as providing a map of this loss, which can guide and improve the diagnosis of certain pathologies (glaucoma, retina disorders, damage in the optic tract, etc.). Download Citation on ResearchGate | On Feb 1, , A. Benjumeda-Salinas and others published Campimetría y glaucoma }. y/o PIO ≥ 21 mmHg fueron remitidos al oftalmólogo para su valoración ( campimetría). Glaucoma prevalence confirms published findings from other similar.

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A questionnaire with ophthalmologists was conducted where slides of a digital photograph of the optic disc and computerized visual field exam were presented. Physicians were instructed to answer whether glaucoma was observed in each of the slides. No other information was given to those examiners.

Half of the patients had glaucoma with corresponding visual field, and the other half had physiological cupping and normal visual field. The slides were equally divided between retinography and corresponding visual field same patient and exams randomly exchanged, where an optic disc of glaucoma with a normal visual field was placed, and vice-versa. The order in which the slides were presented was also randomized.

Forty slides were evaluated by 29 ophthalmologists. No glaucoma specialist was included. The overall agreement among the examiners Kappa was 0. The diagnosis was made correctly in glaucoma patients with corresponding visual field exam in When the exams were exchanged, the results dropped to Os slides foram igualmente divididos em: The functional damage assessed by the visual field, although late in the pathogenesis glaucma glaucoma, 1 generally occurs in correspondence with the structural damage.

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The clinical judgment is the core of the medical profession. Physicians, however, tend to use complementary information to increase their ability to diagnose. A widely used exam to help ophthalmologists to evaluate glaucoma, the visual field, has an element of subjectivity, which includes the physician’s own learning curve 4 – 6 and multiple sources of variability 7 such as individual errors, fixation loss, false-positive and false-negative results.

A glaucomatous visual field may, therefore, only be a result of a learning experience with the exam. On the other hand, initial glaucomatous optic disc damage may not have a correspondent visual field defect.

The result of a given exam may campimetrja the clinical judgment by examiners. It has been shown that knowledge of chronology of optic disc stereophotographs influences the determination of glaucomatous progression. This study aims to determine whether the visual field may influence the diagnosis of glaucoma. Patients with glaucoma criteria belowand patients with physiological cupping, 11 but without characteristic signs of glaucomatous optic disc described below were included in the study.

At least two reliable and normal SITA Standard visual field Humphrey Systems, Dublin, CA 12 and intraocular pressure less than 18mmHg were eligibility criteria required for inclusion in the last group.

Patients were ccampimetria during 3 consecutive months. Each patient’s visual field and retinography were displayed into one slide and then sent to prospective evaluation by 29 ophthalmologists, none of whom were glaucoma specialists. Each ophthalmologist received glaaucoma pair of tests 40 slideshalf of which with a corresponding exam of the eye visual field and retinography. In the other half, the exams were randomly exchanged, and only the position of the eye right or left was observed.

This means, physiological cupping retinography with glaucomatous visual field, and glaucomatous optic disc with normal visual field.

Cinco pruebas comunes para el glaucoma | Glaucoma Research Foundation

Consequently, ten slides of each of the four groups – glaucomatous retinography and visual field, normal retinography and visual field, glaucomatous retinography and normal visual field and normal retinography with glaucomatous visual field – were sent to the examiners.


Neither the patients’s names nor their initials were disclosed to the ophthalmologists; slides were marked with numbers instead. Actual distribution of the exams in each slide was only known to the study’s authors and the order of the slides presented was randomized.

All randomization done in the study was through the website www. One of the authors of the study presented the slides to each of the examiners individually on a inch screen laptop. Completion of the questionnaire was not timed.

The identity of each ophthalmologist remains confidential. Examiners were initially informed that this was a study to assess the ability of diagnosing glaucoma through exams without direct examination of the patient, especially designed to serve remote areas, without the presence of an expert on-site.

They were also informed that all patients had glaucoma or suspicion of having glaucoma. All physicians made conclusions as to whether each patient had glaucoma after evaluating each such patient’s slide. Only after data collection, the examiners were informed of the real purpose of the study.

Subsequently, they provided consent for analysis and possible publication. Statistical analysis was performed using SPSS software, version Normality of the samples was glaicoma using the Kolmogorov- Smirnov test. The independent Student test was used to compare the groups’ assessments. Categorical data were compared using the chi-square test, and the agreement between examiners by cross tabulation and Kappa index correct tests vs.

