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Abstract

Objective/Purpose: To evaluate whether alternating 24–2 and 10–2 visual field (VF) testing improves overall glaucoma progression detection compared with 24–2 or 10–2 alone, and to determine whether this enhances detection within the macular region, using simulated series derived from real-world data.

Design: Retrospective, observational simulation study.

Subjects, Participants, and/or Controls: Retrospective VF data from 426 eyes were used for simulations.

Methods, Intervention, or Testing: Pointwise slopes were estimated from 24–2 and 10–2 VFs using hierarchical modelling with location-level random intercepts/slopes. Eye-specific residuals formed noise templates. These were combined with estimated slopes to simulate 426 dense VF series (every 3-months), representing stable (slope=0) and progressing eyes. Four strategies were created and tested over 24-months: (A) simultaneous 24–2 and 10–2 at every visit, (B) 24–2 alone, (C) 10–2 alone and (D) alternating 24–2 and 10–2. Progression was determined using hierarchical modeling and strategy detection (hit) rate was assessed via cluster-adjusted ROC analyses, reporting sensitivity at 95% specificity and partial AUCs.

Results: At 12-months, sensitivity at 95% specificity was 79%, 67%, 67% and 63% (A–D); corresponding partial AUCs were 0.033 (A) and 0.025 (B–D). A had a significantly higher AUC than B, C, and D at 12-months (p < 0.001 each). B exceeded C at 12 months (p = 0.015), while D and B did not differ (p = 0.570) and D exceeded C (p = 0.016). By 24-months, sensitivities converged for A and B (87% each), with 79% (C) and 80% (D). Similar results were seen in 244 eyes defined as early-stage glaucoma at baseline. For 284 eyes defined as macular progressors at 12-months, B detected 80% and D 81% of eyes identified by 10–2.

Conclusions: Alternating 24–2 and 10–2 testing provided no clear benefit over 24–2 alone, which remained robust for progression detection. Simultaneous testing is optimal but not clinically practical.

Publication Type:	Article
Additional Information:	This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	Glaucoma, Glaucoma progression, Visual field testing, 10–2, 24–2, Simulation, Hierarchical modeling
Subjects:	R Medicine > RE Ophthalmology
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Optometry & Visual Science
SWORD Depositor:	Symplectic Administrator

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