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Visual field defect classification in the Zhongshan Ophthalmic Center–Brien Holden Vision Institute High Myopia Registry Study
  1. Xiaohu Ding1,
  2. Robert T Chang1,2,
  3. Xinxing Guo1,
  4. Xing Liu1,
  5. Chris A Johnson3,
  6. Brien A Holden4,,
  7. Mingguang He1
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  2. 2Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, USA
  3. 3Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
  4. 4Brien Holden Vision Institute, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Robert T Chang, Byers Eye Institute at Stanford, 2452 Watson Ct, Palo Alto CA 94303, USA; viroptic{at}


Purpose To describe a new combined myopia and glaucoma visual field classification system in order to report the visual field defects in a population of mostly young Chinese high myopes aged 7–70 years.

Methods A total of 1434 visual fields (including confirmatory repeats of abnormal defects) from 487 high myopes (sphere ≤−6.0 D) were analysed from the prospective Zhongshan Ophthalmic Center–Brien Holden Vision Institute (ZOC–BHVI) High Myopia Registry Study. The predefined classification definitions covering high myopia and glaucoma categories were: normal, enlarged blind spot, abnormal suspect and abnormal with nine subtypes. Two independent graders reviewed the first 150 of 1434 fields for initial grading calibration and the remaining 1284 fields were used to assess intergrader agreement. For the percentage distribution of visual fields, the repeats and unreliable fields were excluded, leaving 894 fields.

Results The intergrader agreement of this combined classification system was a κ value of 0.61 (95% CI 0.59 to 0.63). Among the 894 unique fields, the most common visual field was normal at 33.7% followed by enlarged blind spot at 25.6%. The per cent of ‘arcuate-like’ field defects (combining nasal step, early arcuate and advanced arcuate) was 16.1% with advanced arcuate at 3.4%.

Conclusions A proposed combined visual field classification for high myopia and glaucoma demonstrates acceptable intergrader agreement. A total of 16.1% of defects in young high myopes were found to mimic classic glaucomatous defects. These subjects are being followed prospectively to assess which ones will progress to differentiate myopic from glaucomatous field defects.

  • Glaucoma
  • Field of vision

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  • Deceased 27 July 2015

  • Correction notice The author affiliation information for the authors Brien A Holden and Mingguang He has been updated since this paper was first published online.

  • Contributors XD: collected the data, conducted the analysis, organised the writing and compiled the initial draft. RTC: collected the data, organised the writing and compiled the initial draft. XG: collected the data and organised the writing. XL: reviewed the literatures. CAJ: reviewed the literatures. BAH: conceived and designed the study. MH: conceived and designed the study and organised the writing.

  • Funding The study was supported by the Fundamental Research Funds of the State Key Laboratory in Ophthalmology, the National Natural Science Foundation of China (81125007) and a research grant from the Brien Holden Vision Institute. The funding sources had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Ethics approval Ethics approval was provided by the Zhongshan Ophthalmic Center Ethics Review Board.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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