​​Two SITA-Faster Tests per Visit Detects Glaucoma Progression Six Months Earlier

The frontloaded approach (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). Detection time occurred approximately half a year earlier when using frontloading. Photo: Brian D. Fisher, OD. Click image to enlarge.  An ongoing problem in visual field (VF) testing is how to undertake the required number of fields to detect progression. Researchers from Australia developed an approach that incorporated faster testing algorithms to undertake multiple tests during one visit, an approach they have called “frontloading.” This approach has provided savings in terms of the number of clinical visits and time required to attain evidence-based recommended numbers of tests for glaucoma monitoring and has been proven amenable for patients.Their recent study, published in American Journal of Ophthalmology, leveraged longitudinal data obtained from a university-based glaucoma clinic to compare the proportion of progressors identified when using frontloading (at least two visual field tests per eye per patient per visit) in comparison with clinical standard protocol (one test per eye per patient per visit). 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. For those who progressed, there was no significant difference in progression rate measured using either method.“The advantages of frontloading should be limited to time to detection, rather than necessarily rate estimation,” the researchers wrote in their paper.In 6,654 reliable VF tests of 340 patients, the average baseline mean deviation (MD) values were -1.91dB and -1.75dB for right and left eyes, respectively. Over approximately 2.7 to 2.8 years of follow-up and 6.2 to 6.4 visits, there were 25 (8.3%) and 33 (10.1%) unique cases of progression detected for right and left eyes, respectively.“Implementing frontloaded visual fields in a glaucoma clinic increased detection of glaucoma progression using mean deviation in comparison to the clinical standard of performing only one test per eye per visit,” the study authors noted.They did emphasize that “while potentially more benefits may be found in groups with faster rates of progression, our conclusions are largely applicable to slower progressors or glaucoma suspects due to the nature of the cohort.”Perhaps earlier detection means earlier intervention opportunities, potentially preventing irreversible vision loss in patients with glaucoma.Click here for the journal source. Phu J, Wang H, Masselos K, et al. Visual field progression rates in glaucoma: frontloaded versus clinical standard (non-frontloaded) SITA-Faster. Am J Ophthalmol. July 28, 2025. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.