Central Visual Field Defects in Patients with Distinct Glaucomatous Optic Disc Phenotypes

PURPOSE: To investigate central visual field (VF) defects among 4 phenotypes of glaucomatous optic discs. center dot DESIGN: Cross-sectional study. METHODS: Optic disc phenotypes were determined in eyes with definite or suspected glaucoma that had a 242 VF with mean deviation (MD) better than L12 dB and a 10-2 VF. 10-2 VFs were classified as abnormal based on a cluster criterion. Additionally, the average of the total deviation values at each 10-2 test point was compared by optic disc phenotype. RESULTS: The following 4 glaucomatous optic disc phenotypes were identified in 448 eyes of 309 patients: focal ischemic (FI) (n = 121); generalized cup enlargement (GE) (n = 109); myopic glaucoma (MY) (n = 66); and senile sclerotic (SS) (n = 152). Although 242 VF MD values were similar among optic disc phenotypes, GE eyes had higher 10-2 VF MD (P = .004), as well as lower 24-2 VF pattern standard deviations (PSD) (P < .001) and VF 10-2 PSD (P < .001) than the other phenotypes. The prevalence of an abnormal VF 10-2 was highest in FI eyes (78.5%) and lowest in GE eyes (50.5%) (P < .001). In glaucoma suspects, the prevalence of an abnormal 10-2 VF was highest in the MY eyes (31.2%) and FI eyes (23.5%) and lowest in GE eyes (8.6%). In mild glaucoma, the prevalence of abnormal 10-2 VF test results was highest in FI eyes (79.2%) and lowest in GE eyes (44.4%) (P = .013). CONCLUSIONS: The severity and prevalence of central VF loss varied among different glaucomatous optic disc phenotypes. Glaucomatous eyes with FI and MY optic disc phenotypes are more likely to have 10-2 VF loss, particularly in early disease, and especially may benefit from testing with both 10-2 and 24-2 VF tests. (Am J Ophthalmol 2021;223:229-240. (c) 2020 Elsevier Inc. All rights reserved.)

Automated summary

The severity and prevalence of central visual field loss varied among different glaucomatous optic disc phenotypes. Glaucomatous eyes with focal ischemic (FI) and myopic glaucoma (MY) optic disc phenotypes are more likely to have 10-2 visual field loss.