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Initial Parafoveal Versus Peripheral Scotomas in Glaucoma: Risk Factors and Visual Field Characteristics.
MedLine Citation:
PMID:  21665283     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To assess risk factors for an initial parafoveal scotoma (IPFS) compared with an initial nasal step (INS) in glaucoma. DESIGN: Retrospective, observational study. PARTICIPANTS: Sixty-nine patients with glaucoma with an isolated IPFS and 53 patients with an isolated INS. METHODS: On the basis of 2 reliable, consistent 24-2 Swedish interactive threshold algorithm standard visual fields (VFs), 2 groups of patients with glaucoma were studied: those with an IPFS in 1 hemifield (≥3 adjacent points with P<5% within the central 10 degrees of fixation, ≥1 point with P<1% lying at the innermost paracentral points, and no VF abnormality outside the central 10 degrees) and those with an INS in 1 hemifield (≥3 adjacent points with P<5% in the nasal periphery outside 10 degrees of fixation, the nasal-most point with P<1%, and no VF abnormality within the central 10 degrees). Clinical characteristics and systemic factors were recorded from charts and compared between the 2 groups. MAIN OUTCOME MEASURES: Maximum untreated intraocular pressure (IOP), disc hemorrhage (DH) detection during follow-up, systemic risk factors, and VF mean deviation (MD) and pattern standard deviation (PSD). RESULTS: Maximum untreated IOP (21.6±4.5 vs. 28.3±9.6 mmHg; P<0.001) was significantly lower, and frequency of DH detection (44% vs. 17%; P=0.001) and systemic risk factors (hypotension, migraine, Raynaud's phenomenon, and sleep apnea; 16%, 23%, 24%, and 9% vs. 0%, 4%, 9%, and 0%; P=0.001, 0.002, 0.025, and 0.030, respectively) were significantly higher in patients with an IPFS than in patients with an INS. There were no significant differences in age, gender, family history of glaucoma, refractive error, central corneal thickness, and disc area between the 2 groups (all P>0.1). Mean deviation was similar between the 2 groups (P=0.346), but PSD was significantly greater in the IPFS group than in the INS group (P=0.043). CONCLUSIONS: Eyes with an IPFS differ from those with an INS. These findings may help clinicians identify patients at higher risk of early central field loss. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Sung Chul Park; Carlos Gustavo De Moraes; Christopher C W Teng; Celso Tello; Jeffrey M Liebmann; Robert Ritch
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-10
Journal Detail:
Title:  Ophthalmology     Volume:  -     ISSN:  1549-4713     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology, New York Medical College, Valhalla, New York.
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