VISUAL FIELD PROGRESSION IN GLAUCOMA. A REVIEW.

by Alfredo Benjumeda MD, PhD

UNIVERSIDAD DE SEVILLA-FACULTAD DE MEDICINA

6002 rebmetpeS

33.secnerefeR 13snoisulcnoC 82..........................noissergorp fo noitalumiS 72..stset noissergorp rof senilediuG 42.ytilibats ro noissergorP 42.eulav noitciderP ehT 32mhtirogla tseb eht fo eciohC 51.noisse rgorp gnitceted rof sdohteM 41......................egnahc eurt .sv ytilibairaV 21.noitautculf eht gnirusaeM 11..esion eht fo gniretlif laitapS 01.sesioN dna langiS 7...etar noissergorP 4 egamad lanorueN 4 ... noissergorP fo erutaN ehT 3.. noitcudortnI

CONTENTS

.stnemtaert suoiverp htiw noitcennoc ni eb dluoc ytilibats noitcnuf eht taht dnim ni peek ot yrassecen si ti sselehtreveN .stceffe-edis detaicossa evah amocualg rof stnemtaert ynam ;yltsoc dna lufniap htob eb nac tnemtaert yrassecennu neht ,elbats si tcefed eht fI .)tcapmi cituepareht( deifisnetni eb dluohs nemiger tnemtaert eht taht noitacidni gnorts a sa dedrager yllausu erofereht si dna esaesid eht fo gninesrow eht tcelfer ot nekat si ssol dleif lausiv evissergorp nierehw ,amocualg htiw stneitap ni esaesid fo esruoc eht trahc ot desu era sdohtem yrtemirep ehT .ecalp nekat sah noisiv s tneitap eht ni egnahc a taht ngis lacinilc ylno eht netfo si noissergorp dleif lausiv hguohtla derrucco sah ssol lanoruen rehtruf retfa tset eht no tnerappa semoceb ylbaborp noitaroireted lanoitcnuF .stneitap evresbo ot dna amocualg fo ecnedive ylrae tceted ot sdohtem desu yltneuqerf tsom eht fo eno sniamer sdleif lausiv fo seires lanidutignol a fo noitaulave ,22-53 egamad lanoitcnuf erofeb amocualg elpmis ni detceted eb yllausu nac egamad larutcurts hguohtlA .weiver siht fo tcejbus eht si ,sdleif lausiv amocualg eht fo noissergorp fo tnuoma eht gnirotinom ni deyolpme sdohtem fo lasiarppa lacitirc ehT .rehcraeser dna naicinilc htob gnicaf sksat tluciffid tsom eht fo eno si egamad amocualg fo noissergorp/noitazilibats setutitsnoc tahw gninimreted sselehtreveN .egamad larutcurts dna ssol dleif lausiv fo noissergorp ro noitazilibats rehtie fo noitanimreted seriuqer amocualg elgna-nepo htiw stneitap fo pu-wollof mret-gnoL .eye taht ni noisiv eht fo ssol etelpmoc ni tluser yam siht yllautneve ;saera rehto ot gnidaerps ro/dna gninesrow saera detceffa ni ssol noisiv eht ni gnitluser ,ssergorp yllamron lliw esaesid eht ,detaertnu fI .sesac tsom ni tnemtaert etairporppa yb detlah neve ro dewols eb nac enilced eht hguohtla ;elbisreverri si ti ,derrucco sah ssol gnidulcni sesoprup suoirav rof tnemeganam amocualG ni desu si yrtemire noisiv ecnO .gnineercs esaesid dna noitciderp ksir ,sisongorp ,sisongaid

Introduction

eht nialpxe neht dluoc siht ,setar tnereffid ta etaroireted sllec tnereffid fI .stneitap ni nees ytivitisnes dleif lausiv fo ssol laudarg eht nialpxe dluow siht noitcnuf fo ssol laudarg htiw etaroireted sllec noilgnag laniter fI .ytilanoitcnuf fo ssol etelpmoc lautneve ot ytilanoitcnuf %001 morf )retemarap noitaroireted( t doirep emit emos revo yllaudarg gnitaroireted ,elpmaxe rof ,sllec noilgnag htiw evitcepsrep lanoitcnuf a morf setaroireted llec hcae oiranecs noitcnufsyd llec noilgnag a nI .noitcnuf fo ssol latot eht naht rehtar sllec ni noitcnufsyd ot gnidnopser era seuqinhcet lacisyhpohcysp tnecer eht fo emos taht elbissop osla si ti tuB .ytivitisnes ni noitcuder a gnisuac dna gniyd sllec noilgnag yhtlaeh ylsuoiverp yb desuac elpmaxe rof ,neddus si sisab llec-yb-llec a no ssol :oiranecs evila-ro-daed A .noissergorp suotamocualg gnirud snoitaretla llec noilgnag rof soiranecs elbisaef owt era erehT

.eugitaf dna gninrael ot eud egnahc suoirupS )c( .esioN )b( egamad lanorueN )a( :elbisnopser eb ot ylekil era srotcaf eerht gniwollof eht ,seires dleif lausiv a ni detceted si egnahc a nehW

.amocualg gnirotinom rof kramhcneb eht sraey ynam retfa sniamer gnitset dleif lausiv deziretupmoc stcapmi cituepareht dna citsongaid sti htob yB .derevocer sah ro deraps si noitcnuf taht eetnaraug ton seod siht ,noissergorp on wohs erutcurts evren citpo fo serusaem fi nevE .eye namuh gnivil eht ni ssenevitceffe ssessa nac taht gniht ylno eht si gnitset noitcnuf lausiV .noissergorp esaesid tneuqesbus dna ecnailpmoc noitacidem roop esuac flesti yam noissergorp fo sisongaid evitisop -eslaf a morf tluser yam hcihw ycamrahpylop dna segnahc noitacidem elpitluM

Neuronal damage

The nature of progression

fo segats tnereffid ta dna snoitacol tnereffid ta taht dnim ni enrob eb ti ,)ssol

llec noilgnag laniter( egamad larutcurts fo noissergorp fo etar eht gniyfitnauq nI

eht ni 1 .gif ni desopxe si tahT .sesaerced ytivitisnes sa ytilibairav ni esaercni . 51 ledoM noitcnufsyD tnegreviD
Figure 1. Simplified version of the principle behind the Divergent Dysfunction model. The outcome of the Divergent Dysfunction model is that as glaucoma progresses (i.e., as t increases), the sensitivities will be spread over a wider range, since each is deteriorating by an amount different. In the figure as the three cells deteriorate over time at different rates, the resulting variability caused by sampling randomly from one of the three increases. The black symbols represent the average sensitivities of each of the three cells, with 90% confidence intervals shown by the error bars above and below; the gray box shows the overall 90% confidence interval for the sensitivity when any one cell is picked at random. At t = 0, a theoretical stimulus has an equal probability of hitting any one of three receptive fields, each of whose sensitivities varies slightly over time, as indicated by the error bars above and below the symbol representing the sensitivity of each mechanism (in fact a Size III stimulus could cover as many as 200 receptive fields, but such numbers would result in too complicated a figure). The response will then vary within the gray-boxed range, giving roughly a 90% confidence interval for the sensitivity measurement. Over time, these three mechanisms deteriorate at different rates; by t = 40, the response will vary within the much larger range shown by the gray box on the right-hand side In the actual model, the sensitivity is given by the maximum of the sensitivities of many cells chosen out of a larger population, instead of (as here) just one cell chosen out of three. (Gardiner, S.K., Demirel, S and Johnson, C.A, 15). 5

gniraeppa yltnerappa stcefed dleif lausiV .tneserp yltnetsisnoc emoceb ot sraey 5 ot pu ekat nac seitilamronba tnettimretni ;retal raeppaer ot ylno ,tnemtaert gniwollof raeppasid neve yam esehT .noitcnuf lausiv ni segnahc cigolohtap fo rotacidni ylrae na eb nac ytilibairav dlohserht desaercni taht nwonk llew si tI .tnettimretni eb ot detseggus neeb evah ytilibatceted fo dlohserht eht ta stcefed dleif lausiV )b . ssalc tnetal a dellac eb nac ssenlli fo etats elbavresbonu tub eurt siht ,noitnevnoc lacitsitats dna cirtemohcysp gniwolloF .lamron niamer sdleif lausiv etihw-no-etihw elihw tneserp si esaesid lacinilc bus hcihw gnirud doirep tlucco degnolorp a si ereht ,yllaitinI )a : 55 lacitirc dna dlohserht ,tlucco :sesahp eerht ni srucco deredisnoc eb yam noissergorp a hcuS

gnissergorp-non dna ,)%7( cidosipe ,)%02( raenilivruc ,)%94( raenil :debircsed neeb sah spuorg tcnitsid ruof oS .sessergorp amocualg fo egamad lanoruen woh tuoba su llet nac emit revo egnahc sdleif lausiv woh gnivresbO .
22

lausiv dna rebmun llec noilgnag neewteb spihsnoitaler tnereffid era ereht esaesid

Figure 2. Relationship between ganglion cells loss and threshold sensitivity with conventional automated perimetry. Mean, standard deviation, and fitted curve are shown (Girkin C.A., 16).

rieht fo dne eht ta gnivirra dlohserht ta esoht tneserper ylpmis yam yltpurba

.)2 .gif(45 )%42(

noitcnuf

dleif lausiv htob gnidulcni ylbissop srotcaf lanoitidda suoremun yb decneulfni si etar noissergorP .laitnesse si noissergorp fo noitceted ylrae mohw ni ssol dleif lacitirc htiw esoht rof ro ytilibairav mret-gnol hgih htiw snosrep rof tnatropmi ylralucitrap eb yam noitanimaxe tneuqerf yb deniag rewop lacitsitats ni esaercni ehT .seires emit eht nihtiw sdleif lausiv eht fo noitisop dna,15snoitanimaxe fo ycneuqerf ,ytilibairav fo eerged ,noissergorp fo epyt dna etar gniylrednu gnidulcni srotcaf yb decneulfni era noissergorp eht fo nrettap eht dna noissergorp tceted ot deriuqer emit ehT .slavretni raluger ta detaulave si sutats esaesid s tneitap amocualg hcae ,noitaulave lacinilc lacidoirep eriuqer dna smotpmys tuohtiw ssergorp netfo taht sesaesid fo seiduts lavivrus ni ylnommoc srucco ti sA

esuffid erom ,.e.i( devlovni emoceb snoitacol tset erom ,egamad suotamocualg gnicnavda htiW .tnenopmoc esuffid a htiw detaicossa yllausu si amocualg ni ssol dleif lausiv lacof taht nwohs evah seiduts lareveS .92degnellahc neeb netfo sah dezilacof ylevisulcxe era sessol dleif lausiv suotamocualg taht sisehtopyh ni yltneuqerf ,tnemegralne hguohtla ,gninepeed yb evlove yltneuqerf atamotocS .4stcefed gnitsixe fo noisnapxe ro gninepeed sa dezilacof raeppa ot sdnet gninesrow dleif-lausiv ,sessergorp amocualg sa ,taht thguoht neeb gnol sah tI .sraey 03 nihtiw ssol dleif lausiv etulosba dna edaced a nihtiw tneserp eb yam tnemriapmi lausiv tnacifingiS .63noissergorp tnacifingis yllacitsitats detsefinam stneitap detaert fo driht-eno naht sseL .noitaroireted lausiv wohs lliw seye emos ,tnemtaert etipsed dna ,ylrae regnol on si esaesiD .ssendnilb fo ksir tnacifingis gniyrrac ,esahp lacitirc a sretne esaesid eht ,dlohserht tsap ecnO )c .03 htaed llec suotamocualg morf gnitluser seitisned llec noilgnag rewol yb desuac langis esnopser llec noilgnag fo gniloop decuder ro ,sllec noilgnag laniter degamad fo scitsiretcarahc gnirif lacipyta elpmaxe rof ,esion laruen dnuorgkcab retaerg edulcni dluoc egats amocualg siht ni ytilibairav desaercni rof elbisnopser srotcaf taht detalutsop neeb sah tI .esahp tneisnart

ehT .

