Central Visual Field Loss Patterns in Glaucoma

Abstract

Purpose : To illustrate and quantify the central visual field (CVF) loss patterns in glaucoma.

Methods : Total deviation values from reliable 10-2 VFs from 5 academic glaucoma services in the US were used to determine the CVF loss patterns for eyes with all glaucoma severities using the most recent 10-2 VFs. Furthermore, the CVF loss patterns were identified for mild, moderate and severe glaucoma separately. The 10-2 VFs tested within 3 months of or before any 24-2 VF with mean deviation (MD) ≥ -6 dB were assigned to mild glaucoma, were assigned to severe glaucoma if tested within 3 months of or after any 24-2 VF with MD < -12 dB, and were assigned to moderate glaucoma if they were tested within 3 months of or between 24-2 VFs with -12 dB ≤ MD < -6 dB. The most recent 10-2 VFs of each eye were selected for each glaucoma stage. An unsupervised machine learning method of archetypal analysis was applied to determine the CVF loss patterns. Cross-validation was performed to determine the optimal number of patterns for archetypal analysis.

Results : 13,951, 3,529, 1,528 and 3,066 VFs were selected to determine the CVF patterns for eyes with all glaucoma severities, mild, moderate and severe glaucoma, respectively, for which 17, 11, 11 and 16 CVF loss patterns were identified. For eyes with all glaucoma severities (Fig. 1), the most common pattern is intact field (38.1%). There were 4, 4, and 5 CVF patterns related to superior loss, inferior loss and overall loss with island of vision, which accounted for 17.2%, 12.5% and 19.8% CVF loss, respectively. The total loss pattern accounted for 5.2% CVF loss. Notably, 4 of the 5 CVF loss patterns with island of vision preserved the less vulnerable zone proposed by Hood and co-workers. When comparing the 3 glaucoma severities, similar CVF defects include superonasal defects and temporal island patterns (Fig. 2a). Unique patterns include central defect (6.0%) and superior-peripheral loss (10.0%) for mild glaucoma, central-nasal loss (5.2%) for moderate glaucoma, and total loss (8.6%) and inferotemporal loss (4.1%) for severe glaucoma (Fig. 2b).

Conclusions : Various CVF loss patterns in glaucoma were illustrated and quantified for the first time. Some CVF defects were present in eyes with all severities, while some were specific to particular glaucoma severities. Our quantified CVF loss patterns are promising to advance understanding of CVF loss in glaucoma.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Fig. 1

 

Fig. 2