Photography-based Retinal Vasculometry and Visual Field Progression in Primary Open Angle Glaucoma.

PURPOSE: To evaluate whether retinal vasculometry features derived from baseline fundus photographs are associated with subsequent longitudinal visual field (VF) change in glaucoma suspects and eyes with primary open-angle glaucoma. DESIGN: Retrospective cohort study. METHODS: Retinal vasculometry metrics, including length-diameter ratio, tortuosity, branching measures, fractal dimension, and vessel-density measures, were derived from baseline fundus photographs using an automated deep-learning system. Linear mixed-effects models evaluated associations between baseline vasculometry and longitudinal VF mean deviation (MD) change. Clinical-only, full vasculometry, and parsimonious models were compared, with hierarchy-respecting backward selection performed under maximum likelihood using the Akaike information criterion. RESULTS: A total of 1,595 eyes (757 POAG and 838 glaucoma suspect) from 929 participants with at least 2 years of follow-up and 5 VF examinations were included. A mean of 14.5 VFs were obtained over 10.3 years, and the mean VF MD change was -0.15 dB/year. In the parsimonious model, VF MD slope differed by 0.079 dB/year (95% CI, 0.034-0.123) per 1-SD higher venous fractal dimension, 0.056 dB/year (95% CI, 0.025-0.087) per 1-SD higher arterial fractal dimension, and 0.032 dB/year (95% CI, 0.015-0.050) per 1-SD higher arterial tortuosity (all P<0.001). CONCLUSIONS: Baseline retinal vasculometry features were associated with subsequent longitudinal VF change after adjustment for demographic and clinical factors. These findings support further investigation of fundus photograph-derived vascular features as potential prognostic markers, although independent validation is needed before their clinical predictive utility can be established.