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It is not clear whether glaucomatous optic nerve damage is the end result of one pathological process or whether there are several mechanisms by which the final disease is manifest. The use of electrophysiological and psychophysical tests which measure the function of specific subdivisions of the visual pathways have been shown to be of use in the early diagnosis of glaucoma. In addition these results may help to elucidate the mechanisms of loss of visual function in patients with early glaucoma. One hundred and ninety-three patients with ocular hypertension (intraocular pressure &gt; 24 mmHg, with normal visual fields and optic discs), 30 with glaucoma and 35 controls underwent pattern electroretinogram (PERG), peripheral colour contrast thresholds, motion detection thresholds (MDT) and Humphrey automated visual fields at the same visit. For each test there was a significant proportion of patients with abnormal results as has been found in previous studies of these techniques. However, there was a significant lack of correlation between the groups with only a small number of patients having abnormalities on more than one test. Of the patients demonstrating abnormal PERGs, 36% had abnormal colour contrast and 32% abnormal MDT, but only 15% were abnormal on both tests. Early glaucomatous damage may be focal or diffuse in nature. Similarly there may be preferential damage to ganglion cells subserving different visual functions or damage at different retinal layers. The results lend support to these hypotheses and give further evidence that more than one pathomechanism may be involved early in the glaucomatous process.

Electrophysiology and psychophysics in ocular hypertension and glaucoma: Evidence for different pathomechanisms in early glaucoma