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Editors Selection IGR 16-4
Clinical Examination Methods: Perimetric visual field pattern and early defect screening
Comment by Chris Johnson on:
60424 Modifying the Conventional Visual Field Test Pattern to Improve the Detection of Early Glaucomatous Defects in the Central 10°, Ehrlich AC; Raza AS; Ritch R et al., Translational vision science & technology, 2014; 3: 6
It has been reported by many laboratories that there is structural damage to the macula in glaucoma patients and glaucoma suspects based on optical coherence tomography (OCT) measurements. 1 Dr. Hood and his associates have previously reported that there are functional visual field deficits that occur due to the macular damage in glaucoma patients and suspects.1-3
Adding macular test points to the 24-2 pattern improved the ability to detect functional losses associated with glaucoma
While the six-degree spacing of test points for the conventional 24-2 visual field test pattern does not properly evaluate the macula, it can be appropriately tested with the 10-2 pattern with a two-degree spacing between points within the central ten degrees of vision. However, administering both the 24-2 and 10-2 test patterns for both eyes can be quite time consuming and exhausting for the patient, and can be difficult to perform in a busy clinic. The present study was designed to evaluate the benefit of adding either four (two per superior and inferior hemifield ) or 16 (eight per superior and inferior hemifield) test points to the 24-2 test pattern as a means of detecting macular functional abnormalities in glaucoma.
The investigation was performed on 144 eyes of 144 glaucoma patients with early damage, and was performed in a careful, well-constructed manner. Adding macular test points to the 24-2 pattern improved the ability to detect functional losses associated with glaucoma, which has important clinical and quality of life implications. Generalization of this finding to other clinics could help refine the arrangement and number of additional macular test locations, and assist in determining the clinical utility of this procedure.
References
- Hood DC, Raza AS, De Moraes CG, Liebmann JM, Ritch R. Glaucomatous damage of the macula. Progress in Retinal and Eye Research. 2013; 32: 1-21.
- Hood DC, Raza AS, De Moraes CG, et al. Initial arcuate defects within the central 10 degrees in glaucoma. Investigative Ophthalmology and Visual Science. 2011; 52: 940-946.
- Hood DC, Nguyen M, Erlich AC, et al. A test of a model of glaucomatous damage of the macula with high-density perimetry: Implications for the locations of visual field test points. Translational Vision Science and Technology. 2014; 3: 1-10.
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