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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...

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Updated: Jan 14, 2026

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential

Published on: May 25, 2020

Evaluating Increment and Decrement Stimuli Responses in Patients with Glaucoma Using Virtual Reality-Based Perimetry.

Albert Xu¹, Allen Khudaverdyan¹, Corinne Shiu¹

¹Department of Ophthalmology, University of California, San Francisco, California.

Ophthalmology Science

|October 27, 2025

Summary

Virtual reality perimetry reveals distinct visual responses in glaucoma stages. Early glaucoma shows better increment detection, while advanced stages favor decrement detection, indicating shifting pathway vulnerabilities.

Keywords:

Glaucoma Increment/decrement stimuli ON/OFF pathway Perimetry Virtual reality

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Area of Science:

Ophthalmology
Visual Neuroscience
Medical Technology

Background:

Glaucoma diagnosis and monitoring rely on visual field testing.
Conventional perimetry may have limitations in detecting subtle visual field changes.

Purpose of the Study:

To evaluate responses to increment and decrement stimuli using virtual reality perimetry (VVP).
To compare VVP findings with conventional perimetry (Humphrey Visual Field [HVF]).

Main Methods:

A cross-sectional study involving 69 participants with glaucoma, preperimetric glaucoma, or glaucoma suspect/ocular hypertension.
Vivid Vision Perimetry (VVP) tested increment and decrement stimuli at 12 locations per eye.
Contrast sensitivities (CSs) were recorded and compared between VVP and HVF using cluster bootstrapping.

Main Results:

Perimetric glaucoma eyes showed stronger CS correlation between VVP and HVF compared to earlier stages.
Decrement testing generally yielded higher correlations than increment testing across all groups.
Moderate to severe perimetric glaucoma showed greater CS to decrement stimuli, while preperimetric glaucoma favored increment stimuli.

Conclusions:

Significant differences in visual stimuli responses exist between preperimetric and perimetric glaucoma.
Early glaucoma exhibits OFF-pathway vulnerability (increment stimuli), shifting to ON-pathway vulnerability in severe glaucoma (decrement stimuli).