Glaucomatous Visual Field Abnormalities Research Articles

Specificity of various cluster criteria used for the detection of glaucomatous visual field abnormalities

PurposeThis study aimed to evaluate the specificity of commonly used cluster criteria for defining the presence of glaucomatous visual field abnormalities and the impact of variations in the criterion used.MethodsThis...

Baseline Risk Factors that Predict the Development of Open-Angle Glaucoma in a Population: The Los Angeles Latino Eye Study

To determine which baseline sociodemographic, lifestyle, anthropometric, clinical, and ocular risk factors predict the development of open-angle glaucoma (OAG) in an adult population. A population-based, prospective cohort study. A total of 3772 self-identified Latinos aged ≥40 years from Los Angeles, California, who were free of OAG at baseline. Participants from the Los Angeles Latino Eye Study had standardized study visits at baseline and 4-year follow-up with structured interviews and a comprehensive ophthalmologic examination. We defined OAG as the presence of an open angle and a glaucomatous visual field abnormality and/or evidence of glaucomatous optic nerve damage in ≥1 eye. Multivariate logistic regression with stepwise selection was performed to determine which potential baseline risk factors independently predict the development of OAG. Odds ratios for various risk factors. Over the 4-year follow-up, 87 participants developed OAG. The baseline risk factors that predict the development of OAG include older age (odds ratio [OR] per decade, 2.19; 95% confidence interval [CI], 1.74-2.75; P<0.001), higher intraocular pressure (IOP; OR per mmHg, 1.18; 95% CI, 1.10-1.26; P<0.001), longer axial length (OR per mm, 1.48; 95% CI, 1.22-1.80; P<0.001), thinner central cornea (OR per 40 μm thinner, 1.30; 95% CI, 1.00-1.70; P = 0.050), higher waist-to-hip ratio (OR per 0.05 higher, 1.21; 95% CI, 1.05-1.39; P = 0.007) and lack of vision insurance (OR, 2.08; 95% CI, 1.26-3.41; P = 0.004). Despite a mean baseline IOP of 14 mmHg in Latinos, higher IOP is an important risk factor for developing OAG. Biometric measures suggestive of less structural support such as longer axial length and thin central corneal thickness were identified as important risk factors. Lack of health insurance reduces access to eye care and increases the burden of OAG by reducing the likelihood of early detection and treatment of OAG. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Four-Year Incidence of Open-Angle Glaucoma and Ocular Hypertension: The Los Angeles Latino Eye Study

To estimate the 4-year incidence of open-angle glaucoma (OAG) and ocular hypertension (OHT) among adult Latinos 40 years of age and older. Population-based longitudinal study. Comprehensive ophthalmologic examinations including intraocular pressure, visual field testing, and stereoscopic fundus photography were performed at both baseline and the 4-year follow-up examination. Incident OAG at the 4-year follow-up examination was defined as the presence of an open angle and a glaucomatous visual field abnormality or evidence of glaucomatous optic disc damage, or both when not present at baseline. Incident OHT was defined as intraocular pressure of more than 21 mm Hg and the absence of optic disc damage or abnormal visual field results at the 4 year follow-up examination when not present at baseline. Among the 3939 participants (mean age, 54.7 ± 10.5 years) with complete data for a diagnosis of glaucoma at both baseline and follow-up examination, incident OAG at the 4-year follow-up was identified in 87 persons (4-year incidence rate, 2.3%; 95% confidence interval, 1.8% to 2.8%). Incident OHT at the 4-year follow-up was identified in 124 persons (4-year incidence rate, 3.5%; 95% confidence interval, 2.9% to 4.1%). In participants with OAG in 1 eye, the 4-year risk of OAG developing in the fellow eye was 5 times as high as the risk for those without OAG in either eye at baseline. In participants with OHT in 1 eye, the 4-year risk of OHT developing in the fellow eye was 10 times as high as the risk for those without OHT in either eye at baseline. The incidence rates of OAG and OHT were higher in older Latinos than in younger Latinos. Incidence of OAG in Latinos is higher than in non-Hispanic whites, but lower than in Afro-Caribbeans. The relatively high rate of incident OAG and OHT underscores the need for community screening programs in this fastest growing segment of the United States population.

