Clinical Paper of the Month - Practical landmarks for visual field disability in glaucoma

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Journal Club

Clinical Paper of the Month - Practical landmarks for visual field disability in glaucoma

Practical landmarks for visual field disability in glaucoma

Publishing date: September 2012

Author(s): Saunders LJ, Russell RA, Crabb DP.

City University London, London, UK.

BACKGROUND/AIMS: To assess whether mean deviation (MD) from automated perimetry is related to the visual field (VF) component for legal fitness to drive (LFTD) in glaucoma patients.

METHODS: Monocular 24-2 VFs of 2604 patients with bilateral VF damage were retrospectively investigated. Integrated visual fields were calculated and used as a surrogate to assess LFTD according to current UK driving licence criteria. The better eye MD (BEMD), worse eye MD (WEMD) and a measure utilising MD of both eyes were compared, to assess respective diagnostic capabilities to predict LFTD (using the integrated visual field surrogate test as the gold standard) and a 'Probability of Failure' (PoF) for various defect levels was calculated.

RESULTS: BEMD appears to be a good predictor of the VF component for a patient's LFTD (receiver operating characteristic area under the curve: 96.2%); MDs from both eyes offered no significant extra diagnostic power (area under the curve: 96.4%). PoF for BEMD thresholds of ≤-10 dB and ≤-14 dB were 70 (95% CI 66% to 74%) and 92% (87% to 95%), respectively.

CONCLUSION: There is a strong relationship between BEMD and a patient's LFTD. PoF values for LFTD associated with readily available MD values provide practical landmarks for VF disability in glaucoma.

Br J Ophthalmol. 2012 Jul 14.
PMID: 22797319
http://www.ncbi.nlm.nih.gov/pubmed/22797319

Clinical Paper of the Month manager: Andreas Boehm

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