01The stage
Experts reading the same field often disagree.
Across three studies, glaucoma experts grading the same visual fields agreed only fair to moderately (kappa 0.32-0.47).
Review of visual field assessment, PubMed Central
Read the source →■ Tue, Nov 17 · 7pm ET · Free · Replay and guide included
Find glaucoma earlier.
Refer with confidence.
Keep patients on track.
Live webinar + Q&A from CarrotThe 2027 Glaucoma Workup Guide
From screenings to treatment management, we'll walk you through the best clinical workup methods—based on the latest clinical studies and data from more than 3 million visual fields run on Carrot's platform.
45 min + Q&A · Tue, Nov 17 · 7pm ET / 6pm CT / 5pm MT / 4pm PT
Built forODs who manage or refer glaucomaOphthalmologists and glaucoma cliniciansTechnicians who run the testingPractice administrators building 2027 protocols
Save your seat
Tue, Nov 17 · 7pm ET · Free · Replay and guide to every registrant
Registering also gets you The 2027 Glaucoma Workup Guide. Not CE. Carrot Protocols are shown for a few minutes at the end.
The workup, stage by stage
The field, the stage, the cross-checks.
Follow one patient from the comprehensive exam to monitoring. Click a stage to see which test belongs there, why, and the report it produces.
The Pupillometer and Contrast Sensitivity are Carrot Pro tests; Visual Field Screening and the 24‑2 Visual Field with Severity Index run on every Carrot.
Stage 01 · Detect
Visual Field Screening
What it is
A suprathreshold Visual Field Screening (C-40) in under 90 seconds, with a refer flag when the field isn't clean. Fast enough for every comprehensive exam.
When it belongs
Every comprehensive exam, every adult. The step most practices skip because a full field takes too long.
What the evidence says
About half of people with glaucoma don't know they have it, so the workup starts at the comprehensive exam, not at the suspect visit.
Stage 02 · Suspect
24‑2 Visual Field with Severity Index
What it is
The 24‑2 Visual Field in under 3 minutes an eye, read objectively: Normal, Mild, Moderate or Advanced on every report.
When it belongs
Anyone the Visual Field Screening flags, and anyone whose risk earns a 24‑2 Visual Field even when the screening is clean. This is the baseline everything after depends on.
What the evidence says
Agreement between readers of the same field is only fair to moderate (kappa 0.32-0.47). An objective, AI-assisted stage gives everyone the same reference point; the clinician still decides.
Stage 03 · Refer
Refer with the stage, plus an objective Pupillometer read Pro
What it is
The referral carries the 24‑2 Visual Field and its stage. An objective Pupillometer read, under a minute for both eyes, adds a second, independent measure, so the referral rests on two kinds of evidence instead of one.
When it belongs
At the referral decision, alongside the field. An adjunct that strengthens the referral, not a replacement.
What the evidence says
Meta-analysis: pupillometry detects glaucoma with pooled sensitivity 0.81 and specificity 0.83 (Suo, Front Neurol 2020). Between-eye asymmetry tracks the difference in field loss, R = 0.83 (Chang and Boland, IOVS 2013).
Stage 04 · Treat
The doctor's call, with the fullest picture
What it is
Drops, laser or surgery: the treating doctor decides. Carrot doesn't treat and doesn't diagnose.
What Carrot adds
Everything the decision rests on, in one place: the 24‑2 Visual Field, its objective Severity Index stage, the baseline and trendline, the Pupillometer read and Contrast Sensitivity. The fullest clinical picture we can give, so the call is made on evidence, not on a single read.
What the evidence says
Six fields in the first two years are needed to catch rapid progression (Chauhan, BJO 2008). That is the monitoring load the workup has to make practical.
Stage 05 · Monitor and manage
Progression trendlines, plus Contrast Sensitivity Pro
What it is
Progression trendlines from the second 24‑2 Visual Field onward. Contrast Sensitivity in 2 minutes or less, each eye scored on the same scale as the Pelli-Robson chart, as a functional measure of how the patient actually sees.
When it belongs
After diagnosis, on the interval the panel proposes: the 24‑2 Visual Field tracks the disease, Contrast Sensitivity tracks the function the patient notices.
What the evidence says
In advanced glaucoma, acuity explains less than 40% of contrast loss (Jammal, BJO 2020). Contrast, not acuity, tracks glaucoma-related quality of life (Ramulu, ARVO 2018).
What you'll walk away with
A workup you can run the next morning.
Forty-five minutes, then your questions. By the end of the session you'll know exactly how to:
- Catch glaucoma at the comprehensive exam, not visits later. Who gets a 90-second Visual Field Screening, who gets a 24‑2 Visual Field even when the screening is clean, and how often.
