Vol. 8 Issue 1 Part A

Background: Glaucoma, a leading cause of irreversible blindness, is characterized by progressive optic nerve damage, often leading to visual field loss, with early detection critical for effective management and prevention of vision impairment.

Aims: To study the glaucoma staging system with macular visual field measurements.

Methods: A cross-sectional study was conducted in the Ophthalmology Department at Government Medical College, Kota, Rajasthan, from May 2016 to December 2024. Forty glaucoma patients (20 males, 20 females) diagnosed with Primary Open-Angle Glaucoma (POAG) or Normal-Tension Glaucoma (NTG) were enrolled. Exclusion criteria included Primary

Angle-Closure Glaucoma (PACG), secondary glaucomas, congenital glaucoma, and patients who had undergone intraocular surgeries. Participants underwent a comprehensive ocular examination, including 24-2 and 10-2 perimetry, Spectral Domain Optical Coherence Tomography (SD-OCT) imaging, and clinical assessments. Glaucoma severity was classified using the Hodapp-Parrish-Anderson (HPA) staging system, and macular damage was analyzed using 10-2 perimetry and SD-Oct.

Results: The study revealed that macular involvement was detected in all glaucoma patients using the 10-2 perimetry test, whereas the 24-2 perimetry missed macular damage in 17.5% of cases SD-OCT showed macular abnormalities in 77.5% of the patients, with significant thinning of the retinal ganglion cell complex (GCC) and inner plexiform layer (IPL) correlated with increasing disease severity. The correlation between functional loss (as measured by visual field tests) and structural damage (GCC and IPL thinning) was strong, suggesting that macular testing provides valuable insights into glaucoma progression.

Conclusion: This study emphasizes the importance of incorporating macular visual field testing and SD-OCT in the routine glaucoma workup. The findings suggest that 10-2 perimetry and SD-OCT offer a more comprehensive approach to detecting early glaucomatous damage, particularly in the macula, which is often overlooked by conventional testing methods.

Integrating these tools into clinical practice can improve early diagnosis, disease staging, and individualized treatment strategies, ultimately enhancing patient outcomes and preserving vision in glaucoma patients.