Identifying Rapid Glaucoma Progression Using Hemifield Rates of Progression.
Leshno Ari, Li Johnny X, De Moraes Carlos Gustavo, Harizman Noga, Wang Qing, Garg Shukla Aakriti, Cioffi George A, Liebmann Jeffrey M
AI Summary
Studying glaucoma progression, hemifield rates were more sensitive than global rates, identifying more rapid progressors. This helps tailor earlier, more aggressive treatment for better patient outcomes.
Abstract
Précis: Hemifield rates of progression are more sensitive to focal progression (or faster progression) than global rates. This can aid in tailoring management and treatment decisions.
Purpose
To determine if the rate of progression (ROP) of each hemifield of the 24-2 visual field (VF) aids in the detection of rapidly progressing eyes.
Methods
In this retrospective longitudinal study, we evaluated 1658 eyes of 1658 consecutive glaucoma patients with global mean deviation (MD) VF loss between -3 and -15 dB at baseline and ≥8 reliable VF tests (Swedish Interactive Thresholding Algorithm 24-2) with over ≥3 years of follow-up. The ROP (dB/year) based on global MD, superior hemifield MD, and inferior hemifield MD was calculated. The worst hemifield ROP (ROPworst) and hemifield ROP absolute difference (ROPdiff) were determined for each eye. Eyes were categorized based on the ROP from each metric as slow (-0.5 dB/year or better), rapid (worse than -0.5 dB/year), very rapid (worse than -1.0 dB/year), and catastrophic (worse than -2.0 dB/year) progression. The rate of significant asymmetric hemifield progression rate (ROPdiff ≥0.5 dB/year) was also evaluated.
Results
On average, ROPworst was faster than ROPglobal by 0.25±0.3 dB/year ( P <0.001). Based on ROPworst, 422 eyes (25%) were classified as progressing more rapidly than the ROPglobal classification. Over 40% (153/339) of the eyes classified as rapid progressors by ROPglobal were classified as very rapid or catastrophic progressors based on ROPworst. Eyes that progressed more rapidly based on ROPworst also had a higher rate of asymmetric progression.
Conclusion
Hemifield ROPs are more sensitive to focal progression (or faster progression) than global rates and can aid in tailoring management and treatment decisions.
MeSH Terms
Shields Classification
Key Concepts5
Hemifield rates of progression (ROPworst) were on average faster than global rates of progression (ROPglobal) by 0.25±0.3 dB/year (P <0.001) in 1658 eyes of 1658 consecutive glaucoma patients with global mean deviation (MD) visual field loss between -3 and -15 dB at baseline and ≥8 reliable visual field tests over ≥3 years of follow-up.
Based on the worst hemifield rate of progression (ROPworst), 422 eyes (25%) were classified as progressing more rapidly than the global rate of progression (ROPglobal) classification in 1658 eyes of 1658 consecutive glaucoma patients with global mean deviation (MD) visual field loss between -3 and -15 dB at baseline and ≥8 reliable visual field tests over ≥3 years of follow-up.
Over 40% (153/339) of the eyes classified as rapid progressors by global rate of progression (ROPglobal) were reclassified as very rapid or catastrophic progressors based on the worst hemifield rate of progression (ROPworst) in 1658 eyes of 1658 consecutive glaucoma patients with global mean deviation (MD) visual field loss between -3 and -15 dB at baseline and ≥8 reliable visual field tests over ≥3 years of follow-up.
Eyes that progressed more rapidly based on the worst hemifield rate of progression (ROPworst) also had a higher rate of asymmetric progression in 1658 eyes of 1658 consecutive glaucoma patients with global mean deviation (MD) visual field loss between -3 and -15 dB at baseline and ≥8 reliable visual field tests over ≥3 years of follow-up.
Hemifield rates of progression are more sensitive to focal progression (or faster progression) than global rates and can aid in tailoring management and treatment decisions for glaucoma patients.
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