Glaucoma is a progressive optic neuropathy characterized by retinal ganglion cell loss. Progression is irreversible, so diagnosis and monitoring are important for management. Progression can be monitored structurally with HRT, GDX, and OCT, or functionally with perimetry. Clinical evaluation and perimetry are standard for detecting progression, but have limitations like subjectivity. Trend and event analysis of visual fields are used to objectively detect progression over time. Various programs analyze parameters like TD, MD, and CPSD for trend analysis or look for deteriorating thresholds beyond baseline levels for event analysis. HVF STATPAC provides overview prints, change analysis, GCP plots, and GPA to facilitate interpretation of visual field changes

1. HVF PROGRESSION
SIVATEJA CHALLA

2. • Glaucoma is progressive optic neuropathy
characterised by progressive loss of retinal
ganglion cells
• Progress is totally irreversible

3. In this scenario,the main thrust in glaucoma management is
diagnosing progression so as to halt it.

4. Can be monitored….
structurally
• HRT
• GDX
• OCT
functionally
• Perimetry

5. • Clinical detection of changes in the optic disc and
RNFL corroborated by visual field assessment
still remain the accepted methods to detect
progression in glaucoma
• Drawback in clinical evaluation of the optic disc
and RNFL is that it is subjective with considerable
intra and inter observer variation

7. • VF is gold standard to asses progression objectively in
glaucoma
• conventional perimetry is probably not the most
sensitive technique to monitor changes in the visual
field.
• lot of programs like modified Andersons criteria,
overview printout, Peridata and delta program of
Octopus, and Glaucoma change & Probability analysis in
the Humphrey are all designed to facilitate
interpretation of change

9. progression
Trend
analysis
Event
analysis

10. PROGRESSION
TREND ANALYISIS
• various parameters TD,MD,
CPSD is calculated by the
software to analyze change
and compared to the
threshold value
• significantly negative, then
it is said to have progressed
EVENT ANALYSIS
• determined when the
threshold deteriorates
beyond the previously
prescribed level
• uses paired t tests,
confidence intervals, point
wise glaucoma change
probability analysis

11. Trend analysis Event analysis

12. • HVF STATPAC prints field in four formats
1.Overview print out
2.Change analysis
3.Glaucoma change probability plot(GCP)
4.Glaucoma progression analysis (GPA)

13. OVERVIEW PRINT OUT
• 16 serial follow ups of a particular
patient, just by a glance
• does not give us the reliability
indices
• all the fields being compared should
be of the same strategy.

15. CHANGE ANALYSIS PRINT OUT
• Produces analytical summary of changes in
patients visual field from time of earliest test
to most recent test
• Box plots are seen
• Also gives summary of four global indices
SF,PSD,CPSD and MD

18. CHANGE ANALYSIS PRINT OUT

21. Linear regression analysis

22. Glaucoma change
probability
• An improved sensitivity is designated as
an Open triangle and a worsened
sensitivity is depicted as close triangle
• >3 closed triangles depicts progression
• Important limitation is use of MD as an
indicator of progression is its inability to
distinguish between focal and diffuse
change. Cataracts are characterised by
the diffuse perimetric defects which may
coincide or be confused wit
glaucomatous progression.

24. GLAUCOMA PROGRESSION ANALYSIS
• Developed by carl zeiss,event based
• Change based on pattern deviation plot
• Requisites2 base line VF and 1 f/u VF
• Up to 14 follow up tests can be compared with
baseline

25. X signifies that the data at that point was out of range for
analysis.

26. BASE LINE EXAMINATIONS
VISUAL FIELD HISTORY AND TREND
CURRENT EXAMINATION

28. GPA baseline examination
• VFI a new summary measurement of visual field status
expressed as a percent of a normal age-adjusted visual field.

29. VFI rate of progression analysis

31. Current VF summary

32. GPA Alert
• Possible progression:
same 3 or more points
show deterioration in at
least 2 consecutive tests
• Likely progression:
same 3 or more points
show deterioration in at
least 3 consecutive
tests.

33. problems
• Learning curve
• Long term fluctuations
• Already Bad fields
• Other pathologies

35. THANK YOU