Short-term Detection of Fast Progressors in Glaucoma: The Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study.
Medeiros Felipe A, Malek Davina A, Tseng Henry, Swaminathan Swarup S, Boland Michael V, Friedman David S, Jammal Alessandro A
AI Summary
This study found intensive, clustered glaucoma testing over 6 months effectively identifies fast progressors. This method is valuable for clinical trials and short-term assessment of high-risk patients.
Abstract
Purpose
To evaluate the performance of an intensive, clustered testing approach in identifying eyes with rapid glaucoma progression over 6 months in the Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study.
Design
Prospective cohort study.
Participants
A total of 125 eyes from 65 primary open-angle glaucoma (POAG) subjects.
Methods
Subjects underwent 2 sets of 5 weekly visits (clusters) separated by an average of 6 months and then were followed with single visits every 6 months for an overall mean follow-up of 25 months (mean of 17 tests). Each visit consisted of testing with standard automated perimetry (SAP) 24-2 and 10-2, and spectral-domain OCT (SD-OCT). Progression was assessed using trend analyses of SAP mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness. Generalized estimating equations were applied to adjust for correlations between eyes for confidence interval (CI) estimation and hypothesis testing.
Main outcome measures
Diagnostic accuracy of the 6-month clustering period to identify progression detected during the overall follow-up.
Results
A total of 19 of 125 eyes (15%, CI, 9%-24%) progressed based on SAP 24-2 MD over the 6-month clustering period. A total of 14 eyes (11%, CI, 6%-20%) progressed on SAP 10-2 MD, and 16 eyes (13%, CI, 8%-21%) progressed by RNFL thickness, with 30 of 125 eyes (24%, CI, 16%-34%) progressing by function, structure, or both. Of the 35 eyes progressing during the overall follow-up, 25 had progressed during the 6-month clustering period, for a sensitivity of 71% (CI, 53%-85%). Of the 90 eyes that did not progress during the overall follow-up, 85 also did not progress during the 6-month period, for a specificity of 94% (CI, 88%-98%). Of the 14 eyes considered fast progressors by SAP 24-2, SAP 10-2, or SD-OCT during the overall follow-up, 13 were identified as progressing during the 6-month cluster period, for a sensitivity of 93% (CI, 66%-100%) for identifying fast progression with a specificity of 85% (CI, 77%-90%).
Conclusions
Clustered testing in the Fast-PACE Study detected fast-progressing glaucoma eyes over 6 months. The methodology could be applied in clinical trials investigating interventions to slow glaucoma progression and may be of value for short-term assessment of high-risk subjects.
Financial disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.
MeSH Terms
Shields Classification
Key Concepts7
In the Fast-PACE Study, 19 of 125 eyes (15%, CI, 9%-24%) with primary open-angle glaucoma (POAG) progressed based on SAP 24-2 MD over a 6-month clustering period.
In the Fast-PACE Study, 14 eyes (11%, CI, 6%-20%) with primary open-angle glaucoma (POAG) progressed on SAP 10-2 MD over a 6-month clustering period.
In the Fast-PACE Study, 16 eyes (13%, CI, 8%-21%) with primary open-angle glaucoma (POAG) progressed by RNFL thickness over a 6-month clustering period.
In the Fast-PACE Study, 30 of 125 eyes (24%, CI, 16%-34%) with primary open-angle glaucoma (POAG) progressed by function, structure, or both over a 6-month clustering period.
In the Fast-PACE Study, the 6-month clustering period demonstrated a sensitivity of 71% (CI, 53%-85%) for identifying progression in primary open-angle glaucoma (POAG) detected during an overall mean follow-up of 25 months (35 eyes progressing during overall follow-up, 25 identified in 6 months).
In the Fast-PACE Study, the 6-month clustering period demonstrated a specificity of 94% (CI, 88%-98%) for identifying progression in primary open-angle glaucoma (POAG) detected during an overall mean follow-up of 25 months (90 eyes not progressing during overall follow-up, 85 also not progressing in 6 months).
Clustered testing in the Fast-PACE Study identified 13 of 14 eyes considered fast progressors by SAP 24-2, SAP 10-2, or SD-OCT during overall follow-up within a 6-month cluster period, demonstrating a sensitivity of 93% (CI, 66%-100%) for identifying fast progression with a specificity of 85% (CI, 77%-90%) in primary open-angle glaucoma (POAG).
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