A total glauckma evaluations per group were performed: The mean MD of glaucoma eyes was The average kappa value between examiners was 0. When visual field and corresponding retinography were considered in each patient, the average kappa value was 0. Diagnosis was accurate in The values decreased to The normal optic disc can have different dimensions for both the size and cup. The relationship between the damaged optic disc and the corresponding visual field is generally used in the evaluation of glaucoma.

However, visual field examination is subjective, and therefore subject to variability 7 such as the physician’s learning curve, becoming more reliable with increased patient testing experience.

Proper glaucoma diagnosis can be improved when both the optic disc and visual field are analyzed concurrently.

In the present study, the examiners had access to a digital retinography and visual field per eye to perform the diagnosis of glaucoma. All eyes included in the glaucoma group were from patients under treatment for glaucoma, with glaucomatous optic disc and reproducible glaucomatous visual field defects in at least two different visual field tests.

Therefore, theoretically, these patients had glaucoma more perceptible than glauxoma only patients with pre-perimetric glaucoma had been considered, glahcoma diagnosis is suggestive where only optical disc is examined; this could, consequently, bias the results.

The mean MD was Patients with physiological cupping had to have their optic disc with minimal confounding factors as possible and had to have a reliable and reproducible normal visual field. There was poor agreement between the examiners in the diagnosis of glaucoma Kappa: Kappa values near one express full agreement, and results near zero indicate no agreement or expected by chance. Negative Kappa values indicate agreement less than expected by chance and suggest disagreement, but its absolute value should not be considered as the intensity of the disagreement.

One may anticipate increased agreement in the diagnosis of glaucoma when both tests from the same patient was presented, which however did not happen. Despite the increased rates of correct diagnosis in this subgroup of slides, individual slide evaluation had great variability, as can be noted in the figure, where the distribution cloud of the two groups is glaucomq dispersed to both sides of the line from the linear regression.


These results indirectly reflect the low accuracy of relating the optic disc with a given visual field. It seems that clinicians usually rely on their judgment mainly in the visual field results. In a previous paper, ophthalmologists were asked to match optic discs with their corresponding visual field and of classifying them as healthy or glaucomatous.

They correctly matched in In most mismatches, the clinicians overestimated the visual field damage. It is possible that the presentation of the optic disc and RNFL through optic disc stereophotographs could increase the diagnostic ability of the observers, 20 a potential weakness of the study. However, a previous paper failed to demonstrate any significant advantage of cakpimetria photographs compared to monoscopic optic disc photographs to estimate glaucoma likelihood.

Furthermore, the presentation of the optic disc and RNFL in a digital retinography and not in a stereoscopic slide affects both groups equivalently, at least reducing this possible bias.

However, even with the digital retinography glaucomaa glaucoma or normalitythe visual field was decisive in this selected sample to characterize an eye as glaucomatous or not. Although there are no epidemiological data in the majority of countries, including Brazil regarding this subject, a large amount of patients who are being evaluated or who have been diagnosed with glaucomw aren’t treated by glaucoma specialists.

Additionally, a larger power of the tests is obtained with a greater number of observers. That is the reason why glaucoma eb were not included as observers, as they could produce different opinions.

In conclusion, it is possible to suggest that the clinical evaluation of patients with glaucoma or under investigation should be conducted before the interpretation of the visual field. The knowledge of the results of the visual field can influence the judgment of the diagnosis of glaucoma.

The authors would like to thank Isabela Danielsen for important contribution in the manuscript revision. Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons. Invest Ophthalmol Vis Sci. Louis, Missouri; USA; The optic disc in glaucoma II: Learning effect of standard automated perimetry in healthy individuals.

Arquivos brasileiros de oftalmologia. The effect of perimetric experience in patients with glaucoma. Factors associated with a learning effect in glaucoma patients using automated perimetry. Evaluating several sources of variability for standard and SWAP visual fields in glaucoma patients, suspects, and normals. The collaborative initial glaucoma treatment study: The Optic Nerve in Glaucoma.

Knowledge of chronology of optic disc stereophotographs influences the determination of glaucomatous change. Pseudoglaucomatous physiologic large cups. Clinical Decisions in Glaucoma.

Louis, Missouri, USA; The variation and covariation of cup and disc diameters. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Ranking of optic disc variables for detection of glaucomatous optic nerve damage. Inter-observer and intra-observer agreement in the interpretation of visual fields in glaucoma.

Agreement of visual field interpretation among glaucoma specialists and comprehensive ophthalmologists: