Purpose To investigate the prevalence of visual field defects in glaucomatous eyes, glaucoma suspects, and ocular hypertensives with 24-2 and 10-2 visual fields. Design Prospective, cross-sectional study. Participants Patients with or suspected glaucoma. Testing 24-2 and 10-2 visual fields. Patients were classified into 3 groups based upon the presence of glaucomatous optic neuropathy (GON) and 24-2 visual field abnormalities: early glaucoma (GON and abnormal visual field, mean deviation >−6 dB), glaucoma suspects (GON and normal visual field), and ocular hypertensives (normal disc, normal visual field, and intraocular pressure >22 mmHg). For the classification of visual field abnormalities, 24-2 and 10-2 tests performed on the same visit were analyzed. Main outcome measure Comparison of the prevalence of abnormal 24-2 versus 10-2 visual field results based upon cluster criteria in each diagnostic group. Results 775 eyes (497 patients) were evaluated. 364 eyes had early glaucoma, 303 were glaucoma suspects, and 108 were ocular hypertensives. In the glaucoma group, 16 of the 26 (61.5%) eyes classified as normal based upon cluster criteria on 24-2 tests were classified as abnormal on 10-2 visual fields. In eyes with suspected glaucoma, 79 of the 200 (39.5%) eyes classified as normal on 24-2 were classified as abnormal on 10-2 visual fields. In ocular hypertensive eyes, 28 of the 79 (35.4%) eyes classified as normal on the 24-2 were abnormal on the 10-2. Patients of African descent were more likely to have an abnormal 10-2 result (67.3 vs. 56.8%, P=0.009). Conclusions Central visual field damage seen on 10-2 is often missed with 24-2 strategy in all groups. This finding has implications for the diagnosis of glaucoma and classification of severity.

PurposeTo determine the effectiveness of detecting glaucomatous progression by a qualitative evaluation of wide-field (12 × 9 mm) scans on optical coherence tomography imaging. This method was compared to a conventional quantitative analysis of the global circumpapillary retinal nerve fiber layer (cpRNFL) thickness.MethodsA total of 409 eyes with a clinical diagnosis of glaucoma or suspected glaucoma for which two wide-field scans were obtained at least 1 year apart (n = 125) and within one session (n = 284) were included to determine the sensitivity of detecting progression at 95% specificity. Qualitative OCT evaluation was performed in a similar manner to flicker chronoscopy by superimposing the two scans, and the progression probability was graded. A quantitative event-based analysis of the global cpRNFL thickness also was performed.ResultsThirty-three and 25 eyes were deemed to have progressed based on qualitative and quantitative approaches, respectively (P = 0.152). A post hoc review of cases where the two methods disagreed revealed that all eyes missed by the quantitative analysis had established glaucomatous damage that appeared to show characteristic patterns of progression. All eyes missed by the qualitative evaluation appeared to be free of such established damage, and instead showed a generalized reduction in cpRNFL thickness.ConclusionsQualitative evaluation of OCT imaging information more frequently detected change consistent with known patterns of glaucomatous progression than global cpRNFL thickness, warranting further studies to evaluate its value.Translational RelevanceA framework for qualitatively evaluating progressive glaucomatous changes on OCT imaging clinically shows promise.

PurposeTo evaluate a manual region-of-interest (ROI) approach for detecting progressive macular ganglion cell complex (GCC) changes on optical coherence tomography (OCT) imaging.MethodsOne hundred forty-six eyes with a clinical diagnosis of glaucoma or suspected glaucoma with macular OCT scans obtained at least 1 year apart were evaluated. Changes in the GCC thickness were identified using a manual ROI approach (ROIM), whereby region(s) of observed or suspected glaucomatous damage were manually identified when using key features from the macular OCT scan on the second visit. Progression was also evaluated using the global GCC thickness and an automatic ROI approach (ROIA), where contiguous region(s) that fell below the 1% lower normative limit and exceeded 288 μm2 in size were evaluated. Longitudinal signal-to-noise ratios (SNRs) were calculated for progressive changes detected by each of these methods using individualized estimates of test–retest variability and age-related changes, obtained from 303 glaucoma and 394 healthy eyes, respectively.ResultsOn average, the longitudinal SNR for the global thickness, ROIA and ROIM methods were −0.90 y−1, −0.91 y−1, and −1.03 y−1, respectively, and was significantly more negative for the ROIM compared with the global thickness (P = 0.003) and ROIA methods (P = 0.021).ConclusionsProgressive glaucomatous macular GCC changes were optimally detected with a manual ROI approach.Translational RelevanceThese findings suggests that an approach based on a qualitative evaluation of OCT imaging information and consideration of known patterns of damage can improve the detection of progressive glaucomatous macular damage.

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PurposeOur purpose was to compare the effectiveness of detecting progressive retinal nerve fiber layer (RNFL) thickness changes using widefield scans compared to circumpapillary circle scans derived from optic disc volume scans when using a manual region-of-interest (ROI) approach.MethodsIn a prospective observational study, a total of 125 eyes diagnosed clinically with glaucoma or suspected glaucoma that had both widefield (12 × 9 mm) and optic disc (6 × 6 mm) scans obtained at least one year apart were included. Changes in the RNFL thickness between the two visits were evaluated within region(s) of observed or suspected glaucomatous damage, which were manually outlined after reviewing key features from each scan on the second visit (described as a manual ROI approach). Within ROI(s), changes in the widefield and circumpapillary RNFL thickness (wfRNFLROI and cpRNFLROI), as well as in the global circumpapillary RNFL thickness (cpRNFLG), were determined. The performance of these three methods for detecting progressive changes was compared using longitudinal signal-to-noise ratios (SNRs), whereby the rate of change determined by each method was normalized by individualized estimates of measurement variability and age-related change.ResultsOn average, the longitudinal SNRs for the wfRNFLROI, cpRNFLROI, and cpRNFLG methods were −0.57, −0.38, and −0.23 y−1, respectively, being significantly more negative for the wfRNFLROI than the latter two methods (P ≤ 0.009).ConclusionsProgressive RNFL thickness changes were more effectively detected on widefield optical coherence tomography (OCT) scans using a manual ROI approach compared to conventional derived circumpapillary circle scans.Translational RelevanceWidefield OCT scans show promise for improving the detection of glaucomatous progression.