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- W4235203416 abstract "We appreciate the sincere concern of our esteemed colleagues regarding our article,1Saeedi O.J. Elze T. D'Acunto L. et al.Agreement and predictors of discordance of 6 visual field progression algorithms.Ophthalmology. 2019; 126: 822-828Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar and appreciate the opportunity to clarify the purpose of our work. Specifically, we set out “to determine the agreement of six established visual field progression algorithms in a large dataset of visual fields from multiple institutions.”1Saeedi O.J. Elze T. D'Acunto L. et al.Agreement and predictors of discordance of 6 visual field progression algorithms.Ophthalmology. 2019; 126: 822-828Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Rabiolo et al state that, “to adequately compare the various methods, the authors should provide a measure of specificity for each technique.” This comment assumes comparison of the various methods requires an assessment of the validity of each measure using some “ground truth” by which sensitivity and specificity can be calculated or estimated. Because we had only the visual field (VF) data available (i.e., no imaging or clinical information), there is no clear gold standard for glaucomatous VF progression to which we could compare each of the algorithms we evaluated. Validity estimations based on simulating stable VFs and forecasting future outcomes are alternative approaches but were not in the scope of the present work. Given this limitation, our work addresses the agreement of algorithms in a large, real-world dataset and does not address the question of the validity of these progression measures (i.e., if they truly measure glaucomatous VF loss progression). We specifically do not address validity in the article, leaving it open as to which of the measures is “best.” The agreement of these algorithms is particularly important in comparing prior studies that have used ≥1 of these algorithms. Previous studies have attempted to determine agreement of VF progression algorithms (independent of their sensitivity/specificity) on smaller datasets and concurred with our findings that different algorithms show moderate agreement at best (reference 8 in the original article).2Katz J. Congdon N. Friedman D.S. Methodological variations in estimating apparent progressive visual field loss in clinical trials of glaucoma treatment.Arch Ophthalmol. 1999; 117: 1137-1142Crossref PubMed Scopus (98) Google Scholar, 3Rao H.L. Kumbar T. Kumar A.U. et al.Agreement between event-based and trend-based glaucoma progression analyses.Eye (Lond). 2013; 27: 803-808Crossref PubMed Scopus (13) Google Scholar, 4Nouri-Mahdavi K. Caprioli J. Coleman A.L. et al.Pointwise linear regression for evaluation of visual field outcomes and comparison with the advanced glaucoma intervention study methods.Arch Ophthalmol. 2005; 123: 193-199Crossref PubMed Scopus (49) Google Scholar Nouri-Mahdavi et al,4Nouri-Mahdavi K. Caprioli J. Coleman A.L. et al.Pointwise linear regression for evaluation of visual field outcomes and comparison with the advanced glaucoma intervention study methods.Arch Ophthalmol. 2005; 123: 193-199Crossref PubMed Scopus (49) Google Scholar for example, compared the agreement of pointwise linear regression and the Advanced Glaucoma Intervention Study criteria. The second comment that “the cutoffs used for some of the trend-based methods seem not to be suitably chosen” assumes that there is an optimal cutoff for trend-based methods and assumes that the purpose of our study was to determine the performance of each criteria against some arbitrary criterion of “true” VF worsening or stability. The slopes we selected have been applied in the past to determine VF progression, and we feel this justifies their inclusion here. An alternative approach would be to turn the mean deviation (MD) cutoff slope into a function and optimize it to produce the best agreement with Advanced Glaucoma Intervention Study and Collaborative Initial Glaucoma Treatment Study, but this was not our intent. Furthermore, we cite prior work from Artes et al (reference 20 in the original article), which uses different, less stringent cutoffs for progression for MD and VFI and similarly finds moderate agreement between the 2 methods by Fleiss’s criteria (reference 17 in the original article). Therefore, changing the cutoffs is both beyond the scope of the article and unlikely to change the results. We believe the results of this study are valid and important both to clinicians who treat glaucoma and to researchers in the field. While the question of validity of VF progression algorithms is outside the scope of our work, it is very important and best done with databases that include other clinical information. Re: Saeedi et al: Agreement and predictors of discordance of 6 visual field progression algorithms (Ophthalmology. 2019;126:822–828)OphthalmologyVol. 126Issue 10PreviewWe read with interest the article by Saeedi et al.1 The authors tested 6 methods to detect glaucomatous visual field (VF) progression on a large cohort of glaucomatous patients: mean deviation (MD) rate, Visual Field Index (VFI) rate, pointwise linear regression, permutation analyses of the pointwise linear regression, the Collaborative Initial Glaucoma Treatment Study scoring system, and the Advanced Glaucoma Intervention Study scoring system. They found poor to moderate intermethod agreements with only about 6% of eyes labeled as progressing by the majority of the methods. Full-Text PDF" @default.
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