Editors Selection IGR 22-3
Clinical Examination Methods: How best to assess Visual Field loss in Glaucoma?
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The determination of structural and functional progression in glaucoma has been evaluated by many investigators,1-19 and a review of many of the procedures for visual field progression, ranging from simple to highly complex, has recently been published.1 Previous comparisons have reported large differences in the sensitivity and specificity of various procedures, and only moderate amounts of agreement among the methods that have been applied to the various procedures.2-6 Stubeda and colleagues indicate that there is currently no consensus as to which progression analysis provides the most informative information regarding visual field progression. In their recent publication, they compared five different criteria for assessing glaucomatous visual field progression by applying them to a large visual field data set that included a wide range of levels of visual field damage. The five procedures consisted of the Glaucoma Hemifield Test (GHT) criteria, the Hodapp, Anderson and Parrish2 (HAP2) criteria, the Foster (FOS) criteria, the United Kingdom Glaucoma Treatment Study (UKGTS) criteria, and the Low-pressure Glaucoma Treatment Study LoGTS) criteria. In conjunction with prior studies, the authors found that there were considerable differences in the performance of the five procedures. HAP2 and UKGTS had the highest sensitivity but low specificity, whereas LoGTS had the highest specificity but lower sensitivity. Basically, the differences were related to degree of conservative versus liberal criteria employed by the five techniques, which accounts for the variable amount of agreement among the procedures. Only 37% of the visual fields yielded positive results for all five progression analysis procedures.
These findings confirm that there is presently no consensus on a single procedure that is optimal for determining glaucomatous visual field progression. Rather than regarding this as a problem it is helpful to regard this as an opportunity for new investigators to pursue
These findings confirm that there is presently no consensus on a single procedure that is optimal for determining glaucomatous visual field progression. Rather than regarding this as a problem it is helpful to regard this as an opportunity for new investigators to pursue. Perhaps deep learning, archetypal analysis and artificial intelligence techniques will be able to provide comprehensive comparisons of the current procedures, as well as generating new approaches. In this view, it should be kept in mind that new techniques must be clinically meaningful and simple enough to be rapidly understood and useful in a busy clinical setting.
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