Multiple (frontloaded) visual field tests increase identification of very slow mean deviation progression in glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Visual Field Testing

Background:

• Glaucoma is a progressive optic neuropathy characterized by visual field (VF) loss.
• Early and accurate detection of glaucoma progression is crucial for timely intervention.
• Current methods may have limitations in detecting slow progression rates.

Purpose of the Study:

• To evaluate the impact of frontloading (multiple) VF tests per visit on detecting mean deviation (MD) change in slowly progressive glaucoma.
• To compare the efficacy of frontloading versus single VF testing in identifying glaucoma progression.

Main Methods:

• A computer simulation study involving 10,000 patients with simulated baseline MD and progression rates.
• Simulated VF tests over up to 10 years, incorporating progression and variability.
• Independent variables included number of VF tests per visit (one vs. two), VF reliability, repeat testing, and follow-up interval (6-monthly vs. yearly).

Main Results:

• Frontloading identified significantly more progressors (62.7%-79.2%) compared to non-frontloading (31.0%-36.7%) at 10 years (p < 0.0001).
• Six-monthly follow-ups enhanced detection rates compared to yearly intervals.
• While non-frontloading detected some progressors slightly sooner, the difference was not clinically significant.

Conclusions:

• Frontloading VF tests at 6-monthly intervals substantially improves the detection rate of MD progression in slowly progressive glaucoma.
• This strategy offers a more sensitive approach compared to single VF tests per visit at yearly intervals.