Visual Field Loss in Progressive Glaucoma

This is a case of a patient with progressive glaucoma resulting in advanced visual field loss whilst under care.

Glaucoma is the name given to a group of conditions which causes premature death of retinal ganglion cells (RGC) that make up the optic nerve. These cells modulate visual information and are the means of communication between the eye and the brain.

There are multiple factors that can lead to the development of glaucoma. However, lowering eye pressure seems to protect the RGC from rapid death.

As glaucoma develops, the patient loses vision. In most cases of glaucoma, the visual loss starts in the periphery and hence the patient is unaware of it as the brain is very good at filling in the missing bits of vision. It is often only when the disease is advanced that the patient becomes aware and as glaucoma related vision loss is not reversible, it leaves the patient with permanent vision loss which can be very disabling.

When managing patients with glaucoma, we examine peripheral vision using a visual field test.

The charts below are from a patient whose glaucoma was sub-optimally managed. It shows what happens to the field of vision over time. White areas are those that are clearly seen and as the patient loses field of vision, the area becomes darker when testing.

The patient sought a second opinion from Mr Mohamed in 2007. After successful management requiring multiple glaucoma operations, the patient was able to maintain her level of vision.

Left Eye Visual Field from 2001 – 2007

Right Eye Visual Field from 2001 – 2007

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