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The 24-2 Visual Field Test Misses Central Macular Damage Confirmed by the 10-2 Visual Field Test and Optical
Lola M Grillo1, Diane L Wang1, Rithambara Ramachandran1
1Department of Psychology, Columbia University, New York, NY, USA.
Purpose:
To determine the extent to which the 24-2 visual field (VF) misses macular damage confirmed with both 10-2 VF and optical coherence tomography (OCT) tests and to evaluate the patterns of damage missed.
Methods:
One hundred forty-one eyes of 141 glaucoma patients or suspects underwent 24-2 VF (mean deviation [MD] better than -6 dB), 10-2 VF, and OCT testing. Retinal nerve fiber layer (RNFL) and retinal ganglion cell plus inner plexiform (RGC+) probability plots were combined with 10-2 VF probability plots. Eyes were classified as "abnormal macula" if abnormal regions on both the 10-2 VF and OCT plots agreed. The number of abnormal eyes missed (i.e., false negatives) was determined for the following 24-2 VF metrics: MD; pattern standard deviation (PSD); glaucoma hemifield test (GHT); cluster criteria (CC); and abnormal points within ± 10°. Eyes that were missed on one or more of the 24-2 metrics were classified by damage type based upon circumpapillary RNFL thickness plots.
Results:
Fifty-nine (41.8%) eyes were classified as "abnormal macula," and comprised the reference standard. Of the 59, 31 (52.5%) were missed by one or more of the 24-2 metrics. The individual 24-2 metrics missed between 7 (CC) and 20 (MD) eyes. The eyes missed had widespread macular damage, as well as both shallow and deep local defects.
Conclusions:
Eyes with macular glaucomatous damage may be classified as normal based on the 24-2 VF alone.
Translational Relevance:
To detect macular damage with perimetry, the 10-2 VF test (or a modified 24-2 VF test) is essential.
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