The Evolution of Visual Field Testing: A 40-Year Perspective on Modern Perimetry in Glaucoma

The assessment of the human visual field, a concept explored since ancient Greece, underwent a critical transformation in the 19th century with the advent of objective measurement techniques. Early methodologies concentrated on mapping the outer limits of vision, a practice known as perimetry. However, the focus soon shifted toward campimetry (although the name perimetry remained), which involves assessing defects within the central/paracentral visual field-a crucial development for diagnosing diseases such as glaucoma. Although historical methods such as Bjerrum tangent screen and Goldmann kinetic perimetry were foundational, the last 4 decades have been defined by the rise of static automated perimetry (SAP). Coinciding with the inception of the American Glaucoma Society, the 1980s marked a pivotal transition from manual techniques to computerized, automated testing. Static automated perimetry, exemplified by the Humphrey Field Analyzer (HFA), has since become the clinical standard, offering a precise and reproducible method for quantifying visual field sensitivities, which is indispensable for the detection and management of glaucoma. This review examines the evolution of modern visual field testing over the past 40 years, focusing on the technological advancements in hardware, software algorithms, and novel testing paradigms that have reshaped our approach to glaucoma care. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.