Spatial analyses of glaucomatous visual fields; a comparison with traditional visual field indices

False Positive Responses in Standard Automated Perimetry

PURPOSE

To analyze the relationship between rates of false positive (FP) responses and standard automated perimetry results.

DESIGN

Prospective multicenter cross-sectional study.

METHODS

One hundred twenty-six patients with manifest or suspect glaucoma were tested with Swedish Interactive Thresholding Algorithm (SITA) Standard, SITA Fast, and SITA Faster at each of 2 visits. We calculated intervisit differences in mean deviation (MD), visual field index (VFI), and number of statistically significant test points as a function of FP rates and also as a function of general height (GH).

RESULTS

Increasing FP values were associated with higher MD values for all 3 algorithms, but the effects were small, 0.3 dB to 0.6 dB, for an increase of 10 percentage points of FP rate, and for VFI even smaller (0.6%-1.4%). Only small parts of intervisit differences were explained by FP (r² values 0.00-0.11). The effects of FP were larger in severe glaucoma, with MD increases of 1.1 dB to 2.0 dB per 10 percentage points of FP, and r² values ranging from 0.04 to 0.33. The numbers of significantly depressed total deviation points were affected only slightly, and pattern deviation probability maps were generally unaffected. GH was much more strongly related to perimetric outcomes than FP.

CONCLUSIONS

Across 3 different standard automated perimetry thresholding algorithms, FP rates showed only weak associations with visual field test results, except in severe glaucoma. Current recommendations regarding acceptable FP ranges may require revision. GH or other analyses may be better suited than FP rates for identifying unreliable results in patients who frequently press the response button without having perceived stimuli.

Development and clinical deployment of a smartphone-based visual field deep learning system for glaucoma detection

By 2040, ~100 million people will have glaucoma. To date, there are a lack of high-efficiency glaucoma diagnostic tools based on visual fields (VFs). Herein, we develop and evaluate the performance of 'iGlaucoma', a smartphone application-based deep learning system (DLS) in detecting glaucomatous VF changes. A total of 1,614,808 data points of 10,784 VFs (5542 patients) from seven centers in China were included in this study, divided over two phases. In Phase I, 1,581,060 data points from 10,135 VFs of 5105 patients were included to train (8424 VFs), validate (598 VFs) and test (3 independent test sets-200, 406, 507 samples) the diagnostic performance of the DLS. In Phase II, using the same DLS, iGlaucoma cloud-based application further tested on 33,748 data points from 649 VFs of 437 patients from three glaucoma clinics. With reference to three experienced expert glaucomatologists, the diagnostic performance (area under curve [AUC], sensitivity and specificity) of the DLS and six ophthalmologists were evaluated in detecting glaucoma. In Phase I, the DLS outperformed all six ophthalmologists in the three test sets (AUC of 0.834-0.877, with a sensitivity of 0.831-0.922 and a specificity of 0.676-0.709). In Phase II, iGlaucoma had 0.99 accuracy in recognizing different patterns in pattern deviation probability plots region, with corresponding AUC, sensitivity and specificity of 0.966 (0.953-0.979), 0.954 (0.930-0.977), and 0.873 (0.838-0.908), respectively. The 'iGlaucoma' is a clinically effective glaucoma diagnostic tool to detect glaucoma from humphrey VFs, although the target population will need to be carefully identified with glaucoma expertise input.

Threshold Static Automated Perimetry of the Full Visual Field in Idiopathic Intracranial Hypertension

Purpose

To characterize visual loss across the full visual field in idiopathic intracranial hypertension (IIH) patients with mild central visual loss.

Methods

We tested the full visual field (50° nasal, 80° temporal, 30° superior, 45° inferior) of 1 eye of 39 IIH patients by using static perimetry (size V) with the Open Perimetry Interface. Participants met the Dandy criteria for IIH and had at least Frisén grade 1 papilledema with better than -5 dB mean deviation (MD) centrally. Two observers (MW and AS) evaluated the visual field defects, adjudicated any differences, and reviewed optical coherence tomography data.