Detection of visual field defects in pre-perimetric glaucoma using fundus-oriented small-target perimetry

To evaluate the usefulness of automated fundus-oriented small-target perimetry in detecting glaucomatous visual field abnormalities. One eye from each of 60 normal, 37 pre-perimetric glaucoma (PPG) and 29 early stage of primary open-angle glaucoma (POAG) persons were included. The new perimeter had two monitors, one for a campimeter and the other for the examiner's operation. A test area within the central 15° was set in the fundus image. The target size was 2.9 min in diameter, and the distance between the two adjacent targets was 60 min. The rate of negative response (RNR) among the age-matched controls, PPG and POAG were compared. The relationship between the RNR and age of the normal or standard automated perimetry (SAP) global indices in PPG and POAG was examined. The areas under the receiver-operating characteristic curve (AROC) to discriminate PPG or POAG versus normal were determined. The RNR increased significantly with age in normal and differed significantly (P < 0.001) among control (1.8 ± 1.3 %), PPG (9.2 ± 10.4 %) and POAG (21.2 ± 14.3 %). Significant correlation was found between the RNR and SAP global indices. The AROC was 0.89 for PPG and 0.95 for POAG. Fundus-oriented small-target perimetry is useful in detecting visual field abnormalities in PPG.

Axial Length Does Not Correlate With Degree of Visual Field Loss in Myopic Chinese Individuals With Glaucomatous Appearing Optic Nerves

We previously described a group of patients of Chinese ancestry who presented with optic nerve appearance and visual field loss suggestive of glaucoma but did not show progression characteristic of this disease for up to 7 years. The purpose of this study was to assess whether axial length is a risk factor for visual field loss in patients presenting with this cluster of findings. Twenty patients of Chinese ancestry with characteristics of this previously described condition including myopia, tilted discs, and glaucomatous visual field abnormalities who also had asymmetric visual field loss were enrolled in this study. Patients underwent axial length measurement of both eyes and a fellow eye analysis was performed to determine the relationship between axial length and visual field loss. Tilted discs were found in 30 out of 40 eyes, with cup/disc ratios ranging from 0.5 to 0.9. Myopia >6.00 diopters was also found in 30 out of 40 eyes. In these subjects with disease that was discordant between the 2 eyes, longer axial length was not found to be associated with greater visual field loss (P>0.99, Freeman-Halton extension of the Fisher exact test). No correlation was found between axial length and mean deviation on visual field testing (r=-0.06). We did not find axial length to be a risk factor for visual field loss in eyes with asymmetric disease in this patient population. These findings suggest that factors other than progressive lengthening of the eye play an important role in the etiology of glaucomatous appearing optic nerve damage and visual field loss in this specific subset of patients.

Symptoms related to glaucomatous visual field abnormalities among male Japanese workers in a population‐based setting

To identify symptoms potentially related to glaucomatous visual field abnormalities (VFAs) in a population-based setting, and to assess the applicability of using these symptoms to identify persons at risk of developing glaucoma. In this study, 10,214 Japanese male general workers (mean age, 45.3±8.8 years) filled out a self-administered questionnaire and underwent frequency doubling technology (FDT) perimetry testing. The questionnaire inquired about whether the participant was suffering from any of nine symptoms, with scores for each response graded on a four-item Likert scale: 0 (none), 1 (rarely), 2 (sometimes), and 3 (always). Results from the questionnaire were compared among three groups: participants without any VFAs (9767), participants with VFAs as determined by the FDT test (FDT-VFA; 447), and 227 participants (of the 447 FDT-VFA participants) with glaucomatous VFAs who were newly diagnosed by ophthalmologic examinations. The mean summed scores for the total items were significantly (p<0.01) higher in FDT- and glaucomatous VFA groups than in normal subjects. In particular, responses citing the symptoms 'feeling of something in the front of the eye' and 'feeling of hardness to see in dark places' were significantly (p<0.05) more frequent in subjects with FDT- and glaucomatous VFAs than among normal participants. However, the respective areas under the receiver operating characteristic curve of summed scores for the nine total items and for the two items which showed significant differences for the glaucoma groups were 0.57 (95% confidence interval=0.53-0.60) and 0.58 (95% confidence interval=0.54-0.61). Although the symptoms 'feeling of hardness to see in dark places' and 'feeling of something in the front of the eye' could be associated with glaucomatous VFA in a population-based setting, inquiring about symptoms is of little aid in identifying subjects with glaucomatous VFA as a strategy for public health.

