Article

Visual field testing: timing and analysis in patients with primary open-angle glaucoma

The periodic assessment of vision function with visual field testing is a standard and important part of the management of primary open-angle glaucoma (POAG). Automated achromatic static threshold perimetry is the preferred technique, although other static and kinetic techniques are acceptable alternatives in patients who are unable to complete automated perimetry reliably or when the technology is not available.

The periodic assessment of vision function with visual field testing is a standard and important part of the management of primary open-angle glaucoma (POAG).1 Automated achromatic static threshold perimetry is the preferred technique,2-5 although other static and kinetic techniques are acceptable alternatives in patients who are unable to complete automated perimetry reliably or when the technology is not available.1

Determining an optimal interval between visual field testing in an individual patient with POAG can be challenging. Like most things in glaucoma, care must be individualized. In addition to considering clinical characteristics and patient risk factors in scheduling follow-up examinations, the physician must consider the data set required for using statistical tools to analyze visual field changes over time. This article explores clinical features and risk factors that should be considered in scheduling follow-up visits for visual field testing and the two primary analytical strategies-event analysis and trend analysis-in current use for quantifying visual field changes.

Recommended follow-up intervals

As shown in the table, the recommended follow-up interval varies from 1 to 12 months-a relatively wide range-depending on patient characteristics. A follow-up interval as short as 1 month may be indicated for patients who are just learning to take fields and whose tests are unreliable, for those in whom progression is suspected, to confirm progression, or for those in whom target IOP is not achieved. With new visual field software, it may be advisable to obtain a few fields in the first several months to establish a solid baseline. Other clinical settings also may require a short follow-up interval. No patients have a recommended follow-up interval longer than 12 months; thus, visual field and optic nerve head evaluation should be done at least annually under the best of circumstances. Of course, visual field testing may not provide for far advanced glaucoma when the field is nearly extinguished.1

In addition to automated achromatic threshold perimetry (AAP), several other visual field testing technologies are available. Visual field testing based on short-wavelength automated perimetry (SWAP) and frequency-doubling technology (FDT) may detect defects earlier than conventional white-on-white perimetry.6 To generate a useful measure of progression in an individual patient, the physician should employ a consistent testing strategy over time. It is not established whether SWAP or FDT will provide additional information about progression once AAP has demonstrated a glaucomatous defect.

The following factors should be considered when determining an appropriate follow-up interval for visual field testing and optic nerve evaluation1 :

Newsletter

Don’t miss out—get Ophthalmology Times updates on the latest clinical advancements and expert interviews, straight to your inbox.

Related Videos
(Image credit: Ophthalmology Times) ASCRS 2025: Taylor Strange, DO, assesses early visual outcomes with femto-created arcuate incisions in premium IOL cases
(Image credit: Ophthalmology Times) ASCRS 2025: Neda Shamie, MD, shares her early clinical experience with the Unity VCS system
Patricia Buehler, MD, MPH, founder and CEO of Osheru, talks about the Ziplyft device for noninvasive blepharoplasty at the 2025 American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting
(Image credit: Ophthalmology Times) ASCRS 2025: Bonnie An Henderson, MD, on leveraging artificial intelligence in cataract refractive surgery
(Image credit: Ophthalmology Times) ASCRS 2025: Gregory Moloney, FRANZO, FRCSC, on rotational stability
Sheng Lim, MD, FRCOphth, discusses the CONCEPT study, which compared standalone cataract surgery to cataract surgery with ECP, at the 2025 ASCRS Annual Meeting.
(Image credit: Ophthalmology Times) ASCRS 2025: Steven J. Dell, MD, reports 24-month outcomes for shape-changing IOL
Alex Hacopian, MD, discusses a presbyopia-correcting IOL at the 2025 American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting
(Image credit: Ophthalmology Times) ASCRS 2025: Parag Majmudar, MD, on bridging the gap between residency and real-world practice
Brett Bielory, MD, discusses his poster at the ASCRS annual meeting, which focuses on an under-diagnosed corneal pathology: neurotrophic keratitis.
© 2025 MJH Life Sciences

All rights reserved.