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View PowerPoint Presentation - Vision Research Coordinating Center

Confirmation ofVisual Field Abnormalities in theOcular Hypertension Treatment Study(OHTS)The Ocular Hypertension Treatment Study Group (OHTS)National Eye Institute, National Center for Minority Health and HealthDisparities, NIH grants EY09307, EY09341, EY02687, Unrestricted Grant fromResearch to Prevent Blindness, Merck Research Laboratories and Pfizer, Inc.


Ocular HypertensionTreatment StudyPURPOSETo determine the reproducibility of abnormalvisual fields observed during follow-up ofpatients in the OHTS


Ocular HypertensionTreatment StudyNational Eye InstituteResearch GrantNIH EY09341, EY09307Unrestricted Grant fromResearch to Prevent Blindness


Ocular HypertensionTreatment StudyRandomized, multi-center clinical trialto assess:• Safety• Efficacy of ocular hypotensivemedication in preventing or delayingPOAG


Ocular HypertensionTreatment StudyEnrollmentTarget:Achieved:1,500 subjects1,637 subjectsClinics22 Clinics nationwide


Definition of OHTS VISUAL FIELDABNORMALITYA reliable visual field is defined“abnormal”when…• The GHT index is abnormal (OutsideNormal Limits or General Reduction ofSensitivity), and or• The CPSD index has a p value of


ORIGINAL RETEST PROTOCOL• If a reliable follow-up field is abnormal, theeye is retested• If the retest is reliable and abnormal on thesame indices and in approximately the samelocation, the abnormality is defined asconfirmed


Visual Field AbnormalitiesReturning to Normal:Between April 1, 1994, and March 1, 199921,603 visual fields were performedon 1,636 patients in the OHTS


Visual Field AbnormalitiesReturning to Normal:• 1,006 of 21,603 were follow-up retestsperformed because of abnormality (748) orunreliability (unacceptability) 258:• 703 (94%) of the 748 visual fields wereabnormal and reliable (acceptable)


Visual Field AbnormalitiesReturning to Normal• On retesting, abnormalities were notconfirmed for 604 (86%) of the 703 originallyabnormal and reliable (acceptable) visualfields


Abnormalities Replicated and Not Replicated# VF's (%) # VF's (%) # VF's (%)ABNORMALITY REPLICATED 99 (14.1)ABNORMALITY NOT REPLICATED1. Normal 467 (66.4)2. Normal but with bordeline resultsGHT Borderline 39 (5.5)CPSD p


Figure 1: The Quality Control Performance of OHTS Clinics forVisual Fields Performed Between July 1998 and June 2000


Figure 2: A Trial Lens Rim Artifact that Might be Misinterpreted asGlaucomatous Visual Field Loss. It is Absent on Retest.TEST (5/20/97)TOTAL DEVIATONODPATTERN DEVIATONRx Used: + 5.00 + 0.50 x 180Pupil Diameter: 4.0 mmGHT: outside normal limitsCPSD: p < 0.5%RETEST (5/27/97)TOTAL DEVIATONPATTERN DEVIATONRx Used: + 5.50 DSPupil Diameter: 4.0 mGHT: normalCPSD: normal


Figure 3: A Drooping Lid or Brow that is Absent on RetestTEST (5/3/96)TOTAL DEVIATONODPATTERN DEVIATONRx Used: + 3.00 DSPupil Diameter: 4.0 mmGHT: normalCPSD: p < 5%RETEST (5/17/96)TOTAL DEVIATONPATTERN DEVIATONRx Used: + 2.00 DSPupil Diameter: 4.0 mmGHT: normalCPSD: normal


Figure 4: An Inferior Arcuate Visual Field Defect thatCompletely Clears Up on RetestTEST (4/2/97)TOTAL DEVIATONOSPATTERN DEVIATONRx Used: + 4.00 DSPupil Diameter: 4.5 mmGHT: Outside Normal LimitsCPSD: p < 2%RETEST (4/9/97)TOTAL DEVIATONPATTERN DEVIATONRx Used: + 4.00 DSPupil Diameter: 4.5 mmGHT: normalCPSD: normal


