PerspectiveImproving the Detection of Glaucoma and Its Progression: A Topographical ApproachHood, Donald C. PhD*,†; Zemborain, Zane Z. MSc*; Tsamis, Emmanouil PhD*; De Moraes, Carlos Gustavo MD, MPH, PhD†Author Information Departments of *Psychology †Ophthalmology, Columbia University Medical Center, New York City, NY Supported by the NIH/ NEI grant: EY002115 and EY025253. Disclosure: D.C.H. receives lecture fees, research support and equipment from Topcon Inc. and Heidelberg Engineering. E.T. received lecture fees from Topcon Inc. C.G.D.M. receives research support from Topcon, Inc. and Heidelberg Engineering and is consultant for Carl Zeiss Meditec. Z.Z.Z. declares no conflict of interest. Reprints: Donald C. Hood, PhD, Department of Psychology, 406 Schermerhorn Hall, 1190 Amsterdam Avenue, MC 5501, Columbia University, New York, NY 10027 (e-mail: [email protected]). Journal of Glaucoma: August 2020 - Volume 29 - Issue 8 - p 613-621 doi: 10.1097/IJG.0000000000001553 Buy Metrics Abstract Glaucoma is typically defined as a progressive optic neuropathy characterized by a specific (arcuate) pattern of visual field (VF) and anatomic changes. Therefore, we should be comparing arcuate patterns of damage seen on VFs with those seen on optical coherence tomography (OCT) maps. Instead, clinicians often use summary metrics such as VF pattern standard deviation, OCT retinal nerve fiber (RNF) global thickness, etc. There are 2 major impediments to topographically comparing patterns of damage on VF and OCT maps. First, until recently, it was not easy to make these comparisons with commercial reports. While recent reports do make it easier to compare VF and OCT maps, they have shortcomings. In particular, the 24-2 VF covers a larger retinal region than the commercial OCT scans, and, further, it is not easy to understand the topographical relationship among the different maps/plots within the current OCT reports. Here we show how a model of RNF bundles can overcome these problems. The second major impediment is the lack of a quantitative, and automated, method for comparing patterns of damage seen on VF and OCT maps. However, it is now possible to objectively and automatically quantify this agreement. Together, the RNF bundle model and the automated structure-function method should improve the power of topographical methods for detecting glaucoma and its progression. This should prove useful in clinical studies and trials, as well as for training and validating artificial intelligence/deep learning approaches for these purposes. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.