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Evaluating Visual Field Progression in Advanced Glaucoma Using Trend Analysis of Targeted Mean Total Deviation.
Atsuya Miki1,2, Tomoyuki Okazaki1, Robert N Weinreb3
1Departments of Ophthalmology.
Journal of Glaucoma
|January 12, 2022
Summary
Glaucoma progression may be underestimated in severe cases. Analyzing visual field data excluding undetectable points, using targeted mean total deviation, offers a more accurate assessment of disease progression.
Area of Science:
- Ophthalmology
- Medical Technology
- Clinical Research
Background:
- Glaucoma is a progressive optic neuropathy.
- Visual field (VF) testing is crucial for monitoring glaucoma.
- Current trend analysis of global indices may miss progression in severe disease.
Purpose of the Study:
- To test if trend analysis of visual field global indices underestimates progression in severe glaucoma.
- To compare VF progression rates with and without exclusion of undetectable points.
Main Methods:
- Retrospective analysis of 648 eyes from 366 glaucoma patients with >2 years of 30-2 standard automated perimetry.
- Calculation of targeted mean total deviation (TMTD) excluding consistently undetectable points.
- Classification of disease severity (early, moderate, advanced, severe) based on baseline mean deviation (MD).
Main Results:
- The mean deviation (MD) slope in severe glaucoma (-0.34 dB/y) was significantly slower than the targeted mean total deviation (TMTD) slope (-0.42 dB/y).
- This underestimation was most prominent in eyes with MD < -25 dB.
- The difference between MD and TMTD slopes was significant in severe glaucoma (P=0.028).
Conclusions:
- Undetectable visual field locations can lead to underestimation of glaucoma progression rates, particularly in severe stages.
- Trend analysis using TMTD provides a more accurate and practical method for assessing progression in severe glaucoma.
- Excluding undetectable points improves the reliability of visual field progression monitoring.
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