A method to measure the rate of glaucomatous visual field change

Purpose: To develop a method to measure the rate of glaucomatous visual field (VF) deterioration and to identify fast progressors. Methods: Retrospective, longitudinal, observational study of 8486 eyes of 4610 glaucomatous patients with ≥6 VFs and ≥3 years of follow-up. A Glaucoma Rate Index (GRI) was calculated. VF locations were partitioned into exponential decay or exponential improvement models. A pointwise rate of change (PRC) was estimated with an exponential fit and expressed as the percent/year change of the age-and location-matched normal perimetric range, presented as a spatially conserved VF map. PRCs were summed and normalized with boundary rates set by simulated decaying and improving VF series on a scale of 100 to +100, respectively. Results: A total of 89,704 VF examinations with 425,039 test location series was used. Median follow-up and number of VFs/eye were 9.7 years and 9 VFs, respectively. Initial and final mean deviations (±SD) were 4.2 (±5.2) and 5.7 (±6.4) dB. The proportions of test locations designated as decayed, improved, and unchanged were 13%, 4%, and 83%, respectively. Mean PRCs for decay, improvement, and no change were 3.7 (±4.7)%/y, 2.5 (±2.6)%/y, and 0.5 (±2.1)%/y, respectively. The number of eyes with negative and positive GRIs was 5802 (68%) and 2390 eyes (28%), respectively. The proportion of eyes defined as fast progressors was 6.8%. Conclusions: GRI provides a robust measure of glaucomatous VF change, operates without discontinuity over the entire perimetric range, and can be used to identify fast progressors. Translational Relevance: This study describes a novel method that can help the clinician to determine VF progression.