To describe a new time-saving threshold visual field-testing strategy-Swedish Interactive Thresholding Algorithm (SITA) Faster, which is intended to replace SITA Fast-and to report on a clinical evaluation of this new strategy. DESIGN: Description and validity analysis for modifications applied to SITA Fast. METHODS: Five centers tested 1 eye of each of 126 glaucoma and glaucoma suspect patients with SITA Faster, SITA Fast, and SITA Standard at each of 2 visits. Outcomes included test time, mean deviation, and the visual field index (VFI), significant test points in probability maps, and intertest threshold variability. RESULTS: Mean (standard deviation) test times were 171.9 (45.3) seconds for SITA Faster, 247.0 (56.7) for SITA Fast, and 369.5 (64.5) for SITA Standard (P < .001). SITA Faster test times averaged 30.4 % shorter than SITA Fast and 53.5 % shorter than SITA Standard. Mean deviation was similar among all 3 tests.VFI did not differ between SITA Fast and SITA Faster tests, mean difference 0%, but VFI values were 1.2% lower with SITA Standard compared to both SITA Fast (P [ .007) and SITA Faster (P [ .002). A similar trend was seen with a slightly higher number of significant test points with SITA Standard than with SITA Fast and SITA Faster. All 3 tests had similar test-retest variability over the entire range of threshold values. CONCLUSIONS: SITA Faster saved considerable test time. SITA Faster and SITA Fast gave almost identical results. There were small differences between SITA Faster and SITA Standard, of the same character as previously shown for SITA Fast vs SITA Standard. (Am J
ABSTRACT.In most patients, chronic open-angle glaucoma is a slowly progressive disease. Eyes with very high intraocular pressure (IOP > 30 mmHg) represent an exception to this and should be treated and followed extremely intensively. As lowering IOP is, so far, the only means of treating glaucoma, the majority of research reports deal with the IOP-lowering effect of the treatment. The primary goal of treatment, however, is to prevent glaucomatous damage to the structures and function of the eye. The effectiveness of treatment is monitored with optic disc and retinal nerve fibre layer imaging and with visual field examinations. If the glaucomatous changes are progressing, more effective treatment should be given. In the course of follow-up, it should be noted that the changes in the optic nerve structure and function appear and progress at different time-points with delays of up to several years. The assessment of abnormalities is dependent on the examination method and requires a great deal of experience on the part of the examiner. The important risk factors in glaucoma are elevated IOP (even if IOP is within normal range in half of patients ), age, positive family history, exfoliation, race and myopia.
Primary surgery lowers IOP more than primary medication but is associated with more eye discomfort. One trial suggests that visual field restriction at five years is not significantly different whether initial treatment is medication or trabeculectomy. There is some evidence from two small trials in more severe OAG, that initial medication (pilocarpine, now rarely used as first line medication) is associated with more glaucoma progression than surgery. Beyond five years, there is no evidence of a difference in the need for cataract surgery according to initial treatment.The clinical and cost-effectiveness of contemporary medication (prostaglandin analogues, alpha2-agonists and topical carbonic anhydrase inhibitors) compared with primary surgery is not known.Further RCTs of current medical treatments compared with surgery are required, particularly for people with severe glaucoma and in black ethnic groups. Outcomes should include those reported by patients. Economic evaluations are required to inform treatment policy.
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