Results

We found a greater MD loss peripherally than centrally (central 26°). The median MD (and corresponding median absolute deviations) was -1.37 dB (1.61 dB) for the periphery and -0.77 dB (0.87 dB) for the central 26°, P < 0.001. There were about 30% more abnormal test locations identified in the periphery (P = 0.12), and the mean defect depth increased with eccentricity (P < 0.001). The most frequent defect found was a temporal wedge (23% of cases) in the periphery with another 23% that included this sector with inferior temporal loss. Although the presence of papilledema limited correlation, 55% of the temporal wedge defects had optical coherence tomography retinal nerve fiber layer deficits in the corresponding superonasal location. Other common visual field defects were inferonasal loss, superonasal loss, and superior and inferior arcuate defects. Seven patients (18%) had visual field defects in the periphery with normal central visual field testing.

Conclusion

In IIH patients, we found substantial visual loss both outside 30° of the visual field and inside 30° with the depth of the defect increasing linearly with eccentricity. Temporal wedge defects were the most common visual field defect in the periphery. Static threshold perimetry of the full visual field appears to be clinically useful in IIH patients.

Comparison of regression models for serial visual field analysis

PURPOSE

Our aim was to compare fit and predictive performance effectiveness of four pointwise regression models in measuring the visual field (VF) decay rate of progression in patients with open-angle glaucoma.

METHODS

We selected Humphrey VF data of patients with open-angle glaucoma with a minimum follow-up time of 6 years. For each eye (n = 798 from 588 patients), we regressed threshold sensitivity (y) at each VF test location for the entire VF series against follow-up time (x), with four candidate first-order regression models: (1) ordinary least-squares linear regression model (y = β 0 + β 1 x); (2) nondecay exponential regression model (y = β 0 + β 1e (x) ); (3) decay exponential regression model ([Formula: see text]); (4) Tobit-censored, maximum-likelihood linear regression model (y* = [Formula: see text], ε ~ N(0, σ(2))), where x is follow-up time and y is threshold sensitivity.

RESULTS

The average [± standard deviation (SD)] baseline VF mean deviation (MD) was -8.2 (±5.5) dB, the mean follow-up was 8.7 (±1.9) years, and the number of follow-up VFs was 14.7 (±4.4). The decay exponential model was the best-fitting (42.7 % of locations) and best-forecasting (65.5 % of locations) model. The decay exponential model was the best prediction model in all categories of severity.

CONCLUSIONS

It is not clear that the ordinary least-squares linear regression model is always the favored model for fitting and forecasting VF data in patients with glaucoma. The pointwise decay exponential regression (PER) model was the best-fitting and best-predicting model across a wide range of glaucoma severity and can be readily understood by clinicians.

Baseline visual field findings in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT)

PURPOSE

To characterize visual field (VF) loss at the baseline visit and to evaluate VF quality control (QC) procedures in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).

METHODS

The Visual Field Reading Center (VFRC) evaluated 660 baseline VFs (1320 hemifields) from 165 enrolled patients. Three readers independently classified each superior and inferior hemifield and identified any abnormalities. A subset (20%) of the hemifields was reread to evaluate within- and between-reader agreements. The QC system addressed test parameters, patient data, and shipment errors.

RESULTS

The majority (60%) of the baseline hemifields consisted of localized nerve fiber bundle-type VF loss. Approximately one-third (31.5%) of all the classifications consisted of partial arcuate defects combined with an enlarged blind spot, making this the most common type of hemifield classification. Inferior hemifield loss was greater than superior loss for both study and nonstudy eyes. Reader agreements were >90% for both inferior and superior hemifields for two out of three readers. Test-retest reliability agreement for individual readers was 95% for both hemifields. There were few QC errors with only 5.48 error points per 100-point VF.

CONCLUSIONS

The most common type of IIHTT baseline hemifield abnormality was a localized nerve fiber bundle-like defect. Localized inferior hemifield loss was more common than superior hemifield loss. Quality control and within- and between-reader agreement were excellent for the IIHTT (ClinicalTrials.gov number, NCT01003639).

Repeatability of Normal Multifocal VEP: Implications for Detecting Progression

PURPOSE

To assess the repeatability of the multifocal visual evoked potential (mfVEP) and to compare it with the repeatability of standard automated perimetry (SAP) in the same group of 50 normal controls retested after 1 year. Our second aim was to assess the repeatability of false alarm rates determined previously for the mfVEP using various cluster criteria.

