Development of Glaucomatous Visual Field Defects in Preperimetric Glaucoma Patients Within 3 Years of Diagnosis

Purpose: To determine the characteristics of eyes diagnosed with preperimetric glaucoma (PPG) that developed glaucomatous visual field defects (VFDs) within 3 years of the diagnosis. Patients and Methods: The medical charts of 77 eyes of 77 patients with PPG were reviewed. An eye was diagnosed with PPG when there was neuroretinal rim thinning, cupping of the optic disc, or a suspicious retinal nerve fiber layer (RNFL) defect, and had no conditions fulfilling Anderson’s criteria for glaucoma. The Central 30-2 SITA-Standard program of the Humphrey Field Analyzer was used to determine the presence of VFDs and the thicknesses of the retinal layers was determined by spectral-domain optical coherence tomography. Results: Ten of the 77 patients with PPG (13.0%) developed glaucomatous VFD. These 10 eyes had significantly thinner macular ganglion cell and inner plexiform layer (mGCIPL) thickness in the inferior and inferotemporal sectors, and also the circumpapillary retinal nerve fiber layer (cpRNFL) thickness at the 7 or 8 o’clock sectors. In the 3 years post-PPG period, these eyes had significant decreases in the mGCIPL thickness of all the inferior sectors, and cpRNFL at the 7 or 8 o’clock sectors. The mean intraocular pressure in eyes with VFDs (15.2±2.0 mm Hg) was significantly higher than that in those without VFDs (13.5±2.6 mm Hg; P=0.042). Conclusions: Significant structural changes were observed in the mGCIPL and cpRNFL at PPG diagnosis, before the development of a VFDs. Close monitoring of intraocular pressure is essential for the appropriate management of PPG.