Clustered testing approach may identify fast-progressing glaucoma

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A clustered testing methodology detected fast-progressing glaucoma, indicating a potential approach for assessing high-risk individuals.

The prospective Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study took place at the Bascom Palmer Eye Institute at the University of Miami and the Duke Eye Center at Duke University. A total of 126 eyes from 65 patients (mean age, 68 years) with open-angle glaucoma were assessed. Patients underwent 2 clusters of testing consisting of 5 weekly visits at baseline and again approximately 6 months later. Patients continued cluster testing every 6 months for a mean duration of 25 months (mean, 17 tests total). Each visit consisted of testing with standard automated perimetry (SAP) 24-2 and 10-2, and spectral-domain optical coherence tomography (SD-OCT).

A total of 19 eyes (15%) progressed based on SAP 24-2 MD over the 6-month period. Median rates of change for progressors and non-progressors were –2.70 dB/year and 0.02 dB/year, respectively (P<.001).

A total of 14 eyes (11%) progressed on SAP 10-2 MD, and 16 eyes (13%) progressed by retinal nerve fiber layer thickness, with 30 eyes (24%) progressing by function, structure, or both.

Of the 35 eyes that progressed during overall follow-up, 25 did so during the 6-month cluster period (sensitivity, 71%). Of the 90 eyes that did not progress during overall follow-up, 85 did not progress during the 6 months (specificity, 94%).

Of the 14 eyes considered fast progressors by SAP 24-2, SAP 10-2, or SD-OCT during overall follow-up, 13 were identified as progressing during the 6-month cluster period (sensitivity, 93%; specificity, 85%).

The study is limited by its relatively smaller sample size. In addition, the authors indicated that patients who agreed to undergo intensive testing may have been more inclined to participate if they thought their disease could be worsening.

“Our intensive clustered testing methodology offers promising implications for clinical trials investigating interventions to slow down glaucoma progression. It may also be of value for short-term assessment of high-risk subjects,” the authors concluded.


Medeiros FA, Malek DA, Tseng H, et al. Short-term detection of fast progressors in glaucoma: The Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study. Ophthalmology. 2023;S0161-6420(23)00938-7. doi:10.1016/j.ophtha.2023.12.031