.ophtha.2020.08.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine whether the 10-2 test of the Humphrey Field Analyzer detected a higher proportion of abnormal visual fields compared with the 24-2 test in the central 10° of patients with early glaucomatous visual field damage. DESIGN Prospective observational study. PARTICIPANTS Patients with open-angle glaucoma and healthy control participants. METHODS All participants underwent a 24-2 and 10-2 test. Only the 12 central test locations of the 24-2 test were included to analyze equivalent visual field areas. The performance of the 2 tests was compared across 4 pointwise criteria: total deviation (TD) and pattern deviation (PD) analyses at the 5% and 2% levels. Analyses also were conducted for 2 pairs of follow-up tests, each performed 4 months apart. MAIN OUTCOME MEASURES (1) Area under the receiver operating characteristic curve (AUC), (2) sensitivity at identically matched specificity for the 4 criteria, (3) overlap (entire field and by quadrant) of abnormal visual fields with both tests, and (4) repeatability of the findings in 2 subsequent follow-up tests. RESULTS One eye each of 97 glaucoma patients (median mean deviation, -2.31 dB) and 65 control participants were included in the study. The AUCs for the 24-2 and 10-2 tests were not significantly different for any of the 4 criteria and ranged from 0.88 to 0.93 and from 0.91 to 0.94, respectively. At matched specificity, the sensitivity of the 24-2 test was significantly higher for all criteria except for PD analysis at 5%. In patients with an abnormal field with either test, the overlap varied from 60% to 86% depending on the criterion, whereas by quadrant, concordance ranged from 70% to 87%. Over the follow-up, the repeatability of test results (both 24-2 and 10-2 abnormal, either abnormal, or both normal) was achieved in 55% to 70% of patients. CONCLUSIONS In this study of glaucoma patients with early damage with the 24-2 test, there was little evidence that adding the 10-2 test revealed additional undetected defects in the central visual field. It may be more prudent to reserve 10-2 testing for following up selected patients with higher risk of central visual field progression.
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Affiliation(s)
- Michael E West
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Glen P Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Donna M Hutchison
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Paul E Rafuse
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Lesya M Shuba
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Marcelo T Nicolela
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Jayme R Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada.
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Thompson AC, Jammal AA, Berchuck SI, Mariottoni EB, Wu Z, Daga FB, Ogata NG, Urata CN, Estrela T, Medeiros FA. Comparing the Rule of 5 to Trend-based Analysis for Detecting Glaucoma Progression on OCT. Ophthalmol Glaucoma 2020; 3:414-420. [PMID: 32723699 DOI: 10.1016/j.ogla.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The rule of 5 is a simple rule for detecting retinal nerve fiber layer (RNFL) change on spectral-domain OCT (SD-OCT), in which a loss of 5 μm of global RNFL on a follow-up test is considered evidence of significant change when compared with the baseline. The rule is based on short-term test-retest variability of SD-OCT and is often used in clinical practice. The purpose of this study was to compare the rule of 5 with trend-based analysis of global RNFL thickness over time for detecting glaucomatous progression. DESIGN Prospective cohort. PARTICIPANTS A total of 300 eyes of 210 glaucoma subjects followed for an average of 5.4±1.5 years with a median of 11 (interquartile range, 7-14) visits. METHODS Trend-based analysis was performed by ordinary least-squares (OLS) linear regression of global RNFL thickness over time. For estimation of specificity, false-positives were obtained by assessing for progression on series of randomly permutated follow-up visits for each eye, which removes any systematic trend over time. The specificity of trend-based analysis was matched to that of the rule of 5 to allow meaningful comparison of the "hit rate," or the proportion of glaucoma eyes categorized as progressing at each time point, using the original sequence of visits. MAIN OUTCOME MEASURES Comparison between hit rates of trend-analysis versus rule of 5 at matched specificity. RESULTS After 5 years, the simple rule of 5 identified 37.5% of eyes as progressing at a specificity of 81.1%. At the same specificity, the hit rate for trend-based analysis was significantly greater than that of the rule of 5 (62.9% vs. 37.5%; P < 0.001). If the rule of 5 was required to be repeatable on a consecutive test, specificity improved to 93.4%, but hit rate decreased to 21.0%. At this higher specificity, trend-based analysis still had a significantly greater hit rate than the rule of 5 (47.4% vs. 21.0%, respectively; P < 0.001). CONCLUSIONS Trend-based analysis was superior to the simple rule of 5 for identifying progression in glaucoma eyes and should be preferred as a method for longitudinal assessment of global SD-OCT RNFL change over time.
