A Data-Driven Model for Simulating Longitudinal Visual Field Tests in Glaucoma

PURPOSE: To develop a simulation model for glaucomatous longitudinal visual field (VF) tests with controlled progression rates. METHODS: Longitudinal VF tests of 1008 eyes from 755 patients with glaucoma were used to learn the statistical characteristics of VF progression. The learned statistics and known anatomic correlations between VF test points were used to automatically generate progression patterns for baseline fields of patients with glaucoma. VF sequences were constructed by adding spatially correlated noise templates to the generated progression patterns. The two one-sided test (TOST) procedure was used to analyze the equivalence between simulated data and data from patients with glaucoma. VF progression detection rates in the simulated VF data were compared to those in patients with glaucoma using mean deviation (MD), cluster, and pointwise trend analysis. RESULTS: VF indices (MD, pattern standard deviation), MD linear regression slopes, and progression detection rates for the simulated and patients’ data were practically equivalent (TOST P < 0.01). In patients with glaucoma, the detection rates in 7 years using MD, cluster, and pointwise trend analysis were 24.4%, 26.2%, and 38.4%, respectively. In the simulated data, the mean detection rates (95% confidence interval) for MD, cluster, and pointwise trend analysis were 24.7% (24.1%–25.2%), 24.9% (24.2%–25.5%), and 35.7% (34.9%–36.5%), respectively. CONCLUSIONS: A novel simulation model generates glaucomatous VF sequences that are practically equivalent to longitudinal VFs from patients with glaucoma. TRANSLATIONAL RELEVANCE: Simulated VF sequences with controlled progression rates can support the evaluation and optimization of methods to detect VF progression and can provide guidance for the interpretation of longitudinal VFs.