nommoc osla era stcefed wen fo tnempoleved eht dna ,aera s murrejB

Progression rate

.)sessol

eht ,derusaem gnieb tcejbo eht taht tcaf eht yb dednuofnoc si ytilibicudorper ,yrtemirep fo esac eht nI .stnemerusaem lareves gnoma ecnereffid eurt a tceted ot ecived gnirusaem yna fo ytiliba eht si ytilibicudorpeR .erusaem ot dednetni si ti tahw ylbailer dna yletarucca erusaem ot tset a fo ytiliba eht ot srefer ytidilaV .71 seye tfel dna thgir ni noissergorp esaesid neewteb pihsnoitaler eht fo noitamitse etacilpmoc nac noissergorp fo semit deit esehT .atad derosnec-lavretni fo gnittes eht ni noissergorp esaesid fo semit deit fo srebmun laitnatsbus ot sdael siht dna ecnerrucco rieht ni seye neewteb snoitalerroc tcefrep morf raf tub gnorts stibihxe ,si amocualg sa ,esaesid eye rojam A .6 tnacifingis yllacinilc dna yllacitsitats dednuof saw amocualg cinorhc htiw stneitap ni noissergorp dleif lausiv fo noitalerroc eye-neewteB .detaertnu tfel fi ssergorp dluow stcefed dleif lausiv suotamocualg ylkciuq woh no elbaliava era atad evitcepsorp on ,stniartsnoc lacihte fo esuaceB .65ssol dleif lausiv erom htiw naht dleif lausiv fo ssol fo etar dipar erom a si ereht ,sdlohserht dleif lausiv fo ssol etaredom ylevitaler htiW .05POI sediseb srotcaf rehto ot eud eb yam dna ssol dleif etaredom ot elttil ylno si ereht nehw yldipar strats ssol dleif lausiv fo noissergorp ehT .2rotciderp elbailer a ton si egamad enilesab tub ssol esaesid eht fo egats eht no tnedneped si ssol dleif lausiv fo noissergorP .04erusserp ralucoartni eht fo gnirewol evisnetxe etipsed dleif eht fo noissergorp rehtruf ecneirepxe nac stneitap ynam taht eurt si esiwekiL .sdleif evissergorp dna elbats htiw stneitap amocualg neewteb dehsiugnitsid ylbailer taht level erusserp ralucoartni raelc a dnuof eb ton dluoc ti ,ylesrevnoC . 64POI naem rehgih dna noitautculf erusserp ralucoartni retaerg ,noitnevretni amocualg tsrif fo emit eht ta ega redlo eht eb ot smees noissergorp dleif lausiv rof srotciderp tnatropmi tsom ehT .82noitulove esaesid eht no erusserp ralucoartni fo gnirewol fo tceffe eht tuoba nettirw neeb sah laed taerg a :ssenevitceffe dna epyt ,tnemtaert tnerruc dna egamad ot ytilibarenluv larutcurts laitnereffid sa hcus ,srotcaf tnednepedni-tnemerusaem dna noisicerp dna ycarucca dlohserht ni snoitairav sa hcus ,srotcaf tnedneped-tnemerusaem

noises Signal and noises

tnacifingis tuB .72 stset tneuqesbus naht esrow si dleif lausiv enilesab stneitap eht yberehw deifitnedi neeb sah tceffe gninrael eht sa nwonk nonemonehp A .86-81 )eugitaf ot detubirtta ylnommoc si ytilibairav ni esaercni siht ytilibairav dlohserht eht rehgih eht ,tset eht regnol eht yberehw noitautculf llarevo fo level eht gninimreted ni elor tnatropmi na syalp ylekil noitarud tseT .42-01 ylroirefni naht ylroirepus rehgih dna yllaropmet naht yllasan rehgih :yticirtnecce tniop tset htiw retaerg yllatnemercni si ytilibairaV .ertnec eht ni stniop naht erom etautculf ot dnet stniop tset larehpirep dleif lamron a nO .)tnadneped ytisned sllec noruen( dleif lausiv eht fo noitarugifnoc laitaps eht no desab tnenopmoc a evah ot detcepxe era sessalc sesion htoB .ytilibairav )tset-neewteb( tset-retni sa ot derrefer era dna snoitautculf ytivitisnes laruen dna raluco elbisrever ot detubirtta neeb evah snoitaludom ytivitisnes mret regnol esehT .noitautculf mret-trohs yb denialpxe ton ytilibairav ten eht si dna ,ytivitisnes laniter ni noitautculf lacigoloisyhp eht sa denifed eb nac noitautculf mret-gnoL .syad ro sruoh revo snoisses gnitset tnereffid neewteb ylsuonegomoh seirav dleif eritne eht fo ytivitisnes eht taht snaem hcihw ,)FL( noitautculf mret-gnol si tnenopmoc ronim a ylbaborP .)FS( noitautculf mret-trohs eht sa nwonk si noitacol sulumits nevig a ta noitanimaxe dleif lausiv a nihtiw etamitse dlohserht eht ni noitairav ehT .ytilibairav eht fo tnenopmoc rojam eht si ytilibairav mret-trohS .ygetarts gnidlohserht dna 83 )noiretirc noitceted langis( tneserp si sulumits thgil a rehtehw gnidiced rof airetirc s eno eht ,)noitcnuf evitingoc( tset eht od dna dnatsrednu ot ytiliba s tcejbus eht ,93-81 esion laruen gnidulcni ,srotcaf ynam no sdneped noitautculf fo tnuoma ehT .9gnitset detaeper no setautculf netfo laudividni lamron a fo dleif lausiv eht taht dezingocer llew si tI .revewoh ,ytilibairav elbaredisnoc ssessop smetsys lamron lacigoloiB esion lamroN .73raeppasid gninesrow taht evah yltneuqesbus lliw tset elgnis a no dleif lausiv eht ni gninesrow a evah ot mees taht seye fo ytirojam tsav ehT .)esion( ytilibairav morf )langis( sutats dleif lausiv ni egnahc eurt etaitnereffid ot tluciffid erofereht si ti dna ,ytitnauq elbats a ton si dleif lausiv ehT .)ytilibairav ,noitautculf( ssam yllej ykahs a ekil gnitfihs yltnatsnoc eb ot smees ,dlohserht ytilibisnes
(

dah sa devorpmi dah seye fo rebmun lauqe na ylhguor dna ,elbats erew seulav naem eht tisiv htnom-6 eht ta taht noitavresbo eht si noitpmussa siht ot troppus

gnidneL .43egnahc eurt naht rehtar ,ytilibairav tneserper retal shtnom 6 tisiv a dna tisiv enilesab a neewteb stnemerusaem ni segnahc taht noitpmussa eht ekam dluoc eno ,wols si amocualg elgna-nepo cinorhc detaert yletauqeda fo noissergorp fo etar eht esuaceB .melborp tnatropmi na semoceb noitautculf morf dleif lausiv eht ni egnahc eurt fo noitarapes eht ,ytilibairav fo stnuoma egral fo ecneserp eht nI .76-15 dnah ni sdleif lausiv detamotua xis ot evif tsael ta tuohtiw esaesid fo noissergorp tuoba stnemgduj ekam ton dluohs snaicinilc taht detseggus neeb sah taht hcus si ytilibairav eht fo edutingam ehT .noitaretla eniuneg a sa dezingocer eb ot noitautculf cigoloisyhp detcepxe eht naht retaerg eb tsum semit tnereffid ta enod snoitanimaxe neewteb ecnereffid A .suodrazah ylhgih egnahc a fo noisiced eht ekam dna sgnidrocer eht fo ytilibailer eht tceffa ylsuoires tsum siht ,sdlohserht fo noitautculf yb deinapmocca ylbativeni era stcefed dleif fi ,ta dekool revenehW .46 noituloser laitaps fo ssol fo tsoc eht ta ,ezis sulumits regral gniyolpme decuder eb nac amocualg htiw stneitap ni ytilibairaV .samotocs gnitsixe fo saera eht ylesolc gnihcraes ni ytilibatsni hcus etaulave ot ,weiv fo tniop lacitcarp a morf ,etarucca erom eb dluow ti noissergorp lanoitcnuf roF .ytivitisnes rehgih fo aera na nihtiw stniop tset naht erom etautculf ot dnet )tcefed a nihtiw ,.e.i( ytivitisnes rewol htiw stniop tseT .esaesid eht fo ytireves eht yb decneulfni era snoitautculf mret-gnol dna mret-trohs htoB .metsys noitpecrep revresbo eht ni ro sulumits eht ni rehtie etanigiro nac noitautculf sihT .03-52 stcejbus lamron ni naht amocualg htiw dna stneitap tcepsus amocualg fo sdleif lausiv eht ni dnuof era ytilibairav fo stnuoma regral taht dehsilbatse neeb won sah ti tuB esion lamronbA .enilesab ta sdleif lausiv elbailer dna lamron ylbicudorper evah stcejbus taht deriuqer saw ti nehw ylekilnu era stceffe gninrael

