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Editors Selection IGR 17-4

Function Tests: Microperimetry versus Humphrey 10-2

Comment by Chris Johnson on:

25055 A Comparison between Microperimetry and Standard Achromatic Perimetry of the Central Visual Field in Eyes with Glaucomatous Paracentral Visual Field Defects, Lima VC; Prata TS; De Moraes CG et al., British Journal of Ophthalmology, 2010; 94: 64-67

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Lima et al. (162) compare the results of scanning laser ophthalmoscope microperimetry (SLO-MP) and the central 10-2 program of the Humphrey Field Analyzer for evaluating macular function in glaucoma patients. In a group of twenty eyes with an average mild to moderate amount of visual field loss by standard automated perimetric techniques using the 24-2 SITA Standard test procedure, the authors found high correlations between the two procedures, and also report that SLO-MP found deficits in some locations that were reported as normal with standard automated perimetry. It is encouraging to me that these authors, as well as other investigators, are paying more attention to the macular region in glaucoma. Many studies have now reported that there is retinal nerve fiber layer thinning in the macular region, which creates an incentive to develop new methods of assessing functional abilities in this area. In this view, the authors are to be congratulated on performing this study.

Retinal nerve fiber layer thinning in the macular region creates an incentive to develop new methods of assessing functional abilities in this area

There are also several questions and concerns that this work also generates: 1) What is the accuracy and precision of the SLO-MP instrument when it comes to minimizing the influence of head and eye movements to achieve reasonable retinal image stabilization? Additional studies that are directed towards this question, mapping of angioscotomas and exudates repeatedly and at different sessions, and related investigations will help to answer this question; 2) Even though the results of the SLO-MP and standard automated perimetry are highly correlated, the SLO-MP threshold values are two to five times lower than those for standard automated perimetry. Why? Both procedures are using very similar test conditions ‐ this is puzzling; 3) What patients will benefit from this procedure, and what will it tell us that current techniques are not able to provide? 4) What relationship do macular visual field deficits have to glaucomatous damage and what type of structure-function relationship is present for the macula? 5) How can one delineate glaucoma-related macular deficits from losses in this region that are due to other etiologies? These are important questions, and with the increased attention that is occurring for macular function in glaucoma, I am confident that some answers and useful information will be forthcoming.

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