EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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95 EW GLAUCOMA October 2014 advanced glaucoma, and perimetry is the mainstay for following these patients," she said. Perimetry is challenging in these patients for a number of reasons. Eyes with advanced glaucoma produce visual fields that are highly variable, and these tests are subsequently excluded from the GPA analysis based on their quality. "Additional information can be obtained in eyes that have advanced damage or poor visual acuity by test- ing with a size V stimulus," she said. "However, there are no statistical tools to assist in the serial analysis of fields using the size V stimulus." There is also a 10-2 testing algorithm for those with small central islands and a macular algorithm for those with truly end-stage disease, she said. "Where available, Goldmann perimetry is still of value in ad- vanced glaucoma and can identify temporal islands of vision missed by automated perimetry." Visual field testing in advanced glaucoma is reasonably performed twice a year. Some clinicians prefer to obtain a visual field at eve y visit in patients with end-stage disease. Clinical implications Many treated glaucoma patients continue to progress. Rate of change is an important metric to guide clinical decisions and assess response to therapy. Advanced glaucoma is more likely to progress and to do so rapidly. Advances in both visual field and optic nerve imaging technolo- gy can help us identify those who are progressing. Structural testing is most valuable in early and mid-stage disease, and functional testing most helpful in mid-stage or advanced disease. Tests that show change over time should be repeated and cor- related with other testing modalities. There is good news about glau- coma progression. A series of studies from the Mayo Clinic in Minnesota has demonstrated that the overall rate of progression of glaucoma patients has decreased substantially over the past 20 to 30 years. (Editors' note: For more on this series of studies, see "Glass half full" on page 96.) This is likely attributable to advances in testing modalities and significant therapeutic advances as well. EW Editors' note: Dr. Caprioli has financial interests with Allergan (Irvine, Calif.), Alcon (Fort Worth, Texas), and New World Medical (Rancho Cucamonga, Calif.). Dr. Johnson has no related financial interests. D . Piltz-Seymour has financial interests with Alcon and Allergan. Dr. Varma has financial interests with Allergan, Replenish (Pasadena, Calif.), AqueSys (Aliso Viejo, Calif.), and Genentech (South San Francisco). Contact information Caprioli: glaucoma@jsei.ucla.edu Johnson: chris-a-johnson@uiowa.edu Piltz-Seymour: jody.piltz@outlook.com Varma: rvarma@usc.edu Cataract Retinal Refractive Glaucoma Corneal Ocular Surface Disease Oculoplastic Beaver-Visitec International, Inc. | 411 Waverley Oaks Road Waltham, MA 02452 USA | Merocel trademark is the property of Medtronic Xomed, Inc. BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of a Beaver-Visitec International ("BVI") company © 2014 BVI For more information, call 1.866.906.8080 or visit us at www.beaver-visitec.com Keeping your vision in sight with the most trusted brands in your ophthalmic specialty Come See What's New! Visit AAO booth #2321 Beaver ® Visitec ® Merocel ® Parasol ® Wet-Field ® Atomic Edge ® Accu-Temp ® Osher ThermoDot ® UltraClean™ Readypak ™ CustomEyes ® — and Endo Optiks! NEW!