10

.noissergorp naht rehtar noitairav gnivresbo erew ew taht gnitseggus ,denesrow

seulav fo xirtam eht yb detacidni sa noihsaf ekil-dirg a ni deknil yllacigoloisyhp ton era ,segami latigid ni seulav lexip yas ekilnu ,snoitacol tset dleif lausiv ehT .
41

gnieb erew stcefed dezilacol eurt rehtehw osla tub ,gniretlif yb decuder gnieb saw esion eht rehtehw ylno ton tset ot evitceffe neeb sah noitalumis retupmoC .)3 gif( noitulos elbissop a sa atad eht fo gniretlif laitaps sdrawot stniop dna noitamrofni latigid fo ytilauq eht evorpmi ot desu euqinhcet gnissecorp-egami deyolpme ylediw a si gniretlif laitaps fo elpicnirp sihT .31seitivitisnes decuder evah osla ot ylekil erom era srobhgien sti neht ,ytivitisnes decuder a sah tniop eno fi ,ecnesse ni ;stniop tnereffid fo seitivitisnes lautca eht neewteb spihsnoitaler eht gnitiolpxe no seiler siht gniod fo yaw enO .emit gnitset lanoitidda yna tuohtiw ,decuder eb dluow esion eht taht yaw a hcus ni atad eht ssecorp osla nac eW .etarucca erom tnemerusaem eht gnikam naht rehtar noitanimaxe yrtemirep fo emit eht gnicuder no sucof ot dednet evah noitisiuqca atad fo sdohtem devorpmI .elbahsiugnitsid yllacitsitats semoceb ti erofeb esion eht naht regral eb ot sah dleif lausiv suotamocualg a ni egnahc eurT

csid-citpo htiw tcefed siht etalerroc ,yllaedi ,dna amocualg htiw tnetsisnoc si egnahc eht taht yfitnedi neht ,)snoitautculf lamronba+lamron( laudividni taht rof )FTL( noitautculf mret-gnol fo level eht deecxe taht segnahc yfitnedi tsum naicinilc eht ,noissergorp dleif-lausiv suotamocualg yfitnedi ot ,tneserp ta ,oS .23ssol dleif lausiv suotamocualg evissergorp fo noitanimreted eht rof rotacidni lacitsitats a sedivorp amocualg elbats htiw stneitap morf devired FL ehT egamad fo sngis swohs csid citpo eht ro dleif lausiv eht taht doohilekil eht enimreted ot naicinilc eht swolla noitalupop yhtlaeh a ni stnemerusaem eht fo ytilibairav lacigoloib eht fo egdelwonK .tceffe ytilibairav yb derucsbo emoceb nac noitaroireted ro ytilibats ,retteb rof :egnahc ytilibisnes sdleif lausiv fo seitilibissop eerht eht llA
.

filtering Spatial filtering of the noise

11

tuo derrulb

.ecnaraeppa

erauqs eht sa denned si tcejbus hcae rof dleif lausiv eritne eht fo noitautculf latot eht ,ecnairav no desab dohtem siht gnisU .dlohserht fo snoitanimreted detaeper fo ecnairav eht nopu ,yllabolg desab neeb evah yrtemirep detamotua ni noitautculf fo snoitaluclac ,lareneg nI .rennam siht ni edam ytilibairav fo tnemerusaem ecneulfni ,erofereht ,dna rorre tnemerusaem fo stnuoma tnereffid ecudortni noitamitse dlohserht rof desu seigetarts yrtemirep gniyraV .srekrow lareves yb depoleved neeb evah emit revo dleif lausiv eht fo noitautculf eht gnirusaem rof seuqinhceT .02stcefed eurt gnirucsbo tuohtiw esion eht ecuder lliw taht ] 91 dehsilbup ylsuoiverp dleif lausiv lartnec eht fo stniop eht lla neewteb )2r( noitanimreted fo stneiciffeoc no desab[ reyal rebif evren laniter eht fo erutcurts eht tnuocca otni gnikat retlif laitaps a gnipoleved melborp eht detaivbo sah asoR al ed zelaznoG esnes taht nI
Figure 3. How the new sensitivity is calculated by a Gaussian filter. In this method, the raw sensitivity value is replaced by one derived from a linear combination of the sensitivities at the nine points in a square centered on the point of interest. This is repeated for each point in the field in turn, each time looking at the points in a square surrounding the point of interest (Gardiner, SK , Crabb, DP, Fitzke FV, Hitchings, RA, 14).

.csid citpo eht fo erutcurts lacimotana lautca eht fo tnuocca on sekat retlif naissuaG eht dna trahc dleif lausiv eht no

Measuring the fluctuation

12

rof snoitacol tset gnidulcxe ,snoitacol tset s'tcejbus lla fo ecnairav naem eht fo toor

.)6 gif( ytilibairav tset-neewteb dna nihtiw fo erusaem dnuopmoc a sa dedrager eb dluohs taht
52

derehtag atad gnisu ytilibairav )FTS+FTL( gniyfitnauq rof dohtem evitanretla nA .noitautculf mret-gnol naht ytilibairav latot gninimreted rof rotcaf tnatropmi erom raf a si noitautculf mret-trohs taht dnuof evah
31-9

dna snoitavresbo laciripme ,dias ylsuoiverp sA .23noitatnemurtsni laicremmoc no elbaliava ton si xedni siht hguohtla ,snoitanimaxe dleif lausiv elpitlum morf yllacitamehtam detaluclac eb nac hcihw ,)FTL( noitautculf mret-gnol sa ot derrefer ,ytilibairav tset-retni fo tnelaviuqe lacinilc eht erusaem ot elbissop osla si tI .slaudividni lamron ni Bd 2 dna 1 neewteb yllausu si dna )VLs( sretemirep supotcO dna )DSP( AFH eht htob no segakcap lacitsitats eht ni elbaliava si FTS .snoitacol tset denifederp fo rebmun a ta snoitamitse dlohserht owt neewteb secnereffid eht fo noitaived dradnats egareva eht sa yllacitsilpmis fo thguoht eb yam dna tset dleif lausiv eno gnirud gnirrucco rettacs eht sa denifed yllanigiro saw FTS .ygetarts gnidlohserht eht yb decneulfni si hguohtla ,ytilibairav tset-artni fo tnelaviuqe lacinilc eht sa deredisnoc eb yam FTS .tset elgnis a gnirud edam setamitse dlohserht elpitlum morf devired si xedni labolg elpmis a hcihw ,)FTS( noitautculf mret-trohs si retemarap derusaem nwonk ylediw tsom ehT .Bd orez syawla saw ytivitisnes eht erehw snoitacol tset gnidulcxe ,snoitacol tset lla fo ytilibairav egnar eht fo naem eht sa denifed saw tcejbus elgnis a rof dleif lausiv eritne eht fo noitautculf latot ,dohtem siht htiW .noitacol tset taht rof sgnidaer ytivitisnes tsewol dna tsehgih eht neewteb ecnereffid etulosba eht sa denned si noitacol tset elgnis a rof ytilibairav egnaR .seulav fo rebmun llams a morf detaluclac ecnairav a naht dleif eht ni egnahc evissergorp gnitceted rof lufesu erom eb yam sdleif tsal dna tsrif eht neewteb ecnereffid ro egnar eht ,tneitap a no elbaliava era sdleif lausiv wef a ylno fI .66 egnar eht no snoitaluclac ytilibairav desab evah ,revewoh ,srohtua emoS .ygetarts eht yb decudni srorre eht dna tcefed lacol eht ,noitautculf trohs eht :stnenopmoc eerht evah sexedni labolg DSP dna VLS ehT .Bd orez syawla saw dlohserht eht hcihw

13

rettacs eht seifitnauq ti dna ,stroper fo rebmun a ni desu neeb sah euqinhcet sihT sisylana tseter-tset si noitatnemurtsni dleif lausiv lacinilc htiw

stnemirepxe detalumis

ssenkciht

csid citpo ,yleman ,egamad amocualg fo setalerroc larutcurts eht htiw noitanimaxe dessorc hguorht noissergorp gnissessa tuoba nettirw neeb sah sseL .94 )emit revo dewollof noitalupop a fo yduts eht morf devired( ciripmE ro )egnahc tnacifingis stneserper Bd y yb gnignahc stniop x( yrartibrA neeb evah esu lacinilc rof depoleved airetirC .egnahc rof airetirc laciripme dna yrartibra htob fo tnempoleved eht ot semitemos del sah derusaem eb nac egnahc suotamocualg hcihw tsniaga dradnats dlog fo kcal ehT .noissergorp eurt morf ekaf hsiugnitsid ot desived neeb evah sdohtem lacitsitats lareves dna ,egnahc suotamocualg cimim dna ksam htob nac ytilibairav sihT .tluciffid erom ksat siht gniredner ,stcejbus lamron ni naht amocualg htiw stneitap ni retaerg eb ot sdnet dna hgih si ytilibairav tset-retni fo edutingam eht tuB .noitcnuf lausiv ni enilced eurt a dna noitautculf neewteb hsiugnitsid ot si sdleif lausiv detamotua ni noissergorp tceted ot dengised sdohtem fo laog eht oS .snoitanimaxe neewteb ytilibairav ylerem ro ssecorp cigolohtap a fo noissergorp stneserper txen eht ot noitanimaxe eno morf egnahc a rehtehw enimreted ot gnitpmetta rof egnellahc tnacifingis a stneserp siht ,ylraelC .tnemurtsni eht fo egnar tnemerusaem eritne eht tsomla ssapmocne ot sdnetxe ytilibairav eht ,Bd 81- dna Bd 8- neewteb sticifed laitini htiw snoitacol ni ,eromrehtruF .tnemurtsni eht fo egnar tnemerusaem eht fo flah ylraen ni sekat stcefed laitini hcus rof ytilibairav tseter tset eht taht snaem sihT .detseter nehw snoisacco fo %09 no Bd 61- ot Bd 1- neewteb fo sticifed ytivitisnes elbairav tibihxe nac Bd 6 - fo sticifed ytivitisnes htiw snoitacol tset ,elpmaxe rof ;srucco ytilibairav tseter tset elbaredisnoc ,dleif lausiv eht fo saera degamad nI .amocualg ni ytilibairav fo tceffe dnuoforp eht setartsnomed ylisae dna stnemnorivne lacinilc ot dezilareneg eb nac ti sa suoegatnavda si sisylana tseter tseT .amocualg ot eud decuder si ytivitisnes nehw snoitamitse dlohserht fo rettacs desaercni setartsnomed osla dohtem siht ,debircsed seuqinhcet noitacifitnauq ytilibairav rehto eht ekiL .snoisses tset tnereffid ta snoitanimaxe erom ro owt no edam serusaem fo

