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Utility of targeted mean total deviation trend analysis for detecting progressive visual field changes in early-to-moderate stage glaucoma

Eye volume 38, pages 545–552 (2024)Cite this article

Subjects

Abstract

Objectives

To evaluate the clinical utility of trend-based analysis of the targeted mean total deviation (TMTD) by comparing its rates of visual field (VF) change and sensitivities of detecting VF progression with those of the mean total deviation (mTD) in the global and hemifield VF area in early to-moderate glaucoma patients.

Methods

A single eye from 139 open-angle glaucoma patients with hemifield VF defects and a minimum two year follow-up were retrospectively evaluated. The TMTD was estimated by averaging the total deviation (TD) values after excluding VF points that had a threshold sensitivity of <0 dB in three baseline tests, and the mTD by averaging the entire VF TD values. The study patients were classified as VF progressors vs. non-progressors using both event- and trend-based analysis. The rates of change and ratios of progression detection were compared between TMTD and mTD.

Results

This study included 49 VF progressors and 90 non-progressors. Slopes for the global and VF-affected hemifield TMTD were significantly faster than those for the mTD in each subgroup and in the entire cohort (P < 0.001). Trend-based TMTD analysis detected VF progression in greater proportion than either trend-based mTD or event-based analysis (38.1% vs. 30.2% vs. 27.3%, respectively: VF affected hemifields).

Conclusions

The rates of change in the TMTD are significantly faster than those for the mTD globally and in the VF-affected hemifields. Trend-based TMTD analysis shows greater sensitivity for detecting VF progression than trend-based mTD or event-based analysis in early-to-moderate glaucoma patients with hemifield VF loss.

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Fig. 1: Venn diagrams representing the distribution of VF progression according to the event-based analysis and trend-based analyses of TMTD and mTD globally and in the VF-affected hemifields.
Fig. 2: Two representative early-to-moderate stage OAG patients in the study cohort with a single hemifield VF defect, and calculation of their TMTD and mTD slopes.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea

    Woo Keun Song, Ko Eun Kim, Anna Lee, Jooyoung Yoon & Michael S. Kook

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  1. Woo Keun Song
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  2. Ko Eun Kim
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  5. Michael S. Kook
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Contributions

Conception and design: MSK Acquisition, analysis, and interpretation of data: WKS, KEK, and MSK. Drafting of the manuscript: WKS and MSK. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: WKS, AL, JYY, and KEK. Supervision: MSK.

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Correspondence to Michael S. Kook.

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Song, W.K., Kim, K.E., Lee, A. et al. Utility of targeted mean total deviation trend analysis for detecting progressive visual field changes in early-to-moderate stage glaucoma. Eye 38, 545–552 (2024). https://doi.org/10.1038/s41433-023-02726-2

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