Purpose: To investigate the usefulness of visual field (VF) reliability indices and gaze tracking (GT) for the accurate assessment of progression in glaucoma.

Design: Institutional practice. Participants: Four hundred eighty-three eyes of 304 patients with open-angle glaucoma.

Methods: In each eye, a series of 10 VFs were examined. Using the GT chart at the bottom of the VF printout (Humphrey Field Analyzer, Swedish interactive threshold algorithm standard), average tracking failure frequency (TFF), average blinking frequency (BF), and the total amount of eye movement per stimulus (MPS) were calculated. Mean total deviation (mTD) was calculated based on the 52 total deviation values in each 24-2 VF, and linear regression was applied to the series of mTD measurements over time. Progression was deemed to have occurred based on 2 separate definitions: (1) the mTD rate across all 10 VFs (VF1-10) was significant (P < 0.05) and less than 0 dB/year and (2) the mTD rate was less than -0.5 dB/year and significant at P < 0.05. The mTD rate also was calculated in shorter VF series (VF1-5-VF1-9). The area under the receiver operating characteristic curve (AUC) was calculated from the relationship between mTD rates of shorter VF series (n < 10) and the diagnosis of progression in all 10 VFs. This analysis was iterated after excluding eyes with increasingly strict cutoff values for the standard VF reliability indices (fixation loss [FL], false-positive [FP] rate, and false-negative [FN] rate) and the GT parameters (TFF, BF, and MPS). Main outcome measures: Area under the receiver operating characteristic curve values with different exclusion criteria for GT and standard reliability indices.

Results: The AUC was largely unchanged according to stricter FL and FP criteria. The AUC increased with a more stringent FN criterion, but only when progression was described using the second definition (a rate of less than -0.5 dB/year). The AUC increased with stricter criteria for TFF, BF, and, to some extent, MPS.

Conclusions: Mean total deviation progression rates are more reliable when FN, TFF, BF, and MPS indices are stricter. Gaze-tracking results should be considered when assessing glaucomatous progression.