1 Aoki S, et al. Br J Ophthalmol 2017;0:1–8. doi:10.1136/bjophthalmol-2016-310069 Clinical science Investigating the usefulness of a cluster-based trend analysis to detect visual feld progression in patients with open-angle glaucoma Shuichiro Aoki, 1 Hiroshi Murata, 1 Yuri Fujino, 2 Masato Matsuura, 3 Atsuya Miki, 4 Masaki Tanito, 5 Shiro Mizoue, 6,7 Kazuhiko Mori, 8 Katsuyoshi Suzuki, 9 Takehiro Yamashita, 10 Kenji Kashiwagi, 11 Kazunori Hirasawa, 12 Nobuyuki Shoji, 13 Ryo Asaoka 14 To cite: Aoki S, Murata H, Fujino Y, et al. Br J Ophthalmol Published Online First: [please include Day Month Year]. doi:10.1136/ bjophthalmol-2016-310069 ► Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bjophthalmol-2016-310069). For numbered affiliations see end of article. Correspondence to Dr Ryo Asaoka, Department of Ophthalmology, The University of Tokyo, 7-3-1 Hongo, Bunkyo- ku, Tokyo 113-8655, Japan; ryoasa0120@mac.com Received 15 December 2016 Revised 16 March 2017 Accepted 24 March 2017 ABSTRACT Background/aims To investigate the usefulness of the Octopus (Haag-Streit) EyeSuite’s cluster trend analysis in glaucoma. Methods Ten visual fields (VFs) with the Humphrey Field Analyzer (Carl Zeiss Meditec), spanning 7.7 years on average were obtained from 728 eyes of 475 primary open angle glaucoma patients. Mean total deviation (mTD) trend analysis and EyeSuite’s cluster trend analysis were performed on various series of VFs (from 1st to 10th: VF1-10 to 6th to 10th: VF6-10). The results of the cluster-based trend analysis, based on different lengths of VF series, were compared against mTD trend analysis. Result Cluster-based trend analysis and mTD trend analysis results were significantly associated in all clusters and with all lengths of VF series. Between 21.2% and 45.9% (depending on VF series length and location) of clusters were deemed to progress when the mTD trend analysis suggested no progression. On the other hand, 4.8% of eyes were observed to progress using the mTD trend analysis when cluster trend analysis suggested no progression in any two (or more) clusters. Conclusion Whole field trend analysis can miss local VF progression. Cluster trend analysis appears as robust as mTD trend analysis and useful to assess both sectorial and whole field progression. Cluster-based trend analyses, in particular the definition of two or more progressing cluster, may help clinicians to detect glaucomatous progression in a timelier manner than using a whole field trend analysis, without significantly compromising specificity. INTRODUCTION Glaucoma is a leading cause of blindness in the world. 1 Accurate and early detection of visual field (VF) progression is essential for achieving proper management of the disease. However, aggressive IOP-reduction interventions, such as trabeculec- tomy, can be associated with serious complications so unnecessary treatment must also be avoided. 2 3 Accurate and timely detection of VF progression are somewhat opposing requirements, determined by the statistical sensitivity and specificity of the detection method. Point-wise trend analysis offers a granular assessment of VF progression and the opportunity to detect change sooner;however, point-wise trend analysis can be unreliable as the variability of point-wise VF sensitivity measure- ments is large, which can mask genuine damage. 4–6 However, trend analysis of global indices, such as mean total deviation (mTD), mitigates variability, but localised VF defects may be ignored. 7–10 Trend analysis using VF clusters offers a compromise between these two approaches; the VF is divided into small clusters, and a trend analysis is carried out in each sector. Indeed, we already reported on the merits of a cluster-based approach to predict future VF sensitivity. 11 12 EyeSuite is the software used in Octopus perim- etry (Haag-Streit, Switzerland) to give an assess- ment of VF progression. In this software, 10 anat- omy-based VF clusters are drawn (see figure 1), and cluster trend analysis is carried out in each of the sectors. In this study, the usefulness of a cluster trend analysis was investigated and compared with an mTD trend analysis. We have recently developed a multicentral retrospective collection of glauco- matous VFs known as the Japan Archives of Multi- central Database In Glaucoma (JAMDIG), 13 and the current investigation was performed using this data set. METHOD The study design was an observational case series. The review board of each institute reviewed and approved all protocols. The studies complied with the tenets of the Declaration of Helsinki. Written consent was given by patients for their information to be stored in the hospital database and used for research, otherwise, based on the regulations of the Japanese Guidelines for Epidemiologic Study 2008, issued by the Japanese Government, the study protocols did not require that each patient provide written informed consent, instead the protocol was posted at the outpatient clinic to notify the study to the participants. Data used in analysis All of the data analysed in the current study were drawn from the JAMDIG. 13 JAMDIG is a database collected from eight institutes in Japan, as intro- duced in the online supplementary appendix. The details of the database are given elsewhere. 13 In short, all VF data satisfying the inclusion criteria below were retrospectively collected from the BJO Online First, published on April 27, 2017 as 10.1136/bjophthalmol-2016-310069 Copyright Article author (or their employer) 2017. 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