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Visual field defects in pre‐perimetric glaucoma identified by customized oct ‐ guided white‐on‐white automated perimetry
Author(s) -
MAGOURITSAS G,
GEORGIADIS O,
PORTALIOU DM,
MOSCHONAS K
Publication year - 2014
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2014.t037.x
Subject(s) - nerve fiber layer , ophthalmology , visual field , glaucoma , medicine , retinal , optical coherence tomography , optometry , optic disc
Purpose We studied cases of “preperimetric” glaucoma using detailed strategies of the AP in order to detect any functional disturbance in visual field areas corresponding to the localized structural damage. Methods We enrolled 5 patients with inter‐ocular optic disc cupping asymmetry, ocular hypertension asymmetry, optic disc hemorrhage and retinal nerve fiber layer (RNFL) outside normal limits, as measured by means of optical coherence tomography (OCT). All of the 5 patients fulfilled the diagnostic criteria for “preperimetric” glaucoma, showing a normal standard visual field analysis. They were submitted in a more specific white‐on‐white AP using customized programs with a 3 degrees grid, instead of the standard 6 degrees used in routine 24‐2 and 30‐2 programs of the Humphrey AP. The examination of the visual field test points in a customized pattern has been guided by the corresponding abnormal region of the OCT, according to the structure‐function map proposed by Garway‐Heath et al (Ophthalmology. 2000;107:1809) Results Using the denser grid of 3 degrees spot, we detected reduced threshold sensitivity in 3 study eyes, in specific areas of the visual fields. The topography of these areas corresponded to the morphology of the localized RNFL lesion. In 2 eyes the 3 degrees customized, OCT guided, AP could not identify any functional disturbance. Conclusion Early defects of visual fields may coexist with morphological damage of optic nerve and RNFL, even in “preperimetric” glaucoma, but remain undetected by the currently available routine 6 degrees grid programs of AP. Customized OCT guided AP may establish the diagnosis of glaucoma and put controversy in the term of “preperimetric” glaucoma.