Detecting Change Using Standard Global Perimetric Indices in Glaucoma.
Gardiner Stuart K, Demirel Shaban
AI Summary
This study found Mean Deviation (MD) detects glaucoma progression significantly sooner than Visual Field Index (VFI) or Pattern Standard Deviation (PSD), especially in early follow-up, making MD a more sensitive clinical indicator.
Abstract
Purpose
Various global indices are available to summarize results from standard automated perimetry. This study asks which index can detect significant deterioration earliest, for a fixed specificity.
Design
Comparison of prognostic indices.
Methods
Two cohorts were tested. A test-retest cohort contained 5 reliable visual fields, within a short interval, from 45 eyes of 23 participants with glaucoma and/or likelihood of developing glaucoma. A separate longitudinal cohort contained 508 eyes from 330 participants, tested on average 13 times. Three global indices were extracted: mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). For each index we defined a critical P value Crit Index , such that 5% of test-retest series showed significant deterioration with P < Crit Index , using artificial "test dates" in random order. Therefore these criteria have 95% specificity over series of 5 tests. The times to detect significant deterioration in the longitudinal cohort were compared using a survival analysis model.
Results
The median time to detect significant deterioration with MD was 7.3 years (95% confidence interval [CI] 6.8-7.9 years). For VFI, the median was 8.5 years (95% CI 7.9-9.0 years); this comparison had P = .088. For PSD, the median was 10.5 years (95% CI 9.3-11.7 years), slower than MD with P < .001. Within the first 5 years of a series, MD detected significant deterioration in 138 eyes, vs 104 for VFI (P = .0013) and 107 for PSD (P = .029).
Conclusions
MD detected significant deterioration sooner than VFI or PSD. In particular, MD detected more eyes in the first 5 years of their follow-up, which were presumably undergoing more rapid progression.
MeSH Terms
Shields Classification
Key Concepts6
In a study comparing prognostic indices for glaucoma, the median time to detect significant deterioration with mean deviation (MD) was 7.3 years (95% confidence interval [CI] 6.8-7.9 years).
In a study comparing prognostic indices for glaucoma, the median time to detect significant deterioration with visual field index (VFI) was 8.5 years (95% CI 7.9-9.0 years), which was not significantly different from mean deviation (MD) (P = .088).
In a study comparing prognostic indices for glaucoma, the median time to detect significant deterioration with pattern standard deviation (PSD) was 10.5 years (95% CI 9.3-11.7 years), which was significantly slower than mean deviation (MD) (P < .001).
In a study comparing prognostic indices for glaucoma, within the first 5 years of follow-up, mean deviation (MD) detected significant deterioration in 138 eyes, which was significantly more than visual field index (VFI) (104 eyes; P = .0013) and pattern standard deviation (PSD) (107 eyes; P = .029).
A study comparing prognostic indices for glaucoma used a longitudinal cohort of 508 eyes from 330 participants, tested on average 13 times, to assess the time to detect significant deterioration.
A study comparing prognostic indices for glaucoma established critical P values for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI) such that 5% of test-retest series showed significant deterioration, ensuring 95% specificity over series of 5 tests.
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