Variability vs. true change

14

ralucam

dna

,sretemarap

reyal

rebbif

evren

,noitarugifnoc

selpicnirp citsirueh fo rebmun detimil a no yler strepxe ehT .strahc hguorht gnikool ylpmis sdleif lausiv detamotua ro detamotua-non htiw derrucco dah noissergorp rehtehw flesmih yb denimreted revresbo eht ,si taht ;strepxe yb detaulave neeb sah seiduts ynam ni ssol dleif lausiv fo noissergorP .s n a e m e v I t c e j b u S )A . 2 noissergorp suotamocualg ot gnirrefer taht rehtar ,segnahc csid citpo dna dleif lausiv neewteb hsiugnitsid ylraelc ot tnedurp eb yam ti ,erutcurts ro noitcnuf fo erusaem a nopu yler ton seod flesti ni taht noissergorp suotamocualg fo erusaem tnednepedni na kcal ew esuaceB .emit ni snoitavresbo ynam fo sesylana lacitsitats xelpmoc ot snoitavresbo owt ylno no desab tnemgduj lacinilc evitcejbus a morf egnar taht sdohtem fo yteirav a gnisu derusaem neeb evah segnahc csid citpo dna dleif lausiV .?ytitnauq niatrecnu na fo eulav eht ro tneve niatrecnu na fo ytilibaborp eht ssessa ew od woH . 75 noissergorp rof dleif lausiv a gnissessa nehw noitaredisnoc yramirp a sa dedrager eb dluohs tset dleif lausiv eht fo secidni ytilibailer ehT .yek eht s tI .edutingam a taht rehtar ssenlli eht edisni noitacifidom a si noissergorP .stneitap ro/dna srotagitsevni yb stnemssessa evitcejbus eriuqer ro ssecorp esaesid eht ot ylgnorts etaler ton od taht esoht era stniopdne "tfoS" .ytivitcejbus on eriuqer dna ,ssecorp esaesid ot tcepser htiw evitinifed ,locotorp yduts eht ni denifed-llew era lairt lacinilc a no stniopdne "draH" .tniopdne tfos a flesti ni si noissergorp fo tpecnoc ehT .deredisnoc si esaesid fo egnar elohw eht nehw egnahc ot ytivitisnes roop a gnivah elihw ,noissergorp ylrae rof lufesu gnieb suht ,esaesid eht fo segats ylrae ta ylno yllacitamard egnahc yam retemarap nevig A .elbats era snoitidnoc esohw snosrep ni nees ytilibairav eht sdeecxe taht sretemarap ni egnahc a eriuqer lliw noissergorp taht detpecca yllareneg si tI .gnitset dleif lausiv ni sa ,esnopser tneitap evitcejbus eht fo tnenopmoc eht tuohtiw tiebla ,srucco osla gnigami ni ytilibairaV .stnemerusaem

Methods for detecting progression

15

ssol ni stluser atad fo noitcuder citsard a hcus ,terpretni dna esu ot ysae si rebmun elgnis a sa noitcuder ro ssol dleif lausiv fo noitacifitnauq hguohtlA .esu fo esae dna ecitcarp lacinilc laer ot ytiralimis eht era hcaorppa siht fo segatnavdA .egnahc rof desu airetirc eht fo noitazidradnats ,yna fi ,laminim si ereht ,tnemssessa fo epyt siht nI .seye gnissergorp-non dna gnissergorp ezirogetac ot desu neeb sah36-55-44-2 csid citpo dna dleif lausiv eht ni segnahc fo gnidarg evitcejbuS .trap gnidaelsim tsom eht ylbaborp si hcihw ,tuotnirp dleif lausiv eht ni citamehcs elacs-yarg eht no hcum oot yler thgim snaicinilc taht elbissop osla si tI .)emit ni yllaitaps detneserp ytivitisnes lausiv( noitamrofni laciremun lanoisnemid-eerht xelpmoc fo sisylana eht seriuqer yrtemirep detamotua laires fo stluser eht gnissessa ylevitcejbuS
Figure 4. The figure shows a possible event model for clinical evaluation of a series of 6 visual fields. First, a learning effect field (L) is performed that can be excluded from analysis. Next, baseline visual fields are collected (B1, B2). If any future field worse than the worst baseline field (B2) is considered outside normal variability. Thus, follow-up fields that are equal to or better than the worst baseline field are considered stable whereas a field (F1) that shows more defects than the worst baseline field is flagged as suspected progression. If progression is suspected, then one or more confirmatory fields are performed (F2) (F3). If the confirmatory fields are also worse than the worst baseline field, then progression is diagnosed (Jansonius, N.M 33).

ot seulav gnitciderp dna seitilibaborp gnissessa fo sksat xelpmoc eht ecuder tahw

16

.tnetnoc lanoitamrofni laitaps fo

.85snoitarepo latnemgduj relpmis

fo hcae ta ecnairav fo eerged lamron eht dna seulav lamron detcerroc-ega tnuocca otni sekat DM eht fo noitaluclac ehT

dleif lausiv stneitap eht fo noisserped ro noitavele naem eht ot sdnopserroc dna ygetarts tset yna no elbaliava si DM ehT .VLS dna )DM( noitaived naem sa hcus )secidni labolg dellac-os( dleif eht fo serusaem yrammus ni egnahc fo setamitse no seiler noissergorp dleif lausiv gnitceted rof sdohtem fo tes eno gnisu edam eb nac snaicinilc rof stcefed suotamocualg fo tnemssessa kciuq dna detpecca na ,scinilc cimlahthpo ynam ni sa hcus ,tnemnorivne evitisnes-emit a nI .sexedni labolG )a .94yrartibra dna ciripme eht fo epocs eht ot gnoleb airetirc lacinilc eht ro
85stnemgduj

evitiutni eht rehtie secnatsni ynam ni ,scitamehtam eht fo niamod tcirts eht ot gnoleb sgnidnif lacitsitats hguohtla taht dnim ni peek dluohs ti atad gnirotinom nI .segakcap erawtfos elbaliava yb desae ,sehcaorppa naiseyaB dna tsitneuqerf htob ,sesylana lacitsitats fo tnemtrossa na ot elbanema meht gnikam ,seulav ytivitisnes laciremun fo dirg a fo pu edam yllaitnesse era sdleif lausiv detamotuA .s d o h t e M l a c I t s I t a t S )B
Figure 5. An example of agreement /disagreement inter-observer on decision about glaucomatous visual field progression (Viswanathan AC,Crabb DP, McNaught AI, Wescott MC, Kamel D, Garway DF, Fitzke FW, Hitchings RA, 61).

tnacifingis era erehT .85tnetsisnocni eb nac atad dleif lausiv fo noitaterpretni eht ,srevresbo gnoma reffid ot ylekil era noitaroireted cirtemirep rof airetirc esuaceb dna noitaulave evitcejbus rof sdradnats detpecca-llew era rehtien sA

17

.dleif ecnerefer lamron a ot derapmoc

.16tnemeerga retar-artni dna retar-retni roop detroper netfo eht gnidulcni ,snoitatimil

desu smetsys gnirocs fo selacs eht taht ecnedive on si ereht oslA .elacs eht fo srotanigiro eht yb tnacifingis yllacinilc deredisnoc egnahc lufgninaem tceted ot dengised yllacificeps erew smetsys hcuS .debircsed llew neeb ton evah sdohtem lacitylana eseht fo sesab laciripme eht ,elbanosaer yllacinilc dna elbisualp elihW .esaesid ot detubirtta si noissergorp tnerappa erofeb ,snoitacol tset fo retsulc a nihtiw netfo ,egnahc muminim deificeps gniriuqer airetirc dleif lausiv desu lla evah )STHO( ydutS tnemtaerT noisnetrepyH ralucO eht dna ,)STGIC( ydutS tnemtaerT amocualG laitinI evitaroballoC eht )SIGA( ydutS noitnevretnI amocualG decnavdA eht ,)TGME( ydutS tnemtaerT amocualG tsefinaM ylraE eht , )ydutS GTN evitaroballoC( ydutS amocualG noisneT-lamroN evitaroballoC ehT .95 emit revo egnahc erocs sa noissergorp enifed dna erocs yb ssol dleif yfitarts taht smetsys gnirocs tneserper desu airetirc lacinilc evitcejbuS .seiduts nihtiw stluser fo noitaterpretni gnizidradnats rof lufpleh era hcihw ,noitaroireted dleif lausiv gnitaulave rof airetirc evitcejbo detpoda evah slairt ertnecitlum fo rebmun A .SLAIRT LACINILC )1( .sisylana dnert )3( dna sisylana tneve )2( slairt lacinilc )1( :yrtemirep ni segnahc gnikcehc fo sessalc-sdohtem niam eerhT .evitisnes erom esruoc fo era snoitacol laudividni ta ro sdleif eht fo strap ni egnahc gniredisnoc sdohteM .snoitacol dleif lausiv detset eht fo hcae ta ytivitisnes lausiv lamron detcepxe ot tcepser htiw stcefed lausiv fo htped esiw tniop eht nrecnoc yrtemirep morf deniatbo atad tnatropmi tsom ehT .ssol ytivitisnes fo snrettap laitapS )b .egnahc suotamocualg ot evitisnesni eb ot detroper era yeht dna ,stset dleif deziretupmoc nihtiw deniatnoc noitamrofni laitaps deliated eht erongi yletelpmoc ro ylegral yeht taht tcaf eht yb dehgiewtuo si sdohtem eseht fo yticilpmis suoegatnavda ehT .noissergorp wohs ton od taht stniop fo rebmun egral a fo ecneulfni eht yb decuder si DM no tceffe sti ,dleif lausiv eht fo srotces detimil stceffa noissergorp fI
75

elbailer htiw eye na nI .dleif lausiv 2-42 yerhpmuH a ni desu snoitacol tset 45 eht

18

.DM eht ni noitautculf elttil yrev ylno tcepxe dluohs eno ,sdleif lausiv elbats dna

esehT .)egnahc eurt ot naht rehtar ytilibairav ot detubirtta eb ylekil erom nac stluser tset eht neewteb secnereffid yna taht os ,skeew wef a revo ,.g.e noisseccus esolc ni yltneuqerf detset( amocualg elbats htiw stneitap fo puorg a ni ytilibairav tseter -tset fo stimil lacitsitats evired ot si egnahc dleif lausiv gniyfitnedi fo dohtem ehT .sdleif lausiv fo riap enilesab a fo ytilibairav detcepxe eht naht erom segnahc noitacol tset dleif ralucitrap a ta ytivitisnes dlohserht fi derrucco evah ot noissergorp senifed sisylana tnevE .gnidarg evitcejbus rof dessucsid esoht ot ralimis snoitatimil ot tcejbus si )gnissergorp /elbats( hcaorppa siht fo erutan yranib yllacipyt ehT .)4 .gif( snoitanimaxe pu-wollof evitucesnoc fo rebmun nevig a no egnahc fo tnuoma nevig a htiw snoitacol tset fo rebmun nevig a elpmaxe rof ,ffo-tuc nesohc ylirartibra tahwemos a fo sisab eht no denifed neht si noissergorP.
62

a ot derapmoc si noitanimaxe pu-wollof a ,sisylana fo mrof siht nI .stset reilrae owt ro eno fo stluser eht ot dleif lausiv elgnis a serapmoc taht egnahc tceted ot dohtem laciripme na si )margorp ytilibaborp egnahc amocualG( SISYLANA TNEVE EHT )2
.

tey dna ,egnahc lacinilc lufgninaem tceted lliw yeht taht rehtegot esolc yltneiciffus era taht segats neewteb ecnalab tsum metsys gnirocs laedi ehT .)61 ot 21 morf sa egnahc emas eht tneserper ton yam 6 ot 2 morf erocs ni egnahc a ,.e.i( raenil era selacs eseht taht ecnedive on si ereht ,noitidda nI .segnahc sdleif lausiv eltbus tceted ot elbanu eb erofereht yam smetsys gnirocs lacinilc evitcejbuS .segats tnecajda eht neewteb noitcnitsid lufgninaem a ekam ot ytiliba eht skcal dohtem noitanimaxe eht esuaceb ,sselgninaem emoceb snoitadarg eht tniop niatrec a ta ,revewoH .si ytivitisnes eht retaerg eht ,snoitadarg fo rebmun eht retaerg ehT.02 yleman ,erocs rieht ni deyolpme era snoitadarg fo rebmun taerg a ,egamad dleif lausiv fo gnigats hcus roF .yltnereffid noissergorp sterpretni ylbaborp yduts hcae ,yltneuqesnoc ;ytireves esaesid fo stnemercni mrofinu tcelfer ylirassecen