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Affiliation(s)
- Atalie C Thompson
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Alessandro A Jammal
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Samuel I Berchuck
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina; Duke FORGE, Durham, North Carolina
| | - Eduardo B Mariottoni
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Zhichao Wu
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Fabio B Daga
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Nara G Ogata
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Carla N Urata
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Tais Estrela
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Felipe A Medeiros
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina.
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Thompson AC, Jammal AA, Medeiros FA. Performance of the Rule of 5 for Detecting Glaucoma Progression between Visits with OCT. Ophthalmol Glaucoma 2019; 2:319-326. [PMID: 32672674 PMCID: PMC7375168 DOI: 10.1016/j.ogla.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/04/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate whether loss of 5 μm or more in global retinal nerve fiber layer (RNFL) thickness on spectral-domain (SD) between 2 consecutive visits is specific for glaucoma progression. DESIGN Prospective cohort. PARTICIPANTS Ninety-two eyes of 49 control participants and 300 eyes of 210 glaucoma patients. METHODS Patients completed at least 5 standard automated perimetry and SD OCT examinations at 6-month intervals over at least 2 years. Eyes were categorized as progressing from glaucoma if the average RNFL declined by 5 μm or more between 2 consecutive visits. The false-positive proportion was estimated by 2 methods: (1) 5-μm or more loss in control participants and (2) 5-μm or more gain in glaucoma. The false-positive proportion was subtracted from the cumulative proportion of eyes categorized with glaucoma progression to estimate the true progression prevalence. MAIN OUTCOME MEASURES False-positive and true progression prevalence of patients with glaucoma detected as progressing on SD OCT. RESULTS After 5 years of semiannual testing, the cumulative proportion of false-positive results based on 5-μm or more RNFL losses between visits was 24.8% in the control participants. Although 40.6% of glaucoma eyes were diagnosed with progression at 5 years, only 15.8% would have been considered to show true progression based on the expected false-positive ratio from the control participants (i.e., 40.6%-24.8%). The cumulative proportion of an intervisit gain of 5 μm or more at 5 years was 27.4% in glaucoma eyes, suggesting that only 13.2% of eyes with glaucoma truly had progressed (i.e., 40.6%-27.4%). CONCLUSIONS Loss of 5 μm or more in average RNFL thickness between consecutive SD OCT tests is not specific for glaucoma progression. Application of this intervisit rule of 5 can result in a high cumulative proportion of false-positive results over time, which could lead to unnecessary interventions in patients whose disease is stable. More specific diagnostic criteria are needed to help clinicians determine whether patients with glaucoma are progressing so that therapy escalation is both timely and appropriate.
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Affiliation(s)
- Atalie C Thompson
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Alessandro A Jammal
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina.
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Tomairek RH, Aboud SA, Hassan M, Mohamed AH. Studying the role of 10-2 visual field test in different stages of glaucoma. Eur J Ophthalmol 2019; 30:706-713. [DOI: 10.1177/1120672119836904] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess the role of 10-2 visual field (VF) test in different stages of glaucoma. Methods: In our prospective comparative study, 24-2 and 10-2 VF tests were done for 115 eyes with different stages of glaucomatous damage or glaucoma suspects. Optical coherence tomography (OCT) was performed in 79 eyes. We compared field changes of the central 10° on 10-2 and 24-2 tests and studied the correlation between the mean deviation (MD) measured by the two tests. Results: In seven glaucoma suspects, glaucoma diagnosis was missed by 24-2 test but was detected by 10-2 test and confirmed by OCT. In the eyes with early damage, there was no correlation between 10-2 and 24-2 tests regarding the MD of the central 10º. In moderate and severe stages, there was a significant correlation between the results of 24-2 and 10-2 tests. Conclusion: We concluded that 10-2 test could help confirm glaucoma diagnosis in glaucoma suspects missed by 24-2 test before resorting to the more expensive OCT. In early glaucoma, we noted that 10-2, as confirmed by OCT, was a beneficial addition to 24-2 test for precise measurement of the MD and detection of defects of the central 10º missed by 24-2 test, where more intense treatment should be considered to preserve the threatened central visual function. In moderate and severe cases, the role of 10-2 test was not as pivotal as in early cases, but still it was useful for assessment of residual central visual function in severe cases with absolute central 10º defects on 24-2 test for proper management.
