Purpose: To identify ocular hypertension (OHT) subtypes with different trends of visual field (VF) progression based on unsupervised machine learning and to discover factors associated with fast VF progression. Participants: A total of 3133 eyes of 1568 ocular hypertension treatment study (OHTS) participants with at least five follow-up VF tests were included in the study. Methods: We used a latent class mixed model (LCMM) to identify OHT subtypes using standard automated perimetry (SAP) mean deviation (MD) trajectories. We characterized the subtypes based on demographic, clinical, ocular, and VF factors at the baseline. We then identified factors driving fast VF progression using generalized estimating equation (GEE) and justified findings qualitatively and quantitatively. Results: The LCMM model discovered four clusters (subtypes) of eyes with different trajectories of MD worsening. The number of eyes in clusters were 794 (25%), 1675 (54%), 531 (17%) and 133 (4%). We labelled the clusters as Improvers, Stables, Slow progressors, and Fast progressors based on their mean of MD decline, which were 0.08, -0.06, -0.21, and -0.45 dB/year, respectively. Eyes with fast VF progression had higher baseline age, intraocular pressure (IOP), pattern standard deviation (PSD) and refractive error (RE), but lower central corneal thickness (CCT). Fast progression was associated with calcium channel blockers, being male, heart disease history, diabetes history, African American race, stroke history, and migraine headaches.

Automated deep learning analysis of fundus photographs showed high diagnostic accuracy in determining primary open-angle glaucoma, with increased ability to detect glaucoma earlier than human readers. A deep learning (DL) algorithm was trained, validated and tested on the fundus stereophotographs of participants enrolled in the Ocular Hypertension Treatment Study (OHTS), a randomized clinical trial evaluating the safety and efficacy of IOP-lowering medications in preventing progression from ocular hypertension to primary open-angle glaucoma (POAG). Assessment of optic disc and visual field changes in the OHTS was performed by two reading centers and a masked committee of glaucoma specialists, "a demanding, laborious and complicated task," according to the authors. The OHTS data set consisted of fundus photographs from 1,636 participants, of which 1,147 were included in the training set, 167 in the validation set and 322 in the test set. The DL model detected conversion to POAG with high diagnostic accuracy, suggesting that artificial intelligence can offer a reliable tool to automate the determination of glaucoma for clinical trial management, simplifying the process of human interpretation and, possibly, making it more standardized, objective and accurate.