This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Glaucoma  • Ophthalmological Disorders, Other  • Alert me on articles by topic

Steven L. Mansberger, MD; Pamela A. Sample, PhD; Linda Zangwill, PhD; Robert N. Weinreb, MD

Arch Ophthalmol. 1999;117:1473-1477.

Objective  To evaluate visual function and optic disc features in patients with large cup-disc ratios (C/Ds).

Methods  One eye of 86 patients with vertical C/Ds by contour of at least 0.8, who had undergone both standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) testing, was selected retrospectively. Two masked glaucoma specialists independently graded stereoscopic photographs for vertical C/Ds, rim thinning, notching, excavation, optic disc hemorrhages, and nerve fiber layer defects. Visual fields were classified as abnormal if the glaucoma hemifield test result, corrected pattern standard deviation, or mean deviation was outside age-specific normal limits. Confocal scanning laser ophthalmoscopy was used to determine disc area.

Results  SAP and SWAP results were abnormal in 44 (51%) and 52 (60%) of 86 patients, respectively. In patients with normal SAP results, SWAP results were abnormal in 14 (33%) of 42 patients. In patients with normal SWAP results, SAP results were abnormal in 6 (18%) of 34 patients. Small discs are associated with an abnormal SAP result (P=.01) and an abnormal SWAP result (P=.09). An increased vertical C/D greater than the qualifying level of 0.8 was associated with an abnormal SAP or SWAP result (P.001). Rim thinning (P=.01) and disc hemorrhages (P=.04) were associated with an abnormal SAP result.

Conclusions  Many patients with large C/Ds have normal SAP and SWAP results. Compared with SAP, SWAP results were abnormal in a higher percentage of these patients. If a patient has a large C/D and normal SAP results, SWAP testing may detect functional loss earlier. If glaucoma is defined by both structural and functional loss, patients with large vertical C/Ds, normal SAP results, and abnormal SWAP results may have glaucoma. Longitudinal studies are needed to assess this hypothesis and determine whether these patients subsequently develop abnormal SAP results as well.

From the Glaucoma Center and Department of Ophthalmology, University of California, San Diego.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Comparing Multifocal VEP and Standard Automated Perimetry in High-Risk Ocular Hypertension and Early Glaucoma
Fortune et al.
IOVS 2007;48:1173-1180.
ABSTRACT | FULL TEXT  

Detection of psychophysical and structural injury in eyes with glaucomatous optic neuropathy and normal standard automated perimetry.
Bagga et al.
Arch Ophthalmol 2006;124:169-176.
ABSTRACT | FULL TEXT  

Detecting Early Glaucoma by Assessment of Retinal Nerve Fiber Layer Thickness and Visual Function
Bowd et al.
IOVS 2001;42:1993-2003.
ABSTRACT | FULL TEXT