Development of a Visual Field Simulation Model of Longitudinal Point-Wise Sensitivity Changes From a Clinical Glaucoma Cohort

PURPOSE: To develop a new visual field simulation model that can recreate real-world longitudinal results at a point-wise level from a clinical glaucoma cohort. METHODS: A cohort of 367 glaucoma eyes from 265 participants seen over 10.1 ± 2.5 years were included to obtain estimates of “true” longitudinal visual field point-wise sensitivity and estimates of measurement variability. These two components were then combined to reconstruct visual field results in a manner that accounted for correlated measurement error. To determine how accurately the simulated results reflected the clinical cohort, longitudinal variability estimates of mean deviation (MD) were determined by calculating the SD of the residuals from linear regression models fitted to the MD values over time for each eye in the simulated and clinical cohorts. The new model was compared to a previous model that does not account for spatially correlated errors. RESULTS: The SD of all the residuals for the clinical and simulated cohorts was 1.1 dB (95% confidence interval [CI]: 1.1–1.2 dB) and 1.1 dB (95% CI: 1.1–1.1 dB), respectively, whereas it was 0.4 dB (95% CI: 0.4–0.4 dB) using the previous simulation model that did not account for correlated errors. CONCLUSIONS: A new simulation model accounting for correlated measurement errors between visual field locations performed better than a previous model in estimating visual field variability in glaucoma. TRANSLATIONAL RELEVANCE: This model can provide a powerful framework to better understand use of visual field testing in clinical practice and trials and to evaluate new methods for detecting progression.