Progression detection in glaucoma can be made more efficient by using a variable interval between successive visual field tests

Background: This study aimed to gain insight into the optimal spacing in time for visual field tests for progression detection in glaucoma. Methods: Three perimetric strategies for progression detection were compared by means of simulation experiments in a theoretical cohort. In strategies 1 and 2, visual field testing was performed with fixed-spaced inter-test intervals, using intervals of 3 and 6 months respectively. In strategy 3, the inter-test interval was kept at 1 year as long as the fields appeared unchanged. Then, as soon as progression was suspected, confirmation or falsification were performed promptly. Follow-up fields were compared against a baseline assuming linear deterioration, using various progression criteria. Outcome measures were: (1) specificity, (2) time delay until the diagnosis of definite progression, and (3) number of required tests. Results: Strategies 2 and 3 had a higher specificity than strategy 1. Strategies 1 and 3 detected progression earlier than strategy 2. The number of required visual field tests was lowest for strategy 3. Conclusion: Perimetry in glaucoma can be optimised by postponing the next test under apparently stable field conditions and bringing the next test forward once progression is suspected.

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