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Variability in glaucomatous visual fields: implications for shared care schemes

D B Henson1, P G Spry, I C Spencer

  • 1University Department of Ophthalmology, Royal Eye Hospital, Manchester, UK.

Ophthalmic & Physiological Optics : the Journal of the British College of Ophthalmic Opticians (Optometrists)
|August 6, 1998
PubMed
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Glaucoma patients show significant visual field variability, complicating diagnosis. Duplicate visual field testing is recommended to distinguish true progression from natural fluctuation.

Area of Science:

  • Ophthalmology
  • Optometry
  • Clinical Vision Science

Background:

  • Glaucoma is a leading cause of irreversible blindness.
  • Accurate monitoring of visual field changes is crucial for glaucoma management.
  • Variability in visual field testing can obscure true disease progression.

Purpose of the Study:

  • To quantify the extent of variability in visual field test results for patients diagnosed with glaucoma.
  • To investigate factors influencing visual field variability, such as the extent of visual field loss and hemifield.
  • To inform the development of criteria for follow-up examinations in glaucoma care.

Main Methods:

  • 104 patients (126 eyes) with glaucoma underwent two visual field tests using the Henson CFA3000 central visual field analyser on separate days.

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  • A suprathreshold perimetric test strategy was employed, assessing 132 locations within the central 25 degrees.
  • Data analysis focused on the difference in missed stimuli between the two testing sessions, considering defects >= 5 dB.

    • Main Results:

    • Significant variability was observed in the visual field test results.
    • Variability was greatest when all defect levels (>= 5 dB) were considered and was independent of the overall degree of visual field loss.
    • The superior hemifield demonstrated greater variability compared to the inferior hemifield.

    Conclusions:

    • High variability in visual field testing poses a challenge in distinguishing genuine glaucomatous progression from measurement fluctuations.
    • The findings underscore the importance of considering test variability when interpreting visual field changes in glaucoma.
    • Duplicate visual field measurements are advantageous for improving the reliability of glaucoma monitoring and establishing appropriate referral criteria for shared care programs.