Automated white-on-white static threshold perimetry, introduced some 20 years ago by Bebie and colleagues,1 has provided a new and generally higher standard of perimetric testing than was previously available. However, it has not met our initial expectations of providing sensitive and reliable evidence of early glaucomatous optic neuropathy. The first reproducible perimetric defects generally develop late in the disease, and the high rate of long-term fluctuation confounds our ability to detect disease progression. This realization has sparked a search for more reliable, early markers of glaucomatous optic neuropathy. Such markers would identify those patients who are most likely to benefit from treatment and spare others the costs and considerable morbidity of treatment.
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There have been proponents of structural and functional approaches toward the identification of early glaucomatous damage. Clinical and histological studies have suggested that detectable structural changes generally precede structural abnormalities detected with standard
Caprioli J. Early Diagnosis of Functional Damage in Patients With Glaucoma. Arch Ophthalmol. 1997;115(1):113-114. doi:10.1001/archopht.1997.01100150115021