- Stop second-guessing the stage. How an objective, AI-assisted Severity Index stage on every 24‑2 Visual Field gives you and the receiving doctor the same reference point, and where your clinical judgment still decides.
- Send referrals the receiving doctor can act on. What every referral should carry: the 24‑2 Visual Field, its objective stage, a baseline and an objective Pupillometer read that adds a second, independent measure.
- See what your patient is actually living with. Where Contrast Sensitivity fits after diagnosis, and why it tracks quality of life in ways acuity misses.
- Keep patients on track with minimal technician time. The follow-up interval the evidence supports, and how to run the whole workup on one device, in one lane.
- Leave with the tools, not just the talk. The 2027 Glaucoma Workup Guide: the referral letter template, the follow-up interval table and the technician lane checklist.
The evidence behind the workup
We ran Severity Index across 3 million visual fields. The results may surprise you.
Severity Index is the objective, machine-learning model that stages visual field loss on every Carrot 24‑2 Visual Field report, built with Eyelomics, the eye-care AI research group led by Siamak Yousefi, PhD, FARVO, of Bascom Palmer Eye Institute, and Rehan Ahmed, MD, from 50,000 reliable visual fields. Applied to more than 3 million first-time 24‑2 Visual Fields on the platform (1.9 million eyes, published June 2026), 1 in 13 were already at the Advanced stage. It is the evidence behind one decision in the workup: start at the comprehensive exam, not at the suspect visit. The panel walks through the breakdown by age and state live.
Why Severity Index matters
Staging has been subjective, where certainty matters most.
01Severity staging has always depended on interpretation
The same field can be staged differently depending on who reads it and when: results fluctuate between visits, mean deviation hides the pattern, and the frameworks leave room for judgment. That variability lands on the decisions that matter most: monitor or refer, now or later.
02Today's framework dates from 1993 and has no Normal stage
Hodapp-Parrish-Anderson: three stages, thresholds set by expert consensus, and no Normal stage, so no baseline to measure change from.
03Machine learning found the stages in the data
Built with Eyelomics (the eye-care AI research group led by Siamak Yousefi, PhD, FARVO, of Bascom Palmer Eye Institute, and Rehan Ahmed, MD), unsupervised machine learning found four natural severity groups in 50,000 reliable visual fields from Carrot's 5 million+ exams. No human labels; a second model set the MD thresholds between them.
04Every 24‑2 Visual Field now carries the same objective stage
Normal, Mild, Moderate or Advanced, inside the report, powered by Carrot AI. The OD, the MD and the technician read from one framework. An assistive, objective second read; the clinician interprets every result.
Severity Index stage, on every 24‑2 Visual Field report
NormalMildModerateAdvanced
Better ←-2.3 dB-9.6 dB-17.3 dB→ Worse
Mean deviation (MD) thresholds between stages, set by the model from the data. Training fields spanned +5 to -25 dB.
- Signal from noise: a fixed reference for disease vs variability
- Referrals that carry a stage: "Moderate on Severity Index" travels with the patient
- One read everywhere: same field, same stage, every provider and location
- Assistive: a standardized reference point for review and referral, not a diagnosis
The literature behind the session
What the evidence says, cited.
The panel builds the workup on published evidence, not on Carrot data alone. These are the studies the session draws on; each is cited only for what it actually found.
02The stage
The staging framework most of us learned dates from 1993.
Hodapp-Parrish-Anderson defines three stages by expert consensus, with no Normal stage to measure change from.
Hodapp E, Parrish RK, Anderson DR. Clinical Decisions in Glaucoma, 1993 (criteria explained, PubMed Central)
Read the source →03The field
Six fields in two years to catch fast progression.
Detecting rapid visual field progression reliably takes six fields in the first two years after diagnosis.
Chauhan BC et al., Br J Ophthalmol, 2008
Read the source →04The field
Testing and follow-up intervals, set by risk.
The AAO's guideline for primary open-angle glaucoma sets recommended testing and follow-up intervals by risk.
AAO Preferred Practice Pattern, Primary Open-Angle Glaucoma
Read the source →05The cross-checks
Pupil testing detects glaucoma as an adjunct.
Meta-analysis: pooled sensitivity 0.81 and specificity 0.83. The authors call accuracy moderate and the test an adjunct, not a replacement.
Suo L et al., Front Neurol, 2020
Read the source →06The cross-checks
Pupil asymmetry tracks field loss between eyes.
Between-eye asymmetry in the pupillary light reflex correlated with the between-eye difference in mean deviation (R = 0.83; 148 glaucoma patients, 71 controls).
Chang DS, Boland MV et al., Invest Ophthalmol Vis Sci, 2013
Read the source →07The cross-checks
Pupillography separated glaucoma from controls.
A pupillography model including age distinguished glaucoma from controls with an AUC of 0.87.
