Patterns of Early Visual Field Loss in Open-Angle Glaucoma

doi:10.1016/S0002-9394(14)74273-4

American Journal of Ophthalmology

Volume 103, Issue 4, April 1987, Pages 512-517

https://doi.org/10.1016/S0002-9394(14)74273-4 Get rights and content

We examined two groups of patients with primary open-angle glaucoma with distinctly different patterns of early visual field loss using two visual field indices: mean defect and loss variance. Patients were selected on the basis of visual field criteria only. Eight patients were selected for diffuse depression of the differential light sensitivity without localized scotomas (mean defect > 3.0 decibels, loss variance < 10.0 decibels²). Seven patients were selected for localized scotomas without diffuse depression of the differential light sensitivity (mean defect ≤ 3.0 decibels, loss variance ≥ 20.0 decibels²). Patients with diffuse depression manifested intraocular pressures that were higher (mean peak pressure ± S.E.M., 27.6 ± 1.2 mm Hg) than those with localized defects (22.4 ± 1.4 mm Hg). The optic disk rim area of the localized loss group (mean ± S.E.M., 1.02 ± 0.15 mm²) was significantly smaller (P < .05) than the disk rim area of the diffuse loss group (1.33 ± 0.07 mm²). This difference was largely because of thinner temporal disk rims in the localized loss group. Different patterns of visual field loss may be caused by different mechanisms of glaucomatous optic nerve damage.

