Clinicians now have a robust armamentarium for diagnosing glaucoma, even in its nascent stages. Visual field (VF) testing, tonometry, optic nerve evaluation and even optical coherence tomography can all help to detect early glaucomatous damage and set the patient on the right therapeutic path. But with so many tools at their disposal, it can be challenging to know which one is necessary in any given situation. Researchers from the Albuquerque VA Medical Center may have some answers, at least for visual field testing.

They recently studied both glaucoma suspects and those diagnosed with primary open-angle glaucoma (POAG) and discovered 10-2 VF loss rarely affects a patient’s quality of life (QOL), until it becomes bilateral. Their study results, presented last Monday at ARVO 2019 in Vancouver, suggest 10-2 VF testing might not be the right tool when testing for early glaucoma.

The team enrolled 75 suspects and 91 early POAG patients, all of whom were participating in a longitudinal glaucoma research study at their institution. The patients underwent 24-2 and 10-2 VF testing, as well as vision-related QOL assessment with the NEI-VFQ-25 questionnaire. The resultant data shows vision-related QOL was significantly lower for POAG patients compared with the glaucoma suspects. However, QOL scores didn’t differ significantly between those with no VF loss, patients with monocular 10-2 VF loss and even patients with monocular 10-2 and 24-4 VF loss. Only once VF loss became bilateral did vision-related QOL suffer. Patients reported lower QOL when they had both monocular 10-2 VF loss and bilateral 24-2 VF loss, and when 10-2 and 24-2 VF loss were both bilateral.

“Because central visual field loss was generally mild and usually present in only one eye, presence of central visual field loss did not impair quality of life in our early glaucoma subjects,” the researchers noted in their study abstract. “Accordingly, these results do not support adding central visual field testing to the baseline testing batter for early glaucoma.”