Structure and function evaluation (SAFE): II. Comparison of optic disk and visual field characteristics.

Area of Science:

• Ophthalmology
• Optometry
• Neuroscience

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Early detection of glaucoma is crucial for preventing vision loss.
• The relationship between structural optic nerve damage and functional visual field loss requires further elucidation.

Purpose of the Study:

• To investigate the association between glaucomatous optic nerve damage and the development of visual field defects.
• To compare the predictive value of standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP) in identifying eyes at risk for visual field loss.

Main Methods:

• A prospective cohort study involving patients with elevated intraocular pressure and normal SAP visual fields.
• Annual stereo optic disk photography, SAP, and SWAP visual fields were collected over 4+ years.
• Trained readers assessed optic disk photographs for glaucomatous damage and evaluated visual field tests for confirmed changes.

Main Results:

• Of 479 eyes, 272 showed glaucomatous optic neuropathy at baseline.
• 10-17.5% of eyes developed confirmed SAP visual field loss; 75-80% of these had baseline optic disk damage.
• SWAP deficits were present at baseline in 4-12% of eyes and developed in 4-8% over time; a higher proportion of eyes with SWAP deficits had glaucomatous optic neuropathy.

Conclusions:

• Glaucomatous optic disk damage is a significant predictor of subsequent glaucomatous visual field loss on SAP.
• A higher prevalence of glaucomatous optic nerve damage was observed in eyes with SWAP deficits.
• These findings reinforce the predictive value of optic disk assessment for future visual field impairment in glaucoma.