METHODS

Fifty individuals with normal vision participated in this study (33 females and 17 males). The age range was 26.7 to 77.9 years and the group average age (+/- SD) was 51.4 (+/- 12.1) years. Pattern-reversal mfVEPs were obtained using a dartboard stimulus pattern in VERIS and two 8-minute runs per eye were averaged. The average number of days between the first and second mfVEP tests was 378 (+/- 58). SAP visual fields were obtained within 17.4 (+/- 20.3) days of the mfVEP using the SITA-standard threshold algorithm. Repeatability of mfVEPs and SAP total deviation values were evaluated by calculating point-wise limits of agreement (LOA). Specificity (1-false alarm rate) was evaluated for a range of cluster criteria, whereby the number and probability level of the points defining a cluster were varied.

RESULTS

Point-wise LOA for the mfVEP signal-to-noise ratio (SNR) ranged from 2.0 to 4.3 dB, with an average of 2.9 dB across all 60 locations. For SAP, LOA ranged from 2.4 to 8.9 dB, with an average of 4.0 dB (excluding the points immediately above and below the blind spot). Clusters of abnormal points were not likely to repeat on either mfVEP or SAP. When an mfVEP abnormality was defined as the repeat presence (confirmation) of a 3-point (P < 0.05) cluster anywhere within a single hemifield, only 1 (of 200) monocular hemifield was deemed abnormal. Although the LOA of the mfVEP were similar throughout the field, the limited dynamic range of SNR at superior field locations will limit the ability to follow progression in "depth" at those locations.

CONCLUSIONS

Repeatability of the mfVEP was slightly better than SAP visual fields in this group of controls with a 1-year retest interval. This suggests that progression in early stages should be more easily detectable by mfVEP. However, in certain field locations (eg, superior periphery), the relatively more narrow dynamic range of the SNR of the mfVEP may limit detection of progression to just 1 event. Confirmation of a 3-point cluster abnormality is highly suggestive of a true defect on the mfVEP.

Comparison of Diagnostic Ability between a Fast Strategy, Tendency-Oriented Perimetry, and the Standard Bracketing Strategy

PURPOSE

To compare the diagnostic abilities of the standard bracketing strategy (BR) and a fast strategy, the tendency-oriented perimetry (TOP).

METHODS

Seventy-seven controls and 91 eyes from patients with glaucoma were analyzed with the strategies TOP and BR. Sensitivity (Se), specificity (Sp), the area under the receiver operating characteristic (ROC) curve (AC) and the optimum cutoff value (CO) were calculated for the visual field indices mean defect (MD), the square root of the loss variance (sLV) and the number of pathological points (NPP).

RESULTS

In the glaucoma group, the mean MD value using TOP and BR was 7.5 and 8.3 dB, respectively. The mean sLV value using TOP and BR was 5.0 and 5.3 dB, respectively. Indices provided by TOP had higher ROC values than the ones provided by BR. Using TOP, the index with the best diagnostic ability was sLV (Sp = 94.8, Se = 90.1, AC = 0.966, CO = 2.5 dB), followed by NPP and MD. Using BR, the best results were obtained for MD (Sp = 92.2, Se = 81.3, AC = 0.900, CO = 2.5 dB) followed by sLV and NPP.

CONCLUSIONS

A fast strategy, TOP, had superior diagnostic ability than the standard BR. Although TOP provided lower LV values than BR, the diagnostic ability of this index was higher than that of the conventional strategy.

Peristat: a computer-based perimetry self-test for cost-effective population screening of glaucoma

PURPOSE

Peristat is a virtual perimetry system that allows self-testing on any standard computer monitor via Internet connection. The sensitivity and specificity of Peristat to detect visual-field defects were compared to standard Humphrey Visual Field Analyzer data.

MATERIALS AND METHODS

In this prospective, comparative observational case series, 58 eyes of 33 patients were examined. Semiquantitative analyses compared Peristat and Humphrey Visual-Field scores. The study evaluated patients with an established glaucoma diagnosis, as well as glaucoma suspects who had undergone comprehensive ophthalmologic examinations including prior office perimetry evaluation (Humphrey Field Analyzer). Inclusion criteria were (1) diagnosis or suspicion of glaucoma, (2) BCVA better than 20/200, (3) reliable performance on prior standardized office perimetry, and (4) CDR greater than 0.5. Computer literacy was not required, and more than 40% of the patients tested were computer illiterate, with no previous computer or Internet experience. A total of 58 eyes of 33 patients were tested with the Humphrey and the Peristat systems: 10 eyes of 5 patients without documented glaucomatous field loss and 48 eyes of 23 patients with mild-to-severe scotomas by standard 24-2 office perimetry. A standard computer setup was used with a 17" monitor, and the Peristat system was enabled through a remote connection with a server.

