Samantha Slotnick


BACKGROUND: Pre-perimetric glaucoma refers to the indisputable presence of glaucoma in the absence of functional loss sufficient for detection by standard visual field (VF) techniques. Today’s standard of care relies upon VF defects to diagnose glaucoma in patients with borderline IOPs and/or inconclusive observations of disc anatomy. Therefore, many such patients will experience a substantial amount of damage to the nerve fiber layer (NFL) before any therapeutic intervention is first considered.
However, glaucoma Dx, Tx and Mx is advancing with a wave of new technologies which expand our available database and facilitate the early diagnosis of glaucoma through objective measurements. A discussion of the clinical assessment of glaucoma is supplemented with five clinical cases illustrating a definitive Dx of glaucoma in the presence of normal Sita Standard 24-2 VFs.

CASE REPORT(S): 1. PC showed a progression in cupping from .3 to .75, high IOPs, but maintained normal 24-2 VFs. Tx began after GDx demonstrated dramatic NFL loss. 2. JS lost approximately half the thickness of his NFL in 4 yrs after IOPs had risen to 39 mmHg OU. 24-2 VF remains normal. 3. EG has a strong FHx of glaucoma. IOPs rose steadily to 30 mmHg over 10 yrs; VFs remained clear. GDx reveals early glaucomatous NFL loss OD and pre-perimetric loss OS. 4. MG has a strong FHx of glaucoma, pigmentary dispersion syndrome, but normal IOPs. 24-2 VFs are essentially full with subtle inferior loss OU. GDx shows corresponding superior NFL loss OU, suggesting the VF defect is real and glaucomatous. 5. DJ experienced an increase in cupping from .4 to .7 over 5 yrs; IOPs remained low. Non-glaucomatous VF defects were scattered inferiorly. 60-4 VF showed temporal defects coinciding with nasal NFL loss on GDx.

CONCLUSIONS: Pre-perimetric glaucoma, a long-time nemesis of normotensive patients with diffuse NFL loss, is finally subject to early detection with the advent of computerized NFL analysis. Indeed, all forms of glaucoma may benefit from this anatomical measure with low variation in normals and supportive normative databases (GDx, potentially OCT).


Year: 2003

Program Number: Poster 72

Resource Type: Scientific Program

Author Affiliation: State University of New York, College of Optometry

Co-Authors: Marc Sherman, Vasilios Roditis, Jerome Sherman

Co-Author Affiliation: State University of New York, College of Optometry, State University of New York, College of Optometry

Room: n/a