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Editors Selection IGR 24-3
Clinical Examination Methods: Function: An Application of the Amsler Grid in Glaucoma
Comment by Pradeep Ramulu on:
74472 Assessment of patient perception of glaucomatous visual field loss and its association with disease severity using Amsler grid, Fujitani K; Su D; Ghassibi MP et al., PLoS ONE, 2017; 12: e0184230
Fujitani and colleagues examine how often, and in what terms, patients with visual field damage on a 10-2 test describe difficulties when looking at an Amsler grid. Over 80% of patients noticed some form of abnormality, using a variety of terms to describe what they noticed. Patients' words to describe their observations were then grouped into three categories: missing/white, blurry/gray, or black. Some patients also used a combination of these terms, particularly when they had more severe damage. Of note, the least common term used was "black" (<5%), while the most common terms used were missing/white (50%). The specific terms used varied across the spectrum of disease severity, with the patients describing a black scotoma having a higher degree of visual field damage (median 10-2 MD below -20 dB), while those describing either missing/white or blurry/gray regions having more modest levels of damage (median 10-2 MD just below -10 dB).
What most patient see is not reflected in the gray scale print out from visual field machines or in online depictions of what glaucoma looks likeThe article highlights several important points, primarily that what most patient see is not reflected in the gray scale print out from visual field machines or in online depictions of what glaucoma looks like, including pictures shown on prominent websites such as that of the National Eye Institute. A limitation of the work is that the descriptions used to report perceptions from an Amsler grid may not reflect the words used to describe complex real-world scenes in which adjacent objects have more subtle differences in contrast. Additionally, the words or phrases that patients volunteer to describe their perceptions may not be those that most accurately and specifically capture glaucoma-related symptoms. Further research in this important area is needed to help clinicians improve in the art of determining if a patient has become visually symptomatic from glaucoma and in distinguishing visual symptoms due to glaucoma from symptoms of other ocular conditions.
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