Temporal visual field in glaucoma: a re-evaluation in the automated perimetry era

Area of Science:

• Ophthalmology
• Neuroscience
• Medical Imaging

Background:

• Glaucoma is a progressive optic neuropathy characterized by visual field loss.
• Early detection and monitoring of glaucoma progression are crucial for preserving vision.
• The Humphrey Field Analyzer (HFA) is a standard tool for visual field testing.

Purpose of the Study:

• To evaluate the diagnostic utility of testing the temporal periphery, specifically temporal to the blind spot, in glaucoma patients.
• To determine if routine testing in this area provides additional valuable information compared to standard central visual field testing.

Main Methods:

• Prospective study involving 152 glaucoma patients (192 eyes) and 31 normal subjects (31 eyes).
• Visual field testing was performed using the Humphrey Field Analyzer with both the 30-2 program and a customized temporal periphery program.
• Data analysis focused on comparing information gained from temporal testing versus central testing.

Main Results:

• In 53 glaucomatous eyes and all control eyes, both central 30 degrees and temporal peripheral fields were normal.
• For eyes with glaucomatous defects, temporal testing provided equivalent information to the Bjerrum area in 66 eyes, less in 62 eyes, and more in 11 eyes.
• Temporal field testing proved most useful in eyes with a diffusely depressed Bjerrum area (mean defect < -8.30 dB).

Conclusions:

• Automated static perimetry frequently identifies glaucomatous visual field defects in the temporal periphery.
• Testing temporal to the blind spot typically adds significant information beyond central testing only in patients with advanced or late-stage glaucoma visual field changes.