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To investigate the patterns of visual field (VF) defects in primary angle-closure glaucoma (PACG) across different severity levels and to assess hemifield differences within each severity level.
Cross-sectional study.
Three hundred four patients diagnosed with PACG were recruited from glaucoma clinics at a Singapore hospital.
Point-wise total deviation values were recorded from the static automated perimetry (Swedish interactive threshold algorithm standard program 24-2; Humphrey model 750 [Carl Zeiss Meditec, Dublin, CA]) printouts. Patients were excluded if they had unreliable VFs (fixation losses >33% and false-positive responses >15%), had undergone only 10-2 VF testing, had VF defects not typical of glaucoma, or had undergone cataract extraction. Mild, moderate, and severe VF loss were defined by a mean deviation of −6.00 dB or more, −6.01 to −12.00 dB, and −12.01 dB or less, respectively. Each hemifield was divided into regions according to glaucoma hemifield test sectors. The average mean deviation (MD) of each region was obtained using total deviation values.
Between- and within-hemifield differences of the regions across the severity levels.
After excluding ineligible cases, 249 patients with PACG were included in the analysis. Mean age of the patients was 65.7±8.6 years, with a 1:1 gender ratio. The number of patients who had mild, moderate, and severe VFs was 72 (28.9%), 78 (31.3%), and 99 (39.8%), respectively. For between-hemifield comparisons, all regions in the superior hemifield had worse MDs compared with their counterparts in the inferior hemifield across the severity spectrum. Likewise, for within-hemifield comparisons, MDs of the regions gradually worsened with increasing distance from the fixation point.
In this group of clinic-based PACG patients, the superior hemifield was found to be affected more severely than the inferior hemifield, and the differences between them increased with worsening disease severity. The damage was consistently more pronounced in the nasal area.
Overall topographic frequency of glaucoma defects. in memory of Erich Seidel (1882-1948)
2011, Archivos de la Sociedad Espanola de Oftalmologia
Comparison of Optic Nerve Head Topography and Visual Field in Eyes with Open-angle and Angle-closure Glaucoma
2008, Ophthalmology
Citation Excerpt :
Whether the more diffuse nature of PACG field loss results from a different exposure to IOP in height and duration or relates to a difference in pathophysiology is not clear. There is evidence that eyes damaged at lower IOP in POAG have more localized field defects than POAG cases with higher IOP levels,29,30 although other authors found that this association was not strong.31 It is tempting to speculate that any differences between eyes with PACG and POAG may relate to differences in their optic disc structure or the susceptibility of retinal ganglion cells to injury.
To compare the optic disc and visual field (VF) alterations in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).
Observational case series.
A total of 146 persons (217 eyes), 110 with POAG and 36 with PACG, recruited from a university glaucoma service.
Each subject underwent visual acuity measurement, applanation tonometry, gonioscopy, slit-lamp examination, dilated optic disc and retinal examination, axial eye length measurement, central corneal pachymetry, automated perimetry, optical coherence tomography (OCT) nerve fiber layer (NFL) examination, and Heidelberg Retina Tomograph (HRT) optic disc evaluation. Parameters of interest were studied by multivariate regression models.
Heidelberg Retina Tomograph parameters compared between POAG and PACG.
Primary open-angle glaucoma and PACG groups were similar in age, ethnic background, and treated intraocular pressure, but the PACG group had significantly more women, shorter eye length, more hyperopia, and a larger disc area (all Ps < 0.001). The VF average mean deviation (MD) did not significantly differ between POAG and PACG, but the PACG group had lower pattern standard deviation (PSD) for a given MD (P = 0.001). Although 3 HRT parameters differed somewhat between POAG and PACG (cup area, rim area, and cup-to-disc area ratio), they did not significantly differ after correction for multiple comparisons. Mean deviation and disc area were much more significant predictors of the HRT measures than was diagnosis. Similar results were obtained when using OCT NFL thickness as a structural measure of damage as opposed to MD as a functional measure. When controlling for MD, current IOP was not significantly associated with disc parameters in POAG.
When the amount of optic nerve damage is taken into account by adjusting for VF MD or OCT NFL thickness, those with POAG and PACG have no significant differences in optic disc topography. Visual field damage in PACG was more diffuse than that in POAG, as measured by a lower PSD for a given level of MD. There was no corresponding difference in the uniformity of structural damage as measured by OCT NFL thickness.
Alterations in the choroid in hypercholesterolemic rabbits: Reversibility after normalization of cholesterol levels
2007, Experimental Eye Research
Citation Excerpt :
However, few studies have examined ultrastructural changes in choroidal and retinal vascularization during hyperlipidemia, despite epidemiological (Klein et al., 2000; Wong et al., 2001, 2002a,b) and clinical evidences of alterations in patients with this condition. Hyperlipidemic patients are found to have a generalized decrease of retinal sensitivity in the visual field (Hayreh, 1970, 1971; Hayreh et al., 1970; Greve and Geijssen, 1983; Phelps et al., 1983; Caprioli et al., 1987; Schulzer et al., 1990; Terrés et al., 1992) and/or areas of peripapillary atrophy on fundus examination (Jonas et al., 1990, 1992; Tuulonen and Airaksinen, 1992) and histopathology (Kubota et al., 1996). These findings are probably related to choroidal ischemia and alteration of the retinal pigment epithelium (RPE)–photoreceptor complex.
Endothelial damage in atherosclerosis is characterized by abnormal vascular functionality. Hyperlipidemic patients show alterations in ocular vascularization. However, it is not known whether these alterations are reversible after the lipid profile returns to normal. This study evaluates a rabbit model of hypercholesterolemia, examining the ultrastructural changes in the choroid, and the changes in it after a period of normal blood-cholesterol values induced by a standard diet. Rabbits were divided into three groups: G0, fed a standard diet; G1A, fed a 0.5% cholesterol-enriched diet for 8 months; and G1B, fed a 0.5% cholesterol-enriched diet for 8 months followed by a standard diet for a further 6 months. Eyes were processed for transmission electron microscopy. G1A had a buildup of lipids at the suprachoroidea that compressed the vascular layers, and hypertrophy of endothelial and vascular smooth muscle cells. In G1B there was less lipid accumulation than in G1A, but this was not followed by reversal of the choroidal damage. The suprachoroidea thickness of G1B was still greater than in G0 due to abundant collagen fibers. The intervascular spaces of the choroid had fewer lipids than G1A but more collagen fibers than G0. The large- and medium-sized vessel layers and choriocapillaris were less compressed than in G1A but exhibited basal membrane and endothelial changes similar to those in G1A. Normalization of serum cholesterol levels is not enough to reverse cholesterol-induced vascular damage to the choroid. These choroidal changes could be compatible with a chronic ischemia that could produce retinal degeneration.
Intereye Concordance in Locations of Visual Field Defects in Primary Open-Angle Glaucoma. Diagnostic Innovations in Glaucoma Study
2006, Ophthalmology
To determine the overlap in defective visual field locations between the right and left eyes of primary open-angle glaucoma patients.
Cross-sectional retrospective analysis of data from a prospectively designed longitudinal study.
Patients with glaucomatous optic neuropathy in at least 1 eye and 2 consecutive reliable standard automated perimetry fields within 15 months were included, yielding 468 eyes of 234 patients.
Concordance in defective visual field locations between right and left eyes were calculated as the number of overlapping locations divided by the total number of defective locations (intereye concordance ratio). Concordance ratios also were calculated within an eye over time (intraeye concordance ratio) and between unmatched pairs of fields (unmatched concordance ratio).
Intereye concordance (0.24±0.02) was significantly smaller than intraeye concordance (0.37±0.02) and significantly larger than unmatched concordance (0.14±0.01). There was a significant interaction between concordance type and defect size, such that there was no difference in concordance ratios for defects of fewer than 8 locations, and the difference between intereye concordance versus intraeye concordance and unmatched concordance ratios increased with larger defect sizes.
A spatial relationship exists between defective locations of an individual’s eyes. Future studies will show whether information about the spatial relationship is useful to guide the modification of visual field test locations to improve detection of loss and perhaps also progression.
Pupillary evaluation of retinal asymmetry: Development and initial testing of a technique
2005, Vision Research
Glaucomatous damage to upper and lower retina is often unequal. We have developed a rapid, objective, quantitative measure of asymmetry of retinal sensitivity, using infrared pupillometry and pairs of large stimuli that are symmetric about the horizontal meridian. Results for a group of 11 young subjects free of eye disease indicate that the distribution of asymmetry is close to a normal distribution centered near upper/lower symmetry. Some subjects showed modest amounts of asymmetry, which was relatively uniform within each eye, and between the two eyes, of the subject. This approach to determination of asymmetry within an eye is potentially applicable to testing patients with glaucoma. The narrowness of the distribution should make it possible to detect asymmetries caused by disease.

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This study was supported in part by grants from Research to Prevent Blindness, Inc., the Connecticut Lion's Eye Research Foundation, and Foresight, Inc. Dr. Miller was supported by training grant 5 T32 EY07000-10 from the National Eye Institute.

Reprint requests to Joseph Caprioli, M.D., Yale University School of Medicine, P.O. Box 3333, New Haven, CT 06510-8061.

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Patterns of Early Visual Field Loss in Open-Angle Glaucoma

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Surv. Ophthalmol.

A comparative study of visual fields of patients with low-tension glaucoma and those with chronic simple glaucoma

Comparison of glaucomatous visual field defects in patients with high and with low intraocular pressures