What is the Optimal Frequency of Visual Field Testing to Detect Rapid Progression Among Hypertensive Eyes?

Prcis: We evaluated 16,351 visual field (VF) tests from Ocular Hypertension Treatment Study (OHTS) database and showed that more frequent testing resulted in a shorter time to detect glaucoma progression, with the best trade-off being the 6-month intervals for high-risk and 12 months for low-risk patients.
Purpose: To investigate the effect of different testing intervals on time to detect visual field progression in eyes with ocular hypertension.
Methods: A total of 16,351 reliable 30-2 VF tests from 1575 eyes of the OHTS-1 observation arm with a mean (95% CI) follow-up of 4.8 (4.7-4.8) years were analyzed. Computer simulations (n = 10,000 eyes) based on mean deviation values and the residuals of risk groups (according to their baseline 5 y risk of developing primary open angle glaucoma: low, medium, and high risk) were performed to estimate time to detect progression with testing intervals of 4, 6, 12, and 24 months using linear regression. The time to detect VF progression ( P < 5%) at 80% power was calculated based on the mean deviation slope of -0.42 dB/year. We assessed the time to detect a -3 dB loss as an estimate of clinically meaningful perimetric loss.
Results: At 80% power, based on the progression of -0.42 dB/year, the best trade-off to detect significant rates of VF change to clinically meaningful perimetric loss in high, medium, and low-risk patients was 6, 6, and 12-month intervals, respectively.
Conclusion: Given the importance of not missing the conversion to glaucoma, the frequency of testing used in OHTS (6 mo) was optimal for the detection of progression in high-risk patients. Low-risk patients could potentially be tested every 12 months to optimize resource utilization.
Competing Interests: Disclosure: B.M.: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasília, DF, Brazil. C.G.D.M.: Consultant: Belite—San Diego, CA; Reichert—Buffalo, NY; Novartis—East Hanover, NJ; Galimedix Therapeutics Inc.—Kensington, MD; Théa Pharmaceuticals, Inc.—Clemont-Ferrand, France; Carl Zeiss Meditec Inc.—Dublin, CA; Perfuse Therapeutics—San Francisco, CA; Ora Clinical, Inc.—Andover, MA; Recipient: Heidelberg Engineering GmbH—Heidelberg, Germany; Topcon Medical Systems—Oakland, NJ. J.S.P.: Consultant: Allergan, Inc.—Dublin, Ireland. M.O.G.: National Eye Institute, National Institutes of Health. M.A.K.: National Eye Institute, National Institutes of Health. J.M.L.: Consultant: Aerie Pharmaceuticals, Inc.—Pittsburgh, PA; Eyenovia—New York NY; Heidelberg Engineering, GmBH—Heidelberg, Germany; NY:—Laval, Canada; Novartis—East Hanover, NJ; Galimedix Therapeutics Inc.—Kensington, MD; Bausch Healthcare, Inc.—Bridgewater, NJ; Allergan, Inc.—Dublin, Ireland. Financial Support: Heidelberg Engineering, GmBH—Heidelberg, Germany; National Eye Institute—Bethesda, MD; Research to Prevent Blindness, New York, NY. The remaining authors declare no conflict of interest.
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