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Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
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Quantitative Classification of Visual Field Defects in Early Glaucoma.

Jeremy C K Tan1, Jack Phu2

  • 1School of Clinical Medicine, University of New South Wales, Kensington, New South Wales, Australia; Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.

Ophthalmology. Glaucoma
|September 27, 2025
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Summary

This study quantifies visual field defects in early glaucoma, finding nasal step and enlarged blind spots are most common. Quantitative methods improve classification accuracy and consistency for glaucoma diagnosis.

Keywords:
Classification systemGlaucomaPerimetryRepeatable defectVisual field

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Glaucoma Research

Background:

  • Qualitative visual field (VF) grading systems for glaucoma are subjective and prone to interobserver disagreement.
  • Objective characterization of VF defects is needed for accurate glaucoma diagnosis and management.

Purpose of the Study:

  • To quantitatively characterize the types and frequencies of VF defects in a large cohort of subjects with early glaucomatous loss.
  • To evaluate the utility of a quantitative method based on the Ocular Hypertension Treatment Study (OHTS) VF classification system.

Main Methods:

  • A cross-sectional study involving 1330 eyes of 733 subjects with healthy, suspect, or early glaucoma.
  • Translated the OHTS VF classification system into an objective, quantitative method to identify 14 defect patterns.
  • Applied the method to VF tests from subjects who underwent two 24-2 Swedish Interactive Thresholding Algorithm-Faster VF tests per eye.

Main Results:

  • The most common repeatable VF defect patterns were inferior nasal step (22.6%) and inferior enlarged blind spot (19.1%).
  • Initial defects occurred more frequently than repeatable defects.
  • Nasal step defects decreased as mean deviation (MD) worsened, with a rise in arcuate defects.
  • Unreliable tests showed higher frequencies of bundle and nonbundle defects.

Conclusions:

  • Nasal step, enlarged blind spot, and arcuate defects are the most common VF defects in early glaucoma.
  • Significant differences exist in defect distribution between initial vs. repeatable and reliable vs. unreliable tests.
  • Quantitative criteria enhance the accuracy and consistency of VF defect classification in glaucoma.