Progression of advanced glaucoma is best detected at the edges of deep defects on 10-2 visual fields

Abstract

Purpose : To develop a method for detecting the progression of advanced glaucoma based upon the edges of deep defects seen on 10-2 visual fields (VFs).

Methods : A group of 31 eyes (25 patients) with advanced glaucoma (AG_vf), defined based upon a 24-2 mean deviation (MD) worse than -12 dB, with 3 or more 10-2 VFs were included. Their 24-2 MD ranged from -12.2 to -24.9 dB (mean: -15.7 ± 2.9 dB); the number of 10-2 VFs ranged from 3 to 10 (median: 4); and the time between first and last test ranged from 11 to 85 months (mean: 31.4 ± 20.2 months). Figure 1A,B shows the first and last 10-2 total deviation plots for one of these eyes. A deep defect was defined as 4 or more contiguous points that were -10 dB or worse on total deviation maps (blue circles in Fig. 1A). The border between the deep defect and the adjacent points better than -10 dB (red circles in Fig. 1A) was marked on the earliest (baseline) 10-2 VF (red line in Fig. 1A). The mean dB value of these red points (MD_edge) was determined for each defect, and the rate of change over time (i.e. slope) was calculated for both MD_edge and 10-2 MD of each eye (Fig. 1C). The progression of these MD_edge values was compared to change in 10-2 MD using two methods: 1. the number of negative vs. positive slopes, and 2. the slopes from a mixed effects model.

Results : Of the 31 eyes, 30 had deep defects in one (17 eyes) or both (13 eyes) hemifields. Of these 43 defects, the number of negative slopes, 32, was almost 3 times the number, 11, of positive slopes. For the 10-2 MD, the number of negative slopes, 20, was 2 times the number, 10, of positive slopes. Using a mixed effects model with fixed slopes and random intercepts, the edge mean decreases at a significant 1.31 dB/year faster than the 10-2 MD (p<0.001), while the 10-2 MD did not have a slope significantly different from 0 (-0.18 dB/year, p=0.466).

Conclusions : A method for detecting the progression of advanced glaucoma based upon the edges of deep defects seen on 10-2 VFs shows promise as a possible endpoint for clinical trials in glaucoma.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.