Study Shows Typical Visual Field Testing Intervals Delay Glaucoma Progression Detection

A new simulation study highlights how infrequent visual field testing can significantly delay the detection of glaucoma progression in real-world practice. Photo: Shaleen Ragha, OD. Click image to enlarge. A new analysis of US glaucoma testing patterns suggests that current visual field (VF) frequencies may be insufficient to detect clinically meaningful progression in a timely manner. The findings, derived from simulation modeling using the Duke Glaucoma Registry (DGR), highlight a widening gap between recommended and actual practice and underscore the need for more individualized testing strategies.Claims-based analyses have shown that US glaucoma patients are under-tested on visual fields. Nationwide insurance data from 2008 to 2017 indicate a median interval of 1.59 years between VF tests, with the slowest-tested cohort stretching to over three years between exams. While the American Academy of Ophthalmology recommends at least annual VF testing for most patients, real-world adherence remains far lower.To understand the clinical implications of this gap, investigators simulated visual field progression using real-world data from the DGR. The team modeled progression detection under four testing intervals: the 25th percentile (3.03 years between), 50th percentile (1.59 years), 75th percentile (1.14 years) and the AAO-recommended annual schedule.Data showed that time to detect progression in 80% of eyes ranged from 15.2 to 24.3 years at the lowest testing frequency. At the median US interval of 1.59 years, detection times stretched from 9.6 to 17.5 years. More frequent testing helped with patients tested every 1.14 years reaching detection in 8.0 to 14.9 years, while annual testing narrowed the window to 7.1 to 14.1 years.For practicing optometrists, these findings reinforce what many clinicians witness daily: structural and functional testing often lag behind the pace at which glaucoma can silently advance. The modeled delays also demonstrate why relying solely on VF testing, especially if performed infrequently, may not be adequate for timely therapeutic decisions.“The frequency of visual field testing for patients with glaucoma in this US nationwide insured population is inadequate for most patients and leads to considerable delay in detection of glaucoma progression,” the study authors wrote in their Ophthalmology Glaucoma paper.“These results suggest that either visual field testing needs to be done more frequently or other methods of identification of progressive glaucoma vision loss need to be developed,” they concluded, while highlighting the potential role of virtual reality visual field headsets, iPad perimetry or home computer perimetry. “Clinical decision support systems could help tailor the frequency of visual field testing to the needs of individual patients.”Click here for the journal source. Stagg BC, Brintz BJ, Stein JD, et al. Time to identify glaucoma progression given real-world visual field testing frequencies in a US nationwide insured population. Ophthalmol Glaucoma. November 26, 2025 [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.