Patterns of glaucomatous visual field progression identified by three progression criteria.

PURPOSE To determine typical patterns of repeatable glaucomatous visual field progression. DESIGN Retrospective analysis of data obtained from two prospective studies. METHODS Included were 72 eyes of 72 patients tested up to six times over 2 years, and 40 eyes of 40 patients followed annually for up to 12 years. Each patient had two abnormal baseline visual fields, abnormal optic nerves, and serial fields. Progression was identified using three methods: by glaucoma change probability using total deviation (GCP-TD) and pattern deviation (GCP-PD) plots and by a clinical criteria. Progression was categorized as deepening or expansion of an existing scotoma, or a new scotoma. RESULTS The percentage of eyes repeatably progressed ranged from 17% to 27%. The most common pattern of progression was a deepening of an existing scotoma in the annual group, followed by expansion. With two follow-ups required, percentages for deepening only were 20% (clinical classifier). A combination of expansion and deepening was most common for the GCP criteria: 15% (GCP-TD classifier), and 10% (GCP-PD classifier) for the annual group. For the semiannual group, deepening was most common with the clinical criteria (11% of eyes), and deepening with expansion was most common by GCP criteria (14%, GCP-TD and GCP-PD). No eyes showed repeatable new scotomas. CONCLUSIONS Glaucomatous visual fields progress in the area of the visual field where baseline testing showed an existing scotoma. Follow-up testing might be improved by concentrating on already defective locations and using sparser test patterns or screening algorithms in normal areas of the visual field.