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Patterns of Visual Field Loss in Early, Moderate, and Severe Stages of Open-angle Glaucoma.

PRCIS
Even in the early stages of glaucomatous visual field defects, 49% of the defects occurred in both hemifields and 28% involved the central five degrees of the visual field, which may have prognostic values.


PURPOSE
To determine the patterns of glaucomatous visual field defects (VFD) in early, moderate and severe stages of primary open glaucoma, using the Glaucoma Staging Application (GSA).


METHODS
According to the Modified University of Sao Paulo Glaucoma Visual Field Staging System Classification, patients with early, moderate and advanced VFDs were selected by the GSA using all databases of the Humphrey Visual Field Analyser of a glaucoma referral practice. We analyzed one visual field (VF) of the 100 patients included in each group. The analysis consisted of classifying all exams regarding the location of the defects, the hemifields involved, and the connection to the blind spot.


RESULTS
We analyzed 300 VF. In the Early group, 27% of the VFDs are connected to the physiological blind spot, 64% in the Moderate group, and 95% in the Severe group (P<0.01). In the Early group, 28% of the defects involved the central five degrees of the fixation, 59% in the Moderate and 88% in the Severe group. In the Early group, 49% of the defects involved both hemifields, 80% in the Moderate and 80% in the Severe group.


CONCLUSION
With increasing glaucoma severity, VFD showed a more central pattern, connected to the blind spot, and involved both hemifields. In early disease, both hemifields were commonly affected and more than a quarter of VFD involved the central 5 degrees close to fixation. Careful monitoring of the central visual field in glaucoma is suggested.