Modifying the Conventional Visual Field Test Pattern to Improve the Detection of Early Glaucomatous Defects in the Central 10°

Purpose: To simulate modified versions of the 24-2 (6 degrees grid) visual field (VF) test pattern by adding points from the 10-2 (2 degrees grid) test pattern, and to assess their ability to detect early glaucomatous defects in the central 10 degrees. Methods: One hundred forty-four eyes of 144 glaucoma patients and suspects with 24-2 mean deviations better than -6 dB were tested with 10-2 and 24-2 VFs. Based upon both 10-2 VF and optical coherence tomography probability plots, 63 hemifields were defined as abnormal, while 121 hemifields were defined as normal. Three modified 24-2 VF test patterns, called 24-2 +4, 24-2 +16 (Even), and 24-2 +16 (Empirical), were simulated by adding 4 or 16 test points from the 10-2 VF. Results: Based upon the number of abnormal points (P <= 5%), the area under the ROC curves (AROC scores) of the three modified 24-2 VFs were significantly greater than that of the 24-2 VF for both the upper and lower VF. For a specificity of 85%, the number of true positives was 25 (24-2), 30 (24-2 +4), 31 (24-2 +16, even), and 32 (24-2 +16, empirical) of 34 total true positives for the upper VF and 23, 26, 27, and 28 of 29 for the lower VF. Conclusions: Adding points from the 10-2 test pattern to the 24-2 test pattern significantly improved its ability to detect macular defects without employing more test points than a single 10-2 test. Translational Relevance: Additional central points should be added to the 24-2 pattern to improve the detection of macular damage.