Visual field loss from primary angle closure glaucoma: A comparative study of symptomatic and asymptomatic disease

Purpose: To assess the degree of visual field (VF) loss in subjects diagnosed with primary angle-closure glaucoma (PACG), and to compare the severity of such loss between those with symptomatic and asymptomatic disease. Design: Observational case series. Participants: Seventy-six consecutive subjects with PACG who presented at a Singapore hospital. Methods: Primary angle-closure glaucoma was defined as the presence of glaucomatous optic neuropathy and compatible VF loss associated with closed angles. There were 2 groups of subjects studied: group A consisted of those who presented with acute symptomatic angle closure, and group B consisted of those who were asymptomatic. Subjects underwent static automated threshold perimetry, and the first reliable VF was analyzed using the Advanced Glaucoma Intervention Study (AGIS) scoring system. The field tests were graded according to severity as mild, moderate, severe, and end-stage VF defects, based on AGIS scores of 0 to 5, 6 to 11, 12 to 17, and 18 to 20 respectively. Main Outcome Measures: Advanced Glaucoma Intervention Study scores of the first reliable threshold VF test. Results: The mean age of study subjects was 61.4 +/- 9.6 years (range: 33-84), and the majority of subjects were female (59%) and Chinese (91%). In group A (n = 40), most eyes had mild or moderate VF defects (23 eyes [57.5%]), whereas 7 eyes (17.5%) had end-stage defects. This was in contrast to group B (n = 36), in which the majority of eyes had end-stage VF loss (19 eyes [52.8%]), with only 5 eyes (13.7%) having mild VF defects. Mean AGIS scores were 9.1 +/- 7.6 for group A and 14.2 +/- 6.9 for group B (P = 0.004). Cup-to-disc ratio was a significant predictor for VF loss, but age, gender, and level of presenting intraocular pressure were not correlated with VF outcome. Conclusions: Eyes with asymptomatic PACG often present with severe to end-stage VF loss at the time of first presentation to hospital. In contrast, most PACG eyes with previous symptomatic angle closure present with mild or moderate VF defects. The visual morbidity of PACG may be related to the finding that the asymptomatic form of the disease is visually destructive. (C) 2004 by the American Academy of Ophthalmology.