Machine Learning-Based Prediction of Long-Term Intraocular Pressure Fluctuations in Open-Angle Glaucoma.

Objective: To investigate the predictability of long-term intraocular pressure (IOP) fluctuations in open-angle glaucoma eyes implanted with a telemetric IOP sensor. Design: A prospective, open-label, single-arm, multicenter study. Subjects: Twenty-four patients were enrolled, including 20 with primary open-angle glaucoma, 2 with pseudoexfoliative, 1 with pigmentary, and 1 with uveitic glaucoma. Mean age was 65.2 ± 10.2 years. Methods: Telemetric IOP measurements were aggregated into nyctohemeral means. The first 90 postoperative days were excluded. A rolling reference framework was applied, in which temporally paired observations were generated by comparing each eligible day with a future time point at fixed prediction horizons. The relationship between short-term (7, 14, or 28 days) and long-term (273 or 364 days) fluctuations was assessed using Pearson correlation. Multivariate regression was applied to predict long-term fluctuations based on short-term data. In addition, supervised machine learning with a Random Forest Classifier was used to predict long-term fluctuations from clinical, demographic, and IOP-derived features. For each horizon (273 or 364 days) and threshold (+2.0, +3.0, and +4.0 mmHg), changes in mean nyctohemeral IOP were calculated. Outcomes were labeled as "1" if the increase met or exceeded the threshold and "0" otherwise. Main Outcome Measures: Predictability of long-term IOP fluctuations at 273 and 364 days. Results: Short-term fluctuations correlated only weakly with long-term variability (Pearson Conclusions: Long-term IOP fluctuations can be predicted from baseline clinical and demographic data combined with IOP-related features. Telemetric devices and remote IOP monitoring, combined with predictive modeling, could reduce the burden of time-intensive procedures and health care costs while supporting individualized care in the face of rising demand. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.