Sl. Mansberger et al., Achromatic and short-wavelength automated perimetry in patients with glaucomatous large cups, ARCH OPHTH, 117(11), 1999, pp. 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) an
d short-wavelength automated perimetry (SWAP) testing, was selected retrosp
ectively. Two masked glaucoma specialists independently graded stereoscopic
photographs for vertical C/Ds, rim thinning, notching, excavation, optic d
isc hemorrhages, and nerve fiber layer defects. Visual fields ere classifie
d as abnormal if the glaucoma hemifield test result, corrected pattern stan
dard deviation, or mean deviation uas outside age-specific normal limits. C
onfocal 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 w
ere abnormal in 14 (33%) of 42 patients. In patients with normal SWAP resul
ts, SAP results were abnormal in 6 (18%) of 34 patients. Small discs are as
sociated 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 w
as associated with an abnormal SAP or SWAP result (P less than or equal to.
001). Rim thinning (P=.01) and disc hemorrhages (P=.04) were associated wit
h 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 t
hese patients. If a patient has a large C/D and normal SAP results, SWAP te
sting may detect functional loss earlier. If glaucoma is defined by both st
ructural 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.