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Does Retinal Ganglion Cell Loss Precede Visual Field Loss in Glaucoma?

Hood, Donald C. PhD*,†

doi: 10.1097/IJG.0000000000001380
Review Article

It is often said that substantial retinal ganglion cells are lost before glaucomatous damage is detected by standard automated perimetry. There are 4 key articles referenced to support this belief. To test the hypothesis that the 4 key articles are incorrectly cited, the publications in the first 6 months of 2019 that reference 1 or more of these 4 articles were examined. In particular, the degree to which the quotes from these 2019 publications accurately reflected the evidence in the 4 key articles was assessed. These quotes are inadequately supported by the data, and in some cases even by the conclusions found in the abstracts of the key articles. This is despite several review articles that have questioned the evidence in these key articles. Further, a case can be made that the evidence in the key articles better supports the opposite conclusion. That is, the data suggest that sensitivity loss can be seen on standard automated perimetry before retinal ganglion cells are missing.

*Department of Psychology and Ophthalmology, Columbia University

Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY

Supported by NIH/NEI grant: EY002115.

Disclosure: D.C.H. receives lecture fees, research support, and equipment from Topcon Inc., and Heidelberg Engineering.

Reprints: Donald C. Hood, PhD, Department of Psychology and Ophthalmology, Columbia University, 1190 Amsterdam Ave, 405 Schermerhorn Hall, Room 301, New York, NY 10027-7004 (e-mail:

Received July 25, 2019

Accepted September 17, 2019

Online date: October 23, 2019

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