Article Text

other Versions

Download PDFPDF
Long-term perimetric fluctuation in patients with different stages of glaucoma
  1. Paolo Fogagnolo1,
  2. Chiara Sangermani2,
  3. Francesco Oddone1,
  4. Paolo Frezzotti3,
  5. Michele Iester4,
  6. Michele Figus5,
  7. Antonio Ferreras6,
  8. Simona Romano7,
  9. Stefano Gandolfi2,
  10. Marco Centofanti1,
  11. Luca Rossetti7,
  12. Nicola Orzalesi7
  1. 1GB Bietti Foundation–IRCCS, Rome, Italy
  2. 2Eye Clinic, University of Parma, Parma, Italy
  3. 3Dipartimento di Scienze oftalmologiche e Neurochirurgiche, Universita' degli Studi di Siena, Siena, Italy
  4. 4Clinica Oculistica, Università di Genova, Genoa, Italy
  5. 5Eye Clinic, Department of Neuroscience, University of Pisa, Pisa, Italy
  6. 6Department of Ophthalmology, Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain
  7. 7Eye Clinic, Department of Medicine, Surgery and and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy
  1. Correspondence to Dr Paolo Fogagnolo, Eye Clinic, San Paolo Hospital, Via di Rudini' 8, Milan 20142, Italy; fogagnolopaolo{at}


Aim To evaluate the long-term perimetric fluctuation (LF) in patients with different stages of glaucoma according to the Glaucoma Staging System 2 (GSS2).

Methods This multicentre retrospective study included 161 eyes of 161 stable glaucoma patients undergoing four visual-field tests (Humphrey SITA-Standard program over the central 24° or 30°) over a 2-year period. For each patient, the stage of the disease was classified according to GSS2. LF was then calculated as the mean of the standard deviations of point-to-point threshold sensitivities in the four repetitions. LF in GSS2 stages was compared using the t test.

Results LF progressively increased from stage 0 to stage 4, and then decreased at stage 5. Stage 4 had a peak of 3.19±0.94 dB, with statistically significant differences compared with all the other stages. The lowest LF (1.65±0.60 dB) was found for normal subjects, whereas similar data were found for borderline patients and those at stages 1 and 5 (2.09±0.58, 2.13±0.57 and 2.22±0.89 dB, respectively; p>0.13). Visual fields with generalised defects had a lower LF (1.90±0.81) than those with mixed (2.84±0.87, p=0.0003) and localised (2.63±0.72, p=0.004) defects.

Conclusions In this study, the authors showed that the lower the visual-field defect, the lower was LF, except at stage 5 of GSS2. As test–retest changes exceeding LF could represent a sign of progression, the authors suggest that clinicians using this classification system calculate LF, in order to better differentiate true progression from variability.

  • Primary open-angle glaucoma (POAG)
  • perimetry
  • visual field
  • long-term fluctuation
  • long-term variability
  • progression
  • glaucoma staging system
  • psychophysics

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Preliminary results were presented at ARVO, Fort Lauderdale, USA, May 2007.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the San Paolo Hospital.

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

Linked Articles

  • At a glance
    Harminder S Dua Arun D Singh
  • Editorial
    Manuel Gonzalez de la Rosa Marta Gonzalez-Hernandez