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Editors Selection IGR 16-4

Perimetry: Scotoma progression patterns

Comment by Chris Johnson on:

51818 Progression Pattern of Initial Parafoveal Scotomas in Glaucoma, Su D; Park SC; Simonson JL et al., Ophthalmology, 2013; 120: 520-527

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This investigation evaluated eighty eyes of 80 patients with initial parafoveal scotomas (IPFS) in the cross sectional analysis, and 40 eyes of 40 patients with longitudinal results to determine the pattern of visual field progression in these groups. The 10-2 stimulus pattern was used to evaluate the macular and paramacular region. There were four times as many eyes with superior visual field loss in comparison to those with inferior visual field loss for the cross-sectional analysis, so the cases were divided into four subgroups for superior deficits and two groups for inferior visual field loss. Although this was a retrospective study, which can potentially be prone to various sources of bias, it appears that this investigation was performed in a thorough and careful manner. Inclusion/exclusion criteria, definitions of visual field loss and other characteristics are well described, making it possible for others to replicate this investigation. The authors used pattern deviation values for assessment of visual field loss to minimize the influence of ocular media changes (e.g., cataract) on results, and specified their criteria for progression. The authors reported that superior and inferior IPFS display a similar pattern of progression, although the inferior defects tend to be farther from fixation. By evaluating only pattern deviation values rather than total deviation assessments, the authors did not consider the effects of widespread or diffuse visual field sensitivity loss. Additionally, different methods of determining visual field progression will produce varying results, as many laboratories have established to date. These factors represent limitations of the present study, but cautionary indication to these effects have been provided by the authors in the discussion section of this paper. In general, this finding could be of importance to practitioners who follow glaucoma patients with deficits near fixation and emphasizes the significance of evaluating the macula of glaucomatous eyes.

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