Changing Paradigms of Progression
                                                                                    One of the 
          Progressive                       Treatment                              Clinician must 
                                                                                   be able to
          optic                             goal                                    most 
          neuropathy                                                                challenging 
              • All patient is               • To halt or slow                    • Identify high risk  
                                                                                    task
               progress at                     progression                          patient
               different                     • Rate of progression                • Detect and measure 
               rates                           and                                  progression
                                               life expectancy.
      Structure vs Function Testing 
       Which one is better to detect progression?
       Should we choose one method vs the other ?
        25% to                                         Choose 
        50% of                        Combined         base on 
      RGCs  lost      Vice versa         both         the stage 
      before SAP                        testing          of 
      abnormalit                                      glaucoma
          y 
       Early stage use OCT, moderate to advance stage 
        use HVF to detect progression.
       Visual Function Progression Assesment
                                                                      The 
                                                                   Humphre
       Establishin          Follow-up          Progressio          y Guided 
           g a                data             n Analysis          Progressi
         baseline           collection                                 on 
                                                                   Analysis 
                                                                     (GPA)
       Manifestation of Progression
       1.  Conversion from normal to abnormal.
       2.  New defect in a normal region of an 
           abnormal baseline fields.
       3.  Worsening of a defect
       4.  Staging of disease, move from one 
           category to another.
     Baseline Data Collection - first 2 
    years
       A good baseline of reliable VFs is essensial.
       White-on-white SAP, at least 24-2.
       At least 2 reliable VFs in the first 6 months.
       At least 2 further VFs within the next 18 months.
       Ideal :  6 VFs in 2 years to rule out rapid progression 
          (-2dB/year or worse)
       Remove from the analysis : obvious learning effect, 
        high FP, obvious artifact.
       Established  a  new  baseline  after  significant 
        therapeutic intervention as surgery.
      Weinreib RN et all.  Progression of Glaucoma. WGC. Consensus series-8. Kugler Pub. 2011.
     Follow-up data collection – after 2 years
           Conducted by the same strategy.
           Low-moderate risk : 1 VF/year.
           High risk               : 2 VFs/year.
           Repeated sooner if :
            progression is identified on the basis of an 
             event analysis 
            Clinically  noted  or  measured  by  imaging 
             suggestive  of  progression  include  a 
             splinter           hemorrhage,  inadequate  IOP 
             control.