Race, income impact variability in visual field testing

Derek MacDonald, OD, FAAO

Following disease diagnosis, staging, establishing target pressure range, and initiating therapy, “… the most important question becomes whether the disease is stable … or whether the disease is progressive and the therapy in relation to the life expectancy has to be intensified …” (World Glaucoma Association, 2011). This, however, is easier said than done, at least in part due to the variability of AVF analysis, which remains the primary means of assessing functional loss.

Using data from the “real world” Duke Glaucoma Registry, Stagg and colleagues demonstrated that Black patients showed more AVF variability than white patients. This led to significant delays in identifying disease progression, although time to detect change was improved across the board with more frequent testing, and this is a conclusion that all clinicians should pay close attention to.

Chauhan and colleagues have suggested that six AVF tests within the first 24 months post-diagnosis are necessary to detect rapid progression, yet surveys consistently show that testing frequency is woefully inadequate. Despite incredible advances in structural evaluation (and the fact that everyone loves to hate VF testing), we should be performing more, not fewer AVF tests for all patients with glaucoma.

Reference:

Chauhan BC, et al. Br J Ophthalmol. 2008;doi.org/10.1136/bjo.2007.135012.

Disclosures: MacDonald reports no relevant financial disclosures.