Forecasting Risk of Future Rapid Glaucoma Worsening Using Early Visual Field, OCT, and Clinical Data

Purpose: To assess whether we can forecast future rapid visual field (VF) worsening using deep learning models (DLMs) trained on early VF, OCT, and clinical data.Design: A retrospective cohort study.Subjects: In total, 4536 eyes from 2962 patients. Overall, 263 (5.80%) eyes underwent rapid VF worsening (mean deviation slope less than -1 dB/year across all VFs).Methods: We included eyes that met the following criteria: (1) followed for glaucoma or suspect status; had at least 5 longitudinal reliable VFs (VF1, VF2, VF3, VF4, and VF5); and (3) had 1 reliable baseline OCT scan (OCT1) and 1 set of baseline clinical measurements (clinical1) at the time of VF1. We designed a DLM to forecast future rapid VF worsening. The input consisted of spatially oriented total deviation values from VF1 (including not including VF(2 )and VF3 in some models) and retinal nerve fiber layer thickness values from the baseline OCT. We passed this VF/OCT stack into a vision transformer feature extractor, the output of which was concatenated with baseline clinical data before putting it through a linear classifier to predict the eye's risk of rapid VF worsening across the 5 VFs. We compared the performance of models with differing inputs by computing area under the curve (AUC) in the test set. Specifically, we trained models with the following inputs: (1) model V: VF1; (2) VC: VF1+ Clinical(1); (3) VO: VF1+ OCT1; (4) VOC: VF1+ Clinical(1)+ OCT1; (5) V-2: VF1 + VF2; (6) V2OC: VF1 + VF2 + Clinical(1 )OCT(1); (7) V-3: VF1 + VF2 + VF3; and (8) V3OC: VF1 + VF2 + VF3 + Clinical(1 )+ OCT1. Main Outcome Measures: The AUC of DLMs when forecasting rapidly worsening eyes.Results: Model V3OC best forecasted rapid worsening with an AUC (95% confidence interval [CI]) of 0.87 (0.77-0.97). Remaining models in descending order of performance and their respective AUC (95% CI) were follows: (1) model V-3 (0.84 [0.74-0.95]), (2) model V2OC (0.81 [0.70-0.92]), (3) model V-2 (0.81 [0.70-0.82]), model VOC (0.77 [0.65-0.88]), (5) model VO (0.75 [0.64-0.88]), (6) model VC (0.75 [0.63-0.87]), and (7) model (0.74 [0.62-0.86]).Conclusions: Deep learning models can forecast future rapid glaucoma worsening with modest to high performance when trained using data from early in the disease course. Including baseline data from multiple modalities and subsequent visits improves performance beyond using VF data alone.