In glaucoma management, clinicians often face the trade‑off between monitoring peripheral visual field (VF) loss using the standard 24‑2 test and detecting macular progression with the denser 10‑2 grid. Switching entirely to 10‑2 risks missing peripheral changes, while running both tests increases clinic time and patient burden. Now, a new simulation study has proposed a solution: the ARREST A10 approach, which dynamically incorporates 10‑2 locations into 24‑2 testing without extending test time.
ARREST (Australian Reduced Range Extended Spatial Test) works by “censoring” VF points with low utility for progression detection – specifically, locations with sensitivities below 17 dB – thus freeing up presentations to test new points. In A10, these added points are restricted to the 10‑2 region, targeting areas adjacent to existing scotomas. This personalized mapping is triggered only when at least one 24‑2 point within the central 10° shows damage.
Using synthetic longitudinal datasets derived from 126 glaucomatous eyes, the Lions Eye Institute team (Perth, Australia) compared ZEST (standard thresholding) to ZEST+A10 over 10 simulated visits. The average number of test presentations was similar, confirming no increase in test duration. About one‑third of progressing eyes received added 10‑2 points during follow‑up. Diagnostic performance was comparable between A10 and standard 24‑2 for most of the follow‑up, with only minor sensitivity loss in cases where baseline thresholds were near the 17‑dB cutoff. Crucially, A10 enhanced spatial sampling in the macular region while preserving coverage of the peripheral field.
Case simulations illustrated A10’s clinical advantages: in advanced glaucoma, dense central mapping was achieved by replacing blind test points, while retaining peripheral assessment; in localized macular damage, extra central points improved defect characterization without omitting peripheral monitoring.
For clinicians, ARREST A10 could offer a potential “best of both worlds” scenario – adapting the VF grid over time to patient‑specific patterns of loss, enhancing central defect monitoring without sacrificing peripheral surveillance or increasing patient test load. If validated in prospective trials, it could streamline follow‑up protocols, particularly in long‑term glaucoma care.