19

ta ,fI .emit revo devresbo era ohw stneitap fo sdleif lausiv ot deilppa neht era stimil

snoitanimaxe erom ro owt fo naem ro elgnis a fo enilesab

.deton ylbicudorper eb nac yllautca taht segnahc ebircsed ot desu eb nac yeht taht trapa raf yltneiciffus

noisserger raenil etairavinU .13-32-8yrtemirep detamotua laires fo esoht sa hcus atad lanidutignol ni sdnert etamitse ot dohtem elpmis a si noisserger raeniL .emit revo deledom si sdleif lausiv laitneuqes ni egnahc fo nrettap eht ,sisylana dnert htiW .SISYLANA DNERT )3 .)AC ,nilbuD ,cetideM ssieZ lraC ;AFH( rezylana dleif yerhpmuH eht htiw tekram eht ni elbaliava si
52

nosirapmoc eht ,enilesab eurt eht fo evitatneserper ton nosaer yna rof era sdleif enilesab owt eht fI .stset eerht sa wef sa htiw egnahc fo tneve na tceted ot ytiliba laciteroeht sti ni seil hcaorppa siht fo egatnavda ehT .)6 gif( denesrow ylekil sah noitacol eht ,ytilibairav tseter-tset fo timil rewol eht dnoyeb si enilesab dehsilbatse ylsuoiverp a dna tset tnerruc eht neewteb ecnereffid eht ,noitacol tset nevig yna
Figure 6. Test-retest analysis. The changes (i.e. the differences between baseline and follow-up examinations) are compared to the testretest variability from a separate sample of patients. If the observed changes exceed the testretest limits (typically estimated by empirical 5th and 95th percentiles), actual change is likely to have occurred. The analysis is based upon detailed empirical knowledge of the variability found at all stages of glaucomatous visual field loss through knowledge gained in extensive multicentre clinical trials in North America, Europe, and Asia. The plain language analysis (GPA Alert) is based upon the criteria used for ten years in the Early Manifest Glaucoma Trial. (HFA; Carl Zeiss Meditec, Dublin, CA).

20

margorp sisylana )PCG( ytilibaborp egnahc amocualg

ehT .enilesab taht fo txetnoc eht ni denimaxe si nt neht dna ,dlohserht enilesab a enimreted ot desu si 1-nt hguorht 1t fo tesbus emos ,sisylana desab-tneve nI .noisserger htiw naht elbatsnu erom si dohtem siht yb edam

ro senoz lacigolohtap dna lamron fo DM gnitarapes ,24noissergorp tnacifingis htiw stniop fo gniretsulc ,)esiw tniop( noisserger raenil tniop yb tniop ,dleif lausiv eht fo senoz niatrec fo ytivitisnes naem fo noisserger gnisu :sisylana noisserger yb detaulave eb nac stset dleif lausiv morf devired sretemarap tnereffid eht oS
Figure 7. Illustration of event analysis criteria at one test location. Solid horizontal line: the mean of the two baseline test results. If the deviation at a subsequent follow-up examination is more negative than the lower 5% limit of testretest variability (dotted line), deterioration is flagged with a filled triangle. In this example, the progression criterion has been met after the last observation (3 years). Artes PH, Nicolela MT, LeBlanc RP, Chauhan BC. (3)

lausiv lareves ,euqinhcet siht htiw egnahc fo etar eht fo setamitse elbanosaer ekam oT .ecnacifingis lacitsitats hcaer ot ybereht dna atad eht ni ytilibairav eht deecxe ot gnorts yltneiciffus si dnert esohw snosrep esoht yfitnedi ot laitnetop eht sah tI .)8 .gif( stneitap laudividni ni etairporppani eb nac taht stimil ytilibairav devired noitalupop no yler ton od erofereht dna seires atad laudividni eht nihtiw devresbo ytilibairav eht ot egnahc fo edutingam eht etaler sesylana dnerT .elbairav tnednepedni eht sa emit htiw demrofrep si

The

yerhpmuH

21

.cte

15snoitanimaxe

evitucesnoc ni ytilibicudorper tluser gnivresbo

.deriuqer era snoitanimaxe sdleif

eriuqca ot desoppus si redro eht ni level emas eht ta detautis esoht fo noitaived eht ,noitautculf modnar htiw sdlohserht deretlif ylsuoiverp fo seires a tsrow ot tseb morf gniredro nO .sisylana noissergorp gnirotces fo dohtem ticilpxe na ni ,evruc eibeB sa nwonk osla ,)nreB ,tiertS-gaaH( metsys rezylanA dleiF supotcO eht ot evitan ,evruc tcefed evitalumuc eht no gnitarepo noisserger raenil desu sah ,TNT margorp wen dehsilbupnu won ot pu ,sih fo trap a sa asoR al ed zelaznoG niapS nI .sretnec emos ni egnahc rof rotacidni na sa yllacinilc desu si ti dna ,seiduts dehsilbup ni airetirc RLP desu ylnommoc tselpmis eht si sihT .10.0 P fo ecneserp eht ni raey/Bd 0.1 epols noisserger a sa debircsed saw noitacol tset a ta tnemevorpmI .10.0 P htiw raey/Bd 0.1 -- saw epols noisserger eht fi gnissergorp eb ot deredisnoc saw tniop a :elpmaxe noiretirc dradnats A .ytilibaborp dna epols : dnim ni peek ot sretemarap owt teL .ecnacifingis lacitsitats ro/dna epols fo edutingam nevig a gniwohs snoitacol dleif lausiv fo rebmun eht no desab eb nac dna yrartibra si hcaorppa siht gnisu noissergorp fo noitinifed eht ,sisylana desab-tneve ot ralimiS .sdleif tneuqesbus ni deniatniam eb dluohs ti rehtehw dna noissergorp setutitsnoc eulav-P dna epols noisserger fo eulav tahw no susnesnoc on si ereht ,atad dleif lausiv lanidutignol gninimaxe rof loot lufesu yllacinilc a gnieb s RLP fo smialc suoivbo eht fo etips nI .stcejbus fo elpmas egral a morf detcelloc esabatad a no desab si timil ecnedifnoc eht ,niagA .tnacifingis yllacitsitats si dna timil ecnedifnoc denimretederp emos naht retaerg si epols eht fi gnissergorp sa noitacol nevig a sgalf dna ,nt , . . . ,1t ssorca noisserger raenil gnittif tseb eht fo epols eht senimreted )RLP( noisserger raenil esiw tnioP .dleif lausiv eht ni noitacol hcae ta egnahc fo etar eht rof etamitse na sedivorp dna emit revo noitacol tset hcae ta ytivitisnes dlohserht fo dnert eht senimaxe tI . 7 sdleif lausiv detamotua htiw nees dlohserht ni ytilibairav tset-retni eht htiw gnilaed rof euqinhcet a sa depoleved saw )RLP( noisserger raenil esiw tniop ,15egnahc amocualg rof DM fo yticificeps fo kcal evitaler eht neviG .sdleif lausiv evif dnoyeb DM rof epols labolg a setaluclac taht noitcnuf sisylana RLP elos a sedulcni erawtfos retemirep

22

eltbus ot evitisnes eb dluohs ssol dleif lausiv evissergorp fo noitceted rof tset lacinilc laedi ehT .14yticificeps dna ytivitisnes fo smret ni debircsed eb nac mhtirogla noitceted noissergorp a fo ecnamrofrep cisab eht ,tset citsongaid rehto yna htiw sA .)evitagen dna evitisop( seulav evitciderp hgih dna ,yticificeps dna ytivitisnes hgih ,ytidilav gnorts ,ytilibairav wol gnidulcni ,seitreporp cirtemohcysp roirepus etartsnomed dluohs dohtem cirtemirep wen a ,lufesu eb oT

Figure 8. Illustration of trend analysis with point-wise linear regression using the criteria of the two-omitting method. A test location was classified as having progressed if the slope of the linear regression line was more negative than -1 dB/yr and significantly different from zero at P< 5%. These criteria must be met when the last examination is excluded (a) and also when the penultimate examination is excluded (b). Solid lines: regression obtained by omitting the last or penultimate observation (open circles). Dotted line: regression including all observations. In this example, the location was not classified as having progressed because the slope was not significant when the last observation was excluded (a). Artes PH, Nicolela MT, LeBlanc RP, Chauhan BC.(3).

,dnerT sselesioN dlohserhT TNT ,)ynamreG ,htreuH ,HbmG erawtfoS atadireP( atadireP , 26 )KU ,erihstliW ,.dtL KU seirotarobaL FBO( ;rossergorP , 62 2 captatS sa hcus smargorp sisylana dleif lausiv ni elbaliava era sehcaorppa desab-dnerT . 12evruc hcae fo srotces 8 sesylana eH .dleif lausiv eht fo noitisop hcae ta noitautculf derusaem yllautibah naht ytilibats rehgih hcum

Choice of the best algorithm

23

. )niapS ,ytisrevinU anugaL aL (

evitciderp naiseyab ehT .54evitagen si tset eht taht nevig ,ytilibats fo ytilibaborp eht si VPN eht dna ,evitisop si tset eht taht nevig ,noissergorp fo ytilibaborp eht si VPP ehT .tluser tset eht no lanoitidnoc esruoc esaesid fo ytilibaborp eht erusaem eulav evitciderp evitagen dna evitisop ehT .ton si seulav evitciderp tuoba ecnerefni evitarapmoc ,seiticificeps dna seitivitisnes rieht fo smret ni stset citsongaid gnirapmoc rof depoleved llew si ygolodohtem lacitsitats hguohtlA .21yticificeps dna ytivitisnes neewteb esimorpmoc doog a edivorp raey rep stset eerhT .sesaercni RLP fo ytivitisnes eht ,sesaercni gnitset fo ycneuqerf eht sA .)tset evitisnes erom a ,.e.i( rekciuq seye gnissergorp galf yltcerroc lliw taht tset a esu ot retteb si ti ,eye elbats a gnitaert naht gnigamad erom hcum eb dluow eye gnissergorp a taert ot gniliaf nehw ,ylesrevnoC )b .)yticificeps fo eerged hgih a ,.e.i( gnissergorp sa seye elbats wef yrev lebal yleslaf ot nwonk si taht desu eb dluohs dohtem a ,tnemeganam lacinilc ni egnahc yltsoc ro yksir a gniogrednu s tneitap eht eb dluow gnissergorp sa delebal gnieb s eye na fo emoctuo eht nehW )a ot esoprup eht no sdneped esu rof elbatius tsom si taht dohtem eht ,deednI .75 tseb eht si hcihw tuoba tnemeerga on si ereht ,desoporp neeb evah taht noissergorp dleif lausiv gninimreted fo airetirc dna sdohtem tnereffid lareves eht fO .dohtem dradnats ecnerefer a fo ecnesba eht :dradnats dlog tnednepedni na fo kcal eht si noitaroireted eurt gnisongaid ni ytivitisnes dna yticificeps tseb eht sreffo noitceted dleif lausiv fo dohtem hcihw tuoba susnesnoc elttil si ereht taht snosaer eht fo enO .deveihca neeb ton sah laedi siht tneserp ta ,revewoH .sisab tset-yb-tset a no noissergorp dna ytilibats neewteb etanimircsid dluohs ti dna ,ytivitisnes dleif lausiv ni segnahc

