Purpose

While many tests and indices are available to identify glaucoma progression, using them in combinations may decrease overall specificity. The aim of this study was to develop a framework for assessing glaucoma progression using structural and functional indices jointly for a fixed specificity.

Methods

The study included 337 eyes of 207 patients with ocular hypertension or primary open-angle glaucoma selected from the Diagnostic Innovations in Glaucoma Study or the African Descent and Glaucoma Evaluation Study. All patients had at least 9 visits. Each visit had retinal nerve fiber layer thickness (RNFLT) and mean sensitivity from static automated perimetry (SAP MS) measured within a one-month window. Simple linear regression was applied to assess deterioration in each index for series of 5 to 9 visits. To identify progression using the two indices jointly, marginal significance levels set at a specificity of 95% were derived for two criteria: ANY (worsening on either RNFLT or SAP MS) and ALL (worsening on both RNFLT and SAP MS). Positive rate (percentage of eyes flagged as progressing) was determined individually for each index, as well as for the ANY and ALL criteria.

Results

Compared to SAP MS, RNFLT had higher positive rates (15% to 45%) for all series lengths. For the joint analyses, the positive rate was on average 12% higher for the ANY criterion compared to the ALL criterion. While RNFLT-alone had comparable positive rates and time-to-detection as the ANY criterion, each uniquely identified a subset of eyes (Kappa = 0.55 to 0.75).

Conclusions

This study provides a simple framework for assessing glaucoma progression with data from two tests jointly, without compromising specificity. This framework can be extended to include two or more parameters, can accommodate global or regional indices, and can eventually be used with novel parameters identified as predictive of glaucoma progression.

中文翻译：

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结合使用结构和功能指标评估青光眼进展的框架。

目的

尽管有许多测试和指标可用于识别青光眼的进展，但将它们结合使用可能会降低总体特异性。这项研究的目的是建立一个框架，结合固定的特异性使用结构和功能指标来评估青光眼的进展。

方法

该研究纳入了207例高眼压或原发性开角型青光眼患者的337眼，这些患者选自青光眼诊断创新研究或非洲人后裔和青光眼评估研究。所有患者至少进行了9次就诊。每次访视均在一个月的时间内测量视网膜神经纤维层厚度（RNFLT）和静态自动视野检查（SAP MS）的平均灵敏度。应用简单的线性回归来评估5到9次就诊中每个指标的恶化情况。为了共同使用这两个指标来确定进展，针对两个标准得出了95％的特异性边际显着性水平：ANY（对RNFLT或SAP MS较差）和ALL（对RNFLT和SAP MS均较差）。针对每个指标分别确定阳性率（标记为进展中的眼睛百分比），

结果

与SAP MS相比，RNFLT在所有系列长度中的阳性率更高（15％至45％）。对于联合分析，ANY标准的阳性率平均比ALL标准高12％。尽管单独使用RNFLT的阳性率和检测时间与ANY标准相当，但每个人都可以唯一地识别出眼睛的一部分（卡帕值= 0.55至0.75）。

结论

这项研究提供了一个简单的框架，可以结合两个测试的数据评估青光眼的进展，而不会影响特异性。该框架可以扩展为包括两个或多个参数，可以适应全球或区域指标，并且最终可以与识别为青光眼进展的新参数一起使用。