The 24-2 Visual Field Test Misses Central Macular Damage Confirmed by the 10-2 Visual Field Test and Optical Coherence Tomography.

PURPOSE To determine the extent to which the 24-2 visual field (VF) misses macular damage confirmed with both 10-2 VF and optical coherence tomography (OCT) tests and to evaluate the patterns of damage missed. METHODS One hundred forty-one eyes of 141 glaucoma patients or suspects underwent 24-2 VF (mean deviation [MD] better than -6 dB), 10-2 VF, and OCT testing. Retinal nerve fiber layer (RNFL) and retinal ganglion cell plus inner plexiform (RGC+) probability plots were combined with 10-2 VF probability plots. Eyes were classified as "abnormal macula" if abnormal regions on both the 10-2 VF and OCT plots agreed. The number of abnormal eyes missed (i.e., false negatives) was determined for the following 24-2 VF metrics: MD; pattern standard deviation (PSD); glaucoma hemifield test (GHT); cluster criteria (CC); and abnormal points within ± 10°. Eyes that were missed on one or more of the 24-2 metrics were classified by damage type based upon circumpapillary RNFL thickness plots. RESULTS Fifty-nine (41.8%) eyes were classified as "abnormal macula," and comprised the reference standard. Of the 59, 31 (52.5%) were missed by one or more of the 24-2 metrics. The individual 24-2 metrics missed between 7 (CC) and 20 (MD) eyes. The eyes missed had widespread macular damage, as well as both shallow and deep local defects. CONCLUSIONS Eyes with macular glaucomatous damage may be classified as normal based on the 24-2 VF alone. TRANSLATIONAL RELEVANCE To detect macular damage with perimetry, the 10-2 VF test (or a modified 24-2 VF test) is essential.