A new method for eyelid elevation in glaucoma patients with ptosis during automated perimetry testing

Ptosis is a well-recognized confounding factor when interpreting superior visual field defects. As the current technique for eyelid elevation during automated perimetry is cumbersome and inconsistent, we developed a new technique. To evaluate its efficacy and feasibility, we studied a group of glaucoma patients with ptosis and superior visual field defects that had been attributed to nerve fiber layer defects.

A 24-2 SITA-fast visual field was performed without eyelid elevation. Then, it was repeated either with elevation (group A, 14 eyes, 7 patients) or without (group B, 9 eyes, 5 patients). Elevation was achieved by the following method: a 4-0 silk suture (needle removed) was wrapped around a micropore strip, attached to the upper eyelid margin. Suture edges were pulled and attached to the forehead creating a slinglike elevation. Mean thresholds of upper and lower hemifields were calculated. Mean deviation and pattern standard deviation were recorded for each visual field. Results of the first and second tests were compared.

Eyelid elevation resulted in significant improvement in mean thresholds for upper hemifield in group A: values increased by 28% in OD and 22% in OS. Lower hemifield values did not change. Significant improvement also was observed in mean deviation and pattern standard deviation. In group B, there were no significant differences between the 2 sets of tests.

This new method of eyelid elevation significantly improves visual field testing by reducing the confounding effect of ptosis on interpretation of visual field defects in glaucoma patients.