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J.C. Ramos–Esteban, A. Vedula, A. Katz, J. Myers, G.L. Spaeth, L.J. Katz; Comparison of Therapeutic Decision Making in Glaucoma with Heidelberg Retinal Tomograph (HRT) Progression Analysis and Standard Automated Perimetry . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3405.
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To compare rates of glaucomatous progression as assessed clinically with progression by masked interpretation of sequential HRTs and HVFs.
A retrospective review of glaucoma patients' charts for clinical stability or clinical progression defined as change in visual field or uncontrolled IOP and subsequent interventions including change in medications, laser or surgical therapy. Glaucoma progression or stability was also determined by three investigators masked to clinical data by assessment of HRT progression and visual fields (Humphrey Visual Field 24–2 SITA Standard). Investigators were asked to assess progression by reviewing a series of at least 3 consecutive high quality HVFs and HRTs (Standard Deviation <30). Inter–observer agreement (IOA) endpoint was defined as agreement between the 3 masked observers.
The right eyes of 147 patients, 68 males and 79 females mean age of 64.8 years (± SD 11.56) were included; 89, 12 and 46 patients had a diagnosis of POAG, ACG and glaucoma suspect respectively. Each patient underwent on average 3.08 (± SD 0.35) HVF and 3.18 (± SD 0.39) HRT tests. The average time spanned by HRT examinations was 27.8 months (± SD 6.93) and 29.29 months (± SD 7.70) for HVF. The average mean deviation on the first HVF was –3.04 (± SD 5.73) and –3.44 (± SD 3.76) for the last HVF (p=0.599). The IOA for 3 out of 3 observers was 82.5% for each series of HVF and HRT tests. 38 (25.8%) patients were considered as clinically progressed: 30 patients based on IOP (78.9%) level and 8 (21.05%) based on visual field progression. Masked HVF analysis revealed progression in 4 (10.5%) of these patients compared to 10 (9.17%) clinically stable patients. HRT progression analysis revealed glaucoma progression in 11 clinically progressing patients (28.9%) compared to 19 (17.4%) clinically stable patients.
Masked analyses of serial HRT imaging and serial HVF imaging often do not correspond to the clinical impression of the treating physician in this study of 147 eyes over 3 years. HRT progression was more predictive of clinical progression than HVF.
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