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Expanded Visual Field Detects Macular Damage

■ The most common tests for glaucoma can underestimate the severity of the condition by not detecting central vision loss, according to a new Columbia University study. The 57-eye study, published in JAMA Ophthalmology, found that administering the expanded 10-2 variation of the visual field test that better assesses macular damage can improve diagnosis of glaucoma at no extra cost and an additional 10 minutes of examination time.

“When looking for signs of early glaucoma, clinicians tend to focus on loss of peripheral vision and seldom on the macula, which determines our ability to read, drive, and to see our children’s faces,” said Donald C. Hood, PhD, professor of ophthalmic science at Columbia University, who coauthored the study with C. Gustave De Moraes, MD, MPH, the medical director of clinical trials in the department of ophthalmology at Columbia University Irving Medical Center.

“Our work has shown that damage can and does occur in this area, and the most commonly used field test can fail to detect most of the damage,” Dr. Hood said. “It is important to detect this damage, because early diagnosis and treatment can prevent further vision loss.”

“In an early study, we found that in using the 10-2 visual field that over 75% of patients diagnosed with early glaucoma had central vision loss,” added Dr. Hood. Because conventional 24-2 tests often miss or underestimate damage in the central vision, it therefore underestimates disease severity.