The 24-2 Visual Field Guided Progression Analysis Can Miss the Progression of Glaucomatous Damage of the Macula Seen Using OCT

Donald C. Hood*, Sol La Bruna, Emmanouil Tsamis, Ari Leshno, Bruna Melchior, Jennifer Grossman, Jeffrey M. Liebmann, Carlos Gustavo De Moraes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To better understand the efficacy of the 24-2 guided progression analysis (GPA) in the detection of progression in eyes with early glaucoma (i.e., 24-2 mean deviation [MD] better than −6 dB) by comparing 24-2 GPA with a reference standard (RS) based on a combination of OCT and 24-2 and 10-2 visual field (VF) information. Design: Cross-sectional study. Participants: Ninety-nine eyes from 99 individuals, including 70 suspected or early glaucomatous eyes (24-2 MD better than −6 dB) and 29 healthy controls (HCs). Methods: All the eyes had at least 4 OCT and VF test dates over a period that ranged from 12 to 59 months. The 24-2 VF tests included 2 baseline tests and at least 2 follow-up tests. The 2 baseline tests were performed within an average of 5.6 days (median, 7 days), and the last follow-up test was performed at least 1 year after the first baseline visit. Main Outcome Measures: A commercial 24-2 GPA software, with default settings, characterized the eyes as having “likely progression” (LP) or “possible progression” (PP); both were considered “progressing” for this analysis. For RS, 3 authors graded progression using strict criteria and a combination of a custom OCT progression report and commercial 24-2 and 10-2 GPA reports for the same test dates as GPA. Results: The reference standard identified 10 (14%) of the 70 patient eyes and none of the HC eyes as having progression. The 24-2 guided progression analysis identified 13 of the 70 patient eyes as having progression (PP or LP). However, it correctly classified only 4 (40%) of the 10 RS progressors. All 6 of the RS progressors missed by the 24-2 GPA showed progression in the macula. In addition, the 24-2 GPA identified 2 of the 29 HC eyes as progressors and 9 patient eyes without progression based on the RS. Conclusions: In eyes with early glaucoma (i.e., 24-2 MD, > −6 dB) in this study, the 24-2 GPA missed progression seen using OCT and exhibited a relatively high rate of false positives. Furthermore, the region progressing typically included the macula. The results suggest that including OCT and/or 10-2 VFs should improve the detection of progression.

Original languageEnglish
Pages (from-to)614-627
Number of pages14
JournalOphthalmology Glaucoma
Issue number6
StatePublished - 1 Nov 2022


FundersFunder number
Carl Zeiss Meditech Inc
Columbia University Department of Ophthalmology
National Institutes of HealthEY-025253
National Eye InstituteR01EY002115
Research to Prevent Blindness


    • Glaucoma
    • OCT
    • Perimetry
    • Progression


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