Glaucoma progression detection: agreement, sensitivity, and specificity of expert visual field evaluation, event analysis, and trend analysis.
OBJECTIVE
To assess sensitivity, specificity, and agreement among automated event analysis, automated trend analysis, and expert evaluation to detect glaucoma progression.


METHODS
This was a prospective study that included 37 eyes with a follow-up of 36 months. All had glaucomatous disks and fields and performed reliable visual fields every 6 months. Each series of fields was assessed with 3 different methods: subjective assessment by 2 independent teams of glaucoma experts, glaucoma/guided progression analysis (GPA) event analysis, and GPA (visual field index-based) trend analysis. Kappa agreement coefficient between methods and sensitivity and specificity for each method using expert opinion as gold standard were calculated.


RESULTS
The incidence of glaucoma progression was 16% to 18% in 3 years but only 3 cases showed progression with all 3 methods. Kappa agreement coefficient was high (k=0.82) between subjective expert assessment and GPA event analysis, and only moderate between these two and GPA trend analysis (k=0.57). Sensitivity and specificity for GPA event and GPA trend analysis were 71% and 96%, and 57% and 93%, respectively.


CONCLUSIONS
The 3 methods detected similar numbers of progressing cases. The GPA event analysis and expert subjective assessment showed high agreement between them and moderate agreement with GPA trend analysis. In a period of 3 years, both methods of GPA analysis offered high specificity, event analysis showed 83% sensitivity, and trend analysis had a 66% sensitivity.
Hospital de l'Esperança, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain; and Institut Català de Retina, Barcelona, Spain. anton@icrcat.com
Alfonso
A
Antón
Marta
M
Pazos
Belén
B
Martín
José Manuel
JM
Navero
Miriam Eleonora
ME
Ayala
Marta
M
Castany
Patricia
P
Martínez
Javier
J
Bardavío
D018450:Disease Progression; D017889:Exfoliation Syndrome / Q000175:diagnosis; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014065:Tonometry, Ocular; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests; D014794:Visual Fields