緑内障における視野進行基準の精密化：有意性閾値と検査頻度の影響

To assess the stability of visual field (VF) progression events and to evaluate strategies to reduce false positive progression.

Retrospective study.

2,133 eyes of 2133 patients with 12 consecutive VF tests from five NHS glaucoma clinics.

A progression event was defined as a negative slope and P value < 0.05. False positive progression events ("reversions") were defined as events where the P value fell below 0.05 at ≥ one visit and subsequently rose above 0.05 at a later time point. The impact of stricter probability thresholds (P < 0.02, 0.01 and 0.005) and event assessment at later visits on false positive progression was evaluated.

Frequency of false positive progression events.

457 (21.4%) eyes had at least one reversion at the P < 0.05 threshold, for a median interval of two visits. The mean rate of change at the time of apparent progression was -1.05 dB/year (95% CI -1.19 to -0.92 dB/year). The proportions of eyes with false positive progression events were significantly lower at stricter probability thresholds (13.7%, 9.9% and 7.7% at P < 0.02, < 0.01 and < 0.005 respectively, P < 0.001). Using stricter thresholds conferred significantly lower hazards of false positive progression (HR 0.60 for p < 0.02, 0.42 for p < 0.01, and 0.38 for p < 0.005; all p < 0.001).

A substantial proportion of apparent progression at the established P < 0.05 threshold may be falsely positive. Using stricter probability thresholds and initiating event detection at later visits may improve progression specificity in clinical practice.