Evaluation of central and peripheral visual field concordance in glaucoma

Purpose: The purpose of this study was to characterize the extent to which central visual field (VF) loss reflects peripheral VF loss in patients with varying degrees of glaucoma severity. Methods: A total of 232 patients with glaucoma or suspect glaucoma completed static central VF testing using the 24-2 pattern and peripheral VF testing using the suprathreshold 30-60 pattern. Points from 24-2 tests were reclassified as normal/abnormal based on pattern deviation values. Results: Strong positive correlations (r ≥ 0.7) were observed between the proportion of abnormal central and peripheral points for the full VF, superior hemifield, and inferior hemifield, although the percentage of total central and peripheral abnormal points differed by ≥10% in 45% of eyes. In eyes with an average of 10%–40% abnormal points in the central and peripheral VFs, 12.0% more abnormal peripheral points were noted compared with the percentage of abnormal central points (P < 0.001; SD, 16.7%; range, 61% more to 37% less). In eyes with an average of 60%–90% abnormal points in the central and peripheral VFs, 16.4% fewer abnormal peripheral points were noted compared with the percentage of abnormal central points (P = 0.04; SD, 20.9%; range, 19% more to 49% less). Conclusions: Central 24-2 testing generally reflects the extent of damage to the more peripheral VF in glaucoma, although significant disagreement exists for individual eyes. Further work is needed to determine whether integration of peripheral test points can improve detection of true VF loss in early glaucoma or be useful in monitoring progressive glaucomatous damage to areas of preserved VF in advanced glaucoma.