Visual Field Defect Patterns May Predict Glaucoma Progression

Ophthalmology. Visual Filed Testing. Automatic Computer Perimeter
Ophthalmology. Visual Filed Testing- Automatic Computer Perimeter.
A study aligns the visual field defect location with a disease progression staging system.

As the disease progresses, patients with glaucoma exhibit more centralized patterns of visual field (VF) defects. These patterns are connected to the blind spot and involve both hemifields, according to findings published in the Journal of Glaucoma. Researchers suggest clinicians closely monitor the central visual field in patients with glaucoma.

Staging glaucoma progression helps guide the management of the disease. Visual field staging systems can classify the severity of VF loss, estimate the likelihood of progression for each type of VF defect, monitor disease advancement, and provide a more standard nomenclature for clinical practice and research.

Using the University of Sao Paulo Glaucoma Visual Field Staging System, participants in the study were assigned to early VF defect, moderate VF defect, and advanced VF defect groups. Then, researchers analyzed 1 VF for 100 patients from each disease progression group. They found that in early disease, both hemifields were commonly affected, and more than a quarter of VF defects involved the central 5 degrees close to fixation. 

Specifically, the findings revealed that VF defects were connected to the physiological blind spot for 27% of the early group, 64% of the moderate group, and 95% of the severe group (P <.01). In addition, defects involved the central 5 degrees of the fixation for 28% of patients in the early group, 59% in the moderate group, and 88% in the severe group. When they drilled down even further, investigators found that defects involved both hemifields in 49% of the early group, 80% in the moderate group, and 80% in the severe group.

The limitation of this study is that all patients were selected from a single glaucoma referral practice, so this data may not reflect the prevalence of VF patterns seen in other centers.

“True glaucomatous progression is a challenge in clinical practice and demands high attention to the visual fields,” the researchers explain. “The understanding of patterns of VF defects according to the severity of the disease and their natural progression over time is important to improve the management of glaucoma.” 


Germano RAS, Germano CS, Susanna FN, et al. Patterns of Visual Field Loss in Early, Moderate, and Severe Stages of Open-angle Glaucoma. J Glaucoma. Published online January 12, 2022. doi:10.1097/IJG.0000000000001986.