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Catherine Boden, PhD; Pamela A. Sample, PhD; Andreas G. Boehm, MD; Christiana Vasile, MD; Radha Akinepalli, BS; Robert N. Weinreb, MD

Arch Ophthalmol. 2002;120:907-912.

Objective  To evaluate the relationship between visual field loss and glaucomatous optic discs in eyes in which field loss spreads across the horizontal meridian.

Subjects and Methods  Ninety-six patients with glaucoma (9 advanced, 60 moderate, and 27 early) with 2 successive abnormal fields were included. Standard achromatic automated perimetry defects were identified with a nerve fiber bundle map to identify abnormal sectors. Crossover was present if the superior and inferior sectors at the horizontal meridian (nasal, central, or temporal) were both abnormal. Optic disc damage was assessed by masked grading of simultaneous stereophotographs.

Results  Only 30% (29) of glaucomatous eyes showed crossover, and only 2 of those eyes had early loss. The most frequent pattern of visual field loss (41% of eyes) was single hemifield damage with defects in contiguous sectors. Regardless of the pattern or severity of visual loss, most eyes (66 [69%] of 96) had both superior and inferior optic disc damage.

Conclusions  Early glaucomatous visual field loss rarely crosses the horizontal meridian, but defects in both hemifields at the horizontal meridian are more common in more advanced field loss. In 26 (90%) of 29 eyes with crossover, it could be explained by changes at the optic nerve head.

From the Glaucoma Center and the Visual Function Laboratory, Department of Ophthalmology, University of California, San Diego (Drs Boden, Sample, Boehm, Vasile, and Weinreb and Ms Akinepalli), and the Department of Ophthalmology, University of Dresden, Dresden, Germany (Dr Boehm).

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