Monitoring glaucomatous progression using a novel Heidelberg Retina Tomograph event analysis.

PURPOSE To describe an event analysis (EA) for monitoring Heidelberg Retina Tomograph (HRT) progression and to establish specificity, detection rate, and agreement with visual field progression by application to longitudinal data. DESIGN Retrospective analysis of data from a randomized controlled trial. PARTICIPANTS One hundred ninety-eight ocular hypertensive and 21 control subjects. METHODS Change criteria were derived from rim area (RA) repeatability coefficients for different levels of image quality. Event analysis 1 (EA1) through EA4 were applied to longitudinal series of HRT images acquired from the ocular hypertensive and the control cohorts: EA1 (change confirmed in 2 of 3 consecutive tests in 1 or more sector), EA2 (2 of 3 in 2 or more sectors), EA3 (3 of 3 in 1 or more sector), EA4 (3 of 3 in 2 or more sectors). Specificity (1 minus false positive results) was estimated by the proportions of progressing controls and significantly improving subjects. Progression rates were compared with Advanced Glaucoma Intervention Study (AGIS) visual field (VF) criteria, an HRT trend analysis, and a VF trend analysis, with specificity matched at 95%. MAIN OUTCOME MEASURES Estimated specificity, progression rate, and agreement between progression techniques. RESULTS Specificity estimates were 76.2% to 88.1% (EA1), 94.1% to 95.2% (EA2), 92.2% to 95.2% (EA3), and 99.1% to 100% (EA4). Of ocular hypertensive (OHT) subjects, 45.4%, 28.3%, 26.3%, and 16.2% were identified as progressing by each strategy, respectively. With specificity at 95%, 12.1% of OHT subjects progressed by both EA2 and AGIS criteria, with a median time to progression of 3.2 and 3.6 years, respectively. By EA2 alone, 16.2% progressed, and 9.6% progressed by AGIS criteria alone. The RA trend analysis identified 12% of OHT subjects as progressing. CONCLUSIONS The HRT EA represents a simple technique, taking into account image quality. In this cohort, it had a higher detection rate of progression, at 95% specificity, than RA trend analysis and the VF progression criteria.

[1]  J. Tan,et al.  Variability across the optic nerve head in scanning laser tomography , 2003, The British journal of ophthalmology.

[2]  Chris A. Johnson,et al.  The Relationship Between Structural and Functional Alterations in Glaucoma: A Review , 2000, Seminars in ophthalmology.

[3]  Yasuo Ohashi,et al.  Statistical evaluation of the diagnostic accuracy of methods used to determine the progression of visual field defects in glaucoma. , 2004, Ophthalmology.

[4]  D. Garway-Heath,et al.  Factors affecting the test-retest variability of Heidelberg retina tomograph and Heidelberg retina tomograph II measurements , 2005, British Journal of Ophthalmology.

[5]  Paul H Artes,et al.  Visual field progression in glaucoma: total versus pattern deviation analyses. , 2005, Investigative ophthalmology & visual science.

[6]  A. Sommer,et al.  Estimating progression of visual field loss in glaucoma. , 1997, Ophthalmology.

[7]  J. Katz,et al.  Scoring systems for measuring progression of visual field loss in clinical trials of glaucoma treatment. , 1999, Ophthalmology.

[8]  A C Viswanathan,et al.  Detection of optic disc change with the Heidelberg retina tomograph before confirmed visual field change in ocular hypertensives converting to early glaucoma , 1999, The British journal of ophthalmology.

[9]  D. Garway-Heath,et al.  Reasons for rim area variability in scanning laser tomography. , 2003, Investigative ophthalmology & visual science.

[10]  Roger A Hitchings,et al.  Approach for identifying glaucomatous optic nerve progression by scanning laser tomography. , 2003, Investigative ophthalmology & visual science.

[11]  Chris A. Johnson,et al.  Comparison of different methods for detecting glaucomatous visual field progression. , 2003, Investigative ophthalmology & visual science.

[12]  Douglas Hoffman,et al.  Pointwise linear regression for evaluation of visual field outcomes and comparison with the advanced glaucoma intervention study methods. , 2005, Archives of ophthalmology.

[13]  R N Weinreb,et al.  Reproducibility of topographic measurements of the normal and glaucomatous optic nerve head with the laser tomographic scanner. , 1991, American journal of ophthalmology.

[14]  David Garway-Heath,et al.  Results of the betaxolol versus placebo treatment trial in ocular hypertension , 2003, Graefe's Archive for Clinical and Experimental Ophthalmology.

[15]  M Schulzer,et al.  Errors in the diagnosis of visual field progression in normal-tension glaucoma. , 1994, Ophthalmology.

[16]  M. C. Leske,et al.  Measuring visual field progression in the Early Manifest Glaucoma Trial. , 2003, Acta ophthalmologica Scandinavica.

[17]  Catherine A McCarty,et al.  Progression of visual field loss in open angle glaucoma in the Melbourne Visual Impairment Project , 2006, Clinical & experimental ophthalmology.

[18]  Roger A Hitchings,et al.  Optimizing and validating an approach for identifying glaucomatous change in optic nerve topography. , 2004, Investigative ophthalmology & visual science.

[19]  Nicholas G Strouthidis,et al.  Optic disc and visual field progression in ocular hypertensive subjects: detection rates, specificity, and agreement. , 2006, Investigative ophthalmology & visual science.

[20]  B. Chauhan,et al.  Longitudinal changes in the visual field and optic disc in glaucoma , 2005, Progress in Retinal and Eye Research.

[21]  D. Garway-Heath,et al.  Improving the repeatability of Heidelberg retina tomograph and Heidelberg retina tomograph II rim area measurements , 2005, British Journal of Ophthalmology.

[22]  P. Lichter,et al.  The Collaborative Initial Glaucoma Treatment Study: study design, methods, and baseline characteristics of enrolled patients. , 1999, Ophthalmology.

[23]  D. Garway-Heath,et al.  Measurement variability in Heidelberg Retina Tomograph imaging of neuroretinal rim area. , 2006, Investigative ophthalmology & visual science.

[24]  R. Weinreb,et al.  New definitions of glaucoma. , 1997, Current opinion in ophthalmology.

[25]  S. Drance,et al.  Sensitivity and specificity of a diagnostic test determined by repeated observations in the absence of an external standard. , 1991, Journal of clinical epidemiology.

[26]  F W Fitzke,et al.  Use of sequential Heidelberg retina tomograph images to identify changes at the optic disc in ocular hypertensive patients at risk of developing glaucoma , 2000, The British journal of ophthalmology.