A New Graphical Tool for Assessing Visual Field Progression in Clinical Populations

Purpose We demonstrate a new approach for assessing and visualizing visual field (VF) progression in clinics. Methods Two summary measures for VF progression, Rate of Progression (RP) and Loss of Sight Years (LSY), are combined with a novel visualization (Hedgehog Plots). RP is calculated per eye using linear regression of mean deviation (MD) against time of follow-up. LSY is a novel parameter, linked to actuarial data, which estimates the number of years that a patient will have advanced bilateral VF loss in their predicted remaining lifetime. Every eye is given a rank within the sample based on RP and LSY allowing for "priority" patients to be identified. We illustrate differences between the parameters with an experiment comparing the cases flagged as "priority" by each method using data from 1263 VF records. Results RP for every eye in a "clinic" can be visualized and assessed using a Hedgehog Plot. Eyes are ranked against all other eyes by RP and LSY; these parameters provide different and complementary information on a patient's VF progression status. A purpose written interactive application demonstrating the techniques is available in the public domain at https://crabblab.shinyapps.io/hedgehog. Conclusion Hedgehog Plots provide a tool for visualizing VF progression in groups of patients and can be used potentially to prioritize monitoring resources. Translational Relevance This study illustrates a novel visualization technique and an interactive application that can be used to help determine VF progression in large groups of patients.