Value of 10-2 Visual Field Testing for Detecting Progression in Patients with Glaucoma.

Abstract

To determine the value of the 10-2 test of the Humphrey Field Analyzer in detecting visual field progression in early glaucoma. Prospective longitudinal study. Patients with open-angle glaucoma and healthy control subjects. Participants were examined with the 24-2 and 10-2 tests every 4 months. Only those with ≥ 5 pairs of tests were included. To analyze the same area as the 10-2, only the central 12 test locations of the 24-2 test were included from which global and quadrant mean deviation (MD) slopes, and pointwise total deviation slopes were computed. A range of criteria for progression based on pointwise total deviation slope cut-offs was used. (i) area under the receiver operating characteristics curve (AUC) separating glaucoma patients from healthy controls for global, sectoral and pointwise analyses; (ii) overlap in the proportion of patients identified by the two tests at matched specificity. One eye each of 96 glaucoma patients with early visual field damage and 56 healthy subjects was included in the analysis. The participants were followed for a median of 4.69 and 4.49 years with 13 and 11 pairs of tests, respectively. The AUC of the MD slopes for the two tests were not significantly different for global (P = 0.25) or quadrant (P > 0.11) analysis. At 90% specificity for global MD slope, the overlap in patients classified as progressing with both tests was 53%, while for quadrant MD slope, the overlap was less. AUCs were not different for pointwise slope cut-offs > -1.25 dB/y but were significantly higher for the 10-2 test when cut-offs were ≤ -1.25 dB/y. Additionally, patients showing progression with only the 10-2 test with steeper pointwise slope cut-offs had worse baseline 10-2 (but not 24-2) MD. For global and sectoral analyses, there was little evidence that the 10-2 test provided additional information about central visual field progression compared to the 24-2 test. However, pointwise analyses support the use of the 10-2 test for following patients with selectively worse central visual field loss at baseline and who are at risk for faster progression.