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J. Bardavio, B. Martín, M. Ayala, A. Morilla, A. Anton; Glaucoma Progression Detection: Expert Visual Field Evaluation, Glaucoma Progression Analysis I and II Comparison. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2226.
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to compare the ability to detect progression of three different
expert visual field evaluation, Glaucoma Progression Analysis (GPA) by event (GPA I) and tendency (GPA II) algorithms of the Humphrey Visual Field Analyzer (HVFA)Methods: fifty four eyes with diagnosis of open angle glaucoma were recruited from 2000 until 2004 in a prospective study. All patients were examined by static perimetry (HVFA, 24-2 SITA Standard) six monthly being followed for no less than 36 months. The two tests chosen as GPA baseline required a maximum time difference of four months, less than 30% fixation losses, 30% false negative or 15% false positive errors.Main outcome measures; presence or absence of progression as evaluated subjectively by experts instructed to follow the European Glaucoma Society Guidelines, where progression required confirmation in at least two fields; presence, suspicion or absence of progression evaluated by the GPA I algorithm where two black triangles with in the same scotoma were considered suspicious and three black triangles were considered progression; presence or absence of a significant tendency of the Visual Field Index (VFI) analyzed by the GPA II algorithm, a significant tendency was considered when VFI was worse than -1,3% per year with a standard deviation inferior to 3,5%. Coincidence in detection of progression was studied
thirty-eight series of visual fields were finally considered. Sixteen were disregarded due to low reliability or baseline unavailability. Twenty-eight patients (73,7%) showed no progression by any method. Ten patients (26,3%) showed progression by one method or more. Three patients (7,8%) were detected by all three methods. Six patients were detected by both GPA I and expert evaluation (k=0.29). Four patients were detected by VFI significant change and GPA I (k=0.04). Four patients were detected by VFI significant change and expert evaluation (k=0.04). Two further patients showed VFI significant change alone
event and tendency progression detection algorithms agreement was poor. Combination of methods may increase the clinical relevance of the findings in both progressing and non-progressing patients
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