Visual field progression rates in glaucoma: frontloaded versus clinical standard (non-frontloaded) SITA-Faster

• Published in: American journal of ophthalmology
• Main Authors: Phu, Jack, Wang, Henrietta, Masselos, Katherine, Tan, Jeremy C.K., Patel, Nimesh B., Agar, Ashish, Kalloniatis, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 28.07.2025
• Subjects: 24-2; frontloaded; glaucoma suspect; perimetry; standard automated perimetry; visual fields; 24-2; visual fields; standard automated perimetry; perimetry; glaucoma suspect; frontloaded
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2025.07.031

To compare glaucoma progression detection rates using mean deviation (MD) slopes when using frontloaded (two visual field [VF] tests per eye per visit) and clinical standard (one VF test per eye per visit) 24-2 SITA-Faster test protocols in a clinical practice. Prospective accuracy analysis comparing assessment methods. 6,654 reliable VF tests of 340 subjects. Mean deviation (MD) slopes were calculated for each eye for each subject over time, with significant slopes (p < 0.05) defining progression. The number of progressors were compared between frontloaded and clinical standard approaches using McNemar’s test. Time/visit to detection and progression rates were compared for mutually detected cases using Wilcoxon rank sum tests. Cases of progression detected, time/visit to detection, and progression rates. The average baseline MD values were -1.91 dB and -1.75 dB for right and left eyes, respectively. Over approximately 2.7-2.8 years of follow-up and 6.2-6.4 visits, there were 25 and 33 unique cases of progression detected for right and left eyes, respectively. Frontloading detected over 2.3 times more progressors compared to the clinical standard. When considering mutually detected cases, frontloading resulted in an average of 0.5 years’ earlier detection compared to the clinical standard (p = 0.0087). For those who progressed, there was no significant difference in progression rate measured using either method (p > 0.05). Frontloaded (two 24-2 SITA-Faster VF tests per eye per visit) detected over twice the number of glaucoma progressors based on MD slopes in a cohort of subjects with predominantly early glaucoma, compared to the clinical standard (one VF per eye per visit). These results provide, for the first time, empirical evidence supporting frontloaded VF testing to detect more cases of glaucoma progression at an earlier time point, thereby allowing earlier intervention to minimise vision loss.