Combining Structural and Functional Measurements to Improve Detection of Glaucoma Progression using Bayesian Hierarchical Models

PURPOSE. To present and evaluate a new methodology for combining longitudinal information from structural and functional tests to improve detection of glaucoma progression and estimation of rates of change. METHODS. This observational cohort study included 434 eyes of 257 participants observed for an average of 4.2 +/- 1.1 years and recruited from the Diagnostic Innovations in Glaucoma Study (DIGS). The subjects were examined annually with standard automated perimetry, optic disc stereophotographs, and scanning laser polarimetry with enhanced corneal compensation. Rates of change over time were measured using the visual field index (VFI) and average retinal nerve fiber layer thickness (TSNIT average). A Bayesian hierarchical model was built to integrate information from the longitudinal measures and classify individual eyes as progressing or not. Estimates of sensitivity and specificity of the Bayesian method were compared with those obtained by the conventional approach of ordinary least-squares (OLS) regression. RESULTS. The Bayesian method identified a significantly higher proportion of the 405 glaucomatous and suspect eyes as having progressed when compared with the OLS method (22.7% vs. 12.8%; P < 0.001), while having the same specificity of 100% in 29 healthy eyes. In addition, the Bayesian method identified a significantly higher proportion of eyes with progression by optic disc stereophotographs compared with the OLS method (74% vs. 37%; P = 0.001). CONCLUSIONS. A Bayesian hierarchical modeling approach for combining functional and structural tests performed significantly better than the OLS method for detection of glaucoma progression. (ClinicalTrials.gov number, NCT00221897.) (Invest Ophthalmol Vis Sci. 2011;52:5794-5803) DOI: 10.1167/iovs.10-7111