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A Comparison of Primary Open-Angle Glaucoma and Primary Angle-Closure Glaucoma

Gus Gazzard, FRCOphth; Paul J. Foster, PhD, FRCS(Edin); Ananth C. Viswanathan, FRCOphth, MD; Joe G. Devereux, FRCOphth; Francis T. S. Oen, MMed(Sing); Paul T. K. Chew, MMed(Sing); Peng T. Khaw, PhD, FRCP, FRCOphth; Steve K. L. Seah, FRCS(Glasg)

Arch Ophthalmol. 2002;120:1636-1643.

Objective  To compare the characteristics of visual field defects in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG).

Methods  Subjects with primary glaucoma aged 30 years and older were prospectively considered for inclusion. Automated static white-on-white perimetry was performed. A minimum of 2 reliable tests was required with a mean deviation (MD) within 2 dB on 2 tests. Subjects with previous symptomatic angle-closure, normal-tension glaucoma, visually significant cataract, or previous intraocular surgery were excluded.

Results  Of 234 subjects assessed, 129 had POAG, and 105 had PACG. The MDs (POAG group, -13.3 dB; PACG group, -18.0 dB) indicated more severe visual loss in subjects with PACG. In subjects with POAG, the superior hemifield was more severely affected than the inferior. This was less pronounced in subjects with PACG. Following stratification by MD, the difference between hemifields was marked in the mild (-10 dBMD) and moderate (-20 dBMD<-10 dB) subgroups but was not present in the severe (MD<-20 dB) subgroup. We detected differences between POAG and PACG in retinal sensitivity between the superior and inferior hemifields, independent of severity of damage.

Conclusions  The pattern of visual field loss was different in the 2 diseases. This may give insight into the pattern of visual loss in predominantly pressure-dependent glaucomatous optic neuropathy.

From the Singapore National Eye Centre (Drs Gazzard, Foster, Devereux, Oen, Chew, and Seah); the Singapore Eye Research Institute (Drs Gazzard, Foster, and Seah); the Institute of Ophthalmology, University College London, London, England (Drs Gazzard, Foster, Viswanathan, Devereux, and Khaw); and the Glaucoma Research Unit, Moorfields Eye Hospital, London (Drs Gazzard, Foster, Viswanathan, and Khaw).