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Invited Commentary
January 2, 2020

Central Visual Field Loss in End-stage Glaucoma

Author Affiliations
  • 1Departtment of Ophthalmology, Policlinico “Città di Udine,” Udine, Italy
JAMA Ophthalmol. 2020;138(2):198-199. doi:10.1001/jamaophthalmol.2019.5494

In this issue of JAMA Ophthalmology, Wang and coworkers1 deal with an important and often overlooked topic, ie, the precise quantification and categorization of very advanced visual field defects in chronic glaucoma. Even if some studies seem to suggest that patients with severe glaucoma may be longitudinally monitored for progression using optical coherence tomography,2,3 it is well known that structure analysis, unlike in early glaucoma, is often of little (if any) clinical use in the late stages of glaucoma damage because of the floor effect, which strongly limits the possibility to detect small variations in optic disc structure and retinal nerve fiber layer thickness. Careful analyses of the visual function that use proper testing methods typically are needed and important in the follow-up and treatment of these patients with late-stage glaucoma to monitor and possibly to prevent further functional loss.

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