A Staged Approach to the Number and Frequency of Visual Field Testing for Detecting Glaucoma Progression.

Area of Science:

• Ophthalmology and Visual Science
• Medical Technology and Innovation
• Public Health and Epidemiology

Background:

• Glaucoma is a leading cause of irreversible blindness worldwide.
• Early detection of glaucoma progression is crucial for timely intervention and vision preservation.
• Current fixed visual field (VF) review schedules may not be optimal for identifying rapid or catastrophic progression.

Purpose of the Study:

• To evaluate a novel staged visual field review model for detecting glaucoma progression.
• To compare the staged model's efficacy against traditional fixed review approaches.
• To assess the model's ability to detect catastrophic and fast glaucoma progression rates.

Main Methods:

• A computer simulation study involving 100,000 subjects over 30 years.
• Simulated subjects underwent visual field (VF) testing at varying frequencies.
• A staged model initiated intensive testing, downtitrated based on detected progression rates, compared against fixed schedules (e.g., annual, semi-annual testing).

Main Results:

• Staged review models detected 90% of catastrophic and fast progression bins significantly sooner than most fixed methods.
• 50% of all progressors were detected earlier with staged approaches compared to fixed methods.
• The most efficient staged intervals (two tests every 3-6 months) showed the lowest number of visits and tests per detected progression case.

Conclusions:

• A staged visual field review model, initiating with intensive testing and downtitrating over time, enhances the detection of glaucoma progressors.
• This model offers potential long-term efficiencies in case detection compared to conventional fixed review strategies.
• Intensive initial testing (e.g., two tests every 3-6 months) followed by downtitration appears most effective.