Type 2 Diabetes Mellitus and the Risk of Open-angle Glaucoma: The Los Angeles Latino Eye Study

To examine the relationship between type 2 diabetes mellitus (T2DM) and the risk of having open-angle glaucoma (OAG) in an adult Latino population. Population-based cross-sectional study. Latinos 40 years and older (n = 5894) from 6 census tracts in Los Angeles, California. Participants from the Los Angeles Latino Eye Study (LALES), a large population-based study of self-identified adult Latinos, answered an interviewer-administered questionnaire and underwent a clinical and complete ocular examination, including visual field (VF) testing and stereo fundus photography. A participant was defined as having diabetes mellitus (DM) if she or he had a history of being treated for DM, the participant's glycosylated hemoglobin was measured at 7.0% or higher, or the participant had random blood glucose of 200 mg% or higher. Type 2 DM was defined if the participant was 30 years or older when diagnosed with DM. Open-angle glaucoma was defined as the presence of an open angle and a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. Logistic regression analysis was used to identify the risk of having OAG in persons with T2DM. Prevalence of OAG. Of the 5894 participants with complete data, 1157 (19.6%) had T2DM and 288 (4.9%) had OAG. The prevalence of OAG was 40% higher in participants with T2DM than in those without T2DM (age/gender/intraocular pressure-adjusted odds ratio, 1.4; 95% confidence interval, 1.03-1.8; P = 0.03). Trend analysis revealed that a longer duration of T2DM (stratified into 5-year increments) was associated with a higher prevalence of OAG (P<0.0001). The presence of T2DM and a longer duration of T2DM were independently associated with a higher risk of having OAG in the LALES cohort. The high prevalences of T2DM and OAG and their association in this fastest growing segment of the United States population have significant implications for designing screening programs targeting Latinos.

Prevalence of Glaucoma in the Wroclaw Population. The Wroclaw Epidemiological Study

Purpose: Primarily to determine the prevalence of various types of glaucoma and ocular hypertension in Wroclaw inhabitants aged 40–79 years. The second aim of the study was to determine the number of undiagnosed glaucoma cases in this population. Methods: A representative group of the Wroclaw population (4853 people aged from 40 to 79 years) was recruited by a proportional simple random sampling selection with stratification. All participants underwent the first, screening-stage examination, which included a medical history interview, intraocular pressure (IOP) measurement, anterior chamber depth assessment by the Van Herrick technique, and optic nerve head (ONH) assessment by means of indirect ophthalmoscopy (Volk's lens), confocal scanning laser ophthalmoscopy with a Heidelberg Retinal Tomograph (HRT) and scanning laser polarimetry by the GDx Nerve Fiber Analyzer (GDx). The second stage, in glaucoma-suspect patients only, included best corrected visual acuity, static perimetry, 24-hour monitoring of IOP, gonioscopy, and full eye examination with mydriasis. Glaucoma was diagnosed by the presence of any two of the following: characteristic morphological changes in the optic disc, glaucomatous visual field abnormalities, and intraocular pressure greater than 21 mmHg. Results: The overall prevalence of glaucoma was 1.6% (79 subjects). The prevalence increased with age from 0.4% in subjects belonging to the age group 40–49 years to 4.6% in people aged between 70 and 79 years. The prevalence of definite primary open-angle glaucoma was 1.0% (49 subjects). Normal-pressure glaucoma was diagnosed in 13 subjects (0.3%). Ocular hypertension was diagnosed in 92 subjects (1.9%). Conclusion: The prevalence of the different types of glaucoma was similar to that found in other white populations. Among the subjects examined, 79 had various forms of glaucoma and 71% of them had not previously been diagnosed. Undiagnosed glaucoma is a serious public health problem in Poland.

Multifocal Electroretinograms in Early Primary Open-angle Glaucoma

Purpose: To determine the utility of multifocal electroretinograms (mfERGs) in patients with early primary open-angle glaucoma (POAG) with unilateral visual field abnormalities. Methods: mfERGs were recorded from 24 eyes of 12 cases of early POAG (stage I for 1 eye and stage II for the other eye on the Kosaki scale). The implicit times and amplitudes of the second-order kernel summed for the whole visual field, for the superior and inferior hemi-fields, and for quadrantic fields of the stage I and stage II eyes were compared. Results: Neither the first- nor the second-order kernels of the mfERGs showed any changes reflecting glaucomatous visual field abnormalities. The implicit times and amplitudes of the second-order kernel summed for the whole visual field, the superior and inferior hemi-visual fields, and quadrantic visual fields of the stage I and stage II eyes were also not significantly different. Conclusions: We conclude that because the second-order kernel of the mfERG does not correlate with the visual field abnormality in early POAG, the second-order kernel of the mfERG that can be recorded at present is highly unlikely to reflect the function of the ganglion cells in the inner retinal layers.