Value of 10-2 Visual Field Testing for Detecting Progression in Patients with Glaucoma

To determine the value of the 10-2 test of the Humphrey Field Analyzer (Carl Zeiss Meditec) in detecting visual field (VF) progression in early glaucoma.

Prospective longitudinal study.

Patients with open-angle glaucoma and healthy participants.

Participants were examined with the 24-2 and 10-2 tests every 4 months. Only those with 5 pairs of tests or more were included. To analyze the same area as the 10-2, only the central 12 test locations of the 24-2 test were included, from which global and quadrant mean deviation (MD) slopes and pointwise total deviation (TD) slopes were computed. A range of criteria for progression based on pointwise TD slope cutoffs was used.

Measures included the area under the receiver operating characteristic curve (AUC) separating patients with glaucoma from healthy participants for global, sectoral, and pointwise analyses and overlap in the proportion of patients identified by the 2 tests at matched specificity.

One eye each from 96 patients with glaucoma with early visual field damage and 56 healthy participants was included in the analysis. The participants were followed up for a median of 4.69 and 4.49 years with 13 and 11 pairs of tests, respectively. The AUCs of the MD slopes for the 2 tests were not significantly different for global (P = 0.25) or quadrant (P > 0.11) analysis. At 90% specificity for global MD slope, the overlap in patients classified as progressing with both tests was 53%, whereas for quadrant MD slope, the overlap was less. The AUCs were not different for pointwise slope cutoffs of more than -1.25 dB/year, but were significantly higher for the 10-2 test when cutoffs were -1.25 dB/year or less. Patients showing progression with only the 10-2 test with steeper pointwise slope cutoffs showed worse baseline MD on the 10-2, but not 24-2, test.

For global and sectoral analyses, little evidence showed that the 10-2 test provided additional information about central visual VF compared with the 24-2 test. Pointwise analyses support the use of the 10-2 test for following up patients with selectively worse central VF loss at baseline and who are at risk of faster progression.

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