RESULTS

All patients completed the Peristat test without difficulty. Testing time varied between 2 and 5 min, tending to be longer with more severe visual-field defects. Test results were reviewed, in a masked fashion, by two glaucoma specialists and one general ophthalmologist. The Peristat demonstrated a high degree of correlation with the Humphrey system. Among the three reviewers, sensitivity ranged from 80% to 83%. In a second subanalysis in which cases with mild defects were excluded, the Peristat's sensitivity increased to 84%-86% while specificity remained between 94% and 97% for all three reviewers. Patients performed the Peristat test with similar facility to their Humphrey test. Fixation losses and test reliability were comparable for both tests.

CONCLUSIONS

Peristat is a reliable self-test perimetry system that demonstrates high clinical utility for the detection of visual-field defects from glaucoma. Peristat could be a valuable public health tool for cost-effective screening of glaucoma.

Intraocular pressure and visual field loss in primary angle closure and primary open angle glaucomas

AIM

To compare the correlation between visual field loss and the pretreatment intraocular pressure (IOP) in primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG).

METHODS

In a cross sectional observational study of 74 patients (43 PACG, 31 POAG), pretreatment IOP was measured at presentation, before treatment was initiated. The severity of visual field loss was assessed by AGIS score, mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD). Glaucomatous optic neuropathy was assessed from simultaneous stereo disc photographs.

RESULTS

There was a stronger correlation between pretreatment IOP and the extent of visual field loss in PACG subjects than in those with POAG for both MD (PACG: Pearson correlation coefficient (r) = 0.43, p = 0.002; r(2) = 0.19), (POAG: r = 0.21, p = 0.13; r(2) = 0.04) and AGIS score (PACG: r = 0.41, p = 0.003; r(2) = 0.17), (POAG: r = 0.23, p = 0.19; r(2) = 0.05 respectively). No such associations were seen for pattern standard deviation (PSD) or corrected pattern standard deviation (CPSD) in either group (p> 0.29). Both horizontal and vertical cup-disc ratio were well correlated with severity of field loss but not with presenting IOP for either diagnosis.

CONCLUSIONS

This is consistent with the hypothesis of a greater IOP dependence for optic nerve damage in PACG than POAG and, conversely, a greater importance of other, less pressure dependent mechanisms in POAG compared to PACG.

Mapping the visual field to the optic disc in normal tension glaucoma eyes

PURPOSE

To establish the anatomical relationship between visual field test points in the Humphrey 24-2 test pattern and regions of the optic nerve head (ONH) DESIGN: Cross-sectional study.

PARTICIPANTS

Glaucoma patients and suspects from the Normal Tension Glaucoma Clinic at Moorfields Eye Hospital.

METHODS

Sixty-nine retinal nerve fiber layer (RNFL) photographs with well-defined RNFL defects and/or prominent bundles were digitized. An appropriately scaled Humphrey 24-2 visual field grid and an ONH reference circle, divided into 30 degrees sectors, were generated digitally. These were superimposed onto the RNFL images. The relationship of visual field test points to the circumference of the ONH was estimated by noting the proximity of test points to RNFL defects and/or prominent bundles. The position of the ONH in relation to the fovea was also noted.

MAIN OUTCOME MEASURES

The sector at the ONH corresponding to each visual field test point, the position of the ONH in relation to the fovea, and the effect of the latter on the former.

RESULTS

A median 22 (range, 4-58), of a possible 69, ONH positions were assigned to each visual field test point. The standard deviation of estimations was 7.2 degrees. The position of the ONH was 15.5 degrees (standard deviation 0.9 degrees ) nasal and 1.9 degrees (standard deviation 1.0 degrees ) above the fovea. The location of the ONH had a significant effect on the corresponding position at the ONH for 28 of 52 visual field test points.

CONCLUSIONS

A clinically useful map that relates visual field test points to regions of the ONH has been produced. The map will aid clinical evaluation of glaucoma patients and suspects, as well as form the basis for investigations of the relationship between retinal light sensitivity and ONH structure.

Improving the prediction of visual field progression in glaucoma using spatial processing

PURPOSE

The authors show how the predictive performance of a method for determining glaucomatous progression in a series of visual fields can be improved by first subjecting the data to a spatial processing technique.

