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Editors Selection IGR 9-2

Clinical Examination Methods: RNFL and Macular Damage

Comment by Don Budenz on:

In the article by Wang et al., the investigators performed 10-2 visual fields, RNFL, and macular OCT scans on 143 eyes of 143 glaucoma patients or suspects. All subjects had mild visual field loss by 24-2 MD better than -6 dB. They found that of the 61 eyes had abnormal macular and 10-2 visual fields, 77% showed no abnormality on RNFL scans. In 41 eyes, the macular OCT and 10-2 visual field did not agree. The authors state that the research supports performing macular OCT scans and/or 10-2 visual fields to detect macular abnormalities since these may be missed on conventional 24-2 and optic disc cube scans. The conclusions are supported by the data and this adds to the mounting evidence that we are missing detection of defects in the RNFL and visual field near fixation, where defects may have more of an effect on function. This is an important finding since clinicians are not routinely testing near the fovea and, when defects are not found more peripherally, testing should be done centrally using these two techniques. Otherwise, the diagnosis or severe nature of the glaucoma damage may be missed. So, the take home message is that, if the clinician is evaluating a patient for glaucoma and suspects that peripheral testing using visual fields and OCT do not reveal defects or one or the other alone is seeing a defect, it may be beneficial to test the central area with these tests and even follow them for progression once detected.

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