title: Refinement of pointwise linear regression criteria for determining glaucoma progression.
abstract: OBJECTIVE
  A variety of pointwise linear regression (PLR) criteria have been proposed for determining glaucomatous visual field progression. However, alternative PLR criteria have only been assessed on a limited basis. The purpose of this study was to evaluate a range of PLR slope and significance criteria to define a clinically useful progression decision rule for longitudinal visual field examinations.
  
  
  METHODS
  Visual field data for each of 140 eyes (one per participant among 96 cases and 44 controls) were evaluated using the Humphrey Field Analyzer II program 24-2 Swedish interactive thresholding algorithm standard test strategy and Goldmann size III stimuli. The pointwise linear regression A2 (PLRA2) method was used to analyze the data, which included nine visual field examinations performed every 6 months for 4 years. Data from the Ocular Hypertension Treatment Study (OHTS) were used to validate the decision rule.
  
  
  RESULTS
  Several slope criteria produced specificities of 0.90 or higher, particularly slope criteria of less than -1.2 dB/y. The use of the slope criterion less than -1.2 dB/y at a significance level of P < 0.04 for classification resulted in a hit rate of 0.38, more than a 2-fold increase compared with a commonly used standard slope criterion of less than -1.0 dB/y at a significance level of P < 0.01. A similar increase in the hit rate was shown for a slope of less than -1.2 dB/y and P < 0.04 compared with the standard criterion in the independent OHTS validation data.
  
  
  CONCLUSIONS
  When systematically evaluating criteria for detecting glaucoma progression, PLR criteria can be refined by requiring a stricter slope criterion such as less than -1.2 dB/y and relaxing the significance criterion to P < 0.04. Increasing the hit rate of PLR will be useful for early detection and treatment of glaucoma.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Kummet
authors.forename: K D
authors.initials: KD
authors.lastname: Zamba
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Doyle
authors.forename: Chris A
authors.initials: CA
authors.lastname: Johnson
authors.forename: Michael
authors.initials: M
authors.lastname: Wall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D058609:Visual Field Tests; D014794:Visual Fields
keywords: glaucoma progression; perimetry; pointwise linear regression; trend analysis; visual field
references.citation: Ophthalmology. 1997 Aug;104(8):1228-36
references.pmid: 9261308
references.citation: Acta Ophthalmol (Copenh). 1982 Apr;60(2):267-74
references.pmid: 7136538
references.citation: Invest Ophthalmol Vis Sci. 2000 Jul;41(8):2192-200
references.pmid: 10892862
references.citation: Br J Ophthalmol. 1996 Jan;80(1):40-8
references.pmid: 8664231
references.citation: Br J Ophthalmol. 2000 Oct;84(10):1154-8
references.pmid: 11004102
references.citation: Prog Retin Eye Res. 2005 May;24(3):333-54
references.pmid: 15708832
references.citation: Arch Ophthalmol. 2005 Feb;123(2):193-9
references.pmid: 15710815
references.citation: Ophthalmology. 2004 Sep;111(9):1627-35
references.pmid: 15350314
references.citation: Invest Ophthalmol Vis Sci. 2002 May;43(5):1400-7
references.pmid: 11980853
references.citation: Ophthalmology. 1999 Nov;106(11):2144-53
references.pmid: 10571351
references.citation: Invest Ophthalmol Vis Sci. 2003 Sep;44(9):3873-9
references.pmid: 12939303
references.citation: Invest Ophthalmol Vis Sci. 2012 Oct 01;53(11):6776-84
references.pmid: 22952123
references.citation: Arch Ophthalmol. 2007 Sep;125(9):1176-81
references.pmid: 17846355
references.citation: Am J Ophthalmol. 2003 Nov;136(5):949-50
references.pmid: 14597063
references.citation: Ophthalmology. 1995 Aug;102(8):1227-34; discussion 1234-5
references.pmid: 9097752
references.citation: Surv Ophthalmol. 2007 Mar-Apr;52(2):156-79
references.pmid: 17355855
references.citation: Graefes Arch Clin Exp Ophthalmol. 1996 Jul;234(7):411-8
references.pmid: 8817283
references.citation: Br J Ophthalmol. 1997 Dec;81(12):1037-42
references.pmid: 9497460
references.citation: Br J Ophthalmol. 2003 Jun;87(6):726-30
references.pmid: 12770970
references.citation: Ophthalmology. 1997 May;104(5):808-15
references.pmid: 9160027
references.citation: Br J Ophthalmol. 2001 Jun;85(6):696-701
references.pmid: 11371491
references.citation: Acta Ophthalmol Scand. 1997 Aug;75(4):368-75
references.pmid: 9374242
references.citation: Invest Ophthalmol Vis Sci. 2012 Jan 25;53(1):224-7
references.pmid: 22159015
references.citation: Arch Ophthalmol. 1999 May;117(5):573-83
references.pmid: 10326953
references.citation: Arch Ophthalmol. 1999 Jan;117(1):24-33
references.pmid: 9930157
references.citation: Br J Ophthalmol. 1998 Sep;82(9):1097-8
references.pmid: 9893615
references.citation: Eye (Lond). 1994;8 ( Pt 1):117-20
references.pmid: 8013703
references.citation: Clin Exp Ophthalmol. 2012 May-Jun;40(4):369-80
references.pmid: 22339936
references.citation: Invest Ophthalmol Vis Sci. 2000 Jun;41(7):1783-90
references.pmid: 10845599
references.citation: Ophthalmology. 1997 Jun;104(6):1017-25
references.pmid: 9186444