Characteristic Glaucomatous Visual Field Defects

Primary Patterns of Visual Field Loss

Glaucomatous visual field defects follow specific patterns including arcuate scotomas, nasal steps, paracentral scotomas, and generalized depression, with defects respecting the horizontal midline and corresponding to retinal nerve fiber layer damage, as noted by the American Academy of Ophthalmology 1
Paracentral scotoma is an isolated defect in clusters of test sites near fixation, often appearing early in the disease, according to the American Academy of Ophthalmology 1

Visual field defects in glaucoma demonstrate horizontal midline respect, where visual field loss across the horizontal midline in one hemifield exceeds loss in the opposite hemifield, particularly in early to moderate cases, as stated by the American Academy of Ophthalmology 1
Visual field defects must be consistent with retinal nerve fiber layer (RNFL) damage patterns, as emphasized by the American Academy of Ophthalmology 1
New glaucomatous defects require confirmation on repeat testing before establishing progression, with a strength of evidence supported by the American Academy of Ophthalmology 2, 3

Automated 10-2 central visual field testing can discern central defects missed by wider field perimetry, as recommended by the American Academy of Ophthalmology 4

The American Academy of Ophthalmology guidelines specify that standard automated perimetry (SAP) with white-on-white stimuli remains the gold standard for visual field evaluation, with a high level of evidence 3, 5
Testing strategies should be tailored using 24-degree, 30-degree, and 10-degree programs based on disease severity, as suggested by the American Academy of Ophthalmology 2, 3
Goldmann visual fields (manual kinetic/static threshold testing) serve as an acceptable alternative when automated perimetry is unreliable or unavailable, according to the American Academy of Ophthalmology 2, 3
Confirmation testing is essential before changing treatment when new defects appear or results are unreliable, as stated by the American Academy of Ophthalmology 3

Frequency doubling technology measures contrast sensitivity and demonstrates high sensitivity/specificity for detecting defects predictive of later SAP loss, as noted by the American Academy of Ophthalmology 5
Short-wavelength automated perimetry (SWAP) isolates short-wavelength sensitive cells but has not demonstrated clear advantages over SAP in clinical trials, according to the American Academy of Ophthalmology 2, 5

The American Academy of Ophthalmology recommends not relying solely on 24-2 or 30-2 testing in early glaucoma, as central 10-degree defects may be missed; consider adding 10-2 testing when macular involvement is suspected 4
The American Academy of Ophthalmology advises not to diagnose progression on a single abnormal test; always confirm with repeat testing using the same strategy, with a moderate level of evidence 3
The American Academy of Ophthalmology suggests excluding non-glaucomatous causes before attributing visual field defects to glaucoma, including optic disc drusen, optic nerve pits, and retinal or neurological pathology, with a high level of evidence 1