Frontloading visual field tests detect earlier mean deviation progression when applied to real-world-derived...

Area of Science:

• Ophthalmology
• Medical Diagnostics
• Glaucoma Research

Background:

• Early glaucoma detection is crucial for preventing vision loss.
• Standard clinical practice typically involves one visual field (VF) test per visit.
• The diagnostic accuracy of different VF testing frequencies for early glaucoma progression remains an area of investigation.

Purpose of the Study:

• To compare the diagnostic accuracy of a frontloaded (two VF tests) versus a standard (one VF test) approach for detecting early glaucoma progression.
• To evaluate the impact of data loss rates on the detection of glaucoma progression.

Main Methods:

• A computer simulation model analyzed VF data from 10,000 glaucoma patients over 10 years.
• Data from Swedish and Canadian Glaucoma Study (CGS) cohorts were used, incorporating SITA-Faster variability.
• Simulations considered six-monthly or yearly follow-up intervals and 0%, 15%, or 30% perimetric data loss rates.

Main Results:

• The frontloaded strategy detected more glaucoma progressors than the standard method, particularly under higher data loss conditions.
• Early detection of 50% of progressors was achieved 1.0-1.5 years sooner with frontloading.
• Frontloading increased detection rates by 26.7%-32.4% at 4 years and resulted in less severe mean deviation (MD) scores.

Conclusions:

• Applying frontloaded visual field testing to clinical glaucoma data facilitates earlier detection of disease progression.
• This strategy offers a significant advantage in identifying patients who are progressing, allowing for timely intervention.
• The benefits of frontloading are more pronounced with increased rates of data loss during follow-up.