Interocular asymmetry of visual field defects in primary open angle glaucoma and primary angle-closure glaucoma

Abstract

Aim To compare the interocular asymmetry in visual field loss of patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG). Methods Subjects entering a prospective, randomised, controlled trial of intraoperative 5-fluorouracil in glaucoma surgery in Singapore were included. Preoperative visual field testing was performed using automated white-on-white perimetry (24-2 test pattern, threshold program, Mk II, Model 750, ZeissHumphrey, San Leandro, CA, USA). A minimum of two tests were required with mean deviation within 2 dB on two tests, fixation losses o20%, false positives o33%, and false negatives o33%. The second field was scored using AGIS II criteria and the 'mean asymmetry score' defined as the mean difference between eyes for both AGIS scores and global indices. Results In 230 subjects assessed (128 POAG, 102 PACG), mean interocular asymmetry of visual field loss was greater for the PACG group. The mean AGIS asymmetry scores for total (PACG ¼ 9.2176.87 vs POAG ¼ 6.4875.58, P ¼ 0.001), superior (PACG ¼ 4.3173.39 vs POAG ¼ 3.3573.13, P ¼ 0.035), and inferior (PACG ¼ 4.4373.31 vs POAG ¼ 2.6472.77, Po0.0001) areas and mean deviation (MD) asymmetry scores (PACG ¼ 6.89713.22 vs POAG ¼ 1.66716.97, P ¼ 0.012) were all significantly different. Interocular correlation of visual field loss for POAG was significant; total AGIS, r ¼ 0.27 (P ¼ 0.003), superior field AGIS, r ¼ 0.24 (P ¼ 0.008), inferior field AGIS, r ¼ 0.34 (P ¼ 0.0001), and MD, r ¼ 0.27 (P ¼ 0.003). In PACG, there was no significant correlation between eyes; total AGIS, r ¼ À0.02 (P ¼ 0.85), superior field AGIS, r ¼ À0.02 (P ¼ 0.82), inferior field AGIS, r ¼ À0.17 (P ¼ 0.87), and MD, r ¼ 0.015 (P ¼ 0.89). Conclusion There was a greater asymmetry of visual field loss between eyes, as measured by AGIS scores and MD, in PACG than that in POAG.

Study of interocular asymmetry of visual field defects in Primary open angle glaucoma and Primary angle closure glaucoma

“…However, another study by Wang et al 4 had a predominance of male patients in the POAG group (3:1) as compared with almost equal representation in the PACG group. In a study by Rhee et al 9 , the maximum IOPs were higher in PACG group (31.9mm Hg) vs POAG group (25.1 mmHg) and the mean IOP at the time of visual fields test was higher in the POAG group (22.5 +/-4.8 mmHg) vs PACG group (17.2 +/-5.5 mmHg).In our study, the mean IOP at the time of diagnosis, in the PACG group was higher being 30.06 +/-0.5, while the mean IOP in the POAG group was 27.05 +/-0.5mmHg.Caprioli et al 10 reported that IOPs were consistently higher in eyes with diffuse field loss compared to eyes with localised field loss.…”

“…Glaucoma diagnosis and monitoring requires assessment of structure and function of the optic nerve, and visual field analysis by perimetry is considered the gold standard for functional assessment of optic nerve 3 . Visual field studies have revealed rate of uniocular visual field loss being 2-3 times higher in cases of primary angle closure glaucoma and greater interocular asymmetry in visual field loss in patients with PACG 4,5 . This suggests a difference in the pathophysiological process of the two diseases.…”

Efeito da rotação da cabeça na pressão intraocular em decúbito ventral: estudo randomizado

“…This position may be particularly advantageous for patients with glaucoma to prevent the increase in IOP when head rotation 45 o laterally in prone position is used and the more severely affected eye is kept in the upper position. The asymmetry of visual fi eld loss between eyes in primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG) was described by Wang et al 10 . A more marked thinning of the neuroretinal nerve fi ber layer in the eye with the higher IOP has also been described in normal-tension glaucoma patients 11 .…”

Interocular Asymmetry of the Visual Field Defects in Newly Diagnosed Normal-tension Glaucoma, Primary Open-angle Glaucoma, and Chronic Angle-closure Glaucoma

“…[1][2][3] In normal-tension glaucoma (NTG), other factors such as vascular abnormalities may also be involved. Pressure-dependent damage was thought to be the major component causing chronic angle-closure glaucoma (CACG), whereas primary open-angle glaucoma (POAG; high-tension glaucoma, HTG) is more likely to have a mixture of pressure-dependent and pressure-independent etiologies.…”

“…[1][2][3] In normal-tension glaucoma (NTG), other factors such as vascular abnormalities may also be involved. 3,[10][11][12] Population-based studies in Asia showed that unilateral visual field loss was about 2 or 3 times more often found in CACG than in POAG. In an extensive literature review of 1008 NTG patients, Levene 10 concluded that unilateral field loss was more frequently seen in NTG than in HTG.…”