advertisement
Editors Selection IGR 25-1
Clinical Examination Methods: Could a "central 24-2 index" replace a 10-2 test?
Comment by Zhi Wu on:
122394 Enhancing Detection of Glaucoma Progression: Utility of 24-2 Visual Field Central Points vs. 10-2 Visual Fields, Ashrafkhorasani M; Besharati S; Mohammadzadeh V et al., Ophthalmology. Glaucoma, 2024; 0:
Preserving the central visual field (VF) is crucial to preventing functional disability in glaucoma. This study examined if the mean deviation (MD) derived from the central 12 points (or 10º radius) of 24-2 VFs (termed “MD12”) can “enhance detection of disease progression in the macular region” compared to MD from the entire 10-2 and 24-2 VF.
The authors reported that there was “a low level of agreement” in the rate of change in MD12 and 10-2 MD (correlation coefficient = 0.49), and in the eyes showing a significant negative slope. Specifically, of the 33 eyes with a significant negative MD12 or 10-2 MD slope, only one-third was detected by both parameters (whilst one-third each was detected by MD12 and 10-2 MD only). The authors thus conclude that evaluating MD12 does not “replace the need for 10-2 VF MD to monitor central damage”. Is this a valid inference of the data? Large measurement variability is an inherent characteristic of subjective VF tests. To appropriately conclude that 10-2 VF tests cannot be replaced, one would need to show that the agreement between the 10-2 MD and MD12 is lower than with measurement variability alone. This could be evaluated with test-retest data, or with careful computer simulations using paired clinical data.1 This study reported instead that more eyes had a significant negative slope with MD12 than 10-2 MD (35% vs. 30% respectively), when using permutation analyses to achieve matched specificities.
Substituting 24-2 VFs with 10-2 VFs could delay detection of disease progression more broadly,2without providing meaningful gains in detecting central VF progression
Substituting 24-2 VFs with 10-2 VFs could delay detection of disease progression more broadly,2 without providing meaningful gains in detecting central VF progression. It thus remains prudent to consider the conclusion of the recent American Academy of Ophthalmology report3: “Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma.” Careful review of central 24-2 VF sensitivities also remains critical clinically, until device manufacturers incorporate the simple-to-derive MD12 measure in their progression analysis software.4
References
- Wu Z, Medeiros FA, Weinreb RN, Girkin CA, Zangwill LM. Comparing 10-2 and 24-2 Visual Fields for Detecting Progressive Central Visual Loss in Glaucoma Eyes with Early Central Abnormalities. Ophthalmology Glaucoma 2019;2:95-102.
- Wu Z, Saunders LJ, Daga FB, Diniz-Filho A, Medeiros FA. Frequency of Testing to Detect Visual Field Progression Derived Using a Longitudinal Cohort of Glaucoma Patients. Ophthalmology 2017;124:786-92.
- WuDunn D, Takusagawa HL, Rosdahl JA, et al. Central Visual Field Testing in Early Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024;131:240-8.
- Jackson AB, Martin KR, Coote MA, et al. Fast Progressors in Glaucoma: Prevalence Based on Global and Central Visual Field Loss. Ophthalmology 2023;130:462-8.
Comments
The comment section on the IGR website is restricted to WGA#One members only. Please log-in through your WGA#One account to continue.Log-in through WGA#One
