Glaucoma Progression Analysis Software Compared with Expert Consensus Opinion in the Detection of Visual Field Progression in Glaucoma

Abstract

Purpose To compare the results of Glaucoma Progression Analysis (GPA, Carl Zeiss Meditec, Dublin, CA) to subjective expert consensus in the detection of glaucomatous visual field progression. Design Retrospective, observational case series. Participants 100 eyes of 83 glaucoma patients. Methods Five serial Humphrey visual fields from 100 eyes of 83 glaucoma patients were evaluated by five masked glaucoma subspecialists for determination of progression. Four months later, with a randomly reordered patient sequence, the same visual field series were re-evaluated by the same graders, at which time they had access to the Glaucoma Progression Analysis (GPA) printout. Main Outcome Measures The level of agreement between majority expert consensus and GPA, both before and after access to GPA data, was assessed using kappa statistics. Results On initial review and on re-evaluation with access to the GPA printout, the level of agreement between majority expert consensus and GPA was fair (kappa = 0.52, 95% confidence interval [CI] = 0.35 – 0.69 and 0.62, 95% CI = 0.46 – 0.78, respectively). Expert consensus was more likely to classify a series of fields as showing progression than was GPA (p ≤ 0.002). There was good agreement between expert consensus on initial review and reevaluation 4 months later (kappa = 0.77, 95% CI = 0.65 – 0.90). Conclusions The level of agreement between majority expert consensus of subjective determination of visual field progression and GPA is fair. In cases of disagreement with GPA, the expert consensus classification was usually progression. Access to the results of GPA did not significantly change the level of agreement between expert consensus and the GPA result; however, expert consensus did change in 11 of 100 cases.

Intraocular pressure reduction with topical medications and progression of normal‐tension glaucoma: a 12‐year mean follow‐up study

“…1995; Katz 2000). VF progression was defined as a significant decrease from baseline (two examinations) pattern deviation at three or more of the same test points on 2 or 3 consecutive visual field tests, which is classified by the software as ‘possible progression’ or ‘likely progression’, respectively (Tanna et al. 2012).…”

“…VF progression was judged by event-based analysis using the Guided Progression Analysis (gpa) software from the Humphrey Field Analyzer (Carl Zeiss Meditec, Inc.; Birch et al 1995;Katz 2000). VF progression was defined as a significant decrease from baseline (two examinations) pattern deviation at three or more of the same test points on 2 or 3 consecutive visual field tests, which is classified by the software as 'possible progression' or 'likely progression', respectively (Tanna et al 2012).…”

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

“…For decision making and tailoring therapy, most clinicians either rely on subjective evaluation of a sequence of visual fields or utilize the machine assessment of statistically significant progression calculated by proprietary software with automated algorithms. Software such as Glaucoma Progression Analysis (GPA, Carl Zeiss Meditec, Inc.) have greatly improved inter-observer agreement when defining progression compared to subjective, expert judgement (Tanna et al, 2012). Given this lack of consensus, each of the major RCTs defined visual field outcomes in a different way.…”

Detection of Early Glaucomatous Progression With Octopus Cluster Trend Analysis

“…4,5 However, most of the current information on the value of software-provided detection of progression comes from the former instrument family. [6][7][8][9][10] The commercially available Octopus software versions (Peritrend, EyeSuite) offer determination of the rate of progression for global mean defect (MD), diffuse defect (DD), local defect, and pointwise linear regression analysis. 11 However, as several core technical features (background luminance, stimulus duration, number and distribution of the test points, and size of the tested central visual field) are different in the Octopus perimeters and Humphrey Field Analyzers, 4,5 experience on progression determined with the Humphrey system cannot be directly applied to Octopus perimetry.…”