The Clinical Application Of The GPA In The Identification Of Primary Glaucoma Visual Field Progress

Purpose To compare the evaluation efficiency of visual field progression in glaucoma patients assessed by the glaucoma progression analysis (GPA) used in the Humphrey Field Analyzer perimeter and by subjective clinical criteria.Methods Retrospective cross-sectional studies of39eyes of24glaucoma patients with at least five reliable visual fields were conducted. Progression of the visual field damage was analyzed by a masked observer using both GPA and defined clinical criteria. Prevalence of progressive visual field damage were evaluated by clinical criteria and GPA analysis respectively. Agreement between both methods was quantified by kappa analysis. GPA performance was also calculated using clinical criteria analysis as the reference standard.Results The identification efficiency of two methods on the progression of glaucomatous Visual field were equal (P=0.181). Clinical methods using2or3continuous follow-up visual fields to identify the progression of glaucoma had significant difference (P=0.000). Because of the limited number of cases, it was yet uncertain which was better used either2results or3results. GPA analyses using2or3continuous follow-up visual fields to identify the progression of glaucoma had no statistical significance (P=0.544). Both methods using two or three continuous follow-up visual fields to identify the progression of glaucoma had no significance (P=1.000;P=0.784). That clinical methods identify the progression of glaucoma using total deviation and pattern deviation had significant difference (P=0.017).Conclusion There is a strong correlation between GPA identification of glaucomatous progression and a thorough subjective clinical assessment of the visual fields. GPA could be a useful analysis to aid clinicians in the detection and evaluation of glaucomatous progression, with high specificity and good sensitivity, and with strong positive likelihood ratio and negative likelihood ratio.