Patterns of Visual Field Loss in Glaucoma
The hallmark defect of glaucoma is the nerve fiber bundle defect that results from damage at the optic nerve head. The pattern of nerve fibers in the retinal area served by the damaged nerve fiber bundle will correspond to the specific defect. The common names for the classic visual field defects are derived from their appearance as plotted on a kinetic visual field chart. In static perimetry, however, the sample points are in a grid pattern, and the representation of visual field defects on a static perimetry chart generally lacks the smooth contours suggested by such terms as arcuate.
Glaucomatous visual field defects include the following:
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arcuate or Bjerrum scotoma (Fig 8-6)
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nasal step (Fig 9-6)
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paracentral scotoma (Fig 10-6)
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altitudinal defect (Fig 11-6)
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generalized depression (rare in glaucoma in the absence of localized loss)
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temporal wedge (rare)
The superior and inferior poles of the optic nerve are most susceptible to glaucomatous damage. However, damage to small, scattered bundles of optic nerve axons commonly produces a generalized decrease in sensitivity, which is harder to recognize than focal defects. Combinations of superior and inferior visual field loss, such as double arcuate scotomas, may occur, resulting in profound peripheral vision loss. Typically, the central island of vision and the inferotemporal visual field are retained until late in the course of glaucomatous optic nerve damage (see Fig 2-6).
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.