.11 tup eb ot era stluser eht hcihw

values The predictive values

24

. 33 erac tneitap ni elbacilppa yltcerid erom si dna yticificeps dna ytivitisnes eht naht ecnaveler lacinilc retaerg sah eulav

ni ecnamrofrep retteb a ,yroeht eht ni ,serutaef erawtfos RLP hguohtlA .sdohtem 'RLP no hcraeser fo erom tol a ylevitaler syalpsid erutaretil dezilaiceps hserf ehT . 86 dohtem eno naht erom ylppa ot elbasivda si ti ;reffid sdohtem suoirav eht morf stluser dna ssol dleif lausiv evissergorp gnitaulave rof dradnats dlog on si ereht esuaceB .stneitap amocualg fo ytirojam eht ni srucco sraey 5 revo ssol dleif lausiv fo noissergorp ,lareneg nI .2ecalp nekat sah egnahc taht ecnedive eht fo htgnerts eht seifitnauq ti tub ,noissergorp fo tnuoma eht yfitnauq ot tpmetta ton seod sisylana sihT .)9 .gif( dnert eht fo )eulav-p( ecnacifingis lacitsitats eht fo gnidarg lanidro na no desab erofereht erehw sesylana COE ehT .)esion( stnemerusaem eht fo ytilibairav devresbo eht ot )langis( dnert devresbo eht fo edutingam eht gnitaler yb dehsilpmocca si sihT .emit revo degnahc evah stnemerusaem eht taht ecnedive eht fo htgnerts eht erapmoc 2sesylana )COE( xedni egnahc fo ecnedive eht )raey / 2mm ni aera mir laniter-oruen fo ssol eht ro raey/Bd ni emit revo ytivitisnes dleif lausiv fo ssol eht ,elpmaxe rof( segnahc etulosba gnirapmoc taht rehtar ,)larutcurts dna lanoitcnuf( erusaem noissergorp fo sdohtem tnereffid ylevitatilauq gnirapmoc nehW .tsixe ton seod noissergorp -non dna noissergorp yfissalc ylevitinifed nac taht ,tset doolb a sa hcus ,reifilauq tnednepedni nA .egatnavdasid a ta noitinifed yb si rettal eht ,tset lacisyhpohcysp wen a etaulave ot desu si ,yrtemirep detamotua dradnats a fo sisylana desab-dnert o tneve eht no denifed ,noissergorp suotamocualg nehw ecneH . 2 ti enifed ot desu era taht seno yrev eht era noissergorp ro ytireves sti erusaem ot desu era taht stset fo sessalc eht ecnis noissergorp sti ro amocualg fo reifilauq tnednepedni on evah ew sisylana lanif eht nI .dradnats dlog a fo eruliaf eht si elpicnirp-yek ehT

Stability or Progression

25

.delgnat si ytilibaliava sti ylgnisirprus ,noissergorp amocualg gnildnah

fo ytilibairav eht no desab yliramirp ,selur laciripme lacitsitats no rehtar dednuof -llew si ,tekram yrtemireP eht ni tnelaverp tneserp ta ,)APG( sesylana desab-tnevE .amocualg fo gninesrow erutuf rof ytilibaborp a etaluclac ot naicinilc eht wolla dluow ,sepols fo mus sa hcus xedni yrammus A .)noisserger citsigol etairavitlum gnisu( sdohtem RLP dna pu-wollof fo sraey 4 tsrif eht gnirud ylno elbaliava noitamrofni gnisu sraey 8 ta seires dleif lausiv eritne eht fo esruoc eht gnitciderp fo eussi tnatropmi eht desserdda
64.sloc

a fo tnemssessa eht ni tsissa yam noissergorp fo etar derusaem A .noisnetrepyh raluco ni dna ssecorp esaesid eht fo segats tseilrae eht ta lufesu ylralucitrap si sihT .detamitse eb yam egnahc fo etar a ,emoctuo yranib a fo daetsni ,taht ni ecitcarp lacinilc ni sesylana tneve revo egatnavda lufesu a evah erawtfos sesylana dnerT .95seuqinhcet sisylana-tneve naht )emit ro( stset erom eriuqer yam yeht tub stneitap erom ni noissergorp tceted ot dna yticificeps hgih evah ot nwohs neeb evah seuqinhcet RLP gnilledom atad nI . 74 gnivorpmi sa seires dleif lausiv rewef seifitnedi ti ecnis sdohtem SIGA ot roirepus eb yam noisserger raenil esiw tnioP .seye fo noitroporp ralimis a ni noissergorp stceted RLP airetirc SIGA htiw derapmoC
Figure 9. ( Artes PH, Chauhan BC, 2)

26

detceted eb nac stneve evissergorp erom taht ylekil si ti neht ,egnar tnemerusaem eht ot derapmoc ytilibairav wol sedivorp tset a fI .stnemerusaem tseter tset

dna iwadhaM-iruoN ,atad cirtemirep dna lacinilc gnidulcnI .tnemtaert retla ro ecnemmoc ot noisiced

eht ni dna ssol lausiv tnacifingis yllanoitcnuf fo tnempoleved fo ksir s tneitap

noissergorp amocualg fo noitanimreted a laiceps ni ekam dluow taht scitsiretcarahc eht no snoitaredisnoc dna senilediug gniwollof eht ,yletaL .
25secived

lacigolonhcet fo tnemssessa tcerroc rof dehsilbatse era smron tnegnirts emoS . 16 sdohtem tnereffid fo retibra doog a gnieb morf ti sedulcerp siht dna ,tseb ta etaredom ro roop si snaicinilc trepxe neewteb noissergorp no tnemeergA .84 gniledom atad yb degduj eb yam ecnamrofrep )dradnats dlog( noissergorp rof dradnats ecnerefer tnednepedni na fo ecnesba eht ni ,dna detceles airetirc noissergorp eht yb decneulfni era noissergorp tceted ot emit dna ,yticificeps ,ytivitisneS .
06-2

ylisae era ro nwonk era hcihw fo rehtien ,yticificeps dna ytivitisnes neewteb ecnalab yrartibra yllaitnesse na sevlovni airetirc tnereffid neewteb eciohc ehT .dezilauqe eb stset gnitepmoc eht fo seiticificeps eht taht seriuqer rehtona naht egnahc ot evitisnes erom si euqinhcet eno rehtehw fo tnemgduj ehT .eciohc noiretirc eht fo esuaceb tluciffid si
06noitaroireted

gnitceted tuoba sdohtem sisylana dnert dna tneve fo ecnamrofrep eht gnirapmoC .asrev eciv dna ,cificeps ssel era evitisnes erom era taht stset ,yllamroN .elbats ro gnissergorp rehtie eb ot degduj eb dluoc taht dnuorg elddim eht ni seye sgalf dohtem eht yaw hcihw si yek eht ,ylraelC .5yticificeps retteb droffa tub stneitap fo snoitanimaxe erom eriuqer airetirc noitamrifnoc noissergorp dna noicipsus noissergorP .)8 dna 7 gif( airetirc efas-liaf tnereffid htiw deniatbo setar noissergorp eht ni noitairav egral a era ereht ,sesylana tneve ro dnert rehtie htiW .eye eht ni tneve lacigoloib emas eht ot detaler eb ton yam yeht ,ytilibairav tnemerusaem ot tcepser htiw yllacitsitats denifed era stneve eht esuaceB .stneve elbatceted rewef eb lliw ereht ytilibairav rehgih sah tset eht fi ,ylesrevnoC .euqinhcet siht yb

Guidelines for progression tests

27

:yllaretil ,1 desoporp neeb evah elbatpecca lacinilc

denimreted

ylrae

sti htiw derapmoc esaesid fo segats suoirav ta retemarap desoporp eht fo sisylana lanoitces-ssorC .ylsuoiverp desu airetirc eht naht esrow naht rehtar retteb eb yam ti ,dradnats dlog gnitsixe na hctam ton seod noiretirc ro tset wen a fi tub ,lufpleh si airetirc noissergorp gnitsixe ot noiretirc desoporp ylwen a fo nosirapmoC .yrassecen si airetirc dna stnemerusaem etadidnac yna fo noitadilaV .6 .elytsefil s tneitap eht no tcapmi lausiv fo tniop eht ot tesno sti morf esaesid eht fo esruoc eht revo retemarap taht ni egnahc fo egnar eht htiw derapmoc egnahc fo tnemercni llams a gnirusaem ylbailer fo elbapac eb dluohs retemarap emoctuo ehT .5 .rettal eht ylpmi syawla ton seod tnemeriuqer remrof ehT .emoctuo eht retla dluow taht rennam a ni etagorrus eht sretla tnemtaert eht rehtehw no osla tub ,emoctuo eht dna etagorrus eht neewteb noitaicossa detartsnomed a si ereht rehtehw no ylno ton sdneped etagorrus elbatius rehtona fo eciohc ehT .esruoc erutuf detcepxe rof etagorrus a sa detpecca si erusserp ralucoartni ,yltnerruC .emoctuo dna noissergorp erutuf ot egaknil detnemucod neeb sah ereht hcihw rof retemarap evitciderp emos ,si taht ,emoctuo mret-gnol fo etagorrus mret-trohs a eb osla yam tnemerusaem elbatpecca na ,elpicnirp nI .4 .gnitset lacisyhpohcysp lausiv rehto sa llew sa dleif lausiv ,ytivitca llec noilgnag fo stnemerusaem lacigoloisyhportcele ,sretemarap ksid citpo ,stnemerusaem rebbif evren laniter yb ,elpmaxe rof ,deifilpmexe )noisiv( noitcnuf ro )tnuoc noxa( erutcurts fo stnemerusaem tcerid edulcni yam sihT .emoctuo lacinilc sti dna esaesid eht fo esruoc eht ot tnaveler sa detpecca eb dluohs tnemerusaem ehT .3 .esaesid eht fo ecnesba ro ecneserp eht gnizingocer ni cificeps dna evitisnes era taht esoht morf reffid llew yrev yam esaesid eht fo noissergorp gnizingocer ni yticificeps dna ytivitisnes doog edivorp taht airetirc dna seulav derusaem ehT .2 .rehtona ot emit eno morf laudividni na ni noitautculf lacigoloib nwonk dna llams evah desu retemarap eht taht dna stset eht fo ytilibicudorper doog seriuqer sihT .)htrof os dna ,dipar ssel susrev noitaroireted dipar ,elbatsnu susrev elbats( derapmoc gnieb spuorg eht gnitarapes ni dna noissergorp gnizingocer ni ecnamrofrep doog evah dluohs seiduts lacinilc ni desu airetirc dna tnemerusaem ehT .1

