Personalizing the Transition From 24-2 to 10-2 Visual Field Testing Using ARREST – A Simulation Study

The decision to switch between peripheral (24-2) and central (10-2) visual field testing in glaucoma currently rests with clinicians and requires a choice between either intensively sampling central vision or including testing of more peripheral locations (not both). We evaluate an automated approach to incorporate 10-2 locations into the 24-2, without increasing test time or reducing the ability to detect glaucomatous progression at the 24-2 locations. We applied our previously published ARREST approach, restricting added locations to a 10-2 pattern (A10). Using computer simulation, the sensitivity of A10 for detecting progression was compared to a ZEST procedure on the 24-2 pattern. Input fields were a synthetic series of 10 visits (6 monthly) of 126 eyes, derived from empirical longitudinal 24-2 data from people with glaucoma. Forty-seven of the 126 progressing visual field series had locations added by A10. The procedures used a similar number of presentations (mean ± SD: A10, 220 ± 27; ZEST, 226 ± 29). Area under the curve (AUC) and survival time for detecting progressing series were similar between methods. A10 allowed visualization of the macular visual field with higher fidelity. The A10 approach allows automated incorporation of 10-2 locations into the 24-2 pattern that are customized to individuals without increasing test times. The A10 enables higher spatial sampling in individually relevant areas of the 10-2, without neglecting testing of the more peripheral visual field.