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Donald C Hood, Abinaya A Thenappan, Emmanouil Tsamis, Jeffrey M Liebmann, C Gustavo De Moraes; The 24-2 visual field is not a substitute for the 10-2 for detecting early central damage.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4044.
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The central retina is affected in many eyes with early glaucomatous damage suggesting the need for early 10-2 visual field (VF) testing. A recent study[2 ]proposed that a pattern standard deviation metric, PSD(C24-2), based upon the central 12 points of the 24-2 VF test, is as effective as the PSD of the 10-2 VF in detecting central VF abnormalities. However, the PSD of the 10-2 can miss clear central damage. Here we test the hypothesis that neither the PSD(C24-2) or PSD(10-2) metric is a good measure of early central damage.
70 eyes/patients, with a 24-2 MD better than -6dB, were diagnosed by the referring specialist as either definite glaucoma (DG, n=53) or probably glaucoma (PG, n=17) based upon all available information (e.g., VF, OCT, IOP, family history). There were also 45 healthy (H) controls with IOP ≤22 mm Hg and normal fundus exams. All eyes had 24-2 and 10-2 VFs obtained at least twice during a 4-week baseline period. PSD(C24-2) was calculated and compared to PSD(10-2), as previously described.[2} All participants had OCT widefield scans, and associated probability maps for retinal ganglion cell (RGC) and retinal nerve fiber layer (RNFL) thickness.[1,3] The reference standard (RS) for central damage was topographical agreement between abnormal regions on structural (RNFL and RGC) and functional (10-2 VF) probability/deviation maps (Fig. 1B) on two baseline sessions, using an automated method. For the 45 H eyes, there was only 1 false positive based upon the RS.
As expected, the 115 PSD(C24-2) and PSD(10-2) values were significantly correlated (Spearman’s CC: rho = 0.55; p < 0.001) and the number of DG and PG eyes, 19, identified as having “abnormal central vision” by PSD(C24-2) was not significantly different from the number, 22, identified by PSD(10-2), (p = 0.15). However, based upon the RS, 45 of the 70 DG/PG eyes were classified as “abnormal central vision,” and the PSD(C24-2) missed 34 (76%) of these 45 eyes, while the PSD(10-2) missed 26 (58%) as in Fig. 1.
Neither the PSD(C24-2) nor the PSD(10-2) is a good measure of early central damage. A 10-2 VF is needed to more clearly reveal the nature of macular damage, as well to allow for a topographical comparison with OCT probability maps. 1. Hood, Raza et al. PRER. 2013; 2. Wu, Medeiros et al. AJO, 2018; 3. Hood, Tsamis et al. IOVS, 2019.
This is a 2020 ARVO Annual Meeting abstract.
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