Figure 5: An Inferior Arcuate Defect with CentralDepression that Resolves on RetestTEST (5/30/97)TOTAL DEVIATONODPATTERN DEVIATONRx Used: + 3.25 DSPupil Diameter: 4.0 mmGHT: Outside Normal LimitsCPSD: p < 10%RETEST (6/6/97)TOTAL DEVIATONPATTERN DEVIATONRx Used: + 3.25 DSPupil Diameter: 4.5 mmGHT: normalCPSD: normal


Figure 6: A Superior Arcuate Defect with an Inferior NasalStep that Resolves on RetestTEST (5/1/96)TOTAL DEVIATONODPATTERN DEVIATONRx Used: - 2.00 +1.50 x 175Pupil Diameter: 4.0 mmGHT: Outside Normal LimitsCPSD: normalRETEST (5/28/96)TOTAL DEVIATONPATTERN DEVIATONRx Used: -2.00 +1.50 x 175Pupil Diameter: 4.0 mmGHT: normalCPSD: normal


Figure 7: A Generalized Diffuse Loss both Superiorly andInferiorly with a Suggestion of a Double Arcuate Visual FieldDefect that Completely Clears on RetestTEST (7/12/95)TOTAL DEVIATONODPATTERN DEVIATONRx Used: + 2.50 DSPupil Diameter: 5.0 mmGHT: General ReductionCPSD: normalRETEST (7/28/95)TOTAL DEVIATONPATTERN DEVIATONRx Used: + 3.00 DSPupil Diameter: 4.0 mmGHT: normalCPSD: normal


Figure 8: An Inferior Temporal Vertical Step(Etiology Unclear) that Resolves on RetestTEST (7/30/97)TOTAL DEVIATONOSPATTERN DEVIATONRx Used: -3.50 DSPupil Diameter: 6.0 mmGHT: Outside Normal LimitsCPSD: p < 5%RETEST (9/15/97)TOTAL DEVIATONPATTERN DEVIATONRx Used: -3.50 DSPupil Diameter: 5.0 mmGHT: normalCPSD: normal


SUMMARY• Of the 21,603 follow-up visual fields, 1,006 were follow-upretests performed because of abnormality (748) orunreliability (258)• 94% (703 of the 748) visual fields were abnormal andreliable, and 45 (6%) were abnormal and unreliable• 85.9% (604 of the 703) of the abnormalities were notconfirmed on retest• The majority of visual field abnormalities in OHTSpatients were not confirmed on retest.


CONCLUSION• Confirmation of visual field abnormalities isessential for distinguishing reproduciblevisual field loss from long-term variability• OHTS now requires 3 consecutive reliableabnormal visual fields with the sameabnormal indices and location to confirm anabnormality (June, 1997)


OHTS Clinical Centers Bascom Palmer Eye Institute Baylor Eye Clinic Charles R. Drew University Devers Eye Institute Emory University Eye Center Eye Associates of Washington, DC Eye Consultants of Atlanta Eye Doctors of Washington Eye Physicians and Surgeons ofAtlanta Glaucoma Care Center Great Lakes Ophthalmology Henry Ford Hospitals Johns Hopkins University Jules Stein Eye Institute, UCLA Kellogg Eye Center Kresge Eye Institute Krieger Eye Institute Maryland Center for Eye Care Mayo Clinic/Foundation New York Eye & Ear Infirmary Ohio State University Salus University Scheie Eye Institute University of California, Davis University of California, San Diego University of California, SanFrancisco University of Louisville University Suburban Health Center Washington Eye Physicians &Surgeons Washington University, St. Louis


OHTS Resource CentersStudy Chairman’s Office&Coordinating CenterWashington UniversitySt. Louis, MOOptic Disc Reading CenterBascom Palmer Eye InstituteUniversity of MiamiMiami, FLVisual Field Reading CenterUniversity of California, DavisSacramento, CA

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