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Klin Monbl Augenheilkd 2011; 228(4): 311-317
DOI: 10.1055/s-0031-1273216
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Clinical Evaluation of a Novel Population-Based Regression Analysis for Detecting Glaucomatous Visual Field Progression

Klinische Beurteilung einer neuen populationsbasierten Methode zur Erkennung von glaukomatösen GesichtsfeldveränderungenM. P. Kovalska1 , E. Bürki1 , A. Schoetzau1 , S. F. Orguel1 , J. Flammer1 , S. Orguel1 , M. C. Grieshaber1
  • 1Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland (Chairman: Prof. Dr. Josef Flammer)
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Publication History

received: 1.10.2010

accepted: 30.11.2010

Publication Date:
11 April 2011 (online)

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Zusammenfassung

Hintergrund: Echte Gesichtsfeldveränderungen können durch die klinische Beurteilung, oder mithilfe einer Trendanalyse oder Ereignisanalyse von Fluktuationen unterschieden werden. Das Ziel dieser Arbeit war es, die klinische Beurteilung von Gesichtsfeldreihen mit einem neuen statistischen Verfahren (Octopus Field Analysis, OFA) zur Erkennung von signifikanten glaukombedingten Veränderungen im Laufe der Zeit zu vergleichen. Gleichzeitig wird die Leistungsfähigkeit der herkömmlichen Regressionsanalyse mit der neuen Methode verglichen. Patienten und Methoden: 240 Gesichtsfeldreihen von 240 Patienten mit mindestens 9 Untersuchungen wurden durch zwei erfahrene Untersucher bezüglich Stabilität oder Progression klassiert. Die Klassifikation diente als Grundlage und wurde mit folgenden statistischen Testverfahren verglichen: (a) t-Test global, (b) r-Test global, (c) Regressionsanalyse von 10 Gesichtsfeldclustern und (d) punktweise lineare Regressionsanalyse. Ergebnisse: 32,5 % der Gesichtsfelder wurden von den Untersuchern als progressiv eingestuft. Die Sensitivität und Spezifität waren für den r-Test 89,7 % respektive 92,0 %, und für den t-Test 73,1 % respektive 93,8 %. In der punktweisen linearen Regressionsanalyse war die Spezifität vergleichbar (89,5 versus 92 %), hingegen war die Sensitivität deutlich geringer (22,4 versus 89,7 %) für ein Signifikanzniveau von p = 0,01. Die Cluster-Trend-Analyse (p = 0,005) zeigte eine deutlich höhere Sensitivität für den r-Test (37,7 %) als für den t-Test (14,1 %) bei vergleichbarer Spezifität (88,3 versus 93,8 %). Bezüglich der Clusterverteilung waren die parazentralen Cluster und die superiornasalen Hemi-Gesichtfelder am meisten fortschreitend. Schlussfolgerungen: Die populationsbasierte Regressionsanalyse scheint eine Progression beim Glaukom eher zu erkennen als die Trendanalyse und vermeidet bei etwa gleicher Trefferquote verschiedene Nachteile der Ereignisanalyse. Sie erleichtert dank der automatischen Klassierung die Erfassung von glaukombedingten Gesichtsfeldveränderungen und gestattet mithilfe von Gesichtsfeldclustern eine verbesserte Visualisierung der Korrelation zwischen Funktion und Struktur.

Abstract

Background: The distinction of real progression from test variability in visual field (VF) series may be based on clinical judgment, on trend analysis based on follow-up of test parameters over time, or on identification of a significant change related to the mean of baseline exams (event analysis). The aim of this study was to compare a new population-based method (Octopus field analysis, OFA) with classic regression analyses and clinical judgment for detecting glaucomatous VF changes. Patients and Methods: 240 VF series of 240 patients with at least 9 consecutive examinations available were included into this study. They were independently classified by two experienced investigators. The results of such a classification served as a reference for comparison for the following statistical tests: (a) t-test global, (b) r-test global, (c) regression analysis of 10 VF clusters and (d) point-wise linear regression analysis. Results: 32.5 % of the VF series were classified as progressive by the investigators. The sensitivity and specificity were 89.7 % and 92.0 % for r-test, and 73.1 % and 93.8 % for the t-test, respectively. In the point-wise linear regression analysis, the specificity was comparable (89.5 % versus 92 %), but the sensitivity was clearly lower than in the r-test (22.4 % versus 89.7 %) at a significance level of p = 0.01. A regression analysis for the 10 VF clusters showed a markedly higher sensitivity for the r-test (37.7 %) than the t-test (14.1 %) at a similar specificity (88.3 % versus 93.8 %) for a significant trend (p = 0.005). In regard to the cluster distribution, the paracentral clusters and the superior nasal hemifield progressed most frequently. Conclusions: The population-based regression analysis seems to be superior to the trend analysis in detecting VF progression in glaucoma, and may eliminate the drawbacks of the event analysis. Further, it may assist the clinician in the evaluation of VF series and may allow better visualization of the correlation between function and structure owing to VF clusters.

Schlüsselwörter

Glaukom - Octopus Field Analysis - Progression - Gesichtsfeld

Key words

glaucoma - Octopus field analysis - progressive damage - visual field

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Matthias C. Grieshaber, MD, FEBO

University Hospital of Basel, Department of Ophthalmology

Mittlere Strasse 91

CH-4031 Basel, Switzerland

Phone: ++ 41/61/2 65 87 87

Fax: ++ 41/61/2 65 87 45

Email: mgrieshaber@uhbs.ch