Paracentral scotoma in glaucoma detected by 10-2 but not by 24-2 perimetry
- 444 Downloads
To describe, in glaucomatous patients, spectral-domain optical coherence tomography (SD-OCT) results predictive of paracentral visual field (VF) defects present on standard automated perimetry (SAP) 10-2, but not on SAP 24-2.
The SAP 10-2 test was repeated 3 times to determine whether paracentral VF defects were present. Spectralis™ HRA + OCT was used to obtain speckle-noise-reduced macular B-scans. The macular scan protocol consisted of 19 vertical cross-sectional scan lines centered on the fovea (30° × 15° volume scan), each of which was the average of 50 scans. A 3D OCT-2000 was also used to determine macular layer thicknesses and to detect abnormally thin regions (below the 1 % confidence interval of the normative data).
We identified 3 cases in which paracentral VF defects were detected on SAP 10-2, but not on SAP 24-2. Paracentral VF defects were detected on all of the SAP 10-2 tests repeated 3 times, and included absolute scotoma in 2 of the 3 SAP 10-2 results. Retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) damage was diminished on SD-OCT macular images; 2 patients had RNFL and GCL thinning within and central to the parafoveal region, where the GCL is generally thickest in healthy eyes, and 1 patient had evident RNFL and GCL thinning in the papillomacular bundle.
Macular SD-OCT scans may be useful in deciding whether SAP 10-2 should be performed.
KeywordsGlaucoma Paracentral scotoma Spectral-domain optical coherence tomography Visual field testing
This research was supported in part by a Grant-in-Aid for Scientific Research (20592038) from the Japan Society for the Promotion of Science (JSPS), Tokyo, Japan.
Conflicts of interest
M. Hangai, Consultant (NIDEK, Topcon), Grants (Canon, Topcon), Lectures (Heidelberg Engineering, Santen); H. Ohashi Ikeda, None; T. Akagi, None; N. Yoshimura, Consultant (NIDEK), Grants (NIDEK, Topcon, Canon), Lectures (Topcon, Canon).
- 16.Chihara E. Myopia and diabetes mellitus as modificatory factors of glaucomatous optic neuropathy. Jpn J Ophthalmol (in press).Google Scholar
- 18.Kimura Y, Hangai M, Matsumoto A, Akagi T, Ikeda HO, Ohkubo S, et al. Macular structure parameters as an automated indicator of paracentral scotoma in early glaucoma. Am J Ophthalmol. 2013;156:907–17Google Scholar
- 19.Omodaka K, Kunimatsu-Sanuki S, Morin R, Tsuda S, Yokoyama Y, Takahashi H, et al. Development of a new strategy of visual field testing for macular dysfunction in patients with open angle glaucoma. Jpn J Ophthalmol. 2013;57:457–62Google Scholar