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R.A. Covar, A. Lee, A. Kifley, P. Healey, P. Mitchell, Blue Mountains Eye Study, Centre for Vision Research; Pseudo–Glaucomatous Visual Field Defects in an Older Population: Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3434.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the prevalence of non–glaucomatous ocular causes of glaucoma–like visual field defects (VFD) in a population and describe the patterns of field loss.
The baseline Blue Mountains Eye Study (BMES) examined 3654 participants (82.4% response rate) during 1992–4. This study uses data collected from the cohort of 1952 participants (76.5% of survivors) re–examined after 10 years (BMES3). Eye examinations included Humphrey 24–2 SITA–standard automated perimetry and 30° Zeiss stereo–optic disc and retinal photographs. Visual fields were graded for glaucomatous VFD (nasal step, arcuate defect, nasal step and arcuate defect, or altitudinal field loss) in upper or lower hemi–fields. Retinal photographs were graded in a masked manner. At a second stage, all glaucomatous visual fields were correlated with retinal or non–glaucomatous optic disc pathology.
Subjects with visual fields or gradable photographs in either eye were included, in total 1671 participants (85.6%). Typical glaucomatous VFD was present in 138 subjects (8.1%). In total, 49 subjects (2.9%) or 52 eyes (27 right eyes, 25 left eyes) had definite glaucomatous VFD congruent with non–glaucomatous ocular causes. Myopic retinopathy with tilted discs (24.5%), branch retinal vein (22.4%, BRVO) or artery (22.4%, BRAO) occlusions and non–arteritic anterior ischaemic optic neuropathy (14.3%, NA–AION) were the commonest causes. Other causes include optic disc coloboma (4.1%), hemi–retinal vein occlusion (4.1%), retinoschisis (2.0%), retinal pigment epithelial hyperplasia (2.0%), disc drusen (2.0%) and toxoplasmosis scar (2.0%). Bilateral pseudo–glaucomatous VFD was found in 3 cases. Arcuate defects of the upper (11/53 eyes) or lower (12/53 eyes) hemi–field were the predominant pattern seen. Myopic retinopathy with tilted disc was associated with an upper arcuate defect (8/13 eyes), BRVO resulted in variable but mainly lower VFD (8/11), BRAO with upper VFD (8/11, including 2 with combined upper and lower defects), and NA–AION with upper altitudinal VFD (4/8 eyes).
The four most commonly encountered ocular conditions that may mimic glaucomatous Visual Field Defect are Myopic retinopathy with tilted disc, BRVO, BRAO, and NA–AION. Upper and lower arcuate defects and upper altitudinal VFDs are the most common patterns of field loss in this population–based sample.
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