Central Visual Field Loss Associated with More Rapid Vision Loss in Glaucoma
Bad news for all those who dislike taking the visual field test (that would be everyone): monitoring both central and peripheral visual fields was recommended during a presentation at the American Glaucoma Society (AGS) 2017 Annual Meeting in San Diego, CA (March 2-5).
Aakriti Garg and colleagues at Columbia University analyzed the visual field data of 777 patients who had known glaucoma and at least five visual fields. Eyes with baseline (initial) visual fields showing decreased vision present within the central 10 degrees were more likely to worsen over time than eyes that did not have central vision loss. Indeed, those with early central field defects lost vision almost twice as fast as those without central loss!
The implications are clear:
- When initially assessing glaucoma careful attention should be paid to central visual field results. The standard “24-2” visual field provides some data regarding loss of the central field. However, based on the results of this paper it makes sense to actually study the central 10 degrees in detail. This would necessitate obtaining a “10-2” (central 10 degree threshold visual field) in addition to the standard 24-2. How often this additional field testing should be repeated is unknown.
- For those eyes with early central vision loss, more frequent visual field testing should be performed. Ideally, both 24-2 and 10-2 fields would be repeated 2-4 times per year.
- It is likely that eyes with early central field loss would need more aggressive treatment. A lower threshold for moving to glaucoma surgery may be indicated for those who fall into this category.
Of course, it’s one thing to know what should be done and quite another to motivate someone to sit through the mind-numbingly boring visual field multiple times each year. My own approach will be to simply present the results of this study to my patients with the following explanation:
“There is evidence that early central loss of vision can predict how quickly your glaucoma will worsen. I know it’s inconvenient to sit through two separate visual fields, but the added information will help me best protect you from losing vision.”
Don’t delay getting checked for glaucoma.
Make an appointment with an eye doctor in your area now. If you live in the greater Los Angeles area and would like Dr. Richardson to evaluate your eyes for glaucoma call 626-289-7856 now. No referral required. Appointments are available, Tuesday through Saturday.
David Richardson, MD
Medical Director, San Marino Eye
David Richardson, M.D. is recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs MicroPulse P3™ "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from the University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Eye Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at the Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System.