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  • Central Visual Field Testing in Early Glaucoma

    AAO OTAC Glaucoma Panel, Hoskins Center for Quality Eye Care
    Glaucoma
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    Abstract

     A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Glaucoma Panel.

    Darrell WuDunn, MD, PhD;1 Hana L. Takusagawa, MD;2 Jullia A. Rosdahl, MD, PhD;3 Arthur J. Sit, SM, MD;4 Vikas Chopra, MD;5 Yvonne Ou, MD;6 Grace M. Richter, MD, MPH;7,8 O'Rese J. Knight, MD;9 David Solá-Del Valle, MD;10 Stephen J. Kim, MD11 


    Ophthalmology, Vol. 131, Issue 2, P240-248 © 2023 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: To evaluate the current published literature on the utility of the 10-2 visual field (VF) testing strategy for the evaluation and management of early glaucoma, defined here as mean deviation (MD) better than –6 decibels (dB).

    Methods: A search of the peer-reviewed literature was last conducted in June 2023 in the PubMed database. Abstracts of 986 articles were examined to exclude reviews and non-English–language articles. After inclusion and exclusion criteria were applied, 26 articles were selected, and the panel methodologist rated them for strength of evidence. Thirteen articles were rated level I, and 8 articles were rated level II. The 5 level III articles were excluded. Data from the 21 included articles were abstracted and reviewed.

    Results: The central 12 locations on the 24-2 VF test grid lie within the central 10 degrees covered by the 10-2 VF test. In early glaucoma, defects detected within the central 10 degrees generally agree between the 2 tests. Defects within the central 10 degrees of the 24-2 VF test can predict defects on the 10-2 VF test, although the 24-2 may miss defects detected on the 10-2 VF test. In addition, results from the 10-2 VF test show better association with findings from OCT scans of the macular ganglion cell complex. Modifications of the 24-2 test that include extra test locations within the central 10 degrees improve detection of central defects found on 10-2 VF testing.

    Conclusions: Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma. However, early 10-2 VF testing may provide sufficient additional information for some patients, particularly those with a repeatable defect within the central 12 locations of the standard 24-2 VF test or who have inner retinal layer thinning on OCT scans of the macula.

    1University of Florida College of Medicine—Jacksonville, Department of Ophthalmology, Jacksonville, Florida
    2VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
    3Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina 
    4Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
    5Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 
    6Department of Ophthalmology, University of California San Francisco, San Francisco, California
    7Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
    8USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
    9Department of Ophthalmology, University of California San Francisco, San Francisco, California
    10Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts      
    11Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN