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Open Angle Glaucoma: Treatment01:27

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Pericentral Scotometry Guided by Standard Perimetry Using Microperimetry in Glaucoma Patients.

Gustavo Coelho Caiado1, Gustavo Albrecht Samico1, Gilvan Vilarinho da Silva Filho1

  • 1Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil.

Clinical Ophthalmology (Auckland, N.Z.)
|November 12, 2025
PubMed
Summary

Regionally customized microperimetry (MP-3) guided by standard automated perimetry (SAP) regions of interest (ROIs) showed a modest improvement in structure-function correlation with ganglion cell layer thickness (GCLT) in glaucoma patients.

Keywords:
glaucomamicroperimetryoptical coherence tomographyregion of interestvisual field

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Medical Imaging

Background:

  • Glaucoma is a progressive optic neuropathy characterized by visual field (VF) loss and retinal ganglion cell damage.
  • Accurate structure-function correlation is crucial for monitoring glaucoma progression and guiding treatment decisions.
  • Standard automated perimetry (SAP) and microperimetry (MP-3) assess visual function, while optical coherence tomography (OCT) measures retinal structure, such as ganglion cell layer thickness (GCLT).

Purpose of the Study:

  • To compare the strength of structure-function correlations between regionally customized high-density MP-3 microperimetry, guided by regions of interest (ROIs) from SAP, and conventional SAP in relation to GCLT in glaucoma.
  • To determine if an ROI-guided approach enhances the correlation between visual field sensitivity and GCLT compared to standard methods.

Main Methods:

  • A cross-sectional study involving 85 eyes of 55 glaucoma patients.
  • Participants underwent SAP and MP-3 microperimetry. High-density MP-3 grids were customized to target ROIs identified as having the lowest mean sensitivity on SAP.
  • Mean GCLT in the corresponding quadrant (GCLTq) was measured using OCT. Structure-function relationships were analyzed using linear mixed-effects models, comparing model performance with Akaike's Information Criterion (AIC).

Main Results:

  • All visual field indices significantly correlated with GCLTq (p < 0.05).
  • MP-3 mean sensitivity on a linear scale demonstrated the strongest association with GCLTq (R2 = 0.139; p = 0.003), outperforming SAP.
  • ROI-guided MP-3 on the linear scale showed a better model fit (ΔAIC = 8; wi = 0.982) compared to SAP, indicating improved reliability and topographic accuracy.

Conclusions:

  • Regionally customized, ROI-guided MP-3 microperimetry offers a statistically supported, albeit modest, improvement in structure-function correlation compared to conventional SAP in glaucoma.
  • The ROI-targeting strategy enhances the reliability and topographic accuracy of mapping functional and structural damage in glaucoma.
  • This approach provides a wider sensitivity range and stronger spatial correspondence between visual field defects and GCLT loss.