Patterns of central visual field loss in end-stage glaucoma

This retrospective study characterized and classified central visual field loss that occurs in end-stage glaucoma.

Study design

Researchers collected 2,912 reliable 10-2 visual fields from 1,010 patients at 5 U.S. glaucoma services between 1999 and 2014. They used an artificial algorithm (archetypal analysis) to examine and determine patterns in central visual field loss.

Outcomes

The analysis revealed 14 central visual field patterns, the most common of which was temporal sparing patterns (28%), followed by nasal loss (25%), hemifield loss (15%), central island (11%), total loss (8%), nearly intact field (5%), and inferonasal quadrant sparing (4%) and nearly total loss (4%).

Central visual field separated into a more vulnerable superonasal zone and a less vulnerable inferotemporal zone. New defects tended to occur in the more vulnerable zone. During follow-up, nasal loss tended to lead to initial encroachment on an intact central visual field. One of the nasal loss patterns (moderate nasal loss; archetype 4) was highly likely to shift to total loss (P=0.004).

Limitations

The longitudinal study only assessed a 2-year period. Some background demographic data was not recorded.

Clinical significance

This study suggests that there are potential subtypes of central visual field loss that occur with glaucoma. A subtype affecting the nasal 10-2 could be at higher risk for total visual field loss.