© 2011 Wichtig Editore - ISSN 1120-6721 Eur J Ophthalmol ( 2011 ; : 5) 573-579 21 573 DOI: 10.5301/EJO.2011.6357 INTRODUCTION The evaluation of progression of defects in glaucomatous visual fields (VF) is usually carried out by comparing glob- al parameters, such as VF indices (1) or the topographic maps that the instrument provides (2-6). Even if these VF aids are important for the evaluation of progression in glau- coma clinics, clinical judgment is often difficult owing to many variable factors, including the short- and long-term threshold fluctuations, more consistent in glaucoma than Agreement in detecting glaucomatous visual field progression by using guided progression analysis and Humphrey overview printout Michele Iester 1 , Guido Corallo 1 , Elisabetta Capris 1 , Paolo Capris 2 1 Anatomical-Clinical Laboratory for Functional Diagnosis and Treatment of Glaucoma and Neuroophthalmology, Eye Clinic, Department of Neurological Science, Ophthalmology, Genetics, University of Genova, Genova - Italy 2 Division of Ophthalmology, G. Gaslini Institute, Genova - Italy PURPOSE. To examine the level of agreement among 3 clinicians in assessing glaucoma visual field progression by using 2 different methods. METHODS. Each visual field was assessed by Humphrey Field Analyzer (HFA), program SITA standard 30-2 or 24-2. In each printout the first 3 fields were excluded to minimize learning effect: the fourth and fifth full-threshold or SITA Standard examinations were used as baseline. Three clinicians assessed the progression status of each series using both HFA overview printouts and the guided progression analysis (GPA). The level of agreement among the clinicians was evaluated using a weighted kappa statistic (κ). RESULTS. A total of 510 tests, comprising 83 eyes with an average of 6.1 tests each, was assessed by the 3 specialists. The mean follow-up time was 5.8±1.75 years (mean ± standard deviation). When the intraobserver intermethod agreement was evaluated, κ ranged from 0.5 to 0.7. When the interobserver agreement was analyzed, if HFA overview printouts were used, κ ranged from 0.4 to 0.7. But when GPA was used, κ ranged from 0.2 to 0.6. The level of agreement on progression status between the clinicians was always higher when they used HFA overview printouts (median κ = 0.54) than when they used GPA (median κ=0.37). CONCLUSIONS. Agreement among expert clinicians about visual field progression status was moderate when GPA printouts were used. Clinicians’ agreement about patients’ visual field progression status was better when HFA overview printouts were used than with GPA printouts. KEY WORDS. Agreement, Glaucoma, Progression, Stage, Visual field Accepted: January 4, 2011 ORIGINAL ARTICLE in healthy eyes, the lack of defined criteria of progression, and the influence of cataract on general sensitivity thresh- old (7, 8). The simple examination of all the graphical plots and the behavior of VF indices are fundamental for the evaluation of VF progression or stability, which requires clinical expe- rience and time. The printout of a series of VF examina- tions in chronologic sequence utilizing the main graphical plot (grayscale, total and pattern deviation) and VF indices represent a simpler aid for clinicians to evaluate VF pro-