Patterns of Visual Field Loss in Early, Moderate, and Severe Stages of Open Angle Glaucoma.

PRCIS: Even in the early stages of glaucomatous visual field defects (VFDs), 49% of the defects occurred in both hemifields and 28% involved the central 5 degrees of the visual field (VF), which may have prognostic values. PURPOSE: The aim was to determine the patterns of glaucomatous VFDs in early, moderate and severe stages of primary open angle glaucoma, using the Glaucoma Staging Application. METHODS: According to the Modified University of Sao Paulo Glaucoma Visual Field Staging System Classification, patients with early, moderate and advanced VFDs were selected by the Glaucoma Staging Application using all databases of the Humphrey Visual Field Analyser of a glaucoma referral practice. We analyzed one VF of the 100 patients included in each group. The analysis consisted of classifying all exams regarding the location of the defects, the hemifields involved, and the connection to the blind spot. RESULTS: We analyzed 300 VF. In the Early group, 27% of the VFDs are connected to the physiological blind spot, 64% in the Moderate group, and 95% in the Severe group ( P <0.01). In the Early group, 28% of the defects involved the central 5 degrees of the fixation, 59% in the Moderate and 88% in the Severe group. In the Early group, 49% of the defects involved both hemifields, 80% in the Moderate and 80% in the Severe group. CONCLUSION: With increasing glaucoma severity, VFD showed a more central pattern, connected to the blind spot, and involved both hemifields. In early disease, both hemifields were commonly affected and more than a quarter of VFD involved the central 5 degrees close to fixation. Careful monitoring of the central VF in glaucoma is suggested.

Evaluation of a Novel Visual Field Analyzer Application for Automated Classification of Glaucoma Severity.

PURPOSE: To describe the Glaucoma Staging Application (GSA), a new application for automated classification of visual field (VF) severity that can be used in any Humphrey perimeters. We also tested and validated its performance in staging glaucomatous VFs defects and assessed its reproducibility. MATERIALS AND METHODS: The GSA is based upon the modified University of São Paulo Glaucoma Visual Field Staging System, and consists of 3 sections: severity based on the visual field index; defect location based on eccentricity; and extent of topographic damage by hemifields. We analyzed 612 VFs of 32 patients. VFs were analyzed by a glaucoma expert and then compared with the output of the GSA. To evaluate the repeatability, the same search criteria were repeated 1 week later using the same GSA. The classification given by the software was considered correct if it completely agreed in all variables (severity, location, and extent of topographic damage) with the classification performed manually by the glaucoma expert. RESULTS: One hundred seventy-eight eyes were classified as early VF damage, 148 moderate, and 156 severe. One hundred thirty-one VFs were classified as normal. When repeated, 1 week later, the GSA showed excellent repeatability. The automated classification agreed with the expert's grading in 100% of cases. CONCLUSIONS: The GSA allows an automated, fast, reproducible, and objective classification system for multiple 24-2 VFs of Humphrey perimetry. This study is a proof-of-concept that could translate into a useful tool to analyze and stage VFs more objectively and thus help detecting progression of different types of VFs defects.

Effect of Switching From Latanoprost to Bimatoprost in Primary Open-Angle Glaucoma Patients Who Experienced Intraocular Pressure Elevation During Treatment.

PURPOSE: We investigated the intraocular pressure (IOP) variations after switching from 0.005% latanoprost to 0.01% bimatoprost in open-angle glaucoma patients who experienced IOP elevation during treatment. PATIENTS AND METHODS: Retrospective, interventional cohort study. Of the 625 patients with open-angle glaucoma, we included 41 patients on latanoprost who showed a peak IOP increase of at least 15% [assessed during the water drinking test (WDT)2] relative to the peak IOP measured during the previous WDT (WDT1). MAIN OUTCOME MEASURE: Baseline, peak, and IOP measurements at each timepoint (15, 30, and 45 min) during all 3 WDT sessions (WDT1, WDT2, and WDT3) were measured. RESULTS: The mean peak IOP was 15.6 mm Hg (SE, 0.73) during WDT1; 21.1 mm Hg (SE, 0.73) during WDT2; and 16.1 mm Hg (SE, 0.73) during WDT3 (P<0.001, repeated-measures analysis of variance). Comparing WDT1 versus WDT2, the mean peak IOP difference was 5.5 mm Hg (P<0.001); for WDT1 versus WDT3, the difference was 0.5 mm Hg (P=0.312); for WDT2 versus WDT3, the mean difference was -5.0 mm Hg (P<0.001). The mean IOP at each timepoint during the WDT sessions was significantly different between WDT1 and WDT2 and between WDT2 and WDT3. CONCLUSIONS: Our study suggests that glaucoma patients on latanoprost who experienced IOP elevation during the course of therapy may benefit from switching to bimatoprost. This alternative can potentially postpone more costly or invasive treatment options.