28

stimrep

,noissergorp rof detset eb nac seires eht ,ni dedda si esion nehW .noissergorp dna noitautculf fo slevel nesohc htiw )evissergorp ro elbats( seires dleif lausiv gnitteG )c .ytilibairav suotamocualg lacipyt gnitibihxe esoht htiw ytilibairav on htiw seires dleif lausiv detalumis morf sisylana lacitsitats fo semoctuo fo nosirapmoc gniwolla os ,desopmoc yllacitamehtam eb nac ytilibairav gnitceffa srotcaF .detamitse si ytilibairav ro esion siht llew woh si noitalumis dleif lausiv etarucca yna ot yek ehT .emit revo eye na fo roivaheb eerf-esion eht yficeps ot syaw rof kool ot suoivbo si ti ,eroferehT .elbissopmi si sutats lautca eht htiw seigolodohtem tnereffid morf stluser tset gnirapmoc os dna ,nwonknu si seires a fo seye eht fo )eerf-esion( sutats eurt ehT .)esion gnivomer ro gnidda( sretemarap ytilibairav fo lortnoc A )b .)secnamrofrep enihcam .sv nam( tset evitcejbo desoporp a dna trepxe erawanu na htob fo seitiliba evitanimircsid eht detadilav eb osla dluoc ti selbairav gnidnuofnoc hcus gnicudortni yB . ytilibisnes eborp nac ew seires gnissergorp amocualg ysmilf gnitalumis yb erehweslE .seires elbats ekaf amocualg a no tset noissergorp niatrec fo yticificeps eht yevrus nac ew oS .stset noissergorp desoporp lareves fo ecnamrofrep evitaler etamitse ylisae yam selbairav gnidnuofnoc gnisu seires dleif lausiv fo noitalumis retupmoC )a :gnidulcni ,suoremun era sehcaorppa edam-enihcam eseht fo segatnavda ehT .atad degnarra htiw atad laer flesti ni sdnelb noitalumis eht fo cigol ehT .
31

retupmoc yb si stes atad lanidutignol gnissessa fo dohtem evitanretla nA .niatbo ot gnimusnoc emit dna tluciffid yllausu era hcihw ,sdleif lausiv fo stes lanidutignol ,egral setatissecen sdohtem wen gnitaulave dna noissergorp tceted oT .lufesu eb yam retemarap eht hcihw revo esaesid eht fo egnar eht enifed osla yam dna egnahc ezingocer ot ytivitisnes laitnetop fo noitacidni na si ytilibairav

Simulation of progression

29

dna noitautculf fo slevel nesohc htiw seires dleif lausiv detalumis fo noitareneg
35.sloc

dna yrpS yb dehsilbup margorp noissergorp noitalumis ehT .roivaheb deificeps siht htiw derapmoc stluser tset eht dna

.pu-wollof fo htgnel eht dna ,detalopretni stset fo ycneuqerf eht eldnah oT )d

noitalumis

esnopser esiwtniop ehT .alumrof noitubirtsid lamron a morf selpmas modnar tnednepedni yb denimreted si esion ehT .ytilibisnes esiw tniop sti ot detaler yltcerid noitacol tset hcae ta esion fo erusaem eno ylno gnidda detaluclac si ytilibairav esnopser eht )11 gif(
31-11

.tnereffid era sdleif lanif dna laitini eht noissergorp fo noitalumis rof ,esiwrehtO .)01 gif( atad tupni lanif dna enilesab lacitnedi morf detaerc era atad dleif lausiv suotamocualg elbats :dradnats suorogir a sedivorp noissergorp fo noitceted rof loot citylana na fo yticificeps eht ssessa ot atad detalumis fo esU .tneserp si noissergorp on erofereht dna ,emas eht era sdleif lanif dna laitini eht ,stluser tset dleif lausiv elbats tub degamad fo noitalumis rof :drawrofthgiarts si smhtirogla fo esnes lartnec ehT .)evoba erugif ees( noitalopretni yb detalumis era sdleif etaidemretni wen n dna nesohc sdleif lacinilc derusaem laer era seires eht fo sdleif lanif dna laitini ehT .)01 gif( noissergorp

Figure 10. Simulation Computer model C++ as developed by Spry and cols. (53).

30

margorp noitalumis eyE lautriV

renidraG eht nI

Figure 11. Virtual Eye simulations. The figure shows three series of greyscales, representing annual field testing over a six year period. The first column is a noise-free series with six points progressing at 2dB/year, and all other points remaining stable. The second and third columns are produced by using the Virtual Eye simulation to add noise to each point in each field; it becomes very difficult to distinguish the series based on the eye with six progressing points (the middle column) from the series based on a completely stable eye (the right-hand column).( Gardiner, S.K

.elbats ysion dna gnissergorp ysion ,gnissergorp eerf-esion : pu-wollof fo doirep sraet xis a revo seires eerht fo noitalumis elacs-yarg a ees ew erugif evoba eht nI .tniop eno tsuj naht rehtar stniop deretsulc emos ro dleif lausiv eritne na etalumis ot desu eb nac eyE lautriV eht ,yllarutaN .dednetni si noitautculf mret-trohs eht ylno oS .Bd27.2 noitaived dradnats dna Bd82 naem htiw noitubirtsid lamron a morf ylmodnar nward si ytivitisnes detalumis eht neht ,Bd82 si tniop a ta ytivitisnes eurt eht fi ,elpmaxe rof ,oS .ylevitcepser ,72.3 dna 180.0- era B dna A stnatsnoc eht erehw ,B + )Bd(ytivitisnes A = )DS( egol :noitcnuf eht yb detneserper saw ytilibairav

13)

31

ralupop erom hcum era )yticificeps dna ytivitisnes( ycarucca fo sretemarap eht ,ecitcarp lacinilc ni tnatropmi erom eb dluoc seulav evitciderp hguohtlA )4 .dnah ta stneitap amocualg eht rof elbaliava ton si dradnats dlog erutuf siht ,revewoH .dradnats dlog tnednepedni na sa nees eb nac taht depoleved eb lliw tset a yad eno taht eb yam tI )3 .yrartibra dna ciripme eht fo epocs eht ot rehtar gnoleb airetirc lacinilc srotarepo eht secnatsni ynam .)ytilibairav( esion dna langis ni roivaheb lacisyhpohcysp elbatsnu na fo yticanet ehT )1 .seires sdleif lausiv a ni derrucco sah taht egnahc yna fo etar eht gnirotinom ot setaler ti sa noitaulave amocualg wodahsrevo smelborp elbavommi etiuq ruof taht sezilaer eno weiver siht fo tnetnoc eht revo gnidaer ni tuB .sesabatad stneitap detceles no secruoser seuqinhcet detacilpmoc ssel ro erom gniylppa secived wen fo duorp era ew ,syadawoN .roivaheb sdleif lausiv amocualg eht gninrecnoc deniatbo neeb sah noitamrofni fo tnuoma egral a ,sraey 03-02 tsap eht nihtiW ni ,scitamehtam eht fo niamod tcirts eht ot gnoleb sdohtem lacitsitats hguohtlA )2

Conclusions

32

se.su@ujneba .srotarepo-yrtemirep neewteb

REFERENCES
1) Anderson DR, Chauhan B, Johnson C, Katz J, PatellaVM, Drance SM : Criteria for Progression of Glaucoma in Clinical Management and in Outcome Studies . Am J. Ophthalmol,130; 827-29, 2000 2) Artes PH, Chauhan BC : Longitudinal changes in the visual field and optic disc in glaucoma. Prog Retin Eye Res , 24 ; 333354, 2005 3) Artes PH, Nicolela MT, LeBlanc RP, Chauhan BC.: Visual Field Progression in Glaucoma: Total Versus Pattern Deviation Analyses . Invest Ophthalmol Vis Sci.46; 4600 4606, 2005 4) Boden C, Blumenthal EZ, Pascual J, McEwan G, Weinreb RN, Medeiros F, Sample PA : Patterns of Glaucomatous Visual Field Progression Identified by Three Progression Criteria. Am J Ophthalmol, 138:10291036, 2004 5) Chauhan BC, House PH, McCormick TA, LeBlanc RP. Comparison of conventional and high-pass resolution perimetry in a prospective study of patients with glaucoma and healthy controls. Arch Ophthalmol. 117;2433, 1999 6) Chen PP: Correlation of visual field progression between eyes in patients with openangle glaucoma. Ophthalmology 109; 2093-9, 2002 7) Fitzke FW, McNaught AI.: The diagnosis of visual field progression in glaucoma. Curr Opin Ophthalmol 5: 110115, 1994. 8) Fitzke FW, Hitchings RA, Poinoosawmy D, McNaught AI, Crabb DP.: Analysis of visual field progression in glaucoma. Br J Ophthalmol. 80:4048, 1996 9) Flammer J, Drance SM, Zulauf M: Differential light threshold. Short- and long-term fluctuation in patients with glaucoma, normal controls, and patients with suspected glaucoma. Arch Ophthalmol., 102: 704706, 1984 10) Flammer J, Drance SM, Fankhauser F, Augustiny L .: Differential light threshold in automated static perimetry. Factors influencing short-term fluctuation. Arch Ophthalmol 102:876879, 1984 11) Gardiner SK, Crabb DP.: Examination of Different Pointwise Linear Regression Methods for Determining Visual Field Progression. Invest Ophthalmol Vis Sci. 43:1400 1407, 2002

