Predicting Pattern Standard Deviation in Glaucoma: A Machine Learning Approach Leveraging Clinical Data

Visual field (VF) testing is crucial for the management of glaucoma. However, the process is often hindered by technician shortages and reliability issues. In this study, we leveraged machine learning to predict pattern standard deviation (PSD) using clinical inputs. This machine learning retrospective study used publicly accessible data from 743 eyes (541 glaucoma and 202 non-glaucoma controls). An automated neural network (ANN) model was trained using seven clinical input features: mean retinal nerve fiber layer (RNFL), IOP, patient age, CCT, glaucoma diagnosis, study protocol, and laterality. The ANN demonstrated efficient training across 1000 epochs, with consistent error reduction in training and test sets. Mean RMSEs were 1.67 ± 0.05 for training, and 2.27 ± 0.27 for testing. The <i>r</i> was 0.89 ± 0.01 for training, and 0.81 ± 0.04 for testing, indicating strong predictive accuracy with minimal overfitting. The LOFO analysis revealed that the primary contributors to PSD prediction were RNFL, CCT, IOP, glaucoma status, study protocol, and age, listed in order of significance. Our neural network successfully predicted PSD from RNFL and clinical data with strong performance metrics, in addition to demonstrating construct validity. This work demonstrates that neural networks hold the potential to predict or even generate VF estimations based solely on RNFL and clinical inputs.