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Fei Yu, Nariman Nassiri, Naveed Nilforushan, Sasan Moghimi, Dennis Mock, Shane Knipping, Simon K. Law, Joseph Caprioli, Anne L. Coleman; Comparison of Visual Field Progression Between Mean Deviation, Visual Field Index, GPA, CIGTS and AGIS Indices in Patients with Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):193.
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To estimate the level of agreement between mean deviation (MD), visual field index (VFI), guided progression analysis (GPA), Advanced Glaucoma Intervention (AGIS), and the Collaborative Initial Glaucoma Treatment Study (CIGTS) in evaluating global rate of progression of functional damage of glaucomatous neuropathy.
In this retrospective longitudinal study, 157 eyes (127 patients) with primary open angle glaucoma (mean (±SD) age of 69.1± 10.5 years) from the clinical glaucoma database of the Jules Stein Eye Institute were included. The inclusion criteria were age more than 30 years old; baseline best-corrected visual acuity (BCVA) better than 20/80; more than 5 years follow-up and availability of 7 or more reliable visual field exams. Reliability of visual field exams were defined as fixation loss <25%, false positive and negative < 15%. Global progression for MD, VFI, CIGTS and AGIS including all exams were calculated with linear regression analysis. Progression with MD, VFI, CIGTS and AGIS was considered as statistically significant worsening slopes at P value < 0.05, and with GPA was defined as the first time that "likely progression" was flagged. The level of agreement in VF progression among indices was assessed using kappa statistics.
The average (± SD) number of VFs and follow-up time were 10.4 (± 2.6) and 8.5 (± 2.5) years, respectively. The number of eyes showing progression with GPA, MD, VFI, CIGTS, AGIS was 60 (38.2%), 63 (40.1%), 77 (49.0%), 53 (33.8%) and 40 (25.5%), respectively. The agreement of GPA with MD, VFI, CIGTS and AGIS was 0.40, 0.42, 0.24 and 0.21, respectively. The agreement of MD vs. VFI, MD vs. CIGTS, MD vs. AGIS, VFI vs. CIGTS, VFI vs. AGIS and CIGTS vs. AGIS was 0.54, 0.51, 0.42, 0.49, 0.37 and 0.32, respectively. Only 15 eyes showed progression with all indices.
We found that there was a mild to moderate agreement among different indices of visual field progression. This makes comparison of studies using different indices difficult and points to the need for consensus on visual field progression.
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