METHOD

Thirty patients with normal-tension glaucoma, each with at least ten Humphrey fields and 3.5 years of follow-up, were included. A linear regression model of sensitivity against time of follow-up determined rates of change at individual test locations over the first five fields (mean follow-up 1.46 years; standard deviation = 0.08) in each field series. Predictions of sensitivity at each location of the field nearest to 1 and 2 years after the fifth field were generated using these rates of change. Predictive performance was evaluated by the difference between the predicted and measured sensitivity values. The analysis was repeated using the same field data subjected to a spatial filtering technique used in image processing.

RESULTS

Using linear modeling of the unprocessed field series, at 1 year after the fifth field, 72% of all predicted values were within +/- 5 dB of the corresponding measured threshold. This prediction precision improved to 83% using the processed data. At the 2-year follow-up field, the predictive performance improved from 56% to 73% with respect to the +/- 5 dB criterion.

CONCLUSIONS

Predictions of visual field progression using a pointwise linear model can be improved by spatial processing without increased cost or patient time. These methods have clinical potential for accurately detecting and forecasting visual field deterioration in the follow-up of glaucoma.

Value of logistic discriminant analysis for interpreting initial visual field defects

PURPOSE

The authors evaluate logistic discriminant analysis as a method for interpreting visual field results in initial stages of several ophthalmic diseases.

METHODS

The authors retrospectively studied the visual field defects of 96 patients with early glaucomatous damage and prospectively studied 84 subjects with normal eyes (n = 28), cataracts (n = 27), diabetic retinopathy (n = 14), or hypertensive retinopathy (n = 15). The visual fields were examined at least twice with program G1 of Octopus 500 (Interzeag AG, Schlieren, Switzerland). Only one eye per patient was randomly selected and included in the study. The authors created a database with all visual field information provided by Octopus and applied logistic discriminant analysis (SAS Logistic Procedures, SAS Institute, Cary, NC) to obtain classification rules capable of qualifying visual field defects as glaucomatous or nonglaucomatous. The rules were tested with an independent sample.

RESULTS

There were significant differences between the groups in the distribution of visual field defects tested by program G1. Logistic discriminant analysis correctly identified the glaucomatous or nonglaucomatous origin of the defects with a sensitivity of 65% to 85% and a specificity of 60% to 92%.

CONCLUSIONS

Logistic discriminant analysis is a useful tool to aid in the interpretation of early glaucomatous and nonglaucomatous visual field defects.

Analysis of visual field progression in glaucoma

BACKGROUND

Despite the widespread use of computerised perimetry the diagnosis of visual field deterioration in following glaucoma patients over time remains particularly difficult. A new method of analysis using a novel graphical display of longitudinal field data is presented.

METHODS

A linear regression model of the luminance sensitivity at each stimulus location against time of follow up transforms the quantitative data from a series of fields into a colour coded form which illustrates the spatial configuration of change to aid the interpretation of field loss. The method of analysis and the developed computer software (PROGRESSOR) is described. Comparison with STATPAC-2 glaucoma change probability analysis is given including levels of agreement between the techniques using series of fields of 10 eyes from patients with normal tension glaucoma.

RESULTS

Examples of this new method compare well with STATPAC-2 analysis. The level of agreement between the techniques to separate progressing from stable retinal locations is good (kappa = 0.62; SE = 0.04).

CONCLUSIONS

This new technique, which combines the change in perimetric sensitivity over time with colour coding of significant change into one image may provide an efficient method to detect true progression in glaucomatous field loss.

Modelling series of visual fields to detect progression in normal-tension glaucoma

BACKGROUND

Use of statistical modelling techniques to identify models that both describe glaucomatous sensitivity decay and allow predictions of future field status.

METHOD

Twelve initially normal fellow eyes of untreated patients with confirmed normal tension glaucoma were studied. All had in excess of 15 Humphrey fields (mean follow-up 5.7 years). From this cohort individual field locations were selected for analysis if they demonstrated unequivocal deterioration at the final two fields. Forty-seven locations from five eyes satisfied this criterion and were analysed using curve-fitting software which automatically applies 221 different models to sensitivity (y) against time of follow up (x). Curve-fitting was then repeated on the first five fields, followed by projection to the date of the final field to generate a predicted threshold which was compared to the actual threshold. Competing models were therefore assessed on their performance at adequately fitting the data (R2) and their potential to predict future field status.

