Glaucoma Progression Diagnosis: The Agreement between Clinical Judgment and Statistical Software.

Area of Science:

• Ophthalmology
• Medical Technology
• Data Analysis

Background:

• Glaucoma management relies on detecting visual field (VF) progression.
• Accurate assessment of VF progression is crucial for timely treatment adjustments.
• Guided Progression Analysis II (GPAII) offers a quantitative approach to evaluate VF changes.

Purpose of the Study:

• To compare the diagnostic agreement between expert clinical judgment and the GPAII software in identifying glaucoma-related VF progression.
• To assess the sensitivity and specificity of clinical judgment versus GPAII for detecting VF progression.

Main Methods:

• Three glaucoma experts and three general ophthalmologists reviewed 66 VF series, classifying them as progressive.
• Clinical judgment was compared against GPAII's event analysis (EA) and trend analysis (TA) using Cohen's statistic.
• Sensitivity and specificity of clinical judgment were calculated using GPAII results as the reference standard.

Main Results:

• Progression was identified in 39% of VF series by glaucoma experts, 38% by general ophthalmologists, 15% by GPAII EA, and 21% by GPAII TA.
• Clinical judgment showed fair to moderate agreement with GPAII (Cohen's k ranging from 0.30 to 0.51).
• Glaucoma experts exhibited higher sensitivity (90-92.8%) than general ophthalmologists (80-78.5%) in detecting progression.

Conclusions:

• The agreement between clinical judgment and GPAII for VF progression detection in glaucoma is fair to moderate.
• Glaucoma specialists possess a greater capacity than general ophthalmologists in identifying VF progression using clinical judgment.
• GPAII serves as a valuable tool, but clinical expertise remains essential in glaucoma management.