33

12) Gardiner, SK, Crabb DP.: Frequency of testing for detecting visual field progression . Brit. J. Ophthalmol.,86 ;560-64, 2002 13) Gardiner, S.K :Statistical methods for the analysis of visual field data in glaucoma. A thesis submitted in partial fulfilment of the requirements of The Nottingham Trent University for the degree of Doctor of Philosophy. 2003 14) Gardiner, SK , Crabb, DP, Fitzke FV, Hitchings, RA: Reducing noise in suspected glaucomatous visual fields by using a new spatial filter. Vision Res ., 44 ; 839848, 2004 15) Gardiner, S.K., Demirel, S and Johnson, C.A.: Modeling the sensitivity to variability relationship in perimetry. Vision Res.,46; 1732-45, 2006 16) Girkin C.A., Relationship between structure of optic nerve/nerve fiber layer and functional measurements in glaucoma. Curr Opin Ophthalmol., 15; 96101, 2004 17) Glynn RJ, Rosner B.: Multiple imputation to estimate the association between eyes in disease progression with interval-censored data. Statist. Med. 23:33073318, 2004 18) Gonzlez de la Rosa M, Pareja A: Influence of the fatigue effect on the mean deviation measurement in perimetry. Eur J Ophthalmol., 7: 29- 33, 1997 19) Gonzalez de la Rosa, M., Gonzalez Hernandez, M., Abraldes, M., Azuara- Blanco, A. : Quantification of inter-point topographic correlations of threshold values in glaucomatous visual fields. J. Glaucoma, 11, 30-34, 2002 20) Gonzalez de la Rosa M, Gonzalez-Hernandez M , Diaz Aleman T, Sanchez Mendez M.: Stabilization and comparison of TOP and Bracketing perimetric strategies using a threshold spatial filter . International Perimetric Society. Abstracts of the XVII Visual Field and Imaging Symposium, Portland, OR,. Acta Ophthal Scand. 84 ; 576, 2006 21) Gonzalez de la Rosa M, Gonzalez-Hernandez M, Diaz Aleman T.: Linear regression analysis of the cumulative defect curve by sectors and other criteria of glaucomatous visual field progression. International Perimetric Society. Abstracts of the XVII Visual Field and Imaging Symposium, Portland, OR,. Acta Ophthal Scand. 84 ; 577, 2006 22) Harwerth RS, Crawford ML, Frishman LJ: Visual field defects and neural losses from experimental glaucoma. Prog Retin Eye Res. 21:91125, 2002 23) Heijl A, Lindgren G, Olsson J. A package for the statistical analysis of visual fields. Doc Ophthalmol Proc Ser. 49; 153168, 1986 24) Heijl A, Lindgren G, Olsson J .:Normal variability of static perimetric threshold values across the central visual field. Arch Ophthalmol., 105 ; 15441549, 1987 25) Heijl, A.; Lindgren, A.; Lindgren, G.: Test-retest variability in glaucomatous visual field. Am J.Ophthalmol., 108: 130-135, 1989 26) Heijl A, Lindgren G, Lindgren A, :Extended empirical statistical package for evaluation of single and multiple fields: Statpac 2. In: Mills RP, Heijl A, eds. Perimetry Update 1990/1991. New York: Kugler & Ghedini; 1991:303315.

34

27) Heijl A, Bengtsson B. The effect of perimetric experience in patients with glaucoma. Arch Ophthalmol 114: 1922,1996. 28) Heijl A, Leske MC, Bengtsson B, Hyman L, Hussein M. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol., 120:12681279, 2002 29) Henson DB, Artes PH, Chauhan BC. Diffuse loss of sensitivity in early glaucoma. Invest Ophthalmol Vis Sci.;40:31473151, 1999 30) Henson,D.B.; Chaudry, S. Artes, P.H. ; Faragher, E.B. , Ansons, A. : Response variability in the visual field : Comparison of optic neuritis, glaucoma, ocular hypertension and normal eyes. Invest.Ophthal Vis.Sci . 41; 417-23, 2000 31) Holmin C, Krakau CE. Regression analysis of the central visual field in chronic glaucoma cases: a follow-up study using automatic perimetry. Acta Ophthalmol (Copenh). 60:267274, 1982. 32) Hutchings N, Wild JM, Hussey MK Flanagan JG, Trope GE.: The Long-Term Fluctuation of the Visual Field in Stable Glaucoma. Invest Ophthalmol Vis Sci. 41:3429 3436, 2000 33) Jansonius, N.M. Bayes theorem applied to perimetric progression detection in glaucoma: from specificity to positive predictive value. Graefes Arch Clin Exp Ophthalmol. 243:433437, 2005 34) Jampel HD, Vitale S, Ding Y, Quigley H, FriedmanD , Congdon N, Zeimer R.: TestRetest Variability in Structural and Functional Parameters of Glaucoma Damage in the Glaucoma Imaging Longitudinal Study. J Glaucoma, 15 ;152157, 2006 35) Johnson C, Cioffi G, Liebmann J, Sample P, Zangwill L, Weinreb R. The relationship between structural and functional alterations in glaucoma: a review. Semin Ophthalmol. 15:221233, 2000 36) Katz J, Gilbert D, Quigley HA, Sommer A.: Estimating progression of visual field loss in glaucoma. Ophthalmology, 104;1017-25, 1997 37) Keltner JL, Johnson CA, Quigg JM: Confirmation of visual field abnormalities in the Ocular Hypertension Treatment Study. Ocular Hypertension Treatment Study Group. Arch Ophthalmol. 118:11871194, 2000 38) Kutzko KE, Brito CF, Wall M.: Effect of instructions on conventional automated perimetry. Invest Ophthalmol Vis Sci., 41:20062013, 2000 39) Levi DM, Klein SA, Chen I : What is the signal in noise?. Vision Res., 45; 18351846, 2005 40) Martinez-Bello C , Chauhan BC, Nicolela MT, McCormick TA, Leblanc RP: Intraocular Pressure and Progression of Glaucomatous Visual Field Loss. Am J Ophthalmol 129:302308. 2000

35

41) Mayama C, Araie M, Suzuki Y, Ishida K, Yamamoto T, Kitazawa Y, Shirakashi M, Abe H, Tsukamoto H, Mishima HK, Yoshimura K, Ohashi Y. : Statistical evaluation of the diagnostic accuracy of methods used to determine the progression of visual field defects in glaucoma. Ophthalmology. 111;2117-25, 2004 42) McNaught AI,Crabb DP, Fitzke FW, Hitchings RA.: Modelling series of visual fields to detect progression in normal-tension glaucoma. Graefe's Arch Clin Exp Ophthalmol 233:750-755, 1995 43) Mikelberg FS, Schulzer M, Drance SM, Lau W: The rate of progression of scotomas in glaucoma. Am J Ophthalmol .,101; 16, 1986 44) Mills RP, Budenz DL, Lee PP, Noecker RJ, Walt JG, Siegartel LR: Categorizing the Stage of Glaucoma From Pre-Diagnosis to End-Stage Disease. Am J Ophthalmol., 141: 24 30, 2006 45) Moskowitza CS, Pepe MS,: Comparing the predictive values of diagnostic tests: sample size and analysis for paired study designs. Clinical Trials 3; 272279,2006 46) Nouri-Mahdavi K, Hoffman D, Gaasterland D, Caprioli J. : Prediction of Visual Field Progression in Glaucoma . Invest Ophthalmol Vis Sci. 45:43464351, 2004 47) Nouri-Mahdawi K, Caprioli J, Coleman AL, Hoffman D, Gaasterland D.: Pointwise linear regression for evaluation of visual field outcomes and comparison with the advanced glaucoma intervention study methods. Arch Ophthalmol. 123;193-9, 2005 48) Strouthidis NG, Scott A, Peter NM, Garway-Heath DF.: Optic Disc and Visual Field Progression in Ocular Hypertensive Subjects: Detection Rates, Specificity, and Agreement Invest Ophthalmol Vis Sci. 47:29042910, 2006 49) Schulzer M. Errors in the diagnosis of visual field progression in normal-tension glaucoma., Ophthalmology 101: 15891594,1994 50) Schwartz B, Takamoto T, Martin J, : Increased Rate of Visual Field Loss Associated with Larger Initial Visual Field Threshold Values on Follow-Up of Open-Angle Glaucoma. J Glaucoma 13; 120129, 2004 51) Smith, S.D.,Katz, J., Quigley, H.A.: Analysis of progressive change in automated visual fields in glaucoma. Invest.Ophthalmol.Vis.Sci., 37; 1419-28, 1996 52) Sox H, Stern S, Owens D, Abrams HC.: Assessment of diagnostic technology in health care. Rationale, methods, problems and directions. Institute of Medicine. National Academic Press. Washington DC. 1989 53) Spry PGD, Bates AB, Johnson CA, Chauhan BC.: Simulation of Longitudinal Threshold Visual Field Data. Invest Ophthalmol Vis Sci. 41:21922200, 2000 54) Spry PGD, Johnson CA : Identification of Progressive Glaucomatous Visual Field Loss. Surv Ophthalmo.,l 47: 158173, 2002. 55) Tan JCH, Franks WA, Hitchings RA: Interpreting glaucoma progression by white-onwhite perimetry. Graefes Arch Clin Exp Ophthalmol.. 240 ; 585592, 2002

36

56) Tarek M, Spaeth GL, Bitterman A, : Rate and amount of visual loss in 102 patients with open-angle glaucoma followed up for at least 15 years. Ophthalmology. 110; 900907, 2003 57) Tattersall CL,Vernon SA ,Menon GJ: Mean deviation fluctuation in eyes with stable Humphrey 24-2 visual fields. Eye, 20; 15, 2006 58) Tversky A, Kahneman D.: Judgement under uncertainty: heuristics and biases. Science, 185 ; 1124-31, 1974 59) Vesti E, Johnson CA, Chauhan, BC.: Comparison of Different Methods for Detecting Glaucomatous Visual Field Progression. Invest Ophthalmol Vis Sci., 44: 38733879, 2003 60) Viswanathan AC, Fitzke FW, Hitchings RA.: Early detection of visual field progression in glaucoma: a comparison of Progressor and Statpac2. Brit.J.Ophthalmol.,81; 10371042,1997 61) Viswanathan AC,Crabb DP, McNaught AI, Wescott MC, Kamel D, Garway DF, Fitzke FW, Hitchings RA.: Interobserver agreement on visual field progression in glaucoma: a comparison of methods. Brit.J.Ophthalmol.,87; 726-30, 2003 62) Viswanathan, AC, Fitzke FW, Hitchings RA.: Early detection of visual field progression in glaucoma: a comparison of Progressor and Statpac 2. Brit.J.Ophthalmol., 81; 1037-42, 1997 63) Viswanathan, AC, Fitzke FW, Hitchings RA.: Early detection of visual field progression in glaucoma: a comparison of Progressor and Statpac 2. Brit.J.Ophthalmol., 81; 1037-42, 1997 64) Wall, M, Kutzko KE, Chauhanf BC.: Variability in Patients With Glaucomatous Visual Field Damage Is Reduced Using Size V Stimuli .Invest Ophthalmol Vis Sci.; 38:426435,1997. 65) Werner EB, Bishop KI, Koelle J, Douglas GR, LeBlanc R, Mills RP, Schwartz B, Whalen WR, and Wilensky JT: A comparison of experienced clinical observers and statistical tests in the detection of progressive visual field loss in glaucoma using automated perimetry. Arch Ophthalmol .,106; 619, 1988. 66) Werner, EB, Petrig B, Krupin T, Bishop KI.: Variability of Automated Visual Fields in Clinically Stable Glaucoma Patients. Invest Ophthalmol Vis Sci . 30:1083-1089,1989 67) Werner EB. Errors in the diagnosis of visual field progression in normal tension glaucoma. Ophthalmology. 101:1595-99, 1994 68) Wild JM, Searle AE, Dengler Harles M, ONeill EC.: Longterm follow-up of baseline learning and fatigue effects in the automated perimetry of glaucoma and ocular hypertensive patients. Acta Ophthalmol Scand., 9; 210216,1991. 69) Zahari M, Mukesh BN , Rait JL, Taylor HR, McCarty CA: Progression of visual field loss in open angle glaucoma in the Melbourne Visual Impairment Project. Clin Exp Ophthalmol 34: 2026, 2006

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