Prediction of 10-2 Visual Field Loss Using Optical Coherence Tomography and 24-2 Visual Field Data

Abstract

Precis: Using standard glaucoma structural and functional tests, clinicians accurately predicted the presence/absence of 10-2 glaucomatous visual field (VF) loss in 90% of the eyes in this study.Purpose: To investigate how well clinicians with variable experience can predict the presence and location of 10-2 VF loss using structural and functional data that are routinely obtained for glaucoma assessment.Methods: Within a test set of 416 eyes (210 subjects) who were diagnosed glaucoma suspect or primary open-angle glaucoma (with most eyes having mild disease), 6 clinicians were asked to predict the presence and hemispheric location of 10-2 VF loss using 24-2 VF and spectral-domain optical coherence tomography structural data. Prediction accuracies were calculated for each clinician and compared using the weighted κ-statistic. Receiver operating characteristic analyses were used to evaluate models for predicting 10-2 VF loss.Results: Among the 6 clinicians, mean (range) accuracy, false negatives, and false positives for predicting presence/absence of 10-2 VF loss were 90% (87% to 92%), 4.7% (2.4% to 7.0%), and 5.4% (1.7% to 7.5%) respectively. The mean (range) weighted κ-statistic was 0.75 (0.64 to 0.83), suggesting good or very good inter-rater agreement between examiners. Mean accuracy for correctly predicting hemispheric location was 73% (range, 65% to 82%) with the most common error occurring in eyes with both superior and inferior 10-2 VF defects in which one hemisphere was correctly identified but the other missed.Conclusions: In this study, the presence/absence of 10-2 glaucomatous VF loss was highly predictable using standard functional and structural clinical metrics. These findings suggest that 10-2 VF testing is not needed to reliably recognize and confirm central VF involvement in most eyes with glaucoma. Whether error related to identifying second hemisphere involvement in 10-2 VF loss is important requires further study.

Baseline 10-2 Visual Field Loss as a Predictor for Future Glaucoma Progression

“…Although the results from this study show that presence/absence of baseline 10-2 VF loss provides insight regarding the future course of glaucomatous disease, a recent report indicated that accurate prediction of presence/absence of 10-2 VF loss can be achieved in a majority of cases using a combination of standard structural (OCT) and functional (24-2) measures. 33 Accordingly, that study suggests that actually completing the 10-2 VF test may be unnecessary for risk assessment purposes. However, although that study demonstrated ~90% accuracy for predicting presence/absence of 10-2 VF loss, the predictive capability was imperfect with residual false-positive and false-negative errors.…”

“…40,41 Yet, because adding the 10-2 VF test to the baseline testing protocol would be expected to increase burdens to patients, providers, payers, and practice patterns, the benefits of adopting the test for routine use need to be substantial and well supported by published evidence. Although current evidence demonstrating how the 10-2 test improves clinical management and outcomes in early and moderate glaucoma continues to accumulate, 11,12,[33][34][35][36][37][39][40][41] it can be argued that the evidence already supports 10-2 VF testing for monitoring progression, particularly in eyes with history of disc hemorrhage. In addition, the results from this study suggest that 10-2 testing provides independent and valuable information for predicting future glaucoma progression that is more precise than using central 24-2 VF information alone.…”

“…Decisions about when to repeat and how to intermingle 10-2 VF testing with 24-2 testing might be best guided by overall clinical status and progression risk, with more frequent 10-2 testing prompted by macular OCT findings, disc hemorrhage, and central VF loss findings. Because there is evidence that glaucomatous 10-2 VF defects do not present unless detectable structural damage is present,33 deferral of 10-2 VF testing in eyes without definite structural damage may be reasonable. As additional evidence is developed, the role and utilization of the 10-2 VF test across the spectrum of glaucoma will become clearer.…”