Significant Glaucomatous Visual Field Progression in the First Two Years: What Does It Mean?

Purpose: It has been recommended that multiple visual field examinations be performed in the first 2 years after glaucoma diagnosis so that rapid visual field progression (<= - 2 dB/year, using ordinary least squares regression over time of the summary index mean deviation [MD]) can be detected. Here I investigate how predictive a statistically significant regression slope is of truly rapid visual field progression. Methods: I simulated visual field series (N = 100,000) spaced at 4 monthly intervals for the first 2 years. MD values had a standard deviation of 1 dB. The true underlying rates of progression were selected from a modified hyperbolic secant with parameters averaged from fits to large data sets from Canada, Sweden, and the United States. Results: The positive predictive value (PPV) for rapid progression was 0.10 after 2 years, whereas the negative predictive value (NPV) was > 0.99. When using the criterion that a significant regression also had to have a slope of (<= - 2 dB/year, the PPV for rapid progression increased to 0.18 but the NPV was essentially unchanged (NPV >0.99). Conclusion: Although performing multiple visual fields in the first 2 years provides appropriate power to detect rapid progression, a significant regression slope in the first 2 years is not highly predictive of rapid progression, even if slopes (<= - 2 dB/year are considered only. Translational Relevance: Statistically significant visual field progression in a short period after diagnosis may not necessarily indicate the presence of rapid progression, and so confirmatory signs of rapid progression should be sought before implementing treatment changes.