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A. S. Raza, C. G. de Moraes, D. Xin, J. G. Odel, J. M. Liebmann, R. Ritch, D. C. Hood; Small Arcuate "Comma" Defects Within 10 Degrees of the Fovea in Patients With Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5514.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the pattern of visual field loss in glaucoma patients with defects confined to the central 10°.
The visual fields (HVF; Carl Zeiss, Inc) of 241 consecutive patients, referred for multifocal visual evoked potential testing over a 2-year period, were examined. All eyes (160 eyes from 97 patients) with both 10-2 and 24-2 HVFs were studied further. To select the population with little or no evidence of damage outside the central 10° on the 24-2, eyes were eliminated if their 24-2 test had a mean deviation (MD) with a p≤0.01 or a cluster of 3 contiguous points (5%, 5%, 1%). The cluster could not cross the horizontal midline and could not include the 12 points falling within the central 10° (10-2 region). The 10-2 HVFs of the resulting population of 22 eyes (18 patients) were classified as: Normal (MD p>0.05 and without a significant cluster as defined above); Arcuate (an arcuate defect); and Other (diffuse or a non-descript pattern of field loss).
Of the 22 eyes (18 patients) without defects outside the central 10° on the 24-2 HVF, the 10-2 HVF was normal in 9 eyes (9 patients), showed a clear arcuate defect in 11 eyes (9 patients), and had a nondescript loss in 2 eyes (2 patients). The arcuate defects, seen in 85% of the eyes with an abnormal 10-2 test, had the appearance of a "comma" (see fig.-right eye). Along the midline and nasal (field) to the foveal center, these "comma defects" started between 1º to 5º from the center and were between 2º to 8º wide at the midline. (The median total deviation values of the commas at the midline were -4, -8, -5, -3, and -4 dB at 1º, 3º, 5º, 7º, and 9º nasal to the fovea.) The 10 test points associated with the macular papillary bundle (±1º vertically from center to disc; rectangle in fig.) were spared in the comma defects. Ten of the 11 commas were in the superior field.
The 10-2 defect seen in patients with essentially normal 24-2 tests are typically small arcuates. These "comma" defects spare the papillomacular bundle.
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