Validating the efficacy of the binomial pointwise linear regression method to detect glaucoma progression with multicentral database

Adding Genetics to the Risk Factors Model Improved Accuracy for Detecting Visual Field Progression in Newly Diagnosed Exfoliation Glaucoma Patients

BACKGROUND

This study aims to determine whether including genetics as a risk factor for progression will improve the accuracy of the models used in newly diagnosed exfoliation glaucoma patients.

METHODS

This was a prospective cohort study. This study included only patients who were newly diagnosed with exfoliation glaucoma and received treatment upon inclusion. Blood samples were taken from all patients at inclusion to test for the single nucleotide polymorphisms (SNPs) LOXL-1 rs2165241 and rs1048661.

RESULTS

This study found that the frequency of SNPs, as well as intraocular pressure (IOP), mean deviation (MD), and visual field index (VFI) values at diagnosis, were significant predictors of visual field deterioration (p ≤ 0.001). This study showed that interaction terms, including SNPs, were highly significant (p ≤ 0.001). Furthermore, logistic regression analysis also showed highly significant results for interaction terms when SNPs were included (p ≤ 0.001). Finally, the area under the curve (AUC) analysis showed an increased value of around 10-20% when SNPs were included.

CONCLUSIONS

Adding genetic factors to the well-known clinical risk factors can increase the accuracy of models for predicting visual field deterioration in exfoliation glaucoma patients. However, further studies are needed to investigate the role of other genes in this process.

Investigating the clinical validity of the guided progression analysis definition with 10-2 visual field in retinitis pigmentosa

PURPOSE

To investigate the clinical validity of the Guided Progression Analysis definition (GPAD) and cluster-based definition (CBD) with the Humphrey Field Analyzer (HFA) 10-2 test in retinitis pigmentosa (RP).

METHODS

Ten non-progressive RP visual fields (VFs) (HFA 10-2 test) were simulated for each of 10 VFs of 111 eyes (10 simulations × 10 VF sequencies × 111 eyes = 111,000 VFs; Dataset 1). Using these simulated VFs, the specificity of GPAD for the detection of progression was determined. Using this dataset, similar analyses were conducted for the CBD, in which the HFA 10-2 test was divided into four quadrants. Subsequently, the Hybrid Definition was designed by combining the GPAD and CBD; various conditions of the GPAD and CBD were altered to approach a specificity of 95.0%. Subsequently, actual HFA 10-2 tests of 116 RP eyes (10 VFs each) were collected (Dataset 2), and true positive rate, true negative rate, false positive rate, and the time required to detect VF progression were evaluated and compared across the GPAD, CBD, and Hybrid Definition.

RESULTS

Specificity values were 95.4% and 98.5% for GPAD and CBD, respectively. There were no significant differences in true positive rate, true negative rate, and false positive rate between the GPAD, CBD, and Hybrid Definition. The GPAD and Hybrid Definition detected progression significantly earlier than the CBD (at 4.5, 5.0, and 4.5 years, respectively).

CONCLUSIONS

The GPAD and the optimized Hybrid Definition exhibited similar ability for the detection of progression, with the specificity reaching 95.4%.

Glaucoma progression. Clinical practice guide

OBJECTIVE

To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence.

METHODS

After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology.

RESULTS

Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented.

CONCLUSIONS

Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.

Detecting Progression of Retinitis Pigmentosa Using the Binomial Pointwise Linear Regression Method

Purpose

A method of evaluating central visual field (VF) progression in eyes with retinitis pigmentosa (RP) has still to be established. We previously reported the potential merit of applying a binomial test to pointwise linear regression (binomial PLR) in glaucoma progression. In the current study, we investigated the usefulness of binomial PLR in eyes with RP.

Methods

A series of 10 VFs (VF 1–10, Humphrey field analyzer, 10-2 test) from 196 eyes of 103 patients with RP were collected retrospectively. The PLR was performed by regressing the total deviation of all test points with the complete series of 10 VFs. The accuracy (positive predictive value, negative predictive value, and false-positive rate) and the time required to detect VF progression with shorter VF series (from VF 1–5 to VF 1–9) were compared across the binomial PLR, a permutation analysis of PLR (PoPLR), and a mean deviation (MD) trend analysis.

Results

In evaluating VF progression, the binomial PLR was comparable with the PoPLR and MD trend analyses in its positive predictive value (0.55 to 0.95), negative predictive value (0.67 to 0.92), and false-positive rate (0.01 to 0.05). The binomial PLR required significantly less time to detect VF progression (5.0 ± 2.0 years) than the PoPLR and MD trend analyses (P < 0.01, P < 0.001, respectively).

Conclusions

The application of a binomial PLR achieved reliable and earlier detection of central VF progression in eyes with RP.

Translational Relevance

A binomial PLR was useful in assessing VF progression in RP.

Investigating the clinical usefulness of definitions of progression with 10-2 visual field

BACKGROUND/AIM

To investigate the clinical validity of the Guided Progression Analysis definition (GPAD) and cluster-based definition (CBD) with the Humphrey Field Analyzer 10-2 test in diagnosing glaucomatous visual field (VF) progression, and to introduce a novel definition with optimised specificity by combining the 'any-location' and 'cluster-based' approaches (hybrid definition).

METHODS

64 400 stable glaucomatous VFs were simulated from 664 pairs of 10-2 tests (10 sets × 10 VF series × 664 eyes; data set 1). Using these simulated VFs, the specificity to detect progression and the effects of changing the parameters (number of test locations or consecutive VF tests, and percentile cut-off values) were investigated. The hybrid definition was designed as the combination where the specificity was closest to 95.0%. Subsequently, another 5000 actual glaucomatous 10-2 tests from 500 eyes (10 VFs each) were collected (data set 2), and their accuracy (sensitivity, specificity and false positive rate) and the time needed to detect VF progression were evaluated.

RESULTS

The specificity values calculated using data set 1 with GPAD and CBD were 99.6% and 99.8%. Using data set 2, the hybrid definition had a higher sensitivity than GPAD and CBD, without detriment to the specificity or false positive rate. The hybrid definition also detected progression significantly earlier than GPAD and CBD (at 3.1 years vs 4.2 years and 4.1 years, respectively).

CONCLUSIONS

GPAD and CBD had specificities of 99.6% and 99.8%, respectively. A novel hybrid definition (with a specificity of 95.5%) had higher sensitivity and enabled earlier detection of progression.