Purpose: To determine if automated perimetry detects visual field defects before manual Goldmann perimetry. Methods: Subjects with ocular hypertension without field loss on detailed manual perimetry were followed prospectively with annual automated and manual perimetry. Subjects with field loss on manual perimetry were age-matched post hoc to subjects who did not have field loss. The automated fields 1 year before the development of field loss on manual perimetry were compared between the two groups. Subjects were recruited from ophthalmologists' offices, eye clinics, and a population-based glaucoma survey in the Baltimore area. Abnormal results detected on the Humphrey Field Analyzer were defined using the glaucoma hemifield test, mean defect, and corrected-pattern standard deviation. Results: Forty subjects who had field loss during 8 years of follow-up were compared with 145 control subjects with ocular hypertension who did not have defects. Seventy-five percent of converters had abnormal results of the glaucoma hemifield test 1 year before field loss on manual perimetry, whereas 22% of controls had abnormal results of the glaucoma hemifield test (odds ratio, 13.4). The odds ratio of field loss developing on manual perimetry within 12 months was 3.3 for those with borderline results of the glaucoma hemifield test relative to the control subjects. The odds ratio was 6.0 for corrected-pattern standard deviation (P < 0.05) and 3.9 for mean deviation (P < 0.05). Conclusions: Those with field loss on manual perimetry were more likely to have had an abnormal automated field 1 year before conversion than those who did not convert. However, 22% of subjects in whom definitive field loss did not develop on manual perimetry during the study had abnormal automated fields at one visit and 15% had abnormal automated fields on two consecutive visits.
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