Purpose: To explore the spatial distribution of central visual field loss in untreated proliferative diabetic retinopathy (PDR) and to quantify the effect of medium-pulse Optos-guided 20-millisecond Pascal laser treatment on the central field.
Methods: Visual field data (Swedish Interactive Threshold Algorithm 24-2) from 99 eyes (66 patients) with treatment-naive PDR were used to train a self-organizing map (SOM) that classified the defects into nine patterns. Twenty-eight eyes of 23 patients treated with 20-millisecond Pascal retinal laser photocoagulation underwent Optos widefield fundus fluorescein angiography (WF-FFA) at baseline and 3 months after treatment. Postlaser changes in SOM patterns and global indices were analyzed. Visual field defect changes (Total Deviation [TD]) with eccentricity and extent of initial loss were analyzed. Grading of WF-FFA after laser was undertaken by two masked retina specialists.
Results: At baseline, 44.4% of PDR eyes showed early visual field loss patterns (1 to 3), with 23.2% classified into the advanced patterns (7 to 9). Mild SOM patterns had more superior hemifield field defects, whereas advanced patterns involved both superior and inferior hemifield field loss. After laser, a significant shift to early SOM patterns were observed (p = 0.02), as well as improvement of Mean Deviation and Pattern Standard Deviation (p = 0.003 and p = 0.06, respectively). Improvement of TD was commonly observed in test locations of 0 to 10, 10 to 20, and 20 to 30 degrees. Greater improvement was observed with deeper baseline TD (p < 0.001). Masked WF-FFA image grading showed 78.6% PDR regression.
Conclusions: The SOM method is a promising technique to classify and monitor over time PDR-associated visual field defects. Medium-pulse Optos-guided 20-millisecond Pascal laser treatment improved the spatial patterns and global parameters of central field defects.