title: Predicting progression of glaucoma from rates of frequency doubling technology perimetry change.
abstract: OBJECTIVE
  To evaluate the ability of longitudinal frequency doubling technology (FDT) to predict the development of glaucomatous visual field loss on standard automated perimetry (SAP) in glaucoma suspects.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  The study included 587 eyes of 367 patients with suspected glaucoma at baseline selected from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). These eyes had an average of 6.7 ± 1.9 FDT tests during a mean follow-up time of 73.1 ± 28.0 months.
  
  
  METHODS
  Glaucoma suspects had intraocular pressure (IOP) >21 mmHg or an optic disc appearance suspicious of glaucoma. All patients had normal or nonrepeatable abnormal SAP at baseline. Humphrey Matrix FDT (Carl Zeiss Meditec, Inc, Dublin, CA) testing was performed within 6 months of SAP testing. The study end point was the development of 3 consecutive abnormal SAP test results. Joint longitudinal survival models were used to evaluate the ability of rates of FDT pattern standard deviation (PSD) change to predict the development of visual field loss on SAP, adjusting for confounding variables (baseline age, mean IOP, corneal thickness, and follow-up measurements of SAP PSD).
  
  
  METHODS
  The R(2) index was used to evaluate and compare the predictive abilities of the model containing longitudinal FDT PSD data with the model containing only baseline data.
  
  
  RESULTS
  Sixty-three of 587 eyes (11%) developed SAP visual field loss during follow-up. The mean rate of FDT PSD change in eyes that developed SAP visual field loss was 0.07 dB/year versus 0.02 dB/year in those that did not (P < 0.001). Baseline FDT PSD and slopes of FDT PSD change were significantly predictive of progression, with hazard ratios of 1.11 per 0.1 dB higher (95% confidence interval [CI], 1.04-1.18; P = 0.002) and 4.40 per 0.1 dB/year faster (95% CI, 1.08-17.96; P = 0.04), respectively. The longitudinal model performed significantly better than the baseline model with an R(2) of 82% (95% CI, 74-89) versus 11% (95% CI, 2-24), respectively.
  
  
  CONCLUSIONS
  Rates of FDT PSD change were highly predictive of the development of SAP visual field loss in glaucoma suspects. This finding suggests that longitudinal FDT evaluation may be useful for risk stratification of patients with suspected glaucoma.
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California; Department of Ophthalmology, Federal University of São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Meira-Freitas
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatham
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California; Department of Ophthalmology, Federal University of São Paulo, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Lisboa
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tung-Mei
authors.initials: TM
authors.lastname: Kuang
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Zangwill
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Weinreb
authors.affiliation: Department of Ophthalmology, University of Alabama, Birmingham, Alabama.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Girkin
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.affiliation: Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California. Electronic address: fmedeiros@glaucoma.ucsd.edu.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Medeiros
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields; D044465:White People