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Editors Selection IGR 18-1

Clinical examination methods: Patterns of field loss in PACG

Comment by Ramanjit Sihota on:

69343 Pattern of Visual Field Loss in Primary Angle-Closure Glaucoma Across Different Severity Levels, Atalay E; Nongpiur ME; Yap SC et al., Ophthalmology, 2016; 123: 1957-1964

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In this study, the authors looked at the important subject of visual field defects in different severities of primary angle closure glaucoma (PACG) by using an analysis at each pointwise location, and performing between hemifield and within hemifield evaluations. They reported the superior hemifield to be more severely affected than the inferior hemifield, with the difference increasing with severity. The nasal area was consistently more affected.

One issue with this study is that the definition of PACG used was only an inability to see the posterior trabecular meshwork on gonioscopy in primary position, without mention of the additional requirement for evidence of iridotrabecular contact, such as synechiae, etc. This could have led to the inclusion of patients having primary open angle glaucoma (POAG) with a narrow recess (which is likely in the population studied), or other secondary open-angle glaucomas. Therefore, the conclusions regarding visual field defects seen in these patients may not be definitive for PACG.

As well, patients were excluded if they did not have 'defects typical of glaucoma', which was based on the Ocular Hypertension Treatment Study and representative of POAG. It is possible that PACG patients could present with different defect patterns, which were then not considered, contrary to the aim of the study.

The visual field changes reported in this study are very similar to those seen in POAG, and the results may have been different, and more conclusive, if more stringent criteria for PACG had been used and all defects analyzed.

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