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Optometric ManagementClinical: Glaucoma – Play the Field

Utilize these VF-testing guidelines to identify glaucoma earlier and identify development more quickly.

The World Glaucoma Association (WGA) emphasizes the importance of functional testing in the evaluation, staging, and monitoring of glaucoma. This article delves into the specifics of this testing and its implications for optometrists.

Key Points:

  • The WGA states that the diagnosis of glaucoma is increased through the corroboration of abnormal structural and functional tests.
  • Diagnosing glaucoma and detecting its progression depends on a reliable baseline data set of both structural and functional testing.
  • Three key points for optometrists to remember are: a good baseline of reliable visual fields (VFs) is essential for monitoring progression, decisions on progression should not be made by comparing only the most recent field with the one before, and suspected progression should be confirmed by repeating the field.
  • Testing more frequently (two to three times within the first year) may help optometrists detect glaucoma progression sooner.

Additional Points:

  • Patients in the Ocular Hypertension Treatment Study displayed various VF defects, with variability of these defects usually lower among ocular hypertension patients vs. early glaucoma patients.
  • Optometrists should look for deepening of current VF defects, enlargement of current VF defects, and new VF defects to detect progression sooner.
  • There is an observed faster rate of VF loss in the superior hemifield compared to corresponding points in the inferior hemifield in primary open-angle glaucoma patients (POAG).
  • Normal tension glaucoma (NTG) patients have scotomas that are more likely to be deeper, steeper, more localized, and closer to the fixation, whereas the VF loss in POAG eyes is more diffuse and symmetric than that in NTG.


  • When visual field loss is already present, perimetry will find progression more frequently, regardless of the stage of the disease.
  • Dry eye disease (DED) can affect the reliability of structural and functional glaucoma tests.

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Did You Know?
Glaucoma is the second leading cause of blindness worldwide, affecting more than 60 million people.

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