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Affiliation(s)
| | | | - Mansour Hassan
- Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Montesano G, Rossetti LM, Allegrini D, Romano MR, Crabb DP. Improving Visual Field Examination of the Macula Using Structural Information. Transl Vis Sci Technol 2018; 7:36. [PMID: 30619656 PMCID: PMC6314223 DOI: 10.1167/tvst.7.6.36] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate a novel approach for structure-function modeling in glaucoma to improve visual field testing in the macula. Methods We acquired data from the macular region in 20 healthy eyes and 31 with central glaucomatous damage. Optical coherence tomography (OCT) scans were used to estimate the local macular ganglion cell density. Perimetry was performed with a fundus-tracking device using a 10-2 grid. OCT scans were matched to the retinal image from the fundus perimeter to accurately map the tested locations onto the structural damage. Binary responses from the subjects to all presented stimuli were used to calculate the structure-function model used to generate prior distributions for a ZEST (Zippy Estimation by Sequential Testing) Bayesian strategy. We used simulations based on structural and functional data acquired from an independent dataset of 20 glaucoma patients to compare the performance of this new strategy, structural macular ZEST (MacS-ZEST), with a standard ZEST. Results Compared to the standard ZEST, MacS-ZEST reduced the number of presentations by 13% in reliable simulated subjects and 14% with higher rates (≥20%) of false positive or false negative errors. Reduction in mean absolute error was not present for reliable subjects but was gradually more important with unreliable responses (≥10% at 30% error rate). Conclusions Binary responses can be modeled to incorporate detailed structural information from macular OCT into visual field testing, improving overall speed and accuracy in poor responders. Translational Relevance Structural information can improve speed and reliability for macular testing in glaucoma practice.
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Affiliation(s)
- Giovanni Montesano
- City, University of London-Optometry and Visual Sciences, London, UK.,University of Milan-ASST Santi Paolo e Carlo, Milan, Italy.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | | | - Davide Allegrini
- Humanitas University, Eye Unit, Humanitas-Gavazzeni Hospital, Bergamo, Italy
| | - Mario R Romano
- Humanitas University, Eye Unit, Humanitas-Gavazzeni Hospital, Bergamo, Italy
| | - David P Crabb
- City, University of London-Optometry and Visual Sciences, London, UK
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Adams CM, Stacy R, Rangaswamy N, Bigelow C, Grosskreutz CL, Prasanna G. Glaucoma - Next Generation Therapeutics: Impossible to Possible. Pharm Res 2018; 36:25. [PMID: 30547244 DOI: 10.1007/s11095-018-2557-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/12/2018] [Indexed: 12/28/2022]
Abstract
The future of next generation therapeutics for glaucoma is strong. The recent approval of two novel intraocular pressure (IOP)-lowering drugs with distinct mechanisms of action is the first in over 20 years. However, these are still being administered as topical drops. Efforts are underway to increase patient compliance and greater therapeutic benefits with the development of sustained delivery technologies. Furthermore, innovations from biologics- and gene therapy-based therapeutics are being developed in the context of disease modification, which are expected to lead to more permanent therapies for patients. Neuroprotection, including the preservation of retinal ganglion cells (RGCs) and optic nerve is another area that is actively being explored for therapeutic options. With improvements in imaging technologies and determination of new surrogate clinical endpoints, the therapeutic potential for translation of neuroprotectants is coming close to clinical realization. This review summarizes the aforementioned topics and other related aspects.
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Affiliation(s)
- Christopher M Adams
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research (NIBR),, Cambridge, Massachusetts, USA
| | - Rebecca Stacy
- Translational Medicine, Ophthalmology, NIBR, Cambridge, Massachusetts, USA
| | - Nalini Rangaswamy
- Ophthalmology Research, Novartis Institutes for Biomedical Research, 22 Windsor Street, Cambridge, Massachusetts, 02139, USA
| | - Chad Bigelow
- Ophthalmology Research, Novartis Institutes for Biomedical Research, 22 Windsor Street, Cambridge, Massachusetts, 02139, USA
| | - Cynthia L Grosskreutz
- Ophthalmology Research, Novartis Institutes for Biomedical Research, 22 Windsor Street, Cambridge, Massachusetts, 02139, USA
| | - Ganesh Prasanna
- Ophthalmology Research, Novartis Institutes for Biomedical Research, 22 Windsor Street, Cambridge, Massachusetts, 02139, USA.
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