Prevalence and nature of early glaucomatous defects in the central 10° of the visual field.

Published on Mar 1, 2014in JAMA Ophthalmology7.389
· DOI :10.1001/JAMAOPHTHALMOL.2013.7656
Ali S. Raza24
Estimated H-index: 24
(Columbia University)
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Abstract
Importance The macula is essential for visual functioning and is known to be affected even in early glaucoma. However, little is currently understood about the prevalence and nature of central vision loss in early glaucoma. Objective To determine the prevalence and characteristics of visual field (VF) defects in the central 10° in glaucoma suspects and patients with mild glaucoma using a prospective design. Design, Setting, and Participants This prospective observational cohort study was conducted at an outpatient glaucoma specialty clinic. One hundred eyes from 74 patients with glaucomatous optic neuropathy and a 24-2 VF with mean deviation better than −6 dB were prospectively studied and tested with a 10-2 test. Main Outcomes and Measures Reliable VF hemifields were classified as abnormal based on a cluster criterion, and abnormal 10-2 VFs were categorized based on the pattern of abnormal points: arcuatelike, widespread, or other. In addition, at each point of the 10-2 VF, the total deviation values were averaged across eyes and the number of abnormal points with total deviation values below a specific criterion level were calculated. Results There appeared to be as many abnormal 10-2 hemifields (53%) as abnormal 24-2 hemifields (59%). Of the eyes with normal 24-2 hemifields, 16% were classified as abnormal when the 10-2 test was used. Of the abnormal 10-2 hemifields, 68%, 8%, and 25% were arcuatelike, widespread, and other, respectively. The average total deviation values and number of abnormal points plots revealed superior VF defects that were deeper and closer to fixation than those in the inferior VF. Conclusions and Relevance The 10-2 VF was abnormal in nearly as many hemifields as was the 24-2 VF, including some with normal 24-2 VF, suggesting that the 24-2 test is not optimal for detecting early damage of the macula. The pattern of the defects was in agreement with a recent model of macular damage.
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There is a growing body of evidence that early glaucomatous damage involves the macula. The anatomical basis of this damage can be studied using frequency domain optical coherence tomography (fdOCT), by which the local thickness of the retinal nerve fiber layer (RNFL) and local retinal ganglion cell plus inner plexiform (RGC+) layer can be measured. Based upon averaged fdOCT results from healthy controls and patients, we show that: 1. For healthy controls, the average RGC+ layer thickness closel...
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Purpose To better understand the nature of glaucomatous damage, especially to the macula, the inner retinal thickness maps obtained with frequency domain optical coherence tomography (fdOCT) were averaged.
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Preserving central vision is of paramount importance in treating glaucoma. However, it is fair to say we know more about paracentral damage than we do about damage to this most important region for visual function. This is in part due to the fact that visual field (VF) damage is commonly assessed with standard automated perimetry (SAP) and the 24-2 test. The 24-2 test pattern has only four points within the central 4.2° (radius) of fixation and only one point within the fovea, which is optional....
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