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Editors Selection IGR 16-4

Clinical Examination Methods: Predicting Visual Field Progression

Comment by Chris Johnson on:

75682 Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss, Garg A; De Moraes CG; Cioffi GA et al., American Journal of Ophthalmology, 2018; 187: 92-98

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There are many investigations that have reported structural damage to the macular region of glaucoma patients as revealed by Optical Coherence Tomography (OCT). However, there are a more limited number of studies that have reported central functional glaucomatous loss as determined by automated perimetry. This publication utilizes visual field data that was obtained in the African Descent and Glaucoma Evaluation Study (ADAGES) to determine whether central visual field damage in glaucoma (within the central 10 degrees) is predictive of faster global visual field loss. It is encouraging that this investigation places emphasis on careful evaluation of the central visual field in glaucoma.

The study has been conducted quite carefully and has implemented highly appropriate inclusion and exclusion criteria, statistical analyses and interpretation of results. It was found that there was a greater amount of global visual field loss over time for the group with central visual field damage compared to the group that did not have central visual field damage at baseline. This effect persisted when confounding variables were also taken into account. These findings emphasize the importance of carefully assessing central macular visual field properties in glaucoma because it is a significant predictor of overall visual field loss in glaucoma. Such information is highly meaningful for effective management of glaucoma patients. Future studies should direct more effort towards central visual field evaluation.

These findings emphasize the importance of carefully assessing central macular visual field properties in glaucoma because it is a significant predictor of overall visual field loss in glaucoma

The use of a 10-2 visual field test is likely to improve the ability to quantify central visual field loss, but this places additional burdens on the stamina and attentiveness of the patient and the effective management of a busy glaucoma clinical practice. However, it has been reported that adding just two additional central test locations to the 24-2 test can greatly improve the ability to detect macular visual field deficits in glaucoma.¹ Also, given that there are structural and other differences between individuals of African descent and European origins, it would be beneficial in the future to determine whether there are any variations in the importance of central visual field loss for these two groups.

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