Pattern Of Visual Field Defect In Primary Open Angle Glaucoma

Objective:To investigate pattern of visual field defect in primary open-angle glaucoma(POAG),and compare visual field defect Patterns in primary open-angle glaucoma(POAG)and acute primary angle-closure glaucoma(APACG).Methods:The first part,patients with primary open-angle glaucoma(POAG)is treated in our hospital from 2016.12 to 2018.12,included 220 eyes with POAG.Patients with secondary glaucoma,normal tension glaucoma,primary chronic angle-closure glaucoma,congenital glaucoma,combined with other retinal diseases and previous intraocular surgery were excluded.Patients underwent visual field examination,using Humphrey perimeter threshold detection 24-2 program test,SITA-fast statistical analysis strategy.Patients were excluded if they had unreliable VFs.Based on mean defect(MD),the visual field was marked in the mild MD?-10dB,moderate-20dB<MD?-10 dB and severe MD<-20dB.There were three different ways to analyse the visual fields.First,to evaluate the frequency,location and shape of visual field defects with three severity levels.Second,according to the glaucoma hemifield test(GHT),the total deviation numerical map and the pattern deviation probability plots of visual field were used to define five areas in each superior hemifield and the inferior hemifield across the horizontal meridian.These five areas:central,paracentral,nasal,arcuate 1,and arcuate 2 were called C,P,N,A1 and A2,to evaluate the frequency of visual field defects in these five areas with three severity levels.Third,calculate and compare the MD values of the superior and inferior areas.According to the Collaborative Initial Glaucoma Treatment Study(CIGTS),calculate and compare the pattern deviation values(PD)of the five superior and inferior areas.The second part,patients with primary open-angle glaucoma(POAG)is treated in our hospital from 2016.12 to 2018.12.Patients with acute primary angle-closure glaucoma(APACG)are from six areas of multicenter glaucoma study,including POAG 220 eyes and APACG 106 eyes,patients underwent visual field examination,using Humphrey perimeter threshold detection 24-2 program test,SITA-fast statistical analysis strategy.According to the above staging principle,the visual field was marked in the mild,moderate and severe stage.According to the glaucoma staging system 2,to evaluate the type of visual field defects of POAG and APACG.Then according to the glaucoma hemifield test(GHT),the total deviation numerical map and the pattern deviation probability plots of visual field were used to define five areas in each half hemifield,calculate and compare the MD values and PD values of the different five areas with POAG and APACG.Results:1?In the mild stage,the shape of visual field defects were mainly paracentral scotoma and nasal steps,74.42%and 60.46%.In the moderate stage,the shape of visual field defects were mainly arcuate scotoma,78.94%.In the advanced stage,the shape of visual field defects were mainly ring scotoma and temporal island,60.83%and 35%.2?In the mild stage,the most common visual field defects were nasal area and arcuate 1,67.44%and 72.1%.In the moderate stage,the most common visual field defects were arcuate 1,nasal area and paracentral.In the advanced stage,visual field defects of each area were severe,but the central area had a better visual field in three severity levels.3?In the mild stage,there were no significant differences in the MD and PD value of each area between the superior hemifield and their inferior counterparts.In the moderate stage,except for nasal area,the other four areas in the superior hemifield were more worse MD than inferior counterparts,the five areas in the superior hemifield were more worse PD than their inferior counterparts.In the advanced stage,except for nasal area,the other four areas in the superior hemifield were more worse MD and PD than their inferior counterparts.4?The pattern of visual field loss was different in POAG and APACG,in the mild stage of PO AG,the type of visual field defects were mainly localized defects,36.4%.In the moderate and advanced stages,the type of visual field defects were mainly mixed defects,71.9%and 68.2%.In the mild stage of APACG,the type of visual field defects were mainly generalized defects(64.3%).In the moderate stages,the type of visual field defects were mainly mixed defects(60.9%).In the advanced stages,the type of visual field defects were mainly generalized defects(56.1%).5?In the mild stage,the arcuate 2,paracentral and central areas of superior and inferior hemifield had worse MD value in APACG when compared with the superior and inferior hemifield of POAG.Inferior nasal area of POAG were worse PD than inferior nasal area of APACG.PD of other areas in the hemifield were no significant differences with POAG and APACG.In the moderate stage,there were no significant differences in the MD and PD value of superior hemifield between POAG and APACG,inferior five areas of APACG were worse PD and MD values than inferior five areas of POAG.In the advanced stages,the arcuate 1,nasal,paracentral and central areas of inferior hemifield had worse MD value in POAG when compared with the superior hemifield of APACG,there were no significant differences in the PD value of each area between POAG and APACG.Conclusion:1?In the mild stage of POAG,the shape of visual field defects were mainly paracentral scotoma and nasal steps.In the moderate stage,the shape of visual field defects were mainly arcuate scotoma.In the advanced stage,the shape of visual field defects were mainly ring scotoma and temporal island.2?In the mild stage of POAG,the most common area of visual field defects was nasal area and arcuate 1.In the moderate stage,the most common area of visual field defects was arcuate land nasal area and paracentral In the advanced stage,each area visual field defects were severe,but the central area had a better visual field defect in the three severity levels.3?In the mild stage of POAG,there were no significant differences of each area between the superior hemifield and their inferior counterparts.In the moderate stage,the five areas in the superior hemifield were more worse visual field defects than inferior counterparts.In the advanced stage,except for nasal area,the other four areas in the superior hemifield were more worse visual field defects than inferior counterparts.4?In the mild stage of POAG,the type of visual field defects were mainly localized defects.As for APACG,the type of visual field defects were mainly generalized defects.5?In the mild stage,the visual field defect were no significant differences POAG and APACG.In the moderate stage,visual field defect of inferior five areas of APACG were worse than inferior five areas of POAG.In the advanced stages,the visual field defect were no significant differences POAG and APACG.