Qualitative Evaluation of the 10-2 and 24-2 Visual Field Tests for Detecting Central Visual Field Abnormalities in Glaucoma

Prediction of 10-2 Visual Field Loss Using Optical Coherence Tomography and 24-2 Visual Field Data

“…In studies directly comparing 24-2 and 10-2 PD parameters for identification of central VF loss, results suggest that both tests detect central VF loss at similar rates when controlling for specificity. 21,22,25 This study's results align with these prior reports, as we found that glaucomatous 24-2 VF loss that included abnormalities in the central 12 points (central 10 degrees) had good sensitivity (88%) with high specificity (only 6% false positives) for detecting 10-2 VF loss. We also found that any combination of 3 or more abnormal parameters was very sensitive (98%) for predicting 10-2 VF loss, though with a false-positive rate of 16%.…”

“…42 The underlying foundations for this broad recommendation include that central VF loss is common across all stages of glaucoma, [8][9][10][11] that the strong structure/function relationship between 10-2 VF sensitivity and OCT macular structural data can provide diagnostic confirmation of glaucoma, 10,28,[32][33][34][35][36]40 that some eyes with glaucoma demonstrate 10-2 but not 24-2 VF loss, [8][9][10][11][12] that central VF loss is an important consideration in determining treatment intensity, 5,17,18 that central VF loss impacts quality of life, [13][14][15][16] and that the denser testing grid of the 10-2 may improve detection of central VF progression. Despite the potential of 10-2 VF testing, however, it has not yet been shown that 10-2 VF testing is more successful than 24-2 VF testing for detecting the presence of central VF loss, [8][9][10]22,24,25 and this study's findings suggest 10-2 VF loss can be accurately predicted without the employment of 10-2 VF testing. In terms of diagnostic confirmation, it has not been shown that 10-2 VF testing significantly improves the ability to diagnose glaucoma, and only small percentages of patients seem to demonstrate 10-2 VF loss in the absence of 24-2 VF loss.…”

“…This finding, which implies that underappreciation of central visual field loss can occur in some eyes harboring 10-2 VF loss, requires further study to better understand its clinical implications. Additional research is also needed to better understand how best to accomplish testing of the central VF [25][26][27][28][29][30]40,44 and what added clinical value 10-2 VF testing may offer with regard to diagnostic accuracy, detection of progression, quality of life, and long-term prognosis in glaucoma.…”

“…In addition, interpretation of the 10-2 VF test can be more challenging for providers because statistical analysis tools are not as readily available for the 10-2 versus the 24-2 VF test strategy. 19 And because questions persist about how much added value the 10-2 VF test offers compared with the 24-2 test, [20][21][22][23][24][25] the determination about whether 10-2 VF testing should be included in the standard baseline glaucoma testing protocol remains unclear.…”

“…These conditions have led to interest about whether 10-2 VF test results might be clinically predictable as such capability would simultaneously offer the benefits of 10-2 VF testing while avoiding its associated burdens. In prior studies on this general topic, investigators have evaluated relationships between central glaucomatous VF loss and various prognostic factors including sensitivity of central 10-degree test points on the 24-2 VF test, [20][21][22][23][24][25][26] the addition of new central VF points to the 24-2 VF test, [26][27][28][29][30] amsler grid test results, 31 and spectral-domain optical coherence tomography (SD-OCT) measurements of inner-retinal macular thickness and peripapillary retinal nerve fiber layer (RNFL) thickness. [32][33][34][35][36] Although all of these studies describe important inter-relationships between central VF loss and the studied parameters, only modest accuracy for predicting 10-2 VF loss was achieved in any of the studies.…”