Perimetry: New Insights into Glaucoma

Paul H Artes, PhD MCOptom. Professor of Eye and Vision Sciences, Plymouth University

This lecture provides an overview of recent research into functional losses in patients with glaucoma and how they inform changes in how visual fields are used to detect and monitor glaucoma by primary eye care professionals. We discuss new insights into the relationship between ocular structure (imaging) and visual function (perimetry), the need for high specificity in measuring visual field damage and its progression, and the changing role of visual fields in the detection and management of patients with chronic optic neuropathies. We review common artefacts in visual field examinations and how best to deal with them. The lecture aims to change optometrists’ daily practice by providing relevant pointers towards a more evidence-based approach to clinical visual field examination, and by clearing up widely held myths about modern perimetry.

Learning objectives:
  • Understand the non-linear structure/function relationship and the relationship between measurement precision and biological between-patient variability with imaging (e.g. OCT) and visual fields.
  • Review relevant findings from recent glaucoma-related studies (e.g. Ocular Hypertension Treatment Study, Early Manifest Glaucoma Trial, United Kingdom Glaucoma Treatment Study).
  • Translate this theory into actionable changes (which patients are examined, and which tests provide the most clinically useful information at different stages of the disease).