RESULTS

Models that provide the best fit to the data were all complex polynomial expressions (median R2 0.93). Other simple expressions fitted fewer locations and exhibited lower R2 values. However, accuracy in predicting future deterioration was superior with these less complex models. In this group a linear expression demonstrated an adequate fit to the majority of the data and generated the most accurate predictions of future field status.

CONCLUSIONS

A linear model of the pointwise sensitivity values against time of follow-up can provide a framework for detecting and forecasting glaucomatous field progression. Linear modelling allows the clinically important rate of sensitivity loss to be estimated.

New approach to estimating variability in visual field data using an image processing technique

AIMS

A new framework for evaluating pointwise sensitivity variation in computerised visual field data is demonstrated.

METHODS

A measure of local spatial variability (LSV) is generated using an image processing technique. Fifty five eyes from a sample of normal and glaucomatous subjects, examined on the Humphrey field analyser (HFA), were used to illustrate the method.

RESULTS

Significant correlation between LSV and conventional estimates--namely, HFA pattern standard deviation and short term fluctuation, were found.

CONCLUSION

LSV is not dependent on normals' reference data or repeated threshold determinations, thus potentially reducing test time. Also, the illustrated pointwise maps of LSV could provide a method for identifying areas of fluctuation commonly found in early glaucomatous field loss.

Comparison of high-pass resolution perimetry and standard automated perimetry in glaucoma

PURPOSE

We sought to ascertain whether high-pass resolution perimetry would provide results comparable to those of standard perimetry.

METHODS

Thirty-four eyes with primary open-angle glaucoma, 37 eyes suspected of having glaucoma, and 36 normal control eyes were matched for age and lens density. We controlled for refraction, pupil size, and learning effects. Standard and ring visual fields were obtained with the Humphrey perimeter and the Frisén ring perimeter, respectively. Each test was judged according to the Glaucoma Hemifield Test (a statistical visual field analysis method) to be outside normal limits (abnormal) or not outside normal limits (normal or borderline).

RESULTS

Under these conditions, both tests identified 19 of 34 (56%) glaucoma eyes as outside normal limits. High-pass resolution perimetry determined that 34 of 36 (94%) normal eyes were not outside normal limits; standard perimetry determined that all 36 normal eyes were not outside normal limits. High-pass resolution perimetry determined 12 of 37 (32%) eyes that were glaucoma suspects were outside normal limits; standard perimetry determined three of the 37 (8%) glaucoma suspect eyes were outside normal limits. Overall agreement between the two tests was 65%.

CONCLUSION

With the Glaucoma Hemifield Test, high-pass resolution perimetry was comparable to standard perimetry in sensitivity and specificity, and identified a slightly higher percentage of patients at risk for glaucoma as abnormal. These results suggest that high-pass resolution perimetry should continue to be explored as an alternative to standard perimetry for the diagnosis and treatment of glaucoma.

Diffuse visual field loss and glaucoma

It is often claimed that general reduction, or diffuse loss, of perimetric sensitivity is an early sign of glaucoma. Our clinical experience and the results of a few other studies led us to believe otherwise. To investigate factors associated with diffuse field loss we reviewed 4222 Humphrey 30-2 threshold tests from 1582 eyes of 862 patients followed at our department. Most of these patients had ocular hypertension or glaucoma. Each field test was evaluated with the Glaucoma Hemifield Test of the Statpac 2 program. The Glaucoma Hemifield Test classifies field test results as within or outside normal limits regarding localized field loss and general shifts in sensitivity. General reduction of sensitivity without concomitant localized loss was found in 117 tests from 81 eyes of 69 patients. Corresponding patient records were found for 60 eyes of 60 patients. Media opacities or miotic therapy were noted in 46 eyes (77%), 10 eyes (17%) had end-stage field loss, and in 2 eyes (3%) other non-glaucomatous ocular pathology explained the diffuse loss of sensitivity. Thus, general reduction of differential light sensitivity as an isolated finding was almost always associated with reasons other than early to moderate glaucoma in this material mainly consisting of patients with glaucoma or increased intraocular pressure. Since only 2 out of the 1582 eyes had general reduction of sensitivity that was not explained by non-glaucomatous reasons, we conclude that purely diffuse field loss was not a sign of glaucoma.