NAPS 2011: Estimating the overall significance of deterioration with permutation analysis of point-wise linear regression (PoPLR)

8/4/2019 NAPS 2011: Estimating the overall significance of deterioration with permutation analysis of point-wise linear regression (PoPLR)

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Visual field progression in glaucoma2011

Estimating the overall significance of

point-wise linear regression

North American Perimetry Society Meeting 2011

Neil OLeary, Balwantray Chauhan, Paul Artes


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Point-wise Linear Regression

Point-wise linear regression (PLR) is a method to

measure visual field change

Much revious research


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Criteria for PLR

Title Authors Year Slope(dB/y) Pvalue ImprovementAnalysis

Filter Points Location Exclusionofexams Followup/Examfrequency

Remarks

Spatially consistent, localized visual field loss

before and after disc hemorrhageDe Moraes CGV et al. 2009 < -1.0 0.01 no yes 1

non-e ge po nts oredge points < -2.0

dB/y)

First 2 VF in patientsunfamiliar

6.7y / 6 - 12m At least 5 VF

Pointwise linear regression analysis for detectionof visual field progression with absolute versus

corrected threshold sensitivities

Manassakorn A et al.2006 < -1.0 0.01 yes no 2

In the same GHTlocation

Reliability 7.3y / -

Visual Field Progression in Glaucoma: TotalVersus Pattern Deviation Analyses

Artes PH et al.2005 < -1.0 0.05 yes no range range

First VF (red learningeffects). Two-omitting

method9y / 6m At least 5 VF

Pointwise linear regression for evaluation ofvisual field outcomes and comparison with the

advanced glaucoma intervention study methodsNouri-Mahdavi K et al. 2005 < -1.0 0.01 yes no 1 or 2

2 points, 2 cluster, 2hemifield, 2 GHT

Two-omitting method At least 3y / 6mAt least 3y FU. At

least 7 VF.

Pointwise linear progression criteria and thedetection of visual field change in a glaucoma

trial.Wilkins MR et al. 2006 < -1.0 0.01 yes no

1, 2, 3,4 or 5

Anywhere. 2 or 3cluster hemifield. 2cluster GHT. 2 PNFB

cluster. 2 ONHderived cluster.

16m / 3-4m At least 6 VF

Examination of Different Pointwise LinearRegression Methods for Determining Visual Field

ProgressionGardiner SK et al. < -1.0 0.01 no no 1

non-edge points (foredge points < -2.0

dB/y)

No (no randomselection)

Standard criteria.Comparrison with

different ones.

Frequency of testing for detecting visual fieldGardiner SK et al. 2002 < -1.0 0.01 no no 1 Any

No (no random Play withprogress on se ec on requency

Early detection of visual field progression inglaucoma: a comparison of PROGRESSOR and

STATPAC 2Viswanathan AC et al. 1997 < -1.0 0.01 no no 1


dB/y)Reliability / 4m

Visual field progression: comparison ofHumphreyStatpac2 and pointwise linear MacNaught AI et al. 1996 < -1.0 0.01 no no 1


No (no randomselection)

5.6y / 4.2m Play with P value


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Properties

Many strategies with many criteria...not simple!

Properties not well-defined: specificity and sensitivity


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Aims

Develop a method to infer a simple, single, overall

statistical significance of the observed pattern ofsensitivity deterioration from PLR

Show that significance level of this method produces

an e uivalent false ositive level

ompare -ra e an spec c y o o er

criteria for progression


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Methodology

Perform PLR

Combine p-values

Permute test sequence

Permutation of PLR: PoPLR!


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PoPLR: Combining Evidence

RA Fisher

Providing

statistical

since 1925!


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PoPLR: Assessing the Evidence

Combine evidence from different locations into a

single statistic

Test statistic S for observed se uence


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Significance: Permutation

Permute sequence of VF tests and calculate test

statistics under re-ordering1 2 3 4 5 6 7 8

1 23 45 67 8

Sp

Re eat 5000 times for series: 5000 S


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Distribution of permuted test statistics (Sp)

(3498 out of 5000: p = 0.30)


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Distribution of permuted test statistics (Sp)

(4756 out of 5000: p = 0.05)


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-

Experiment: Clinical Data


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Removing any trends

Shuffling time sequence


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Sensitivit and S ecificit of Other

Methods

ity

nsiti

v

S


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Measurin Relative Sensitivit

in Real Data

e At Fixed Specificity

itRa t ate > t ate

Sensitivity A > Sensitivity B


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Data

Median IQR

Baseline MD

(dB)-3.0 -6.3, -1.2

(years)67 59, 75


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Results: Specificity of Method

5 exams


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8 exams


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Final exam


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Results: Hit Rate

5 exams


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Results: Hit Rate

5 exams


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Results: Hit Rate

8 exams


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Results: Hit Rate

Final exam


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Conclusions

PoPLR provides a single, simple, overall estimate of

statistical significance for visual field progression

n v ua se o eac pa en s own a a

Adaptable

Al d R i


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Alexandre ReisBal Paul

Marcelo Nicolela Paul Rafuse

Ra LeBlancLes a Shuba

Documents

NAPS 2011: Estimating the overall significance of deterioration with permutation analysis of point-wise linear regression (PoPLR)