LAUSR

PURPOSE Global indices of standard automated perimerty are insensitive to localized losses, while point-wise indices are sensitive but highly variable. Region-wise indices sit in between. This study introduces a machine learning-based index for glaucoma progression detection that outperforms global, region-wise, and point-wise indices. DESIGN Development and comparison of a prognostic index. METHOD Visual fields from 2085 eyes of 1214 subjects were used to identify glaucoma progression patterns using machine learning. Visual fields from 133 eyes of 71 glaucoma patients were collected 10 times over 10 weeks to provide a no-change, test-retest dataset. The parameters of all methods were identified using visual field sequences in the test-retest dataset to meet fixed 95% specificity. An independent dataset of 270 eyes of 136 glaucoma patients and survival analysis were used to compare methods. RESULTS The time to detect progression in 25% of the eyes in the longitudinal dataset using global mean deviation (MD) was 5.2 (95% confidence interval, 4.1-6.5) years; 4.5 (4.0-5.5) years using region-wise, 3.9 (3.5-4.6) years using point-wise, and 3.5 (3.1-4.0) years using machine learning analysis. The time until 25% of eyes showed subsequently confirmed progression after 2 additional visits were included were 6.6 (5.6-7.4) years, 5.7 (4.8-6.7) years, 5.6 (4.7-6.5) years, and 5.1 (4.5-6.0) years for global, region-wise, point-wise, and machine learning analyses, respectively. CONCLUSIONS Machine learning analysis detects progressing eyes earlier than other methods consistently, with or without confirmation visits. In particular, machine learning detects more slowly progressing eyes than other methods.