title: Glaucoma Progression Analysis software compared with expert consensus opinion in the detection of visual field progression in glaucoma.
abstract: OBJECTIVE
  To compare the results of Glaucoma Progression Analysis (GPA, Carl Zeiss Meditec, Dublin, CA) to subjective expert consensus in the detection of glaucomatous visual field progression.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  We included 100 eyes of 83 glaucoma patients.
  
  
  METHODS
  Five serial Humphrey visual fields from 100 eyes of 83 glaucoma patients were evaluated by 5 masked glaucoma subspecialists for determination of progression. Four months later, with a randomly reordered patient sequence, the same visual field series were reevaluated by the same graders, at which time they had access to the Glaucoma Progression Analysis (GPA) printout.
  
  
  METHODS
  The level of agreement between majority expert consensus and GPA, both before and after access to GPA data, was assessed using kappa statistics.
  
  
  RESULTS
  On initial review and on reevaluation with access to the GPA printout, the level of agreement between majority expert consensus and GPA was fair (kappa = 0.52, 95% confidence interval [CI], 0.35-0.69 and kappa = 0.62; 95% CI, 0.46-0.78, respectively). Expert consensus was more likely to classify a series of fields as showing progression than was GPA (P ≤ 0.002). There was good agreement between expert consensus on initial review and reevaluation 4 months later (kappa = 0.77; 95% CI, 0.65-0.90).
  
  
  CONCLUSIONS
  The level of agreement between majority expert consensus of subjective determination of visual field progression and GPA is fair. In cases of disagreement with GPA, the expert consensus classification was usually progression. Access to the results of GPA did not significantly change the level of agreement between expert consensus and the GPA result; however, expert consensus did change in 11 of 100 cases.
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Tanna
authors.forename: Donald L
authors.initials: DL
authors.lastname: Budenz
authors.forename: Jagadeesh
authors.initials: J
authors.lastname: Bandi
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.forename: Robert M
authors.initials: RM
authors.lastname: Feldman
authors.forename: Leon W
authors.initials: LW
authors.lastname: Herndon
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Rhee
authors.forename: Julia
authors.initials: J
authors.lastname: Whiteside-de Vos
authors.forename: Joyce
authors.initials: J
authors.lastname: Huang
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Anderson
mesh_terms: D018450:Disease Progression; D005103:Expert Systems; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D009798:Ocular Hypertension / Q000175:diagnosis / Q000503:physiopathology; D009885:Ophthalmology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software; D014065:Tonometry, Ocular; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D058609:Visual Field Tests; D014794:Visual Fields