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Primary Open-angle Glaucoma With Initial Visual Field Damage in the Superior and Inferior Hemifields

Comparison in a Population-based Setting

Iwase, Aiko, MD, PhD*,†; Araie, Makoto, MD, PhD‡,§

doi: 10.1097/IJG.0000000000001241
Original Studies

Purpose: To study differences in systemic and ocular factors between eyes with primary open-angle glaucoma (POAG) with an initial visual field defect (VFD) starting in the superior hemifield and those starting in the inferior hemifield in a population-based setting.

Subjects and Methods: The data were analyzed from eyes with definitive category-1 POAG based on the International Society of Geographic and Epidemiological Ophthalmology criteria with VFD constriction in the superior or inferior hemifield (superior and inferior VFD groups, respectively) found in 2 Japanese population-based glaucoma surveys. The visual fields were tested using the Humphrey Field Analyzer Central 30-2 or 24-2 Swedish Interactive Thresholding Algorithm Standard program.

Results: Of 336 eyes of 214 patients with POAG with reliable visual fields results, 36 and 37 eyes with 36 and 37 POAG patients were classified into the superior and inferior VFD groups, respectively. The superior VFD group had significantly greater disc ovality, entire and inferior-half β-peripapillary atrophy (PPA) area, and lower mean total deviation value in the corresponding superior hemifield (P=0.004 to 0.048 after Bonferonni correction) than the inferior VFD group. Multivariate logistic regression analysis showed that the superior VFD group was associated with greater ovality, larger β-PPA area, and thinner central cornea thickness (P=0.013 to 0.035).

Conclusions: In POAG, greater disc ovality and β-PPA and thinner central cornea thickness were associated significantly with the initial VFD starting in the superior hemifield, suggesting some difference in the glaucomatous damaging process between the superior and inferior halves of the disc.

*Tajimi Iwase Eye Clinic, Tajimi

Department of Ophthalmology and Visual Science, Kanazawa University, Graduate School of Medical Science, Kanazawa

Kanto Central Hospital of the Mutual Aid Association of Public School Teachers

§Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan

The Tajimi Study was supported by the Japan National Society for the Prevention of Blindness, Tokyo, Japan; the Japan Ophthalmologists Association, Tokyo, Japan; the Kumejima Study by the Grant-in-Aid for Scientific Research by the Ministry of Health, Labor and Welfare, Tokyo, Japan (H18-Sensory-General-001); a Grant-in-Aid for Scientific Research (C) 17591845 by the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan; and the Japan National Society for the Prevention of Blindness, Tokyo, Japan.

Disclosure: The authors declare no conflict of interest.

Reprints: Aiko Iwase, MD, PhD, Tajimi Iwase Eye Clinic, 3-101-1, Hon-machi, Tajimi 507-0033, Japan (e-mail:

Received October 28, 2018

Accepted March 2, 2019

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