Visual Field Defects in Open-Angle Glaucoma: Progression and Regression

Abstract

How often do glaucomatous visual field defects improve or worsen? What factors predispose a glaucomatous eye to changes in the visual field? Attempting to answer these questions, I reviewed the charts of 130 patients (177 eyes) who met the following criteria: open-angle glaucoma, definite glaucomatous visual field defects, good visual acuity, reliable responses during perimetry, and two perimetric examinations one year apart. Patients were separated into three groups: a surgical group, a group newly started on medical treatment, and a control group continued on previous medication. Visual fields were tested on the Goldmann perimeter, using Armaly’s strategy of ‘selective perimetry’ for detection of defects and quantitative kinetic perimetry for their assessment.

Visual fields improved in 7% and worsened in 15% of the 177 eyes. Improvement occurred more frequently in young patients, in eyes treated surgically, when the reductions of intraocular pressure were large, and when the cup of the optic disc did not extend to its rim. Worsening occurred more often in old patients and in eyes treated medically. Neither systemic blood pressure nor severity or location of visual field defects influenced the prognosis.