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Abstract #99322 Published in IGR 22-4

The 24-2 visual field Guided Progression Analysis can miss progression of glaucomatous damage of the macula seen with OCT

Hood DC; La Bruna S; Tsamis E; Tsamis E; Tsamis E; Leshno A; Melchior B; Grossman J; Liebmann JM; De Moraes CG
Ophthalmology. Glaucoma 2022; 5: 614-627

See also comment(s) by Angelo Tanna

METHODS: All eyes had at least 4 OCT and VF test dates over a period that ranged from 12 to 59 months. The 24-2 VF tests included two baseline tests and at least two follow-up tests. The two baseline tests were within an average of 5.6 days (median of 7 days), and the last follow-up test occurred at least 1 year after the first baseline visit. MAIN OUTCOME MEASURES: The commercial 24-2 GPA software, with default settings, characterized eyes as "Likely Progression" (LP) and "Possible Progression" (PP); both were considered "progressing" for this analysis. For a reference standard (RS), 3 authors graded progression using strict criteria and a combination of a custom OCT progression report, and the commercial 24-2 and 10-2 GPA reports for the same test dates as the GPA. RESULTS: The RS identified 10 (14%) of the 70 patient eyes, and none of the HC eyes, as progressing. The 24-2 GPA identified 13 of the 70 patient eyes as progressing (PP or LP). However, it correctly classified only 4 (40%) of the 10 RS progressors. All 6 of the RS progressors missed by the 24-2 GPA showed progression in the macula. In addition, the 24-2 GPA identified 2 of the 29 HC eyes as progressors, as well as 9 patient eyes without progression based upon the RS. CONCLUSION: In eyes with early glaucoma (i.e., 24-2 MD >-6dB) in this study, the 24-2 GPA missed progression seen with OCT and exhibited a relatively high rate of false positives. Furthermore, the region progressing typically included the macula. The results suggest that including OCT and/or 10-2 visual fields should improve detection of progression.

Department of Psychology, Columbia University, New York, NY, USA; Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA. Electronic address:

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