Prediction of Visual Field Progression in Myopic Normal Tension Glaucoma Using a Nomogram-Based Model

Background/Objectives: This study aimed to develop a nomogram-based prediction tool to estimate visual field (VF) progression in patients with bilateral myopic normal-tension glaucoma (mNTG) by integrating key structural and vascular parameters. Methods: This retrospective cohort study included 150 eyes from 75 treatment-naïve patients with mNTG. All subjects were followed for at least five years with at least six reliable VF examinations. Key structural features, including the lamina cribrosa steepness index (LCSI) via enhanced-depth imaging optical coherence tomography (OCT) and choroidal microvascular dropout (cMvD) via OCT angiography (OCTA), were evaluated. VF progression was determined by event-based glaucoma progression analysis (GPA). To construct the predictive nomogram, clustered logistic regression with forward selection and 1000 bootstrap iterations was used to identify independent predictors. Results: Of the 150 eyes, 58 (38.7%) exhibited VF progression. Multivariable analysis identified steeper LCSI and the presence of parapapillary cMvD at baseline as significant independent predictors of progression. The resulting nomogram demonstrated excellent predictive accuracy, with an AUC of 0.922 and a C-index of approximately 0.92, indicating strong discriminative ability. Conclusions: This nomogram, incorporating structural (LCSI) and vascular (cMvD) markers, may offer a useful individualized tool for predicting VF progression in mNTG. This tool could assist in the early identification of high-risk patients and supports personalized treatment planning to optimize long-term visual outcomes.