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J Glaucoma. 2019 Sep 25. doi: 10.1097/IJG.0000000000001372. [Epub ahead of print]

Threshold Automated Perimetry of the Full Visual Field in Glaucoma Patients with Mild Visual Loss.

Author information

1
Departments of Ophthalmology.
2
Neurology, University of Iowa, College of Medicine, Veterans Administration Hospital, Iowa City, IA.
3
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA.
4
School of Computing and Information Systems, The University of Melbourne, Australia.
5
School of Medicine (Optometry), Deakin University, Geelong, Australia.
6
Computational Optometry, Atarfe, Spain.

Abstract

PRECIS:

We used the Open Perimetry Interface to design a static automated perimetry test of the full field. Abnormal test locations in the nasal midperiphery and temporal inferior sector area best separated glaucomas from normals.

PURPOSE:

The peripheral visual field in glaucoma outside 30° is largely unexplored with static perimetry. Our goal was to use threshold static automated perimetry to characterize the visual loss in glaucoma of the central 30°and the far periphery.

PATIENTS AND METHODS:

We administered our 30-2 perimetric test to 27 early stage (with mean deviation better than -4▒dB) glaucoma patients with the Goldmann III and V stimulus sizes and a custom test from 30° to up to 87° with the size V stimulus twice within a month. We quantified (1) the retest variability, (2) the proportion of patients flagged as abnormal (at level 0.05) based on pointwise probability distributions obtained from 63 ocular healthy observers, (3) the pointwise statistical distance using the Kullback-Leibler divergence between normal and glaucoma eyes and (4) the effect of eccentricity on visual loss.

RESULTS:

Size V 30-2 testing identified significantly more abnormal test locations (36%) than size III 30-2 (30%; P = 0.004). Kullback-Leibler divergence between healthy and glaucoma distributions was greatest for the nasal mid-peripheral test locations and the inferior temporal sector area. We found a more pronounced decrease in visual sensitivity with eccentricity in the glaucoma patients compared to the ocular healthy participants across the full visual field (P < 0.001).

CONCLUSION:

Glaucoma patients demonstrate a systematic decrease in sensitivity with eccentricity across the full visual field. Goldmann size V stimuli better detected visual loss in glaucoma patients with mild loss than size III.

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