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J.L. Keltner, C.A. Johnson, J. Fan, K.E. Cello, M.O. Gordon, M.A. Kass, Ocular Hypertension Treatment Study Group; Classification of Glaucomatous Visual Field Abnormalities In the Ocular Hypertension Treatment Study (OHTS) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):75.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare visual field (VF) abnormalities in eyes developing primary open angle glaucoma (POAG) diagnosed by VF abnormality to eyes diagnosed by optic disc deterioration using a classification system developed for OHTS. Methods: The superior and inferior hemifields of all abnormal VFs in OHTS are classified by three certified readers as to type of abnormality using a classification system with 17 categories. This report compares the abnormality classifications of 146 eyes of 125 participants reaching a POAG endpoint; 32% (47 of 146) of these eyes were first diagnosed by abnormal VFs, 60% (87 of 146) by optic disc deterioration, and 8% (12 of 146) by both disc and VFs concurrently. The OHTS protocol requires 3 consecutive abnormal VFS with the same abnormality in the same location for confirmation of VF abnormality; therefore, our analyses included only the first of the 3 replicate abnormal VFs. Results: A total of 47 first abnormal VF endpoints (94 hemifields) were classified from the 47 ‘field first' eyes, and a total of 10 first abnormal VFs (20 hemifields) were classified from the 87 ‘disc first' eyes. Partial arcuate defects were the most common abnormality for both endpoints at 28% of the hemifields (26 of 94) for the ‘field first’ eyes, and 35% of the hemifields (7 of 20) for the ‘disc first’ eyes. Nasal step defects were found in 25% of the hemfields (23 of 94) in ‘field first’ eyes compared to 0% (0 of 20) in the ‘disc first’ eyes. Paracentral defects were found in 12% of the hemifields (11 of 94) in the ‘field first’ eyes compared to 20% (4 of 20) in the ‘disc first’ eyes. Conclusions: A total of 60% of POAG eyes reached an optic disc endpoint first while 40% reached a VF endpoint first or concurrently. Interestingly more nasal step defects were present in ‘field first’ eyes compared to ‘disc first’ eyes. Further investigation will hopefully determine the significance of this finding.
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