Patterns of optic disk damage in patients with early focal visual field loss

PURPOSE: To study the patterns of structural damage of the optic disk in pa tients with early focal visual field loss using a confocal scanning laser o phthalmoscope. METHODS: Thirty-nine subjects with repeatable early focal visual field loss were included. The Heidelberg:Retina Tomograph (Heidelberg Engineering, He idelberg, Germany) was used to obtain topographic optic disk measurements, For analysis of structural damage, the topographic measurements were divide d into 36 10-degree sectors, Sector analysis was performed using sector rim area to sector disk area ratio. Patients were assigned to one of three gro ups based on the measurement of the optic disk damage: (1) diffuse disk dam age; (2) focal disk damage; or (3) no detectable disk damage. RESULTS: Approximately half of the patients with early focal glaucomatous v isual field loss showed diffuse optic disk damage, one quarter to one third had focal damage, and one sixth had no detectable damage. Optic disk area was smallest in the no-detectable-damage group (1.71 + 0.19 mm(2)), followe d by the focal damage group (2.06 + 0.54 mm(2)), and was largest in the dif fuse damage group (2.29 + 0.48 mm(2); P = .22), CONCLUSION: In patients with early focal glaucomatous visual field loss, ob servable optic disk damage can be diffuse, focal, or undetectable. The Heid elberg Retina Tomograph may be capable of detecting different patterns of d iffuse or focal structural damage. (Am J Ophthalmol 1998; 126:763-771, (C) 1998 by Elsevier Science Inc. All rights reserved.).