Chang DS, Boland MV, Friedman DS et al., Am J Ophthalmol, 2013
Read the source →08Management
In advanced glaucoma, acuity misses most contrast loss.
Almost all eyes with advanced glaucoma (n = 28, median acuity 20/25) had moderate to profound contrast sensitivity loss; acuity explained less than 40% of it.
Jammal AA et al., Br J Ophthalmol, 2020
Read the source →09Management
Contrast sensitivity tracks quality of life.
Contrast sensitivity, not acuity, was the dominant vision measure for glaucoma-related quality of life; acuity led for fear of falling, driving and reading.
Ramulu P, Mihailovic A, ARVO 2018 abstract (via Review of Optometry)
Read the source →10Management
But it isn't a measure of severity.
Contrast sensitivity was not a reliable surrogate for glaucoma severity, which is why the 24‑2 Visual Field tracks the disease.
Fatehi N et al., Am J Ophthalmol, 2017
Read the source →Scroll for all 10 studies
The 2027 Glaucoma Workup: earlier detection, confident referrals, better management
Five questions. 45 minutes.
01
Where does the workup start?
Why the field belongs at the comprehensive exam: what the literature and Carrot's 3 million+ fields say about how late glaucoma arrives, and what it looks like from the clinician's chair.
02
Who needs a field, and how often?
The field: a 90-second Visual Field Screening at every comprehensive exam, a 24‑2 Visual Field by risk, and the follow-up interval the guidelines and the progression literature support.
03
How does every 24‑2 Visual Field get an objective severity stage, built in?
How Severity Index was built with machine learning, what an objective, AI-assisted stage changes about a referral, and where the clinician still decides.
04
How do you enhance accuracy and validity beyond visual fields?
What an objective Pupillometer read adds to the referral, its limits, and where Contrast Sensitivity fits after diagnosis.
05
Can you run it all in one device, in one lane, with minimal time from your techs?
The workup loaded as one of Carrot's Protocols, shown live for a few minutes. Then your questions.
Register and get the guide
The 2027 Glaucoma Workup Guide.
The field, the stage and the cross-checks: a practical standard for earlier detection, confident referrals and better management.
- The whole workup on one page, then a chapter each for the field, the stage and the cross-checks, with the evidence
- The Severity Index stage table and what each stage changes in a referral
- The referral letter template and the follow-up interval table
- The technician lane checklist, built to print
- Web chapters on confirmation, print edition by email
Read it on your phone between patients; the print edition comes by email. Built on Carrot's analysis of 3 million+ visual fields and the published literature.
Save my seat and get the guide →Look inside
Speakers announced Nov 10
The panelists are announced on Tuesday, Nov 10. Registrants hear first.
–days
–hrs
–min
Who we are, and where the data comes from
Where the evidence comes from.
Carrot (formerly Virtual Field) makes the VR-based visual testing platform optometry and ophthalmology practices use for visual fields and comprehensive-exam testing: Visual Field Screenings, the 24‑2 Visual Field, the Pupillometer and Contrast Sensitivity in one wireless platform, no dark room, no chin rest.
Every Carrot number in this webinar comes from tests run on the platform; the rest is cited literature. Because the platform is used across thousands of lanes, it holds one of the largest reliable visual field datasets in eye care, and Severity Index was built from it with Eyelomics, the eye-care AI research group led by Siamak Yousefi, PhD, FARVO, of Bascom Palmer Eye Institute, and Rehan Ahmed, MD.
Find glaucoma earlier.
Refer with confidence.
Keep patients on track.
The 2027 Glaucoma Workup Guide: Live webinar + Q&A
Tue, Nov 17 · 7pm ET / 6pm CT / 5pm MT / 4pm PT · Free
Save my seat →Register once, and get the live seat, replay and guide.
FAQs
Is it a sales pitch?+
It's a clinical-practice session led by a panel of experts. Carrot Protocols are shown for a few minutes near the end. You don't need to use Carrot to attend.
Do I need Carrot to use the workup?+
No. The field, the stage and the cross-checks are described by test, not by brand; Carrot Protocols are shown for a few minutes at the end.
Where does the data come from?+
Carrot's analysis of more than 3 million reliable visual field tests on 1.9 million eyes, first published in June 2026. The figures describe eyes at their first test on Carrot. Some of those patients were already diagnosed or had been tested on other devices, so the data shows what arrives in the lane, not when glaucoma was first found.
Will there be a recording?+
Yes. Every registrant gets the replay, so register even if you can't make it live.
Is this CE?+
No. It's a commercial program from Carrot.
Does Severity Index diagnose glaucoma?+
No. It gives every 24‑2 Visual Field an objective stage, Normal, Mild, Moderate or Advanced, so clinicians share a standardized reference point. The clinician interprets every result.
Tue, Nov 17 · 7pm ET · FreeSave my seat →