Measuring visual field progression in the Early Manifest Glaucoma Trial

The Early Manifest Glaucoma Trial (EMGT) (316 eligible eyes) has used a new set of criteria to define visual field progression in glaucoma. This paper provides estimates of the amount of visual field worsening required to reach the EMGT definition of definite perimetric progression.

In the 148 eyes that reached definite progression, we first determined changes between baseline and the time of definite EMGT progression, both for mean deviation (MD) and for number of highly (p < 0.5%) significantly depressed test points in pattern deviation probability maps. Second, we studied whether such changes depended on baseline MD, intraocular pressure (IOP), age and time to progression, all of which are factors that affect the rate of field progression.

In eyes reaching progression, the mean change in MD from baseline was -1.93 dB (SE +/- 0.20) and the mean change in number of significant points was +4.85 (SE +/- 0.35). These changes did not show linear dependency on baseline MD, IOP or time to progression.

The average amount of field deterioration needed to reach EMGT visual field progression has been measured and expressed in more conventional units (i.e. a loss of about - 2dB in MD and an increase in about five highly significant points). These estimates will facilitate the clinical interpretation of the results of EMGT.